Cumulative Proportion Research Articles

The impact of reminders on representativeness and survey estimates among web-mode invited in the Danish National Health Survey.

Declining response proportions in health surveys may lead to increased non-response bias. Multiple reminders are often used to increase response proportions, and, thus, we aimed to determine if the use of reminders decreased the magnitude of non-response bias among web-mode invited in the Danish National Health Survey 2023. In the Danish National Health Survey 2023, a national random sample of 23467 individuals (aged ≥16 years) with residence in Denmark were invited by a secure electronic mail service. Invited individuals received up to five inquiries: (i) web invitation, (ii) web reminder, (iii) paper invitation including a questionnaire and a prepaid return envelope, (iv) paper reminder, and (v) paper reminder including a questionnaire and a prepaid return envelope. The cumulative response proportions after first-, second-, third-, fourth-, and fifth inquiries were 19.1%, 28.9%, 37.2%, 39.3%, and 42.0%, respectively. In general, third, fourth, and fifth mailing respondents were more often men, at younger ages, with non-Western backgrounds, and unmarried compared to first mailing respondents. Furthermore, third, fourth, and fifth mailing respondents were in general found to have less favorable health behavior than first mailing respondents, but also a lower prevalence of fair or poor self-rated health and long-standing health problems. In conlusion, reminders are an effective way to increase the response proportion. Furthermore, the use of reminders was found to decrease the magnitude of non-response bias; however, the decrease was small due to the low number of individuals responding after fourth and fifth inquiries.

Genetic Characterisation of Feeding Patterns in Lactating Holstein Cows and Their Association With Feed Efficiency Traits.

Feeding behaviour traits, such as number, duration or intake per feeder visit, have been associated with feed efficiency in dairy cattle. Those traits, however, do not fully capture cows' feeding patterns throughout the day. The goal of this study was to propose a new phenotype for characterising within-day feeding patterns and estimate its heritability and genetic correlations with dry matter intake (DMI), secreted milk energy, metabolic body weight and residual feed intake. Feeding patterns were evaluated using 4.8 million bunk visits from 1684 midlactation Holstein cows collected from 2009 to 2023 with an Insentec system. Feed efficiency traits were available from 6099 lactating Holstein cows at six research stations across the United States. Daily bunk visits were ordered, with Time 0 designated as the time of first feed delivery. Intake proportions were calculated by visit for each cow by dividing feed intake per visit by the total intake of the cow for that day. Feeding patterns were characterised by the area under the curve of cumulative feed intake proportions for each cow throughout the day. The feeding pattern phenotype per cow was defined as the average of areas under the curve across days, whereas consistency of feeding pattern was calculated as the natural logarithm of variance of daily area under the curve values. Estimates of heritability and genetic correlations were performed using Bayesian inference with an animal model, considering lactation, days in milk and cohort (trial-treatment) as fixed effects and animal as a random effect. Heritability estimates for average area under the curve and variance of daily area under the curve were 0.35 ± 0.05 and 0.16 ± 0.05, respectively. The genetic correlation between average area under the curve and secreted milk energy was -0.30 ± 0.14. Genetic correlations between average area under the curve and DMI, metabolic body weight and residual feed intake were not statistically significant. Variance of daily area under the curve was genetically correlated with DMI (0.47 ± 0.15), secreted milk energy (0.40 ± 0.17) and metabolic body weight (0.28 ± 0.13). The genetic correlation between variance of daily area under the curve and residual feed intake was not significant. Overall, we provided a reliable method to truly characterise feeding patterns in midlactation dairy cows. Feeding pattern and its consistency were heritable, indicating that a significant proportion of phenotypic variation is explained by additive genetic effects. Genetic correlation estimates indicate that cows with more consistent daily feeding patterns have lower DMI, lower secreted milk energy and lower metabolic body weight.

Identifying quality responses using an analysis of response times: the RTcutoff function in R

IntroductionThe present study aims to develop an R function to develop and visualize thresholds that describe the response time of individuals concerning their sample. The function utilizes the cumulative proportion correct (CUMP) approach, to estimate item-specific time threshold, which originated in the work of Guo and his colleagues. Besides the CUMP approach, the present function presents response time profiles on a measure using the mean of the sample and + 1SD times so that it can discern between thoughtful engagement and processing with an item (termed problem-solving behavior) and rapid responding, guessing, and disengagement with the test. The advantage of the CUMP model utilized here is that it simultaneously engages both response time and response correctness to establish thresholds that differentiate engaged from disengaged participants.MethodsGiven data on a measure of reading comprehension for students in Saudi Arabia (n = 494) using the Progress in International Reading Literacy Study (PIRLS 2021) international assessment, high and low-achieving individuals that engaged in different behavior patterns were identified and plotted against their sample.Results and conclusionResults pointed to the importance and necessity of the RTcutoff function to identify variable forms of engagement that have implications for person-score validity but also have implications for test validity and the need to increase measurement precisio.

