Bivariate Relationships Research Articles

Epidemiology of Congenital Hand Anomalies at a Single Center in Mainland China: An Analysis of 1,415 Cases.

Background: Currently, large-sample epidemiological studies on congenital upper limb differences (CULD) in China are relatively rare. This report presents our centre's experience on the spectrum of diseases and related factors. Methods: Information was collected from patients with CULD who underwent surgical treatment at our centre from September 2018 to October 2023. Data collection included patient name, gender, age, clinical features and diagnosis, family history, parents' age, parents' medical history, pregnancy history and family income. Bivariate relationships between these variables were examined. Results: The average age of the patients was 4 years; 1,398 patients (99%) were aged 9 months to 18 years, and 17 patients (1%) were adults. There were 848 males (60%) and 567 females (40%), with a statistically significant gender distribution (p < 0.05). The most common differences were polydactyly and syndactyly, accounting for 47% and 14%, respectively. Syndromic patients accounted for 14%, and cardiac conditions were the most prevalent non-musculoskeletal issue (55%). First-born patients accounted for 54% of patients, and the average age of parents for first-born patients was 30 ± 5 years for fathers and 29 ± 2 years for mothers. For non-first-born patients, the average age of parents was 33 ± 6 years for fathers and 32 ± 5 years for mothers, with a statistically significant difference between the two groups (p < 0.001). Conclusions: In China, congenital limb differences are still dominated by polydactyly and syndactyly. Heart conditions occur most frequently in patients with syndromes. Level of Evidence: Level IV (Epidemiological).

The Effect of Mulching on the Root Growth of Greenhouse Tomatoes Under Different Drip Irrigation Volumes and Its Distribution Model

Despite the continuous development of greenhouse cultivation technology, the influence mechanism of covering conditions on the root distribution of greenhouse crops remains unclear, which is emerging as a significant research topic at present. The interaction between mulching and irrigation plays a key role in the root growth of greenhouse tomatoes, but its specific impact awaits in-depth exploration. To explore the response patterns of greenhouse crop root distribution to the drip irrigation water amount under mulching conditions, the tomato was chosen as the research object. Three experimental treatments were set up: mulched high water (Y0.9), non-mulched high water (N0.9), and mulched low water (Y0.5) (where 0.9 and 0.5 represent the cumulative evaporation from a 20 cm standard evaporation pan). We analyzed the water and thermal zone of tomato roots as well as the root distribution. Based on this, a root distribution model was constructed by introducing a mulching factor (fm) and a water stress factor (Ks). After carrying out two years of experimental research, the following results were drawn: (1) The average soil water content in the 0–60 cm soil layer was Y0.9 &gt; N0.9 &gt; Y0.5, and the average soil temperature in the 0–30 cm soil layer was Y0.5 &gt; Y0.9 &gt; N0.9. (2) The interaction between mulching and irrigation had a significant impact on the distribution of tomato roots. In the absence of mulch, the root surface area, average root diameter, root volume, and root length density initially increased and then decreased with depth, with the maximum root distribution concentrated around the 20 cm soil layer. Under mulched conditions, roots were predominantly located in the top layer (0–20 cm). Under the film mulching condition, the distribution range of root length density of low water (Y0.5) was wider than that of high water (Y0.9). (3) Root length density exhibited a significant cubic polynomial relationship with both the soil water content and soil temperature. In the N0.9 treatment, root length density had a bivariate cubic polynomial relationship with soil water and temperature, with a coefficient of determination (R2) of 0.97 and a normalized root mean square error (NRMSE) of 20%. (4) When introducing the film mulching factor (fm) and water stress factor (Ks) into the root distribution model to simulate the root length density distribution of Y0.9 and Y0.5, it was found that the NRMSE was 22% and R2 was 0.90 under the Y0.9 treatment, and the NRMSE was 24% and R2 was 0.98 under the Y0.5 treatment. This study provides theoretical support for the formulation of scientifically sound irrigation and mulching management plans for greenhouse tomatoes.

