Estimation Equations Research Articles

Norwegian and Swedish value sets for the EORTC QLU-C10D utility instrument.

This study aimed to develop utility weights for the European Organization for Research and Treatment of Cancer (EORTC) QLU-C10D, a cancer-specific utility instrument, tailored to the Norwegian and Swedish populations. The utility weights are intended for use in the specific welfare contexts of Norway and Sweden to support more precise healthcare decision-making in cancer treatment and care. This cross-sectional study included 1019 Norwegian and 1048 Swedish participants representative in age and gender of the two general populations. Participants completed a discrete choice experiment involving 960 choice sets, each consisting of two EORTC QLU-C10D health states described by the instrument's domains and the duration of each state. Utility weights were calculated using generalized estimation equation models, and non-monotonic levels were merged to ensure consistent valuation. In the Norwegian participants, the largest utility decrements were seen for the domain of physical functioning (decrement of -0.263 for highest level "very much"), followed by pain (decrement -0.205 for level "very much") and role functioning (-0.139). Among the cancer-specific domains, nausea had the largest utility decrement (-0.124). In the Swedish participants, the largest utility decrements were also observed for physical functioning (-0.207 for the response "very much"), followed by pain (-0.139), role functioning (-0.133), and nausea (-0.119). Emotional functioning also exhibited a sizable utility decrement (-0.115). This study provides the first set of utility weights for the EORTC QLU-C10D specific to Norway and Sweden, reflecting the unique health preferences of these populations. The generated utility decrements can inform cost-utility analyses and optimize resource allocation in cancer care within the Norwegian and Swedish healthcare systems.

Estimating the Greenhouse Gas Emission Potential Due to Construction Work on the 225 kV Segou - Bamako High Voltage BI-Ternal Electric Line in Mali in The Context of Climate Change

The aim of this study is to assess the carbon emissions resulting from the construction of the power line linking Bamako to Ségou. It focuses on direct emissions, more specifically those linked to the degradation and desctruction of the vegetation cover in the project right-of-way. To collect the data, surveys were set up on the project right-of-way, through which 3302 trees were inventoried in situ at the three sites. Circumference was measured at 1.30 m from the ground surface. Allometric equations for direct biomass estimation were used as a predictor o f tree diameter. Emission factors were then used to estimate the potential greenhouse gas emissions resulting from tree felling during power line construction. The standard error associated with the carbon fraction in dry biomass was calculated. In the Ségou, Koulikoro and Dioïla project areas, there are a number of plant species that provide local populations with various ecosystem services, including micro-climate regulation through carbon sequestration or absorption of atmospheric CO2. The implementation of the project will undoubtedly result in the felling of these trees. This felling will generate emissions of 22.11 t.eqCO2/ha in Ségou, 16.56 t.eqCO2/ha in Koulikoro and 15.43 t.eqCO2/ha in Dioïla. Across Ségou, Koulikoro and Dioïla, the trees in the project right-of-way represent a reservoir of 34.04 t/ha of above-ground woody biomass. This biomass represents a carbon stock of around 16.58 t.C/ha. This carbon stock will be transformed into a carbon source with emissions of 60.78 t.eqCO2/ha if the trees in the power line right-of-way are systematically felled. Mitigation measures are therefore urgently needed, with compensatory reforestation areas planted with species with high carbon sequestration potential.

Age estimation on post-mortem CT based on pelvic bone mineral density measurement and the state of putrefaction: a multivariate method.

