Steep Increase Research Articles

Approach to Design Sustainable Alkali-Activated Slag Recycled Aggregate Concrete: Mechanical and Microstructural Characterization

There is a steep increase in demand for concrete as the need for infrastructure is increasing with a rapid increase in urbanization. Consequently, there has been a surging demand for cement across the globe. By using alkaline concrete activated with ground granulated blast furnace slag (GGBS), cement usage can be eliminated in concrete, which addresses the issue of CO2 emissions concerned with the cement manufacturing process and promotes the use of industrial by-products as sustainable building materials. The current study focuses on proposing a methodology to design sustainable GGBS-based alkali-activated concrete incorporated with 100% coarse recycled coarse aggregates (RCA) recovered from construction and demolition (C&D), for various strengths by optimizing the mix proportions and verifying the same through experiments. From the current study, it is evident that this mix design procedure can be adopted to design alkali-activated slag recycled aggregate concrete (AASRAC) mixes for strengths ranging from 44MPa to 85MPa. The optimum values of alkalinity factor (λ) and NaOH concentration (M) i.e., 1.5 and 12, have a significant role in the development of high strengths which is attributed to the formation of hydrotalcite. Micrographs captured using scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy (EDS) studies reveal that the alkaline binders promote the development of a denser and stronger interfacial transition zone (ITZ) that enhances the strength of lower AA/B concretes at the microstructural level as Ca/Si ratio is higher for lower AA/B concretes. Global warming potential (GWP) analysis reveals that the alkali-activated concretes have significantly lower GWP compared to conventional OPC-based concrete by approximately 2.5 times. The mix-design chart proposed in this study may pave the way to designing structural grade AASRAC with enhanced performance for the desired strength, which may find its application in fast-track construction and manufacturing of prefabricated elements.

Experimental Investigation on Wave Dissipation of Perforated Pipe Breakwater Under Regular Wave Conditions

The permeable breakwater is an innovative, eco-friendly coastal protection structure that reduces wave impact while minimizing “dead water” and environmental harm. This study introduces a perforated pipe breakwater design with an increasing pipe diameter from top to bottom, evaluated through physical model tests using transmission coefficient Kt and reflection coefficient Kr serving as the primary parameters. The results indicate that Kt decreases as the relative width (B/L), wave steepness (H/L), and relative water depth (h/L) increase, but rises with a steeper breakwater slope. When B/L exceeds 0.3, H/L surpasses 0.06, or the h/L ratio is greater than 0.3, Kt gradually declines until reaching a stable state, resulting in a more pronounced wave reduction. As B/L and H/L increase, the coefficient Kr initially drops, then rises. The slope ratio of 1:1.5 demonstrates the most effective wave energy dissipation, with primary dissipation occurring on the front slope. The mixed pipe diameter design shows superior wave absorption over a uniform diameter. Compared to a porous horizontal plate, the perforated pipe breakwater exhibits better wave absorption. These findings offer valuable guidance for designing eco-friendly coastal protection projects.

Self-poisoning in young Australians: The impact of COVID-19 and recent trends following easing of restrictions

Introduction: Self-poisoning is the most common form of hospitalised self-harm in young people and has been increasing over the last decade. The COVID-19 pandemic was associated with further increases in self-harm in adolescents. There are limited data on changes after pandemic restrictions ended. This study aimed to describe recent trends in self-poisoning in young people. Setting: Australia 2018–2023. Methods: A retrospective analysis of self-poisoning calls to Australia’s poisons information centres. Intentional poisoning exposures in people aged 5–19 years were included in the main analysis. We also examined intentional poisonings in people aged 20 and over for comparison. We used interrupted time-series analysis to estimate the impact of COVID-19 (March 2020) and ‘re-opening’ (December 2021), when many restrictions were lifted in Australia. We compared effects in the jurisdictions with most disruptions and lockdowns with other jurisdictions. Results: There were 201,755 self-poisonings documented, 64% female, with 19,946 children (aged 5–14, 9.9%) and 44,388 adolescents (aged 15–19, 22.0%). There was a steep increase in the rate of poisoning in female children and adolescents – with the annual increase being 1.361 (95% confidence interval = [1.074, 1.735]) and 1.154 (95% confidence interval = [1.049, 1.283]) times faster than pre-pandemic trends in these two groups between March 2020 and December 2021. Following relaxation of restrictions, there was a sudden drop and then slow decline in self-poisonings (despite rising COVID-19 infection rates). There was an overall 29.6% increase in intentional poisonings in young people over the study period. This is markedly more pronounced among young females (37.0%) vs males (11.2%). There were substantial jurisdictional variations, with larger increases in Victoria, Tasmania and the Australian Capital Territory. Conclusion: There has been a marked increase in child and adolescent female self-poisonings over the last 6 years, with increases strongly associated with COVID-19 pandemic restrictions but persisting after their removal.

Distortion-Corrected Posterior Ocular Shape in Myopic Eyes Assessed by Ultrawide OCT Detects Deformations Associated With Vision-Threatening Changes.