Snow depth sensitivity to mean temperature, precipitation, and elevation in the Austrian and Swiss Alps

Abstract. Snow depth plays an important role in the seasonal climatic and hydrological cycles of alpine regions. Previous studies have shown predominantly decreasing trends in average seasonal snow depth across the European Alps. Additionally, prior work has shown bivariate statistical relationships between average seasonal snow depth and mean air temperature or precipitation. Building upon existing research, our study uses observational records of in situ station data across Austria and Switzerland to better quantify the sensitivity of historical changes in seasonal snow depth through a multivariate framework that depends on elevation, mean temperature, and precipitation. These historical sensitivities, which are obtained over the 1901–1902 to 1970–1971 period, are then used to estimate snow depths over the more recent period of 1971–1972 to 2020–2021. We find that the year-to-year estimates of snow depths, which are derived from an empirical–statistical model (SnowSens), that rely solely on the historical sensitivities are nearly as skillful as the operational SNOWGRID-CL model used by the weather service at GeoSphere Austria. Furthermore, observed long-term changes over the last 50 years are in better agreement with SnowSens than with SNOWGRID-CL. These results indicate that historical sensitivities between snow depth, temperature, and precipitation are quite robust over decadal-length scales of time, and they can be used effectively to translate expected long-term changes in temperature and precipitation into changes in seasonal snow depth.

Factors associated with late hospital arrival in acute stroke patients of Bangladesh

ObjectivesUnderutilisation of thrombolysis is a major problem in patients with stroke in Bangladesh as patients do not arrive within the therapeutic window due to delays in their way to emergency...

Institutional courage attenuates the association between institutional betrayal and trauma symptoms among campus sexual assault survivors.

When an institution fails to fulfill its obligations to prevent violence from occurring or to respond adequately to violence, it commits institutional betrayal, which can compound a survivor's distress. One proposed strategy to reduce the harm caused by institutional betrayal is institutional courage, which involves supportive and transparent institutional actions that prioritize the needs of institutional members. The objective of the present study is to examine the unique relationships between the theoretical constructs of institutional betrayal, institutional courage, and trauma-related mental health outcomes among campus sexual assault survivors within one university institution. Self-report questionnaire data were collected from a sample of campus sexual assault survivors enrolled at a large, public university in the Pacific Northwest (N = 85). There were no statistically significant bivariate relationships among institutional betrayal, institutional courage, and trauma symptoms. Consistent with hypotheses, institutional courage moderated the relationship between institutional betrayal and trauma symptoms. Institutional betrayal was positively related to trauma symptoms among students who reported low and moderate levels of institutional courage, but institutional betrayal was no longer linked to trauma symptoms among students who reported high levels of institutional courage. This finding suggests that institutional courage may attenuate the negative influence of institutional betrayal. Overall, institutional courage may be a helpful approach to combat the harms of both sexual violence and institutional betrayal. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Loneliness and health in older adults: a multivariate analysis of Spanish Red Cross users living alone

ABSTRACT Objectives This study investigated the relationships between loneliness, social relations (family and non-family), and perceived health in older adults living alone in Spain. Methods The sample included 306 Spanish older adults aged 65–95 (M = 78.08, SD = 6.95) who lived alone and were Red Cross users. Bivariate relationships were tested before conducting a Stepwise Multiple Regression Analysis to examine the impact of both objective and subjective components of loneliness on perceived health. Results Older participants showed worse health status, less frequent and less close relationships with their family and friends, and a higher risk of non-family isolation. Additionally, participants with lower perceived health were found to have both less frequent and closer family and non-family relations, a higher sense of loneliness, and were older. Multivariate analysis revealed that non-family relations, feelings of loneliness, and age significantly predicted 17.9% of the explained variance in perceived health (adjusted R 2 = .18, p < .001). Conclusions This research highlights the importance of non-family relations in preventing and mitigating feelings of loneliness and improving older adult’s health. These findings are particularly important as they inform the development of effective interventions and strategies to manage loneliness, ultimately enhancing the quality of care for older individuals living alone. Such strategies should be designed to increase opportunities to expand the non-family networks.

Drivers of Depression in Chronic Post-Stroke Aphasia.