Measuring Emotional Self-Efficacy of Students in Online Synchronous Teaching Environments in India

ABSTRACT Emotional self-efficacy of students has been found to be associated with their overall performance in different contexts. The exponential growth of online education and increased use of online synchronous teaching-learning environments presents an opportunity to assess the emotional self-efficacy of students in this unique context. Although there has been research in the area of technological self-efficacy, the unique demands of real-time online teaching in synchronous environments necessitate a deeper understanding of emotional self-efficacy. Grounded in Bandura’s Self-Efficacy Theory (1982) and Mayer and Salovey’s Emotional Intelligence model (1997), this study aims to develop and validate a standardized scale to measure the emotional self-efficacy of students in online synchronous teaching environments in India. The study was conducted on a diverse sample of 480 students from two universities in India. Exploratory factor analysis was performed on the first draft of the scale, which initially included 19 items scored on a 5-point Likert Scale. Two items were dropped from the scale model, with the final version containing 17 items. The four factors identified are “Perceiving emotions,” “Using emotions to facilitate thinking,” “Regulating emotions,” and “Recognizing classmates’ emotions.” The identified factors aligned with the adopted theoretical framework, and the cumulative proportion of variance in the rotated solution was 61.9%. The test–retest reliability of the scale was 0.752. The research has significant implications for designing online courses and programs, as well as for creating policies and practices to capitalize on the emotional gains of students through a well-planned strategy. The study calls for further research in the area of cross-cultural applications of the scale and the relationship between emotional self-efficacy and educational outcomes.

Mortality related to left ventricular ejection fraction and obstructive coronary artery disease in non-ST-segment elevation myocardial infarction

Abstract Background Extent of coronary artery disease (CAD) and the severity of reduced left ventricular ejection fraction (LVEF) have both been associated with the prognosis after non-ST-segment elevation myocardial infarction (NSTEMI). However, the contemporary mortality associated with the extent of obstructive CAD over a range of LVEF remains uncertain. Purpose The aim of this study was to assess the impact of CAD and LVEF on all-cause death following a first-time NSTEMI. Methods We included consecutive first-time NSTEMI patients undergoing coronary angiography from 2010 to 2021 in Western Denmark. Patients were stratified by extent of obstructive vessel disease (VD; 1, 2, or 3VD) and LVEF (≥51%, 41-50%, or 10-40%). Patients with previous myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting were excluded. The primary outcome was all-cause death. We calculated 5-year cumulative incidence proportions (CIP) as a measure of absolute risk and adjusted hazard ratios (HR). Results A total of 8,770 patients with first-time NSTEMI and obstructive CAD were examined with coronary angiography. Two-thirds were male and median age was 68 years (Q1-Q3: 58-78). The increase in mortality associated with decreasing LVEF was greater than observed by extent of CAD (Table). Thus, the 5-year mortality increased stepwise by extent of CAD from 14% for 1VD to 31% for 3VD (adjusted HR 1.35, 95% CI:1.19-1.54), but from 12% for LVEF ≥51% to 40% for LVEF 10-40% (adjusted HR 2.32, 95% CI: 2.04-2.65). When combining LVEF and extent of CAD, an increase in 5-year mortality was found from 9% for 1VD and LVEF ≥51% to 46% for 3VD and LVEF 10-40% (risk difference of 37.1%; Figure). Correspondingly, using 1VD and LVEF ≥51% as reference, the adjusted HRs increased gradually with extent of CAD and decline in LVEF to 3.05 (95% CI: 2.51-3.70) for patients with 3VD and LVEF 10-40% (Table). Conclusion In a contemporary all-comers cohort of first-time NSTEMI patients, increasing extent of CAD and declining LVEF are both associated with a gradual increase in 5-year mortality. Our data suggest that the level of LVEF reduction was more strongly associated with 5-year mortality than CAD extent.

Duration of prehospital and in-hospital cardiopulmonary resuscitation and neurological outcome in paediatric out-of-hospital cardiac arrest

BackgroundBecause of their young age and lack of known comorbidities, paediatric patients with out-of-hospital cardiac arrest (OHCA) often undergo prolonged cardiopulmonary resuscitation (CPR). We aimed to determine the association between...