To develop a quantitative tool for assessing the posterior ocular shape using widefield, volumetric optical coherence tomography (OCT) in eyes with myopia. This observational, cross-sectional study included 178 eyes from 113 participants. Participants underwent a standardized eye examination, including ocular biometry and a custom ultrawide OCT. True ocular shape was reconstructed by tracing the beam propagation from the system to the posterior eye. Gaussian curvature quantified the localized ocular shape, which was further categorized into five distinct categories. An ocular shape irregularity (OSI) was calculated using principal component analysis. Linear regression with breakpoints analyzed the relationship between ocular shape parameters and axial length (AL). Increased curvature mean and variance were associated with more severe myopia (P < 0.001). Curvature categories (convex, normal, concave, and highly concave) differed significantly between the groups (all P < 0.001). Their correlations with AL revealed significant breakpoints between 27.1 and 27.2 mm. OSI, as a single metric for quantifying ocular shape distortion, was associated with more severe myopia (P < 0.001), and its correlation with AL revealed a breakpoint at 27.2 mm with a fourfold increase in slope steepness beyond this pivot. Determination of OSI was highly reproducible and could also be obtained with fewer scans. Eyes exceeding 27.2 mm in length exhibit pronounced shape changes. Our framework can be seamlessly integrated into commercial OCTs for ocular shape deformation detection, which could aid in identifying eyes with pathologic myopia.

Abstract 4120332: RISING TRENDS IN ISCHEMIC HEART DISEASE RELATED MORTALITY AMONG OLDER ADULTS WITH SLEEP APNEA IN THE UNITED STATES FROM 1999 TO 2021

Introduction: Sleep apnea (SA) is often underrecognized and undertreated despite its high prevalence in the adult population and its association with adverse cardiovascular outcomes. There are limited estimates of national trends on cardiovascular mortality in older patients with sleep apnea. We aimed to assess the sex and race-related trends of ischemic heart disease (IHD) mortality in the older adults with SA using a large population-based database. Methods: We utilized the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) database which provides information from death certificates of all US residents according to the International Classification of Diseases, Tenth Revision (ICD-10). The demographic and mortality data were obtained for the United States population &gt;65 years from 1999 to 2021. Ischemic heart disease (ICD-10 codes I20-I25) was listed as the underlying cause of death, and SA (G47.3) as a contributing cause of death. Age adjusted mortality rates (AAMRs) per 1,000,000 population were calculated by standardizing deaths to the year 2000 US population. We used Jointpoint Regression Program to analyze temporal trends in mortality from 2000 to 2021. Average annual percentage change (AAPC) with 95% CI were calculated to examine trends in AAMR over time. Results: Overall, AAMR of IHD mortality for patients with SA increased from 7.9 per 1,000,000 (95% CI, 6.9-8.8) in 1999 to 53.4 per 1,000,000 (95% CI, 51.4-55.4) in 2021 with an AAPC of 9.1% per year (95% CI, 8.8-9.5). Men had consistently higher AAMR than women throughout the study period (overall AAMR men: 45.51 (95% CI, 44.8-46.2); women: 12.5 (95% CI, 12.2-12.8). Both the groups had a similar increasing trend in AAMR, with men having a steeper increase. [AAPC men: 9.3% (95% CI, 8.5-10.8) versus AAPC women: 8.6%, 95% CI, 8.1-9.7]. Non Hispanic (NH) White population had the greatest AAMR throughout the study period, followed by NH Black and Hispanic or Latino. The NH White population had the largest increase in AAMR from 1999 to 2021 (AAPC 9.4%, 95% CI:8.9-10.1). Conclusion: In the United States, there has been a general increase in IHD mortality related to sleep apnea over the last two decades. This rising trend as noted in our analysis is concerning and underscores the need for more robust cardiovascular surveillance in these patients.

The Mediator complex subunit MoMed15 plays an important role in conferring sensitivity to isoprothiolane by modulating xenobiotic metabolism in M. oryzae.