Approximately one third of stroke survivors develop post-stroke depression, which reduces quality of life. Previous studies have often focused on early phases of recovery and excluded people with significant aphasia. Here, we examine relationships of depression symptoms to demographic factors, and different types of stroke-related disability and impairment in adults with chronic left-hemisphere stroke and a history of aphasia. 92 chronic left-hemisphere stroke survivors with a history of aphasia and 70 controls participated in this cross-sectional study. The Beck Depression Inventory-II (BDI-II) measured depression symptoms. The Stroke Impact Scale 3.0 (SIS) assessed stroke-related disability in Cognitive, Physical, and Social Participation domains, as well as self-perceived Recovery. The Western Aphasia Battery Aphasia Quotient and the NIH Stroke Scale total motor score measured language and motor impairment. Spearman correlations examined bivariate relationships between variables. Ordinal regression models examined group differences in BDI-II scores (Model 1), and disability and impairment factors that predicted BDI-II scores (Model 2), accounting for demographic factors and antidepressant medication status. BDI-II scores were on average 3.4 points higher in stroke survivors than controls. Model 1 confirmed that this difference was significant, and found that age was inversely related to BDI-II scores. Bivariate correlations demonstrated that higher BDI-II scores were related to lower SIS Cognitive, Social Participation, and Recovery scores. Model 2 found that these three measures independently predicted BDI-II scores. The factors related to depression may differ depending on the nature of the stroke, the types of deficits experienced, and the phase of recovery. In the chronic phase of left hemisphere stroke with aphasia, cognitive and communication disabilities, social participation, and self-perceived recovery are the primary correlates of depression symptoms. These findings highlight the importance of assessing for depression even long after left hemisphere stroke, and suggest potential targets for psychotherapy to improve depression.

Validation of the Integrated Palliative Care Outcome Scale (IPOS) in adults with cystic fibrosis.

A primary palliative care model for cystic fibrosis (CF) recommends using the Integrated Palliative Care Outcome Scale (IPOS) for screening. Validation of the IPOS is needed. This secondary analysis utilized baseline data from a multisite trial of the palliative care model, Improving Life with CF. Adults with CF completed the IPOS, the Memorial Symptom Assessment Scale-CF (MSAS-CF), the CF Questionnaire-Revised (CFQ-R), the Patient Health Questionnaire (PHQ-8), the Generalized Anxiety Disorder (GAD-7), and the Perceived Stress Scale (PSS). IPOS structure was assessed using Cronbach α coefficients and a factor analysis. Construct validity was evaluated through bivariate relationships between IPOS scores and other questionnaire scores, and linear regressions assessing the extent to which the IPOS explains variance in quality-of-life domains. The sample comprised 256 adults with complete IPOS data. α coefficients were .86 for the IPOS total score, .81 for the Physical Symptoms subscale, .79 for the Emotional Symptoms subscale, and .63 for the Communication/Practical Issues subscale. A two-component factor structure best aligned with the current subscales. IPOS scores were significantly associated with other measures; associations with MSAS-CF and CFQ-R subscales differentiated the IPOS Physical and Emotional subscales. The IPOS total score provided unique information about the variance in the CFQ-R Physical Functioning and Respiratory Symptoms domain scores. In adults with CF, the IPOS has acceptable internal consistency and there is evidence of construct validity. These findings support adoption of the IPOS in the primary palliative care model for CF.

A Novel Method to Predict Carbohydrate and Energy Expenditure During Endurance Exercise Using Measures of Training Load.