Assessing the effect of torrent control structures on sediment continuity and connectivity

The study investigated the effect of torrent control structures on the sediment cascade in the Vegliato mountain basin (Italy) related to an intense rainfall event of 50 years return interval. The Index of Connectivity (IC) was exploited to analyze the interaction of structures with longitudinal sediment (dis)connectivity. Moreover, the Sediment Continuity Ratio (SCR) was used to assess the effect on sediment (dis)continuity. The SCR is a novel parameter considering for each torrent control structure, the net balance of sediment deposition and erosion, and the cumulative proportion of the sediment cascade arriving from upstream. The SCR emphasises which structure was more prone to continuity or discontinuity during an event and to what extent compared toother structures. Moreover, a multi-perspective framework was carried out to help the interpretation of the SCR results within the context of the study area. The results of the (dis)connectivity assessment showed that the torrent control structures impacted sediment dynamics by influencing the slope and flow confinement, which in turn affected the IC. The (dis)continuity assessment showed structures prone to continuity mainly located in the upstream part of the catchment, where most of the over 60000 m3of sediment was generated. In contrast, structures prone to discontinuity were located in the downstream part, where deposition processes were favoured during the analyzed period. A total of 65 % of the structures similarly affected both (dis)continuity and(dis)connectivity. Data on individual structure functions and maintenance conditions were also included, emphasizing the importance of these factors in planning mountain basins management interventions.The study proposed a new metric that, despite being based on a single large event and a single basin, still provides a useful approach to investigate the interaction between sediments and individual structures, the entire sediment cascade and the channel control system.

Modeling the burden of long COVID in California with quality adjusted life-years (QALYS).

Individuals infected with SARS-CoV-2 may develop post-acute sequelae of COVID-19 ("long COVID") even after asymptomatic or mild acute illness. Including time varying COVID symptom severity can provide more informative burden estimates for public health response. Using a compartmental model driven by confirmed cases, this study estimated long COVID burden by age group (0-4, 5-17, 18-49, 50-64, 65+) in California as measured by the cumulative and severity-specific proportion of quality-adjusted life years (QALYs) lost. Long COVID symptoms were grouped into severe, moderate, and mild categories based on estimates from the Global Burden of Disease study, and symptoms were assumed to decrease in severity in the model before full recovery. All 10,945,079 confirmed COVID-19 cases reported to the California Department of Public Health between March 1, 2020, and December 31, 2022, were included in the analysis. Most estimated long COVID-specific QALYs [59,514 (range: 10,372-180,257)] lost in California were concentrated in adults 18-49 (31,592; 53.1%). Relative to other age groups, older adults (65+) lost proportionally more QALYs from severe long COVID (1,366/6,984; 20%). Due to changing case ascertainment over time, this analysis might underestimate the actual total burden. In global sensitivity analysis, estimates of QALYs lost were most sensitive to the proportion of individuals that developed long COVID and proportion of cases with each initial level of long COVID symptom severity (mild/moderate/severe). Models like this analysis can help translate observable metrics such as cases and hospitalizations into quantitative estimates of long COVID burden that are currently difficult to directly measure. Unlike the observed relationship between age and incident severe outcomes for COVID-19, this study points to the potential cumulative impact of mild long COVID symptoms in younger individuals.

Improvement of Spatio-Temporal Inconsistency of Time Series Land Cover Products

In recent years, time series land cover products have been developed rapidly. However, the traditional classification strategy rarely considers time continuity and spatial consistency, which leads to the existence of unreasonable changes among the multi-period products. In order to solve the existing problems, this paper proposes a matrix decomposition model and an optimized hidden Markov model (HMM) to improve the consistency of the time series land cover maps. It also compares the results with the spatio-temporal window filtering model. The spatial weight information is introduced into the singular value decomposition (SVD) model, and the regression model is constructed by combining the eigenvalues and eigenvectors of the image to predict the unreasonable variable pixels and complete the construction of the matrix decomposition model. To solve the two problems of reliance on expert experience and lack of spatial relationships, this paper optimizes the model and proposes the HMM Land Cover Transition (HMM_LCT) model. The overall accuracy of the matrix decomposition model and the HMM_LCT model is 90.74% and 89.87%, respectively. It is found that the matrix decomposition model has a better effect on consistency adjustment than the HMM_LCT model. The matrix decomposition model can also adjust the land cover trajectory to better express the changing trend of surface objects. After consistent adjustment by the matrix decomposition model, the cumulative proportion of the first 15 types of land cover trajectories reached 99.47%, of which 83.01% were stable land classes that had not changed for three years.