Rice blast caused by Magnaporthe oryzae is one of the most economically important rice diseases. Fungicides such as isoprothiolane (IPT) have been used extensively for rice blast control, but resistance to IPT in M. oryzae is an emerging threat. In this study, molecular mechanisms of resistance in IPT-resistant mutants were identified. Through whole-genome sequencing and genetic transformation, we identified the gene MoMed15, encoding a transcriptional glutamine-rich co-activator Mediator complex subunit, in which mutations or deletion resulted in moderate IPT resistance. Further research found that MoMed15 physically interacted with the IPT resistance regulatory factor MoIRR to simultaneously regulate both MoIRR expression and the expression of multiple xenobiotic-metabolizing enzymes in response to IPT stress. We hypothesize that some xenobiotic-metabolizing enzymes enhance IPT toxicity by modifying the IPT structure. Variation of MoMed15 affected the recruitment of the transcriptional Mediator complex and decreased the expression of these xenobiotic-metabolizing enzymes, resulting in moderate IPT resistance. We also found that MoPGR1, encoding a protein that activates cytochrome P450 enzymes, was essential to confer IPT sensitivity, and its expression was directly regulated by MoIRR.IMPORTANCEIsoprothiolane (IPT) has been used extensively for the management of rice blast disease and IPT-resistant subpopulations have emerged in Chinese rice fields. The emergence of resistant pathogen populations has led to a steep increase in fungicide use, increasing pesticide risk for the applicator and the environment. The molecular mechanisms of IPT resistance in M. oryzae remain elusive. In this study, we demonstrated that transcriptional co-activator MoMed15 interacts with IPT resistance regulator MoIRR to recruit the Mediator complex, which promotes the expression of xenobiotic-metabolizing enzymes, leading to exacerbated IPT toxicity. The MoMed15 could be used for IPT resistance detection in rice fields.

Abstract 4125533: Demographic Trends and Disparities in Mortality Related to Coexisting Heart Failure and Diabetes Mellitus Among Older Adults in the United States: A Large Database Analysis from 1999 to 2020

Background: In the United States, over 38 million people have diabetes mellitus (DM) and more than 6 million have heart failure (HF). DM and HF often coexist, and each condition independently increases the likelihood of developing the other. Approximately 40% of individuals with HF also have DM, and this prevalence is even higher among older adults and hospitalized patients. While there has been concern regarding the increasing burden of disease for both conditions individually over the last decade, a comprehensive examination of mortality trends associated with their coexistence has not been thoroughly explored. Methods: This study analyzed death certificates from the CDC WONDER database, specifically focusing on mortality caused by the simultaneous presence of HF and DM among individuals aged 75 years and older. The data covers the period from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, and race/ethnicity. Results: Between 1999 and 2020, a total of 663,016 deaths were reported in patients with coexisting HF and DM. Overall, AAMR increased from 154.1 to 186.1 per 100,000 population between 1999 and 2020, with an initial increase from 1999 to 2005 (APC: 0.80; 95% CI: -0.17 to 2.94), a significant decline from 2005 to 2011 (APC: -2.82; 95% confidence interval (CI): -5.47 to – 1.71), a subsequent increase from 2011 to 2018 (APC: 0.61; 95% CI: -0.59 to 2.18), and finally a steep increase from 2018 to 2020 (APC: 11.30; 95% CI: 6.98 to 14.11). Gender-based analysis revealed that older men had consistently higher AAMRs than older women (Men: 185; 95% CI: 184.3 to 185.6; vs Women: 135.4; 95% CI: 135 to 135.8). Furthermore, we found that AAMRs were the highest among non-Hispanic American Indian or Alaska natives (214.4; 95% CI: 207.5 to 221.4) followed by non-Hispanic African Americans (179.9; 95% CI: 178.5 to 181.4), Hispanics (159.5; 95% CI: 158 to 161.1), non-Hispanic White (152.9; 95% CI: 152.5 to 153.3), and non-Hispanic Asian or Pacific Islander populations (104.1; 95% CI 102.4 to 105.8) (Figure 1). Conclusion: The mortality rate due to coexisting HF and DM has increased in the elderly population over the past decade. Males and non-Hispanic American Indians or Alaskan Natives had the highest AAMRs in our study.

Abstract 4134744: Trends and Disparities in Mortality Among Patients with Hypertensive Heart Disease and Congestive Heart Failure in the United States from 1999 to 2020

Background: Hypertensive heart disease (HHD) poses a growing public health concern. Global data reveal a concerning rise in HHD prevalence, deaths, and disability-adjusted life years (DALYs) between 1990 and 2019. The Framingham Study highlights that hypertension is linked to approximately one-quarter of heart failure cases. This association is even stronger among older adults, in whom hypertension is responsible for up to 68% of heart failure cases. Methods: This study analyzed death certificates within the CDC WONDER database for patients in the United States from 1999 to 2020. We identified deaths among individuals aged 25 years and older caused by HHD and CHF using the International Classification of Diseases, Tenth Revision (ICD-10) code I11.0. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, race/ethnicity, and urbanization status. Results: Between 1999 and 2020, a total of 302,270 deaths were reported in patients due to HHD with CHF. Overall, AAMR increased from 37.3 to 134.9 per 1,000,000 population between 1999 and 2020, with a significant decrease from 1999 to 2004 (APC: -7.91; 95% CI: -20.16 to -1.04), followed by a significant increase from 2004 to 2007 (APC: 42.47; 95% CI: 21.27 to 55.62), a slight decrease from 2007 to 2014 (APC: -0.9; 95% CI: -9.38 to 2.39), and finally a steep increase from 2014 to 2020 (APC: 14.22; 95% CI: 10.87 to 20.84). Gender-based analysis revealed that men had slightly higher AAMRs than women (Men: 63.1; 95% CI: 62.8 to 63.5 vs. Women: 60.7; 95% CI: 60.5 to 61). Moreover, AAMRs were highest among non-Hispanic African Americans (109.6; 95% CI: 108.6 to 110.6), followed by non-Hispanic American Indian or Alaska Natives (66.6; 95% CI: 63.1 to 70.1), non-Hispanic Whites (58.5; 95% CI: 58.2 to 58.7), Hispanics (53.7; 95% CI: 52.9 to 54.5), and non-Hispanic Asian or Pacific Islanders (39; 95% CI: 38–39.9). In addition, non-metropolitan areas had higher AAMRs than metropolitan areas (non-metropolitan: 65.7; 95% CI: 65.2 to 66.3 vs. metropolitan: 62.1; 95% CI: 61.8 to 62.3) (Figure 1). Conclusions: Despite an initial decline, mortality from combined HHD and CHF has risen significantly since 1999. Notably, mortality was most pronounced among men, non-Hispanic African Americans, and individuals residing in non-metropolitan areas.