Sports nutrition guidelines recommend carbohydrate (CHO) intake be individualized to the athlete and modulated according to changes in training load. However, there are limited methods to assess CHO utilization during training sessions. We aimed to (1) quantify bivariate relationships between both CHO and overall energy expenditure (EE) during exercise and commonly used, non-invasive measures of training load across sessions of varying duration and intensity and (2) build and evaluate prediction models to estimate CHO utilization and EE with the same training load measures and easily quantified individual factors. This study was undertaken in two parts: a primary study, where participants performed four different laboratory-based cycle training sessions, and a validation study where different participants performed a single laboratory-based training session using one of three exercise modalities (cycling, running, or kayaking). The primary study included 15 cyclists (five female; maximal oxygen consumption [ O2max], 51.9 ± 7.2mL/kg/min), the validation study included 21 cyclists (seven female; O2max 53.5 ± 11.0mL/kg/min), 20 runners (six female; O2max 57.5 ± 7.2mL/kg/min), and 18 kayakers (five female; O2max 45.6 ± 4.8mL/kg/min). Training sessions were quantified using six training load metrics: two using heart rate, three using power, and one using perceived exertion. Carbohydrate use and EE were determined separately for aerobic (gas exchange) and anaerobic (net lactate accumulation, body mass, and O2 lactate equivalent method) energy systems and summed. Repeated-measures correlations were used to examine relationships between training load and both CHO utilization and EE. General estimating equations were used to model CHO utilization and EE, using training load alongside measures of fitness and sex. Models were built in the primary study and tested in the validation study. Model performance is reported as the coefficient of determination (R2) and mean absolute error, with measures of calibration used for model evaluation and for sport-specific model re-calibration. Very-large to near-perfect within-subject correlations (r = 0.76-0.96) were evident between all training load metrics and both CHO utilization and EE. In the primary study, all models explained a large amount of variance (R2 = 0.77-0.96) and displayed good accuracy (mean absolute error; CHO = 16-21g [10-14%], EE = 53-82kcal [7-11%]). In the validation study, the mean absolute error ranged from 16-50g [15-45%] for CHO models to 53-182kcal [9-31%] for EE models. The calibrated mean absolute error ranged from 9-20g [8-18%] for CHO models to 36-72kcal [6-12%] for EE models. At the individual level, there are strong linear relationships between all measures of training load and both CHO utilization and EE during cycling. When combined with other measures of fitness, EE and CHO utilization during cycling can be estimated accurately. These models can be applied in running and kayaking when used with a calibration adjustment.

An investigation of the relationship between long bone measurements and stature: Implications for estimating skeletal stature in subadults.

The present study introduces new regression formulae that address several challenges of current subadult stature estimation methods by 1) using a large, contemporary, cross-sectional sample of subadult skeletal remains; 2) generating regression models using both lengths and breadths; 3) utilizing both linear and nonlinear regression models to accommodate the nonlinear shape of long bone growth; and 4) providing usable prediction intervals for estimating stature. Eighteen long bone measurements, stature, and age were collected from computed tomography images for a sample of individuals (n = 990) between birth and 20 years from the United States. The bivariate relationship between long bone measurements and stature was modeled using linear and nonlinear methods on an 80% training sample and evaluated on a 20% testing sample. Equations were generated using pooled-sex samples. Goodness of fit was evaluated using Kolmogorov-Smirnov tests and mean absolute deviation (MAD). Accuracy and precision were quantified using percent testing accuracy and Bland-Altman plots. In total, 38 stature estimation equations were created and evaluated, all achieving testing accuracies greater than 90%. Nonlinear models generated better fits compared to linear counterparts and generally produced smaller MAD (3.65 - 15.90cm). Length models generally performed better than breadth models, and a mixture of linear and nonlinear methods resulted in highest testing accuracies. Model performance was not biased by sex, age, or measurement type. A freely available, online graphical user interface is provided for immediate use of the models by practitioners in forensic anthropology and will be expanded to include bioarchaeological contexts in the future.

Protocol for a Cluster Randomized Controlled Trial to Reduce Susceptibility to Tobacco Use Among School Going Adolescents in a South-Indian District—(Project TEACH)

Background: Adolescents are susceptible to using tobacco because of early exposure to tobacco through family members, easy access, or peer pressure. School-based educational programs are crucial for raising awareness of the harms of tobacco, thus preventing its uptake among adolescents. Studies conducted recently have recognized the need to bring change and reinforce ongoing school-based anti-tobacco education programs. Our study protocol aims to evaluate the effectiveness of a revised school-based anti-tobacco education on susceptibility to tobacco use among school-going adolescents. Method: Project TEACH (Tobacco Education and Awareness for Creating Healthier Adolescents) is an educational intervention that will comprise an animated video on the effects of tobacco on physical and mental health, along with dispelling myths about tobacco, which will be delivered along with a standard education program. The control group will only receive the standard school-based anti-tobacco education program. It will be conducted among students between 6th to 10th grade, with a sample size of 3,310 students. Results: Bivariate relations between the main socio-demographic characteristics and susceptibility to tobacco use will be tested using Pearson or Spearman’s correlation coefficients. For multivariable analyses, the binary logistic regression analysis is used to establish a risk model to correlate the socio-demographic factors with susceptibility to tobacco use and awareness of the harms of tobacco. Conclusion: Project TEACH aims to provide a sustainable school-based anti-tobacco education intervention. It will help test the effectiveness of the revised intervention, which could be incorporated into the current school education program being conducted in the district.