Return to Play After an Anterior Cruciate Ligament Reconstruction in the Collegiate Athlete: A Systematic Review Evaluating Return to Play Proportions and Associated Factors.

OBJECTIVE: To estimate anterior cruciate ligament reconstruction (ACLR) return-to-play (RTP) factors and proportions across all National Collegiate Athletics Association (NCAA) sports. DESIGN: Systematic review with prognosis and etiology components. LITERATURE SEARCH: Two independent reviewers searched PubMed, Cochrane Library, and Embase databases using terms related to RTP, ACLR, and NCAA for articles published up to June 30, 2023. STUDY SELECTION CRITERIA: Articles were included if RTP proportions or factors affecting RTP were reported and if the study population included NCAA collegiate athletes recovering from an ACLR. DATA SYNTHESIS: The proportion represents the total number of athletes who returned to play after ACLR over the total number of ACLR athletes from each cohort. The cumulative proportion represents the aggregated total from each included study. When eligibility information was available (ie, athletes in their final year of eligibility), RTP proportions were adjusted. The Newcastle-Ottawa Scale (NOS) was used to assess the study quality and scored by 2 raters. RESULTS: Nine studies were included. RTP criteria varied across the studies. Proportions of RTP ranged from 69% to 92%, with a cumulative RTP proportion after ACLR of 84% (628/745). The primary factors associated with the proportion of RTP were scholarship status, competitive eligibility remaining, depth chart position, and surgical graft type. CONCLUSIONS: The cumulative proportion of RTP was 84% and was associated with patient-specific and operative factors. Psychological and functional factors were not routinely reported, and rehabilitation protocols were unknown. Data were not explicitly available for any athletes outside of Division I. The criteria for RTP after ACLR varied. J Orthop Sports Phys Ther 2024;54(10):1-9. Epub 10 September 2024. https://doi.org/10.2519/jospt.2024.12483.

One-year seizure freedom and quality of life in patients with drug-resistant epilepsy receiving adjunctive vagus nerve stimulation in Japan.

Amount of seizure-free days is a critical determinant of quality of life (QoL) in patients with drug-resistant epilepsy (DRE). The fractions of patients experiencing prolonged periods of seizure freedom with adjunctive vagus nerve stimulation (VNS) have yet to be assessed on a large scale. Retrospective analysis of patients in the Japanese VNS prospective observational registry who experienced at least 1 year of seizure freedom from all seizures, focal seizures, or tonic-clonic seizures (TCS), as well as patient-reported change in QoL in these groups. The study included 362 patients with DRE, 147 were female (40.6%), and the median age at VNS implant was 23.0 years (range: 1.0-73.0). A total of 225 patients reported focal seizures and 184 patients reported TCS. After 36 months of adjunctive VNS, the cumulative proportion of patients experiencing at least 1 year of complete seizure freedom was 11% (38/356) with an average duration of seizure freedom of 19.4 months. In patients with focal seizures, 25% (n = 57/225) experienced at least 1 year of freedom from focal seizures with an average duration of 24.8 months. Higher cumulative rates of freedom from TCS were observed: 55% (n = 101/184) experienced at least 1 year without TCS with an average duration of TCS-free periods of 28.9 months. 82.1% of patients with 12-month complete seizure freedom reported markedly improved or improved QoL compared with 51.9% of patients who were not seizure-free. QoL changes in patients with 12-month seizure freedom from TCS and focal seizures were similar: 61.8% and 63% of respective patients reported either markedly improved or improved QoL at 36 months. Complete seizure freedom is rare in patients treated with VNS; however, this analysis found approximately half of patients who experienced TCS prior to VNS experienced prolonged periods of freedom from TCS with adjunctive VNS. We studied patients in Japan with epilepsy that is difficult to treat. To understand if adding vagus nerve stimulation (VNS) helps such patients, we looked at which patients stopped having all seizures or stopped having a specific seizure type (such as tonic-clonic seizures or focal seizures), and how long these periods lasted. With VNS treatment, about 2 out of 4 patients with tonic-clonic seizures and 1 out of 4 patients with focal seizures had more time without these seizure types. Without seizures, patients felt better about their daily lives. Even patients who still had seizures felt better about their daily lives after 3 years of VNS treatment. The clinical trial registry number is UMIN000014728.

Spatiotemporal Patterns and Equity Analysis of Premature Mortality Due to Ischemic Heart Disease Attributable to PM2.5 Exposure in China: 2007-2022.