Age-at-death estimation is an important issue in forensic medicine and anthropology. Initially, methods relied on morphological criteria, but with the advancement of radiology, new techniques such as morphological studies on multi-slice computed tomography (CT) reconstructions have emerged. Recent studies have shown promising results by investigating the correlation between age and bone mineral density (BMD). However, there is currently a lack of data on post-mortem CTs (PMCT) involving decomposed bodies, and limited information exists regarding changes in Hounsfield Units measurement in a post-mortem context. In light of these gaps, our study aimed to examine the relationship between age at death and pubic and ilium BMD using a sample of forensic bodies. We also aimed to determine whether post-mortem processes, such as putrefaction, could interfere with this correlation. Our retrospective analysis encompassed 637 PMCTs conducted before medicolegal autopsies at Tours University Hospital. Utilizing simple and multiple linear regressions, we investigated the correlation between age and pubic and ilium BMD, as well as the relationship between BMD and the radiologic alteration index (RAI), a scale employed to quantify the degree of putrefaction. Our findings indicate promising outcomes in age-at-death estimation using pubic and/or ilium BMD for bodies exhibiting no or moderate decomposition (RAI < 80), particularly among individuals under 40years old. However, for highly decomposed corpses (RAI ≥ 80), the presence of gas infiltration significantly influences the BMD of both the ilium and pubis. Consequently, we advocate for the incorporation of the RAI score into the age estimation equation to enhance the accuracy of our results in such cases. Further investigation involving a larger cohort of decomposed bodies could facilitate refinement and validation of our method within this specific population.

Fracture Toughness Estimate of H-Section Steel for Offshore Structure

In this study, a novel estimating equation based on the WES2808 standard was proposed to predict fracture toughness through the transition temperature of Charpy impact toughness and CTOD (Crack Tip Opening Displacement) fracture toughness. This equation was specifically developed for 460MPa class H-section steel materials used in marine structures, including the base material (BM), heat-affected zone (HAZ), and weld metal (WM). The experimental results confirmed that the proposed estimation equation accurately predicted the fracture toughness across these different material regions. These findings demonstrate the reliability and applicability of the proposed equation in estimated fracture toughness for marine structure materials, thereby contributing to improved safety and performance in harsh environmental conditions.

Alveolar Bone Reconstruction Simultaneous to Implant Removal due to Advanced Peri-Implantitis Defects: A Proof of Concept.

To evaluate the safety and effectiveness of alveolar bone reconstruction simultaneous to implant removal due to peri-implantitis. Partial or fully dentulous patients subjected to implant removal due to advanced peri-implantitis (≥ 50% of bone loss) lesions and seeking to have the failed implant replaced for esthetic or functional reasons were consecutively included. Guided bone regeneration was performed by means of a mixture of xenograft and autogenous bone and a ribose cross-linked barrier membrane. Re-entry for implant placement was performed at 4-month follow-up. Overall, six radiographic variables were assessed before (T0) and after (T1) alveolar bone reconstruction at four levels in ridge width (RW) and height (RH). Peri-implant conditions were evaluated at latest follow-up. Simple and multiple binary logistic regression models were calculated using generalized estimation equations to evaluate the effect of baseline upon reconstructive outcomes. In total, 20 patients (nimplant = 39) met the inclusion criteria. Alveolar RW and RH were augmented from T0 to T1 at all levels. All implants achieved primary stability. Only ~13% were subjected to ancillary bone regeneration simultaneous to implant placement. After a mean follow-up period after loading of ~2.2 years, ~70% implants demonstrated peri-implant health, while mucositis was diagnosed in the remaining implants. The performance of alveolar bone reconstruction in residual partially contained defects simultaneous to implant removal due to peri-implantitis lesions demonstrates being safe and effective for implant site development.

Examining the link between age of alcohol initiation, adolescent alcohol use and adult substance use

Abstract Background Understanding the relationship between adolescent alcohol use and adult substance use is important for prevention programmes. Existing evidence presents divergent findings and potential mechanisms are debated. Methods We estimated associations between the age of alcohol initiation and alcohol use at age 17 and substance use at age 20 in a nationally representative cohort (n = 4554). Weighted logistic regression models were fitted using Generalised Estimating Equations in multiply imputed and complete case data. Results Our analysis identified that 27% of participants reported first alcohol use at ≤ 14 years old, with 37% engaging in risky alcohol use by age 17. At age 20, 14% reported hazardous alcohol use, while 38% used tobacco, 24% cannabis, and 28% other drugs. The age at which alcohol was initiated and risky alcohol use at 17 years old were both strongly associated with alcohol, tobacco, cannabis and other illicit drug use at 20 years old. Sequential change in effect estimates coupled with non-overlapping confidence intervals suggest a dose-response relationship between age of alcohol initiation and tobacco and other drug use at age 20. Conclusions First use of alcohol at 14 or younger was common. Earlier alcohol initiation and risky alcohol use are each associated with substantially elevated risk for substance use at 20 years old even after accounting for common liability factors. Acknowledgement: Growing Up in Ireland (GUI) is funded by the Department of Children, Equality, Disability, Integration and Youth (DCEDIY). It is managed by DCEDIY in association with the Central Statistics Office (CSO). Results in this report are based on analyses of data from Research Microdata Files provided by the CSO. Neither the CSO nor DCEDIY take any responsibility for the views expressed or the outputs generated from these analyses. Key messages • Delaying alcohol initiation and preventing risky alcohol use during adolescence may reduce levels of substance use in young adults. • Self-reported early use of alcohol remains common.