Trajectories of attention problems in preschoolers born very preterm.

Children born preterm are at heightened risk for neurodevelopmental impairment, including specific deficits in attention. Few studies have investigated change over time in attention problems prior to school entry. The current study aims to describe trajectories of attention problems from age 2 through 5 years in a cohort of children born <30 weeks of gestational age (GA), identify sociodemographic, medical, and neurobehavioral characteristics associated with attention trajectories, and test whether attention problem trajectories predict the risk of a reported attention-deficit/hyperactivity disorder (ADHD) diagnosis. We studied 608 infants from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study, a prospective, multisite study of infants born <30 weeks of GA. Parents reported on child attention problems at ages 2, 3, 4, and 5 years using the Child Behavior Checklist and the Behavior Assessment System for Children. Sociodemographic and medical characteristics were assessed via maternal interview and medical record review. Neurobehavioral characteristics were determined using neonatal and 2-year assessments. Parent report of child ADHD diagnosis was obtained. We used latent growth curve (LGC) modeling to test our study aims. A linear LGC model provided the best fit to the data. The average trajectory of attention problems evidenced low initial levels of symptoms and little change over time, yet there was significant heterogeneity in both initial levels and change over time. Individual differences in trajectory parameters were associated with sociodemographic, medical, environmental, and neurobehavioral characteristics. Children with higher initial levels of attention problems as well as steeper increases in attention problems over time were more likely to have a reported ADHD diagnosis. There is significant heterogeneity in trajectories of attention problems from age 2 to 5 in children born <30 weeks of GA and these differences have clinical relevance. These data could inform follow-up guidelines for preterm infants.

Design and development of a mobile health intervention for rehabilitation support after knee arthroplasty: TeleRehabilitation after knee ArThroplasty (TReAT) project

BackgroundThe steep increase in knee arthroplasties in lower- and middle-income countries has increased demand for personalised rehabilitation care. Technology-based rehabilitation programs offer potential to replace or augment conventional face-to-face rehabilitation for providing continuum of care. We aimed to systematically develop a theory, evidence-driven, contextualised, and user-centred mobile health platform for people undergoing knee arthroplasty to facilitate monitoring progress during rehabilitation.MethodsWe followed the UK Medical Research Council’s framework and adopted a behaviour design thinking approach, consisting of five steps; (1) conduct multiple literature reviews and cross-sectional surveys to determine the needs and problems experienced during the rehabilitation phase by healthcare professionals and individuals with replaced knees, (2) identify target behaviours along with barriers and facilitators, integrated within the Capability, Opportunity, Motivation-Behaviour (COM-B) framework, (3) identify intervention functions and components, behaviour change techniques, and features for the mobile application, selected after discussions with orthopaedic surgeons, physiotherapists and behavioural experts, (4) develop a prototype application for end-users, and a web-based platform for healthcare professionals, and (5) pilot test the intervention for end-users’ feedback on usability of the application and to identify possible strategies for implementing the intervention package.ResultsUsing the COM-B model, education, training, persuasion, enablement, and modelling were chosen as intervention functions for improving adherence to exercise protocol during early-phase of rehabilitation. The application featured five interlinked components; education, training, goal setting and self-management, communication, and a personalized therapy plan utilising 13 behaviour change techniques. An education booklet, exercise videos, text messaging, video consultation, and a digital tool for measuring range of motion were incorporated into the application. Feedback on the interactive prototype and education material was sought from ten patient volunteers and a physiotherapist. Pilot testing in a convenient sample with broad eligibility criteria (n = 30) indicated importance of digital literacy and dedicated time for remote consultation by healthcare provider within the existing clinical work. Overall, the intervention was well received and valued by the end users.ConclusionThis paper demonstrates the development of a contextualised digital behavioural intervention grounded in behavioural theory and evidence from literature to improve end-user’s engagement with rehabilitation protocols after knee arthroplasty in lower- and middle-income country context.Trial registrationStudy registered prospectively (on 16 February 2023) at Clinical Trials Registry of India (CTRI/2023/02/049792).