Long-term exposure to PM2.5 pollution increases the risk of cardiovascular diseases, particularly ischemic heart disease (IHD). Current assessments of the health effects related to PM2.5 exposure are limited by sparse ground monitoring stations and applicable disease research cohorts, making accurate health effect evaluations challenging. Using satellite-observed aerosol optical depth (AOD) data and the XGBoost-PM25 model, we obtained 1 km scale PM2.5 exposure levels across China. We quantified the premature mortality caused by PM2.5-exposure-induced IHD using the Global Exposure Mortality Model (GEMM) and baseline mortality data. Furthermore, we employed the Gini coefficient, a measure from economics to quantify inequality, to evaluate the distribution differences in health impacts due to PM2.5 exposure under varying socioeconomic conditions. The results indicate that PM2.5 concentrations in China are higher in the central and eastern regions. From 2007 to 2022, the national overall level showed a decreasing trend, dropping from 47.41 μg/m3 to 25.16 μg/m3. The number of premature deaths attributable to PM2.5 exposure increased from 819 thousand in 2007 to 870 thousand in 2022, with fluctuations in certain regions. This increase is linked to population growth and aging because PM2.5 levels have decreased. The results also indicate disparities in premature mortality from IHD among different economic groups in China from 2007 to 2022, with middle-income groups having a higher cumulative proportion of IHD-related premature deaths compared with high- and low-income groups. Despite narrowing GDP gaps across regions from 2007 to 2022, IHD consistently "favored" the middle-income groups. The highest Gini coefficient was observed in the Northwest (0.035), and the lowest was in the South (0.019). Targeted policy interventions are essential to establish a more equitable atmospheric environment.

Investigating the timing and site of recurrence for ovarian clear cell carcinoma: Analysis of the JGOG/GCIG trial-JGOG 3017-A3

BackgroundThis study was conducted to determine the optimal monitoring after initial treatment of ovarian clear cell carcinoma (OCCC) using data from patients enrolled in the Japanese Gynecologic Oncology Group (JGOG) 3017 study. The JGOG study evaluated the efficacy of an irinotecan and cisplatin combination regimen compared with that of a paclitaxel and carboplatin regimen for OCCC patients who underwent primary surgery. MethodsYielding 619 total patients in this study, to analyze progression-free and overall survival, the hazards over time were estimated using kernel smoothing curves to identify the peak of event occurrence. The number of progression events was summed by progression site, and the cumulative incidence proportion was estimated for the major progression sites, considering competing risks. ResultsThe peak hazard for progression or death was observed at 12 months post-treatment, and most events were observed by 24 months. The hazard for death peaked at 18 months post-treatment, with most events being observed by 48 months. The hazard for lung, liver, and spleen metastases remained constant for 18 months post-treatment, with a decreasing trend thereafter; most events were observed by 18 months. The hazard for peritoneal dissemination was constant for 12 months, with a decreasing trend thereafter, with most exacerbations observed by 24 months. The risk of pelvic recurrence peaked at 6 months, with most exacerbations observed by 24 months. DiscussionThe incidence of progression events for OCCC peaked at 12 months and most progression events occurred within 24 months. Close follow-up for the initial 24 months post-treatment and fewer visits thereafter may be acceptable. However, closely monitoring symptoms and examining patients based on differences in progression rates at different sites may be important.

Trends and Predictors of Students’ Academic Performances by Levels of Study in University of Health and Allied Sciences in Ghana: A Longitudinal Surveillance Study Among a Cohort of 2020 Graduating Class of Undergraduates at the School of Allied Health Sciences in Ho North Campus

Background: Ascertainment of trends and predictors of academic performances among Allied Health students is critical to United Nation’s Sustainable Development Goals 3, 4 and 8. This article assesses the dynamics and academic risk factors associated with students’ performances at the University of Health and Allied Sciences (UHAS), Ghana. Method: This is a longitudinal cohort study, designed to evaluate retrospectively, the academic records of 180 students of the 2020 graduating class of undergraduates in the School of Allied Health Sciences. The published grades of each student from levels 100 to 400 were collated using a data extraction log that was quality controlled, double-entered and statistically analysed using Microsoft Visual Basic and STATA platforms respectively. The trends and predictors of academic performances by levels were determined using the Cochrane-Armitage test for trends and the Cochran-Martin-Haenszel test for association respectively. Results: The mean rates of scoring grades ‘A’, ‘B+’, ‘B’, ‘C’, ‘D’ and ‘E/F’ among this cohort were 22.2%, 21.2%, 23.3%, 25.8%, 7.9% and 0.5% respectively. The inter-variations in a proportion of grades within the levels were statistically significant (p<0.01). However, the intra-variations in proportional distribution of grades trended insignificantly across the levels (p>0.05). Although, the Spearman’s coefficient depicted a strong negative correlation between grade ‘A’ and levels (r= -0.9); the associations were only between grade ‘A’ and level 200s (OR=1.9; CI: 1.05-1. 33, p<0.001) and between grade ‘A’ and level 300 (OR=1.4;(CI: 1.25-1.59), p<0.001). Conclusion: The cumulative proportion of 43.4% students scoring grade ‘A’ and ‘B +’ reflected above average performances in SAHS. However the distribution of grades on Gaussian curve deviates the Central Limit Theorem. In addition, the observed negative correlation between trends of grade ‘A’ from lower (100) to high (400) levels of studies deviates Bloom’s and SOLO Taxonomies, and Trans-Theoretical Model (TTM) of assessing students’ learning progression. These phenomena have Quality Assurance, Academic Policy and Research implications. Therefore, the use of modify (hybrid) grading System is strongly recommended in SAHS. Also, we strongly recommend an extended study to determine factors that affect the poor performances of levels 100 and 400 students in SAHS.