High physical activity relates to higher risk of incident carotid plaque components

Abstract Background The rupture of carotid atherosclerotic plaque, primarily driven by plaque components, is among the leading causes of ischemic stroke. Although physical activity (PA) stands as a major modifiable target for prevention of atherosclerotic diseases, recent studies suggested a potential adverse impact of high-volume PA on atherosclerotic plaque burden in athletes. Data remains scarce from the community-dwelling population regarding to the impact of PA on the longitudinal change of carotid plaque components. Objectives To assess the association between PA and the incidence of carotid plaque components and explore whether the association of PA with stroke and all-cause mortality differs by the presence of plaque components. Methods Between 2007 and 2012, in a community- dwelling cohort in Netherlands, 1327 stroke-free persons (mean ± standard deviation age 72 ± 9 years, 45% women) with carotid atherosclerosis (carotid intima-media thickness &amp;gt; 2.5 mm) were invited for magnetic resonance imaging (MRI) to assess carotid plaque components. From these, 696 persons (1267 carotid arteries) underwent a follow-up MRI between 2014 and 2017 (median between-scan interval 6 years). Carotid plaque components included calcification, intraplaque hemorrhage (IPH), and lipid-rich necrotic core (LRNC). The volume of moderate, vigorous and total PA (unit: metabolic equivalent task hour, MET-h) was assessed using LASA Physical Activity Questionnaires around the time of the first MRI scan. Participants were followed for the occurrence of stroke or all-cause mortality until December 31, 2019. Generalized estimation equation and Cox regression models were used in the analyses, with adjustments for plaque size and other cardiovascular risk factors. Results Compared to lowest quintile PA group, participants in the highest quintile total PA group had a higher risk of new onset of plaque components, odds ratio (95%CI) 2.69 (1.21; 5.94) for calcification, 1.35 (0.82; 2.24) for LRNC and 1.93 (1.12; 3.34) for IPH (Figure 1). Similar associations were observed for vigorous PA but not for moderate PA. Over a median follow-up of 9.5 years, 118 persons suffered a stroke and 298 died. As shown in table 1, baseline IPH, rather than LRNC or calcification, modulated the associations of PA with stroke and all-cause mortality (P-interaction &amp;lt;0.05): higher total PA was associated with a lower risk of stroke among IPH-free persons, with the hazard ratio (95% CI) of 0.929 (0.867; 0.996) per 10 MET-h/week increase; no associations between PA and stroke were found among those with IPH. Similar associations were found between vigorous PA and all-cause mortality. Conclusions Among the middle-aged and elderly with subclinical atherosclerosis, high level PA, especially high vigorous PA, may lead to an unstable carotid plaque. The beneficial effect of PA on stroke and all-cause mortality is only among persons with a stable carotid plaque profile, especially without IPH.