Nationwide trends in the use of ADHD medications in the period 2006–2022: a study from the Norwegian prescription database

BackgroundThe use of medication for Attention-Deficit/Hyperactivity Disorder (ADHD) increased globally throughout the early 2000s. This study examine trends in prevalences and incidences of medication use in Norway from 2006 to 2022.MethodsData from the Norwegian Prescription Database were used to present one-year-prevalence and incidence rates of ADHD medication (ATC-group N06BA and C02AC02) for the overall population (ages 6–64) and within sex and age subgroups of children (ages 6–17) and adults (ages 18–64). Incident use was defined as the dispensing of medication, with no recorded use in the previous two calendar years.ResultsThe overall prevalence of ADHD medication use in 6- to 64-year-olds increased from 5.2 to 19.4 per 1000 in the period, most pronounced from 2020 and onwards. While males experienced a nearly threefold increase in use (from 7.3 to 20.6 per 1000), the use among females increased almost sixfold during the study period (from 3.0 to 18.1 per 1000). Consequently, the male-to-female prevalence-ratio decreased from 2.4 to 1. Children exhibited a higher prevalence of use compared to adults throughout the period, although the largest relative increase was observed in adults, particularly in female adults. In children the male-to-female ratio decreased from 3.2 to 2.0, primarily due to an increasing use in 13–17-year-old females. Among adults, prevalences were similar across most age groups, with the highest rates observed among those aged 18–24, where female use exceeded male use by the end of the period. The male-to-female prevalence-ratio in adults decreased from 1.6 to 0.9 during the period. Parallel to prevalent use, overall incident use increased from 1.4 to 5.0 per 1000 during the period, with the most pronounced increase occurring from 2020 and onwards. From this point, incident use among females aged 13–17, 18–24, and 25–34, exceeded that of males. The male-to-female incidence-ratio decreased from 1.8 to 0.9. The overall incidence to prevalence ratio remained similar throughout the period, being 0.27 in 2006 and 0.25 in 2022.ConclusionA sustained increase in the prevalence of ADHD medication use was observed, with the most pronounced rise occurring among females and adults from 2020 and onwards. By 2022, the overall gender disparity in ADHD medication use had diminished, which should be considered in the context of a steep increase in incident use among adolescent and young adult females starting from 2020.

The Impact of Media Violence, Narcissism and Sex on Reactive and Proactive Aggression in Adolescents: A One-Year Follow-Up Study.

While the impact of violent media on aggression is well established, less is known about how individual differences influence this relationship over time. This longitudinal study addresses that gap by examining whether narcissism and sex moderated the effect of violent media consumption and reactive and proactive aggression one year later. A sample of 2,284 adolescents from Cyprus (Mage = 16, SDage = 0.89, 49.5% female) participated in this study. Hierarchical regressions, controlling for baseline levels of aggression and age, revealed distinct patterns: violent media and sex predicted reactive aggression, but narcissism did not. In contrast, violent media, sex, and narcissism all predicted proactive aggression. Notably, sex moderated the link between violent media and reactive aggression, with females showing a steeper increase than males. Both sex and narcissism moderated the violent media-proactive aggression association, with males being affected regardless of narcissism, while only highly narcissistic females showed an increase in proactive aggression. These findings show the importance of considering individual differences, such as sex and narcissism, to better understand how violent media influences different functions of aggression.

Increasing event-driven HIV pre-exposure prophylaxis use among gay, bisexual and other men who have sex with men in Australia: results from behavioural surveillance 2019-2023.

HIV pre-exposure prophylaxis (PrEP) has been publicly available since 2018 in Australia as a daily regimen. In 2019, clinical guidelines were updated to support guidance on event-driven PrEP (ED-PrEP) use. We assessed trends in the PrEP dosing regimen by comparing daily PrEP use to ED-PrEP among cisgender gay, bisexual and other men who have sex with men (GBMSM). Data from repeated, cross-sectional, national behavioural surveillance surveys were analysed from 2019 to 2023 among participants not living with HIV. Logistic regression models were conducted to assess trends and compared ED-PrEP users to non-PrEP users and daily PrEP. Among 38,880 participants, overall PrEP use with any regimen increased from 27.6% in 2019 to 42.7% in 2023 (OR = 1.16, 95% CI = 1.15-1.18, p < 0.001). Among 12,922 participants who reported PrEP use in the last 6months, the proportion reporting ED-PrEP use increased from 7.6% in 2019 to 27.8% in 2023 (OR = 1.41, 95% CI = 1.37-1.46, p < 0.001) with those who reported daily PrEP decreasing from 92.4% to 63.3% (OR = 0.64, 95% CI = 0.62-0.66, p < 0.001). In a cross-sectional sub-sample in 2022-2023 (n = 8840), compared to ED-PrEP users, non-PrEP users were less likely to have received three or more HIV tests in the last 12 months (aRRR = 0.26, 95% CI = 0.22-0.31, p < 0.001), have 2-10 male sexual partners in the last 6months (aRRR = 0.24, 95% CI = 0.14-0.41, p < 0.001) or 11 or more (aRRR = 0.26, 95% CI = 0.15-0.45, p < 0.001) compared to none, or to report condomless anal intercourse with casual partners (aRRR = 0.38, 95% CI = 0.32-0.46, p < 0.001). Compared to ED-PrEP users, daily PrEP users were more likely to have received three of more HIV tests in the last year (aRRR = 3.73, 95% CI = 3.15-4.40, p < 0.001) and less likely to be born overseas and lived in Australia for less than 5 years compared to being born in Australia (aRRR = 0.64, 95% CI = 0.49-0.83, p = 0.001). While daily PrEP remains the most common PrEP dosing regimen among GBMSM in Australia, there has been a steep increase in the proportion of PrEP users who are taking ED-PrEP. Monitoring of PrEP use should continue to adapt to new dosing methods and future PrEP options. As ED-PrEP use increases, further work is needed to ensure those taking ED-PrEP are taking it effectively to prevent HIV.