Recurrent Pulmonary Tuberculosis in China, 2005 to 2021

Despite posing a significant challenge to global tuberculosis (TB) elimination efforts, recurrent TB remains understudied due to the challenges of long-term observation. To investigate the burden of recurrent TB using data from patients with pulmonary TB (PTB) in China. This retrospective cohort study included all bacteriologically confirmed or clinically diagnosed PTB cases reported to the Tuberculosis Information Management System with completed or successful treatment outcomes from January 1, 2005, to December 31, 2021. Data were analyzed from July 15, 2022, to October 28, 2023. Newly diagnosed PTB was classified into primary, hematogenous disseminated, or secondary PTB. The primary outcome was the annual recurrence rate, stratified by disease classification, over the 17-year observation period. The recurrence rate for year n was calculated by dividing the number of patients with recurrent TB in year n by observed person-years in year n. The secondary outcome was the annual proportion of recurrent TB among reported cases and associated risk factors. Of 13 833 249 patients with TB reported to the Tuberculosis Information Management System, 10 482 271 with PTB met the inclusion criteria. Of these, 68.9% were male, 22.3% were 65 years or older, 89.6% were of Han ethnicity, and 68.4% were agricultural workers. A total of 413 936 patients experienced a recurrent TB episode after successful treatment, resulting in an overall recurrence rate of 0.47 (95% CI, 0.47-0.48) per 100 person-years. The recurrence rate for patients with primary PTB was 0.24 (95% CI, 0.22-0.26) per 100 person-years; for hematogenous disseminated PTB, 0.37 (95% CI, 0.36-0.38) per 100 person-years; and for secondary PTB, 0.48 (95% CI, 0.47-0.48) per 100 person-years. The cumulative proportion of recurrences within the first 2 years accounted for 48.9% of all recurrent cases. The proportion of recurrent cases among notified incident cases increased 1.9-fold from 4.7% in 2015 to 8.8% in 2021. Among other factors, ages 45 to 64 years (adjusted hazard ratio, 1.77 [95% CI, 1.65-1.89]) and having completed treatment (adjusted hazard ratio, 1.16 [95% CI, 1.14-1.18]) were identified as associated with recurrence. In this retrospective cohort study, the PTB recurrence rate was substantially higher than the incidence, and the proportion of recurrent cases increased. Almost half of the recurrence occurred within the first 2 years, suggesting that routine posttreatment follow-up may represent an important strategy for accelerating TB elimination.

СПЕКТР КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ Х-СЦЕПЛЕННОГО СИНДРОМА АЛЬПОРТА У ДЕВОЧЕК: ОДНОЦЕНТРОЕ КОГОРТНОЕ ИССЛЕДОВАНИЕ