Association of park renovation with park use in New York City

Abstract Background Equity-driven citywide park redesign and renovation, such as the Community Parks Initiative (CPI), has the potential to increase park use and opportunities for physical activity in underserved communities. The objective of this study was to evaluate changes in patterns of park use following park redesign and renovation in low-income New York City (NYC) neighborhoods. Methods The Physical Activity and Redesigned Community Spaces study was a prospective quality improvement pre-post intervention study design with 33 intervention and 21 matched control neighborhood parks. Data were collected at baseline (prerenovation) and 2 follow-up points (3 months and 1-year post renovation) between 2016 to 2022 summers. Main outcomes encompassed park use and physical activity levels assessed using the well-validated System for Observing Play and Recreation in Communities. Park use was quantified by total number of park users, categorized by age group (≤20 years vs ≥ 21 years), sex, and physical activity level (sitting or standing vs walking or vigorous activity). Changes in outcomes between groups were compared via the generalized estimation equation. Results A total of 28,322 park users were observed across 1,458 scans. At baseline, 59.7% were 20 years or younger, 46.3% were female, and 43.8% were sitting or standing. Intervention parks showed more net park users compared with control parks from baseline to the final follow-up (difference-in-difference relative rate ratio, 1.69 [95% CI, 1.22-2.35] users/scan). The association was driven by a significant increase in adult users at intervention parks and an overall decrease in all users at control parks. Conclusions In this quality improvement study, park redesign and renovation were positively associated with park use in low-income neighborhoods. However, park renovations may need to be accompanied by other programmatic strategies to increase physical activity.

Examining factors associated with cocaine use in late adolescence and early adulthood

Abstract Background In 2022, cocaine was the leading problem drug for which individuals sought treatment in Ireland, overtaking opioids for the first time. Despite increasing concerns about cocaine, there is limited longitudinal research examining factors associated with cocaine use in the general youth population. We describe levels of use and associated factors at 17 and 20 years old Methods Past-year cocaine use was studied at age 17 (N = 5965) and 20 (N = 4679) in a nationally representative cohort. Individual, family, social and environmental exposure variables were selected a priori. Weighted logistic regression models were fitted using Generalised Estimating Equations to multiply imputed and complete case data. Results Cocaine use was reported by 220 (4%) at age 17, and 1072 (23%) at age 20. Both individual and community factors predict use. Earlier alcohol initiation and having friends who use cannabis were strongly associated with increased odds of cocaine use at both ages. Those with parents who reported that neighbourhood intoxication or drug-taking was common had elevated odds of cocaine use at age 17. Conclusions Past-year cocaine use at 20 years old in this cohort is substantially higher than other international cohort studies. Levels of cocaine use increase significantly between 17 and 20 years old. Acknowledgement: Growing Up in Ireland (GUI) is funded by the Department of Children, Equality, Disability, Integration and Youth (DCEDIY). It is managed by DCEDIY in association with the Central Statistics Office (CSO). Results in this report are based on analyses of data from Research Microdata Files provided by the CSO. Neither the CSO nor DCEDIY take any responsibility for the views expressed or the outputs generated from these analyses. Key messages • Our study underscores significant cocaine use rates and correlations with early substance initiation and neighbourhood factors. • This emphasizes the necessity of a comprehensive, multilevel strategy for preventing cocaine use.

The evolution of carotid atherosclerotic plaque composition: a prospective study

Abstract Background The rupture of carotid atherosclerotic plaque is one of the major causes of ischemic stroke, and largely determined by the composition of the plaque. To date, most studies on carotid plaque composition focused on individual plaque components, whilst the interplay between different components within the same plaque may be a critical driving force for plaque evolution and rupture. Objectives To determine the interplay between carotid plaque components over time and describe the dynamics of plaque composition with a specific focus on age- and sex-specific changes in a population-based setting. Methods From a population-based cohort in Netherlands, 802 participants (mean age ± SD 68 ± 8 years, 43% women) with subclinical carotid atherosclerosis underwent repeat magnetic resonance imaging (MRI) of carotid plaque (first scan between 2007 and 2012, second scan between 2014 to 2017). We evaluated carotid plaque composition, including calcification, lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH). To assess the relationship between the incidence of one specific component and baseline plaque composition, plaques with this specific component present at the baseline were excluded. Generalized estimation equation models were used with adjustments for baseline plaque size and cardiovascular risk factors. We demonstrated the evolution of plaque composition along age and by sex. Results Baseline presence of calcification in carotid plaque is independently associated with a higher incidence of IPH (adjusted odds ratio: 2.25; 95% confidence interval: 1.40 to 3.63). No associations were found between baseline plaque composition and the new onset of calcification or LRNC. The proportion of complex plaques with multiple components significantly increased at follow-up (Figure 1a). The plaque composition dramatically evolved over time and the proportion of plaques with two or more components started with 10% around 55 years and increased to over 50% after 70 years of age (Figure 1b). Although the age distribution was comparable between men and women, men were more likely to have and develop plaques with multiple vulnerable plaque components such as IPH (Figure 2). Conclusions A higher incidence of IPH was found in plaques with baseline calcification. The pre-existing plaque composition strongly determines how the plaque will evolve over time. Given the interplay between individual components, the overall plaque composition exhibits significant age- and sex- specific characteristics.