A Diathesis-Stress Approach to Understanding Partner Maltreatment Perpetration: A Longitudinal Study.

Despite evidence suggesting that partner maltreatment-a concept which represents a wide array of negative, destructive, and abusive behaviors in romantic relationships-is likely to fluctuate over time, the longitudinal trajectory of partner maltreatment is unclear. This study aims to identify the average trajectory of partner maltreatment over a 5-month period before applying an attachment-informed diathesis-stress framework to explain points of escalation or de-escalation in partner maltreatment perpetration. Two hundred and eight individuals completed 5 monthly assessments of partner maltreatment as well as an assessment of adult attachment and perceived stress at baseline. A nonlinear (i.e., quadratic function) trajectory provided optimal fit for partner maltreatment perpetration over time. An interaction between attachment avoidance and perceived stress predicted the trajectory of partner maltreatment perpetration. Specifically, higher attachment avoidance and higher perceived stress predicted a small initial decline followed by a steep increase in partner maltreatment perpetration. No significant associations were found for the interaction between attachment anxiety and stress and partner maltreatment. The findings suggest that perpetration of partner maltreatment fluctuates over time, and that an attachment-informed diathesis-stress framework can be applied to explain levels of partner maltreatment perpetration and points of escalation and de-escalation over time.

Mediation of beneficial effects of an alcohol-specific inhibition training on drinking of patients with alcohol use disorder: The role of cognitive demands and inhibitory performance

BackgroundA cognitively demanding, alcohol-specific inhibition training (Alc-IT) might enhance treatment success in patients with severe alcohol use disorder (AUD; Anonymus, 2023). An inhibitory working mechanism for Alc-IT has been discussed, but compelling evidence supporting this hypothesis is yet lacking. The present study investigates inhibitory performance during Alc-IT and examines whether inhibitory parameters mediate drinking outcome. MethodsPatients with AUD (N = 232) completed six sessions of either a standard or improved Alc-IT, differing in their inhibitory demands determined by Go/NoGo ratios in a modified Go-NoGo-task, or a control training. During these training sessions, data on inhibitory performance was collected. To assess differences in inhibitory performance and its improvement, alcohol-related errors of commission and relative performance, integrating accuracy and speed, were analyzed with hierarchical linear contrast models. Mediation analyses tested whether inhibitory performance predicted drinking outcome (percent days abstinent at 3-month follow-up). ResultsPatients in improved Alc-IT started with higher errors of commission (γ01(standard) = − 2.74, p < 0.001, R2 = 0.885) and a lower relative performance in the first training session compared to standard Alc-IT (γ01(standard) = 0.51, p = 0.004). They showed a steeper increase in relative performance until the final sixth session (γ1(s6),(standard) = -0.37, p = 0.024, R2 = 0.882). The effect of improved Alc-IT on drinking outcome was mediated by relative performance increase (bootstrap-CI [0.15, 7.11]). ConclusionHigher inhibitory demands enable larger improvements across sessions. Mediation analysis supports an inhibitory working mechanism. Tailoring inhibitory demands to individual performance capacity could optimize future Alc-IT.