X-linked Alport syndrome (XLAS) is an inherited disorder caused by genetic variants in gene COL4A5. The frequency and the severity of clinical manifestations as well as the risk of glomerulopathy progression are variable in XLAS in females, and the disease course features have not been sufficiently studied as yet. Since patient management tactics is determined by the disease course nature, studying the spectrum of XLAS clinical manifestations and prognosis in girls remains relevant. The purpose of this research was to determine the spectrum and the features of clinical manifestations of XLAS in girls. Materials and methods used: a single-center cohort prospective study was carried out by the Authors that included 74 girls aged 2 to 17 y/o with genetically proven XLAS diagnosis. Authors have analyzed the patients’ medical records identifying sensorineural hearing loss (SNHL), arterial hypertension (AH; blood pressure (BP) over 95% than at the patient’s age/height), albuminuria (Alb; norm<30 mg/mmol of creatinine), proteinuria (Pr; norm<100 mg/sq m/day) - with its degree, decrease in estimated glomerular filtration rate (eGFR, ml/min/1.73 sq m; norm≥90 ml/min/1.73 sq m) and angiotensin-converting enzyme inhibitors (ACEIs) therapy data. Results: all patients had hematuria with episodical macrohematuria in 27% of cases, proteinuria in 40%, eGFR decrease in 15%, SNHL in 8% and peripheral retinopathy in 7%. Girls with missense v. those with non-missense variants of COL4A5 more often had macrohematuria (0.15 v. 0.05; p=0.015) and albuminuria (1 v. 0.5; p<0.001) whilst no statistically significant difference was showed in proteinuria frequency and age of onset (0.48 v. 0.5 and 6.5 [3; 11] v. 5 [5; 8] y/o), eGFR decrease (0.15 v. 0.15; 12.4±2.6 v. 13.2 ±2.8 y/o), SNHL (0.07 v. 0.1; 13±2.8 v. 14.4±3.1 y/o) and retinopathy (0.04 v. 0.15; 14.3±3.5 v. 12.6±2.9 y/o). ACEIs therapy did not show any statistically significant effect on the cumulative proportion of patients with both proteinuria and eGFR decrease (log-rank test=1.25, p=0.213 and log-rank test=0.66, p=0.512, respectively). Conclusion: the results obtained demonstrate the need for a dynamic follow-up of girls with XLAS with the purpose of earliest possible detection of proteinuria and timely prescribing with nephroprotective therapy as well as hearing loss diagnosing and timely audiological correction.

Unravelling the complex interplay of age, comorbidities, and multimorbidities in COVID-19 disease progression: Clinical implications and future perspectives

IntroductionThe COVID-19 infection as an inflammatory disease has posed significant challenges to global public health due to multi-factor risks associated with it leading to disease severity and mortality. Understanding the effect of age and comorbidities on overall disease progression is crucial to identify highly susceptible individuals and to develop effective disease management strategies in a resource limited country like Pakistan. MethodologyA retrospective study was conducted on hospitalized COVID-19 patients to assess the prevalence of various comorbidities among different age groups and their effect on disease severity and mortality rate. ResultsIn this retrospective study, a cohort of 618 hospitalized COVID-19 patients was analyzed, consisting of 387 males (62.6 %) and 231 females (37.4 %). Notably, the young age group (15–24 years), had the lowest frequency of hospitalized COVID-19 patients, while no case was observed in children (≤14 years) showing a significant association (p < 0.001) of age and disease prevalence. Comorbidities were observed in 63.9 % of COVID-19 patients including hypertension (HTN), diabetes mellitus (DM), ischemic heart diseases (IHD), asthma, chronic kidney disease (CKD) and tuberculosis (TB). The most common comorbidities were HTN (42.1 %) followed by DM (33.8 %), IHD (16.5 %), asthma (11.2 %), CKD (7.9 %) and TB (1.9 %).Furthermore, the study revealed a significant association between comorbidities, age groups, and the need for non-invasive ventilation (NIV) (p < 0.001), mechanical ventilation (MV) (p < 0.001), and intensive care unit (ICU) admission (p < 0.001). Patients with specific comorbidities and those in the older age group (≥65 years) demonstrated a higher need for these interventions. However, patients without any comorbidity consistently exhibited the highest cumulative proportion of survival at each time point, indicating better overall survival outcomes. In contrast, patients with multimorbidities of DM/HTN/IHD, HTN/IHD, and DM/HTN/CKD had comparatively lower survival rates and higher mortality rates (p < 0.001). ConclusionThis research highlights the significant impact of age, comorbidities and multimorbidities on the severity and mortality of COVID-19 patients. It highlights the importance of considering these factors in tailoring effective management strategies for patients with COVID-19 or other infectious respiratory diseases.

Long-term continuous changes of vegetation cover in desert oasis of a hyper-arid endorheic basin with LandTrendr algorithm