Discrete Choice Experiment on Financial Incentives for Engaging Young Adults in Vaping Cessation Programs

Introduction Contingency management involves rewarding individuals based on objective evidence of behavioral changes. This study explores preferences for financial incentives in vaping cessation programs. Methods A discrete choice experiment (DCE) was conducted among young adult current e-cigarette users aged 19-29. DCE attributes (and levels) included reward amount ($100, $300), reward schedule (consistent value, escalating value), reward procedure (gain-framed, loss-framed), vaping education modules (yes, no), text messaging support (yes, no), and cost ($30, $100). Participants were randomized into one of the four blocks, each containing four choice sets. Each choice set presented two hypothetical vaping cessation programs. Choice data (n × choice sets × alternative programs = 154 × 4 × 2 = 1,232 observations) were analyzed using generalized estimation equation models. Results Participants showed a preference for vaping cessation programs offering a higher reward amount (odds ratio [OR] = 11.5; 95% CI,7.0-19.2), gain-framed rewards for sustained abstinence (OR = 1.4; 95% CI,1.0-1.8), text messaging support (OR = 1.9; 95% CI,1.4-2.5), and a lower program cost (OR = 2.6; 95% CI,1.8-3.8). Interaction tests showed significant effects of the rewards procedure among daily e-cigarette users (adjusted OR [AOR] = 2.1; 95% CI,1.3-3.5), but not some-day users; and among those with no quit attempts in the past six months (AOR = 2.7; 95% CI,1.5-4.7), but not those with previous quit attempts. Female participants preferred text messaging support (AOR = 3.6; 95% CI,2.3-5.4), whereas male participants did not show this preference. Conclusion A multifaceted vaping cessation intervention augmented with financial incentives might improve participation and engagement among young adults. Future studies should investigate how these attributes can enhance program reach and vaping abstinence outcomes in real-world settings.

Influences of tea consumption on self-rated health and life satisfaction among older adults: Evidence from the CLHLS.

The benefits of tea consumption as a special diet for health and life satisfaction have attracted considerable attention; however, it is not clear whether the effect of tea consumption on self-rated health (SRH) and self-rated life satisfaction (SRL) is equal among all types of tea, and it is unclear whether these associations are impacted by gender and age in older adults. This study aimed to examine the associations between tea consumption, SRH and SRL in older adults and to explore the role of gender and age. Participants aged 65-105 (N = 78,345) were interviewed in the years 2002, 2005, 2008, 2011, 2014 and 2018 in the Chinese Longitudinal Healthy Longevity Study (CLHLS). Generalized estimation equations (GEE) with the identity link function were adopted to estimate the cross-sectional associations of tea consumption with SRH and SRL. GEE with the logic link function were used to explore the longitudinal associations of tea consumption with SRH decline and SRL decline. Drinking tea at present, especially scented tea, was significantly associated with better SRH and SRL for older adults. Male participants benefited more from tea consumption than females, and the protective effect of green tea consumption on improving SRH and SRL in males was evident. Older adults aged 90-105 with current tea consumption daily had better SRH and reduced risk of SRL decline.