Healthcare disparities in access to surgical management and outcomes of patients with nonmetastatic primary liver cancer: A population based study from Louisiana tumor registry

BackgroundThis study aims to identify factors associated with disparities in receipt and outcomes of surgical interventions in patients with primary nonmetastatic liver cancers. MethodsCases from 2010 to 2020 were identified using Louisiana Tumor Registry. Four surgical categories were utilized: none, ablation, resection, transplant. Bivariate relationships were assessed via Chi-square tests. Overall survival (OS) was visualized using Kaplan Meier plots, compared via log-rank test, and analyzed with Cox proportional hazards models. ResultsOnly 24.5 ​% of patients underwent surgical interventions. Black race had decreased odds of undergoing transplant and decreased OS with transplant. Uninsured, Medicaid, and rural residence had decreased odds of receiving surgical intervention. Older age and no domestic partner had decreased odds of transplant. Older age, male sex, no domestic partner, and rural residence had decreased OS post-transplant. ConclusionsIdentifying the population at risk for not receiving surgical intervention and allocating resources to access care is crucial to improve outcomes.

Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center.

High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center. We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other. Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00). We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.

A Quantitative Evaluation of the Influence of Chemical Variables of Biomasses of Poplar SRC Commercial Clones in Torrefaction.

This study aimed to evaluate the influence in torrefaction of the chemical structure of biomasses from nine poplar commercial SRC clones, evaluated through analytical pyrolysis. The chemical data were integrated into a dataset including LHV gain, representative of torrefaction aptitude and six chemical variables obtained through analytical pyrolysis, which were: (i) CH2Cl2 extractives; (ii) total extractives; (iii) Py-lignin; (iv) holocellulose; (v) (syringil/guaiacyl) ratio; and (vi) (pentosan/hexosan) ratio. Significant univariate and bivariate linear relations were obtained with LHV gain from torrefaction as dependent variable vs. Py-lignin, CH2Cl2 extractives and (cP/cH) ratio. Representative results were: (i) a negative correlation of -0.82 and -0.76 between LHV gain and the (pentosan/hexosan) ratio and Py-lignin, respectively, and (ii) a positive correlation of 0.79 between LHV gain and CH2Cl2 extractive amounts. Factorial and discriminant analysis allowed for clustering the tested clones in three groups, evidencing relevant influences of (S/G) ratio, Py-lignin, and, to a lesser extent, (cP/cH) ratio in the classification of these groups, clearly showing the impact of chemical variables of feedstock in torrefaction. The results contribute: (i) to the validation of use of the expedite analytical pyrolysis technique for classification of biomasses in accordance with their torrefaction aptitude and, thereby, (ii) to optimizing strategies in technological issues as diverse as poplar clone genetic breeding and modeling biomass torrefaction and pyrolysis.

A - 2 Risk Factors for Reduced Mobility and Falls in Older Adults: the Role of Medication Use and Cognitive Impairment

Abstract Objective Sedative and anticholinergic (AC) medication use and cognitive impairment impose risk of gait imbalance and falls in older adults, but their combined effects on mobility have not been assessed. Method This cross-sectional study of 392 outpatients (age = 72 ± 7.7; 60.5%women; 93%White; education = 14 ± 3 years) characterized AC use (Anticholinergic Cognitive Burden Scale [ACB]) and number of sedative medications. Balance confidence (Activities-specific Balance Confidence Scale), walking decline compared to 5 years prior (0–3 scale), and recurrent falls (dichotomized by ≥2) were self-reported. Neuropsychological performance was averaged into a norm-adjusted composite (COG). T-tests and Pearson correlations assessed bivariate relationships across medication use, COG, and mobility. Multivariate models regressed falls, balance confidence, and gait changes (in separate models) on COG and medication use (ACs and sedatives examined separately), controlling for covariates. Results Most patients (70%–85%) used ≥1 sedative or AC medication. Few (12%) reported recurrent falls (range = 0–30), but balance confidence was reduced (M = 77.68 ± 21.31%) with mild walking declines reported (M = 1.34 ± 1.03). More sedative medication use and higher ACB scores were bivariately related to worse COG and mobility, and stronger COG was associated with better mobility (p’s ≤ 0.004). Worse COG (β = 0.196, p = 0.002) and more medication use, both sedatives (β = −0.246, p = 0.002) and ACB (β = −0.147, p = 0.047), independently predicted worse balance confidence. Higher ACB (β = 0.182, p = 0.022) and worse COG (β = −0.193, p = 0.007) uniquely predicted walking decline. Each sedative medication increased odds of falls by 27.4% (adjOR = 1.274, p = 0.034). Conclusion AC/sedative medication use and cognitive impairment pose complementary risks for compromised mobility. Clinicians should be alert to AC/sedative use and cognitive impairment in older patients at risk of falls.