Ecological water diversion projects (EWDP) is one of the most important initiatives for oases restoration in arid endorheic basins. Fine monitoring of the long-term and continuous changes in vegetation cover before and after the EWDP is important to evaluate the effects of EWDP on ecosystem restoration. In this study, a trajectory-based change detection approach was applied with the Landsat-based detection of trends in disturbance and recovery (LandTrendr) algorithm on Google Earth Engine to map vegetation cover change trajectories in Ejina Oasis in the lower Heihe River Basin of China during 1990–2020. In addition to monotonic changes (i.e., continuous greening and continuous browning), LandTrendr also can flexibly capture the breaks of greening or browning events, including the greening with negative break, browning with positive break, browning to greening, and greening to browning. These changes mainly happened in shrub land and the area with land use transition. Approximately 82 % of the oasis ecosystem has been restored by the implementation of EWDP since 2000. However, in the past decade, the EWDP also caused some negative effects on vegetation cover in some areas. Both the categories of browning with positive break and greening to browning became widespread after 2010, with the cumulative proportions accounting for 79.4 % and 70.1 % of each category. The mean magnitude and slope of change in NDVI in these two categories after 2010 were −0.03 and −0.008 yr−1, −0.12 and −0.035 yr−1, respectively. This research demonstrated that the proposed approach was effective and useful for continuously monitoring the timing and extent of vegetation recovery processes in the hyper-arid endorheic basin. The EWDP plays an important role in vegetation restoration, but we also need to continuously monitor negative impacts which are crucial for environmental assessment and policy making in the arid endorheic basin.

A method for characterizing disease emergence curves from paired pathogen detection and serology data

Abstract Wildlife disease surveillance programs and research studies track infection and identify risk factors for wild populations, humans and agriculture. Often, several types of samples are collected from individuals to provide more complete information about an animal's infection history. Methods that jointly analyse multiple data streams to study disease emergence and drivers of infection via epidemiological process models remain underdeveloped. Joint‐analysis methods can more thoroughly analyse all available data, more precisely quantifying epidemic processes, outbreak status, and risks. We contribute a paired data modelling approach that analyses multiple samples from individuals. We use ‘characterization maps’ to link paired data to epidemiological processes through a hierarchical statistical observation model. Our approach can provide both Bayesian and frequentist estimates of epidemiological parameters and state. Our approach can also incorporate test sensitivity and specificity, and we propose model fit diagnostics. We motivate our approach through the need to use paired pathogen and antibody detection tests to estimate parameters and infection trajectories for the widely applicable susceptible, infectious, recovered (SIR) model. We contribute general formulas to link characterization maps to arbitrary process models and datasets and an extended SIR model that better accommodates paired data. We find via simulation that paired data can more efficiently estimate SIR parameters than unpaired data, requiring samples from 5 to 10 times fewer individuals. We use our method to study SARS‐CoV‐2 in wild white‐tailed deer (Odocoileus virginianus) from three counties in the United States. Estimates for average infectious times corroborate captive animal studies. The estimated average cumulative proportion of infected deer across the three counties is 73%, and the basic reproductive number (R0) is 1.88. Wildlife disease surveillance programs and research studies can use our methods to jointly analyse paired data to estimate epidemiological process parameters and track outbreaks. Paired data analyses can improve precision and accuracy when sampling is limited. Our methods use general statistical theory to let applications extend beyond the SIR model we consider and to more complicated examples of paired data. The methods can also be embedded in larger hierarchical models to provide landscape‐scale risk assessment and identify drivers of infection.

Natural course of ulcerative colitis in China: Differences from the West?

Whether the natural course of ulcerative colitis (UC) in mainland China is similar or different from that in Western countries is unknown, and data on it is limited. We aimed to provide a comprehensive description of the natural course of UC in China and compare it with Western UC patients. Based on a prospective Chinese nationwide registry of consecutive patients with inflammatory bowel diseases, the medical treatments and natural history of UC were described in detail, including disease extension, surgery, and neoplasia. The Cox regression model was used to identify factors associated with poor outcomes. A total of 1081 UC patients were included with a median follow-up duration of 5.3years. The overall cumulative exposure was 99.1% to 5-aminosalicylic acids, 52.1% to corticosteroids, 25.6% to immunomodulators, and 15.4% to biologics. Disease extent at diagnosis was proctitis in 26.9%, left-sided colitis in 34.8%, and extensive colitis in 38.3%. Of 667 patients with proctitis and left-sided colitis, 380 (57.0%) experienced disease extent progression. A total of 58 (5.4%) UC patients underwent colectomy, demonstrating cumulative proportions of surgery at 1, 5, and 10years after diagnosis of 0.6%, 3.4%, and 8.2%, respectively. In addition, 23 (2.1%) UC patients were diagnosed with neoplasia, demonstrating cumulative proportions of neoplasia at 1, 5, and 10years after diagnosis of 0.5%, 1.0%, and 3.5%, respectively. Chinese UC patients had similar cumulative proportions of exposure to IBD-specific treatments but a lower surgical rate than patients in Western countries, indicating a different natural course, and close monitoring needs for UC in China. However, these results must be confirmed in population-based studies because the hospital-based cohort in our study might lead to selection bias.