Investigating the peri-saphenous vein graft fat attenuation index on computed tomography angiography: relationship with progression of venous coronary artery bypass graft disease and temporal trends

BackgroundTo clarify the fat attenuation index (FAI) change trend of peri-saphenous vein graft (SVG) and determine the association between FAI and graft disease progression based on CCTA images.MethodsPatients with venous coronary artery bypass grafts (CABGs) were consecutively enrolled in this retrospective study. In study 1, 72 patients who had undergone 1, 3, and 5 years of CCTA examinations without graft occlusion were recruited, and generalized estimation equation was used to analyze the peri-SVG FAI change trend over time. In study 2, 42 patients with graft disease progression and 84 patients as controls were propensity score-matched. Generalized linear mixed model and continuous net reclassification improvement (NRI) were used for assessing the associations with graft disease progression. Multivariable Cox regression analysis was used for assessing risk factors predicting cardiac events.ResultsIn study 1, both the FAI of proximal right coronary artery and SVG decreased over time. In study 2, the 1-year CTA-derived FAI of grafts and graft anastomosis were independent indicators of graft disease progression at the 3-year CCTA follow-up (graft: odds ratio [OR] = 1.106; 95% confidence interval [CI] = 1.030–1.188, P = 0.006; graft anastomosis: OR = 1.170, 95% CI = 1.091–1.254, P < 0.001). Inclusion of the graft anastomosis FAI significantly improved reclassification compared with graft FAI (continuous NRI = 0.638, 95% CI: 0.345–0.931, P < 0.001). Moreover, The graft anastomosis FAI was found to be a risk factor for cardiac events after CABG and no statistically significant difference was found in the graft FAI (graft anastomosis: HR = 1.158, 95% CI = 1.034–1.297, P = 0.011; graft: HR = 1.116, 95% CI = 0.995–1.251, P = 0.061).ConclusionsA synchronism was found in the FAI change trend between native coronary artery and venous graft, which both decreased over time. The CCTA-derived FAI of venous grafts showed the potential of demonstrating SVG disease progression and graft anastomosis served as the optimal measured location.

Catchment response to climatic variability: implications for root zone storage and streamflow predictions

Abstract. This paper investigates the influence of multi-decadal climatic variability on the temporal evolution of root zone storage capacities (Sr,max) and its implications for streamflow predictions in the Meuse basin. Through a comprehensive analysis of 286 catchments across Europe and the US that are hydro-climatically comparable to the Meuse basin, we construct inter-decadal distributions of past deviations in evaporative ratios (IE) from expected values based on catchment aridity (IA). These distributions of ΔIE were then used to estimate inter-decadal changes in Sr,max and to quantify the associated consequences for streamflow predictions in the Meuse basin. Our findings reveal that, while catchments do not strictly adhere to their specific parametric Budyko curves over time, the deviations in IE are generally very minor, with an average ΔIE=0.01 and an interquartile range (IQR) of −0.01 to 0.03. Consequently, these minor deviations lead to limited inter-decadal changes in Sr,max, mostly ranging between −10 and +21 mm (−5 % to +10 %). When these changes (ΔSr,max) are accounted for in hydrological models, the impact on streamflow predictions in the Meuse basin is found to be marginal, with the most significant shifts in monthly evaporation and streamflow not exceeding 4 % and 12 %, respectively. Our study underscores the utility of parametric Budyko-style equations for first-order estimates of future Sr,max in hydrological models, even in the face of climate change and variability. This research contributes to a more nuanced understanding of hydrological responses to changing climatic conditions and offers valuable insights for future climate impact studies in hydrology.

EFEITOS DE UM PROGRAMA DE INTERVENÇÃO DE CURTA DURAÇÃO NAS HABILIDADES MOTORAS FUNDAMENTAIS DE CRIANÇAS DO PRIMEIRO ANO ESCOLAR

This study aims to evaluate the effects of an interventional program in the fundamental motor skills of children studding at the first year of Elementary School in São Leopoldo city, Rio Grande do Sul State. The study sample was composed by 40 children that were included in the study criteria, from these 21 were male with ages between six and seven years old. The procedures realized consisted on a “pre-test” followed by an Interventional Program with a “post-test”. The fundamental motor skills performances of the “pre-test” and the “post-test” were evaluated by the Test of Gross Motor Development (TGMD-3). To analyze the effect of the motor interventional program in the fundamental motor abilities related with gender, generalized estimation equations were tested. The differences found were evaluated by the Bonferroni multiple comparison test, using Level of significance a&lt;0,05. The results demonstrated significant difference in the medias of “pre-test” and “post-test” to all abilities tested by TGMD-3, except in the “running” during locomotion, where since the beginning of the tests children showed positive performance. There was no significant difference in the comparison of gender and motor abilities.