Magnetic Field Evolution of the Solar Active Region 13664

On 2024 May 10–11, the strongest geomagnetic storm since 2003 November occurred, with a peak Dst index of −412 nT. The storm was caused by NOAA active region (AR) 13664, which was the source of a large number of coronal mass ejections and flares, including 12 X-class flares. Starting from about May 7, AR 13664 showed a steep increase in its size and (free) magnetic energy, along with increased flare activity. In this study, we perform 3D magnetic field extrapolations with the NF2 nonlinear force-free code based on physics-informed neural networks (R. Jarolim et al.). In addition, we introduce the computation of the vector potential to achieve divergence-free solutions. We extrapolate vector magnetograms from the Solar Dynamics Observatory’s Helioseismic and Magnetic Imager at the full 12 minute cadence from 2024 May 5 00:00 to 11 04:36 UT, in order to understand the AR’s magnetic evolution and the large eruptions it produced. A decrease in the calculated relative free magnetic energy can be related to solar flares in ∼90% of the cases, and all considered X-class flares are reflected by a decrease in the relative free magnetic energy. Regions of enhanced free magnetic energy and depleted magnetic energy between the start and end times of major X-class flares show spatial alignment with brightness increases in extreme-ultraviolet observations. We provide a detailed analysis of the X3.9-class flare on May 10, where we show that the interaction between separated magnetic domains is directly linked to major flaring events. With this study, we provide a comprehensive data set of the magnetic evolution of AR 13664 and make it publicly available for further analysis.

HPV vaccination in Croatia (2016-2023): Increased vaccine uptake and declining sex disparities

Abstract Background The Human papillomavirus (HPV) is a known cause of cervical cancer, and is associated with the development of vaginal, vulvar, anal, penile, and head and neck cancer. The availability of the HPV vaccine has enabled generations of young people to be protected from HPV-related cancers. In 2016, a national immunization program targeting 14-year-old girls and boys has been initiated in Croatia. To date, systematic data on HPV vaccination coverage (VC) in Croatia is lacking. This study aims to determine HPV VC, examine trends in HPV vaccination in Croatia from 2016 to 2023 in the context of the national vaccination program, and assess differences between sexes. Methods The study is designed as a retrospective analysis covering the data from 2016 to 2023, collected from primary healthcare providers. HPV VC within 2000-2008 birth cohorts (BC) are analyzed for all vaccinated with at least one dose and assessed by sex. The trend in HPV vaccination is shown using joinpoint regression. The chi-square for trend is used to compare the vaccination coverage of females (FVC) and males (MVC). The rate ratio between FVC and MVC is calculated. Results HPV VR increased significantly among observed BCs from 6,44 % in 2000 BC to 44,22 % in 2008 BC (FVC rose from 10,67 % to 52,78 %, and males MVC from 2,47 % to 36,05 %). Joinpoint analysis revealed a statistically significant increase in all birth cohorts, while the steeper increase is seen in 2000-2006 BCs (APC = 35,47, P &amp;lt; 0,05) than in 2006-2008 BCs (APC = 13,93, P &amp;lt; 0,05). FVC is significantly higher than MVC in all birth cohorts (Extended Mantel-Haenszel chi-square for linear trend = 809.23, P &amp;lt; 0,001). The highest FVC/MVC rate ratio was observed in the initial 2000 BC (4,31), and the lowest in the last 2008 BC (1,46). Conclusions In Croatia, HPV VC continuously increases among observed BCs. The positive trend is present in both sexes, and the rate ratio between female and male cohorts is decreasing. Key messages • The study presents a systematical overview of HPV vaccination coverage in Croatia from the beginning of the national immunization program, which is crucial for monitoring progress. • In the following years, if the revealed trends persist or advance, Croatia could be closer to reaching Europe’s Beating Cancer Plan concerning eliminating HPV-related diseases.

Regional variation of age-related blood pressure trajectories and their association with blood pressure control rates, disability-adjusted life years and death

Abstract Background/Introduction While the relationship between blood pressure (BP) changes and increasing age is well described, age-related BP trajectories may vary substantially across different populations and associated with differential CV risk and outcomes. Purpose The dataset of the May Measurement Month (MMM) international campaigns enables a unique investigation of regional, socio-economic and sex differences in age-BP trajectories and their association with major public-health outcomes. Method Global BP data from more than 4,5 million adult (≥18 years) screenees obtained during the cross-sectional MMM campaigns in 2017, 2018, 2019, and 2021 were used for analysis. Average BP and slopes of BP changes across age groups were calculated within regional, socio-economic and sex strata. BP slopes of individuals between 30 and 70 years of age were derived from adjusted linear regression models, along with baseline BP estimates at young age. These BP slopes were correlated in regression models adjusted for baseline BP at young age with country-specific all-cause rates of DALYs (Disability-Adjusted Life Years), death (both from Global Burden of Disease Study 2019), life expectancy (World Bank data SP.DYN.LE00.IN 2019) and BP control rates (NCD Risk Factor Collaboration). Results Age-related BP changes differed distinctly across global geographic regions, income levels, and between sexes. The steepest increase in BP with age was observed in populations from Africa and Europe, whereas a more gradual rise in BP with increasing age was seen in South-East Asian populations. Women had lower BP levels than men at younger ages (twenties and thirties), but subsequently experienced a more pronounced age-related BP increase resulting in diminishing sex differences across older age groups. Geographically divergent age-related BP trajectories were significantly associated with major national public health indicators. Globally, the steeper the age-related BP slope, the stronger the association with poor BP control (β = -0.46 [95% CI: -0.74; -0.19], p=0.001), increased DALY’s (β = 66155.68 [95% CI: 44847.0; 87464.36], p&amp;lt;0.001) and death rates. (β = 1017.3 [95% CI: 351.72; 1682.89], p=0.003). Conclusion Age-related BP trajectories vary considerably across global populations and contribute considerably to the variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of lifestyle and other factors contributing to adverse BP trajectories to improve health outcomes.Average blood pressure by ageAssiciations with public health metrics