Analysis of diarrhea incidence based on demographic characteristics and hygiene behavior of adults in Indonesia and Taiwan

Diarrhea is a common manifestation of gastroenteritis, affecting both children and adults globally. Subsequently, gastroenteritis is particularly prevalent in developing countries such as Indonesia and Taiwan. This research aimed to analyze the incidence of diarrhea based on socio-demographics and personal hygiene in Indonesia and Taiwan.The method used in this research was a quantitative design with a cross-sectional approach, and the data collection involved interviews with adults, using a structured questionnaire. The primary goal of the analysis was to examine the bivariate relationships between each variable and the incidence of diarrhea, and the logistic regression test was applied for the multivariate test.A result from Taiwan respondents, the statistical tests showed significant relationships with age with a p-value of 0.009, education with a p-value =0.010, and personal hygiene with a p-value =0.010. Factors that influenced diarrhea in Indonesia were education with a p-value =0.038 and income with a p-value =0.08.In summary, several socio-demographics and personal hygiene practices played a significant role in the incidence of diarrhea. The differences in results obtained from Taiwan and Indonesia were attributed to differing respondent characteristics, emphasizing the importance of promoting clean and healthy behaviors, including handwashing with soap before eating and maintaining a clean environment, as effective measures to prevent diarrhea.

Are Drug Novelty Characteristics Associated With Greater Health Benefits?

The aim of this study was to examine the association between characteristics of novel drugs and incremental health gains relative to standard of care, in terms of quality-adjusted life-years (QALYs). This study's unit of analysis is the drug-indication pair. For pairs approved by the US FDA from 1999 to 2018, we quantified incremental health gains using QALYs from the published literature and characterized each pair's novelty in terms of a series of six binary (yes/no) characteristics of novel drugs given special consideration by Health Technology Assessment agencies: Novel mechanism of action, Indicated for a rare disease, Indicated for a pediatric population, Treats a serious condition, Offers meaningful improvement over available therapies, and Potential to address unmet clinical needs. We analyzed measures of bivariate association (Mann-Whitney U and Kolmogorov-Smirnov tests) and multivariable regression, accounting for the influence of multiple novelty characteristics simultaneously. Our sample of 146 drugs represents 21% of drugs approved the FDA in the time period (1999-2018). Median and mean QALY gains for 'novel' drug-indication pairs exceeded corresponding QALY gains for non-novel drug-indication pairs. For most comparisons, the bivariate relationships between QALY gains and novelty characteristics were significant at p<0.05 except for novel mechanism of action (Kolmogorov-Smirnov test) and pediatric indication (both bivariate tests). Multivariable models revealed an independent association between novelty characteristics and QALY gain except for unmet clinical need and indicated for a rare disease. Drugs with novelty characteristics conferred larger health gains than drugs without these characteristics in bivariate analysis, multivariable models, or both. Future research should examine other aspects of drug novelty, such as patient and health system costs and equitable access.

Cerebrovascular disease is associated with Alzheimer's plasma biomarker concentrations in adults with Down syndrome.