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.

Effect of shared decision-making model on the management of diabetes high-risk groups.

A shared decision-making (SDM) model-based intervention programme was implemented for a population at high risk for diabetes to explore its effectiveness in intervening with blood glucose levels in this population. One hundred residents were selected according to the principle of voluntary participation and divided into the intervention group (n = 50) and the control group (n = 50) by using multistage cluster sampling. The control group received only brief diabetes knowledge education through a disease brochure issued by the hospital; the intervention group implemented a SDM model based on large classroom and individualised education for 4 months. Univariate analysis and generalised estimating equation fitting model were used to analyse the effect of intervention on blood glucose parameters in the study subjects. Univariate analysis showed that after 4 months of intervention, fasting blood glucose was lower in the intervention group than in the control group (5.57 ± 0.56 vs. 6.07 ± 0.77, F = 45.721, p < 0.001); glycosylated hemoglobin was lower in the intervention group than in the control group (5.91 ± 0.28 vs. 6.02 ± 0.24, F = 25.998, p < 0.001), decreased by 0.26% in the intervention group and increased by 0.01% in the control group. One-way analysis of variance (ANOVA) showed that fasting blood glucose and glycosylated hemoglobin in the intervention group decreased to different extents from baseline. The generalised estimation equation was fitted with the intervention programme, gender, hypertension, smoking, alcohol consumption, physical activity, age, waist circumference, body mass index, baseline fasting blood glucose, and baseline glycosylated hemoglobin as independent variables, and fasting blood glucose and baseline glycosylated hemoglobin as dependent variables. Results showed that compared with the control group, fasting blood glucose and glycosylated hemoglobin levels were significantly different between the two groups (p < 0.001). Applying an intervention programme based on SDM model to people at high risk of diabetes can improve patients' adherence to self-management and establish a good lifestyle, thus contributing to their good glycemic control.

Comparison of low-density lipoprotein cholesterol (LDL-c) estimates by in-lab and point-of-care devices in the context of emerging LDL-c equations

Abstract Low-density lipoprotein cholesterol (LDL-c) and lipid measurements are used for hyperlipidemia diagnosis, cardiovascular disease risk classification, and medication management. Millions of lipid panels are performed annually. Given the widespread need for lipid testing, there are two CLIA-waived point-of-care (POC) lipid testing devices. These devices were FDA-approved using the Friedewald equation to estimate LDL-c based on measurements of (triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), and total cholesterol (TC). By contrast, for laboratory-based LDL-c estimation, the Friedewald equation is being replaced by newer, more accurate equations such as the NIH-Sampson equation. These equations use the same lipid panel results to estimate LDL-c and only differ in the arithmetic of the estimation. This study evaluates how differences between the in-clinic POC machines and in-laboratory lipid measurements affect the estimated LDL-c results and are compounded by differences in the equations used for LDL-c estimation. This retrospective observational study collected deidentified lipid results (TG, HDL-c, TC, LDL-c) and demographic data (age, gender) for all samples that had lipid panel results from in-lab and POC within twenty-four hours of each other in a single hospital system between 2014 and 2023. Three hundred twenty samples were identified; samples with non-numerical values or results outside of the reportable range for TG, HDL-c, or TC were not included in subsequent LDL-c calculations using the Friedewald and NIH-Sampson equations (69 results). Patients under the age of 18 were excluded (2 results). Two hundred and forty-nine samples met inclusion criteria; this cohort showed non-significant differences in lipid, age, and gender distributions relative to all POC results tested in the same time frame. Consistent with prior reports, we observed discordance between POC and the in-lab lipid measurements, particularly for TG (Bland-Altman: bias:-23.04 mg/dL, standard deviation:61.3 mg/dL). These analytical differences may not change clinical management if the cardiovascular risk classification using estimated LDL-c is unchanged. However, the risk classification based on the in-lab versus in-clinic testing differed for 20% of patients. The most pronounced difference in LDL-c estimation occurred when the POC machine used Friedewald and in-lab testing used NIH-Sampson, and resulted in 5% more patients differentially classified. Regardless of testing platform, more patients are categorized as higher risk on an individual and population-based level with the NIH-Sampson equation. This study highlights the need for transparency in lipid panel reports regarding which LDL-c equation is used in both POC and in-lab testing formats, and the need for readily available tools for conversion between different LDL-c estimation equations.