By age 40 years, over 90% of adults with Down syndrome have Alzheimer's disease pathology and most progress to dementia. Despite having few systemic vascular risk factors, individuals with Down syndrome have elevated cerebrovascular disease markers that track with the clinical progression of Alzheimer's disease, suggesting a role of cerebrovascular disease that is hypothesized to be mediated by inflammatory factors. This study examined the pathways through which small vessel cerebrovascular disease contributes to Alzheimer's disease-related pathophysiology and neurodegeneration in adults with Down syndrome. One hundred eighty-five participants from the Alzheimer's Biomarkers Consortium-Down Syndrome [mean (SD) age = 45.2 (9.3) years] with available MRI and plasma biomarker data were included in this study. White matter hyperintensity (WMH) volumes were derived from T2-weighted fluid-attenuated inversion recovery MRI scans, and plasma biomarker concentrations of amyloid beta 42/40, phosphorylated tau 217, astrocytosis (glial fibrillary acidic protein) and neurodegeneration (neurofilament light chain) were measured with ultrasensitive immunoassays. We examined the bivariate relationships of WMH, amyloid beta 42/40, phosphorylated tau 217 and glial fibrillary acidic protein with age-residualized neurofilament light chain across Alzheimer's disease diagnostic groups. A series of mediation and path analyses examined statistical pathways linking WMH and Alzheimer's disease pathophysiology to promote neurodegeneration in the total sample and groups stratified by clinical diagnosis. There was a direct and indirect bidirectional effect through the glial fibrillary acidic protein of WMH on phosphorylated tau 217 concentration, which was associated with neurofilament light chain concentration in the entire sample. Amongst cognitively stable participants, WMH was directly and indirectly, through glial fibrillary acidic protein, associated with phosphorylated tau 217 concentration, and in those with mild cognitive impairment, there was a direct effect of WMH on phosphorylated tau 217 and neurofilament light chain concentrations. There were no associations of WMH with biomarker concentrations among those diagnosed with dementia. The findings from this cross-sectional study suggest that among individuals with Down syndrome, cerebrovascular disease promotes neurodegeneration by increasing astrocytosis and tau pathophysiology in the presymptomatic phases of Alzheimer's disease, but future studies will need to confirm these associations with longitudinal data. This work joins an emerging literature that implicates cerebrovascular disease and its interface with neuroinflammation as a core pathological feature of Alzheimer's disease in adults with Down syndrome.

Self-Esteem and Anxiety as Mediators in the Relationship Between Emotional Intelligence and Eating Disorder Symptoms.

This study investigated the relationship between emotional intelligence (EI) and eating disorder symptoms (EDS) by testing the serial mediation model, with self-esteem and anxiety as mediators. A total of 923 participants (61.9% female) aged 15-60 years completed questionnaires assessing their EI, self-esteem, anxiety, and EDS. Correlational analyses were conducted to assess the relationship between the study variables, and a serial mediation analysis was conducted to test the possible mediating role of self-esteem and anxiety in the relationship between EI and EDS. Correlation analyses revealed significant bivariate relationships between EI, self-esteem, and anxiety, but no significant correlation between EI and EDS. The relationship between EI and EDS was serially mediated by self-esteem and anxiety. High levels of EI were associated with higher self-esteem, which, in turn, was associated with lower anxiety and less EDS. The results offer potential mechanisms that could explain the relationship between EI and EDS and highlight the importance of EI in regulating eating behavior through self-esteem and anxiety.

Global leaf sulfur stoichiometry and the relationships with nitrogen and phosphorus: phylogeny, growth form and environmental controls.

Sulfur (S) is an essential bioelement with vital roles in serving regulatory and catalytic functions and tightly coupled with N and P in plants. However, globally stoichiometric patterns of leaf S and its relationships to leaf N and P are less well studied. We compiled 31 939 records of leaf-based data for 2600 plant species across 6652 sites worldwide. All plant species were divided into different phylogenetic taxa and growth forms. Standard major axis analysis was employed to fit the bivariate element relationships. A phylogenetic linear mixed-effect model and a multiple-regression model were used to partition the variations of bioelements into phylogeny and environments, and then to estimate the importance of environmental variables. Global geometric mean leaf S, N and P concentrations were 1.44, 15.70 and 1.27 mg g-1, respectively, with significant differences among plant groups. Leaf S-N-P positively correlated with each other, ignoring plant groups. The scaling exponents of LN-LS, LP-LS and LN-LP were 0.64, 0.76 and 0.79, respectively, for all species, but differed among plant groups. Both phylogeny and environments regulated the bioelements. The variability, rather than mean temperature, controlled the bioelements. Phylogeny explained more for the concentrations of all the three bioelements than environments, of which S was the one most affected by phylogenetic taxa.