Stature estimation equations from fragmentary long bones based on a modern Eastern Mediterranean assemblage.

Stature estimation is central in forensic anthropology and very important in bioarchaeology. For this reason, several different methods have been proposed, employing different skeletal elements and statistical approaches. A major issue with skeletonized individuals is that their bones are often found fragmented, a taphonomic parameter that limits the application of many available methods. As a result, attempts have been made to create equations to predict either directly stature or long bone length (which can then be used with current stature prediction equations) from bone fragments. The current paper is a contribution in this direction. The femur, tibia and humerus of 76 individuals from a modern Greek skeletal collection were divided into different segments using a landmark approach. Subsequently, univariate and multivariate equations were created to predict both maximum long bone length and stature from the "bone fragments". The models varied in performance depending on the specific bone fragment used, the number of variables simultaneously employed for prediction and the sex of the individuals. Although the models used to directly predict stature from bone fragment dimensions should be treated cautiously because the stature of the assemblage from the Athens Collection had itself been anatomically estimated, the results are valuable towards highlighting the complex association between bone dimensions, long bone length and living/estimated stature.

Predictors of moderate-to-severe side-effects following COVID-19 mRNA booster vaccination: a prospective cohort study among primary health care providers in Belgium

BackgroundCOVID-19 vaccine effectiveness declines months after vaccination. Therefore, it is likely that during the next few years, people may be repeatedly offered a booster vaccine to enhance humoral immunity levels. A growing number of people are questioning whether the benefits of a booster vaccine outweigh the side-effects.ObjectiveThis study aims (1) to identify the most frequently reported side-effects after different doses of COVID-19 mRNA vaccines, (2) and the longest lasting symptoms; and (3) to predict the likelihood of having moderate-to-severe side-effects after a booster COVID-19 mRNA vaccine given individual- and vaccine-specific characteristics.Design, setting, and participantsSecondary analysis of a prospective cohort study in primary health care providers (PHCPs) in Belgium conducted between December 2020 and December 2021, and in February-March 2023.MethodsIn nine subsequent surveys over a period of 2 years vaccine dose-number and side-effects after COVID-19 vaccines were collected. A Generalized Estimation Equations approach on the data of the first and second booster dose was used to investigate the probability of having moderate-to-severe side-effects after mRNA booster vaccination. Predictive performance of a binary classifier was assessed by looking at discrimination (i.e., quantified in terms of the area under the receiver operating characteristic curve). The final prediction model was validated using data with regard to the third booster by assessing misclassification rate, sensitivity and specificity.ResultsIn total, 11% of the PHCPs had moderate-to-severe side-effects after their booster COVID-19 mRNA vaccine. The most common side-effects of COVID-19 mRNA doses included fatigue, local pain at the injection site, general pains, and headache. These side-effects typically lasted for a median of 1 to 2 days. The final model included five predictors: sex, alcohol consumption, history of moderate-to-severe side-effects after any previous dose, recent COVID-19 infection, and the booster dose-number (first, second). Having experienced moderate-to-severe side-effects after any previous dose was the strongest predictor of moderate-to-severe side-effects following an mRNA vaccine booster, with an odds ratio (OR) of 3.64 (95% CI: 2.80–4.75). The OR for female sex was 1.49 (95% CI: 1.21–1.84) implying that females have a higher odds of moderate-to-severe side-effects following booster vaccination. The differences in effect for booster dose-number, alcohol consumption and recent COVID-19 infection was not significant.Conclusion and relevanceCOVID-19 mRNA booster vaccination implies a low prevalence of moderate-to-severe side-effects among PHCPs, with a short median duration of symptoms if any. The strongest predictors are a history of moderate-to-severe side-effects after any previous dose and being female. These reassuring findings can help addressing concerns about booster vaccination and encourage their uptake.Trial RegistrationNCT04779424 (registration date: 2021-02-22).