Global variations in coronary revascularisation and acute myocardial infarction mortality between 2006-2020: a longitudinal, population-level analysis of 16 high-income nations from the OECD database

Abstract Background Revascularisation options for ischaemic heart disease (IHD) includes either, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Whilst PCI remains the preferred choice in ST-elevation myocardial infarction (STEMI)(1), several landmark trials have questioned its universal superiority (2,3), thus prompting re-evaluation of guidelines. A wide-scale contemporary overview of revascularisation trends is lacking. Purpose To examine the evolving pattern in PCI and CABG rates, alongside mortality from acute myocardial infarction (AMI) across a group of 16 high-income countries between 2006 and 2020. Methods Standardized PCI and CABG procedure rates alongside AMI age-standardised mortality rate (ASMR) were obtained from the Organisation for Economic Co-operation and Development (OECD) database. Data from 2006-2020 was extracted for; Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, United Kingdom (UK). Together, these countries are commonly known as the European Union (EU) 15+ and represent a cluster of high-income nations with comparable levels of health expenditure. Procedural trends including the estimated annual percentage change (EAPC) were evaluated using Joinpoint analysis whilst Locally Weighted Scatterplot Smoothing (LOESS) models was used to analysis trends in AMI mortality. Results Over 15 years, 14.0 million PCI and 2.8 million CABG procedures were recorded in total. PCI rates varied amongst nations (Figure 1), however showed an overall increase in 11 countries, led by Finland (+36.0%). The steepest increase was observed in France between 2012-2018 (EAPC 5.4, 95% CI: 4.8 – 6.1). The greatest overall decrease in PCI was observed in Luxemburg (-33.5%). The fastest decrease was seen during 2018-2020 in the UK (EAPC -7.2, 95% CI: -9.7 – -4.6). CABG rates declined overall in 15 countries (Figure 1), with Luxembourg (-71.3%), experiencing the largest fall and showing the steepest decline between 2014-2018 (EAPC -20.7, 95% CI: -28.3 – -12.3). Ireland was the only country to show an increase in CABG rate (+16.3%). Throughout the study period, the PCI-to-CABG ratio increased (Figure 2A), whilst AMI mortality decreased consistently across all countries (Figure 2B). Conclusion Despite evidence supporting CABG over PCI in specific scenarios, CABG rates have declined, and PCI rates have increased. This trend may be influenced by several factors including patient preference for less invasive procedures and advancements in interventional techniques. The varied use of PCI among these nations, alongside a sustained decline in AMI mortality rates, may be expected given the importance of optimal medical therapy in the management of IHD. The results further highlight the significance of factors beyond revascularisation in driving improved outcomes.PCI and CABG rates between 2006 and 2020PCI to CABG ratio and AMI mortality rate

Albuminuria is associated with progression of diastolic dysfunction in patients at risk for cardiovascular disease

Abstract Background The number of the patients with heart failure with preserved ejection fraction (HFpEF) is increasing as society ages, which indicates that the number of pre-HFpEF patients is increasing even more. To combat this sociomedical burden, it is critical to establish cost-effective and simple biomarkers to identify the high-risk population at early phase of the disease. Recent studies demonstrated the association between albuminuria and incident heart failure, but the prognostic impact of albuminuria on diastolic dysfunction, an early phenotype of HFpEF, has not been elucidated. Purpose To examine the impact of albuminuria on the diastolic function over time in the patients with cardiovascular risks. Methods One hundred and fifty-eight patients with at least one cardiovascular risk factor without history of heart failure were followed up for 5 years. Echocardiogram was conducted at baseline, year 3, and year 5. Diastolic dysfunction was defined as E/e’ &amp;gt;14. Albuminuria was defined as urine albumin-to-creatinine ratio (UACR) 30 ≧mg/gCre. The patients with ejection fraction &amp;lt;40% and those had diastolic dysfunction at baseline were excluded from the study. The relationship between albuminuria at baseline and diastolic function at year 3 and 5 were investigated. Results Among 158 subjects, 27 showed albuminuria at baseline and the prevalence of hypertension, dyslipidemia, and diabetes was not significantly different between patients with and without albuminuria. The baseline E/e’ tended to be higher in patients with albuminuria, although the difference was not statistically significant (Fig1: E/e’ = 10.0±2.4 vs. 9.4±2.2, p = 0.08) . However, the patients with albuminuria showed a steeper increase in E/e’ than those without albuminuria, and the significant difference was observed at year 3, that was even greater at year 5 (Fig1: E/e’ = 11.1±2.8 vs 10.0±2.6, p = 0.04 in year 3, E/e’ = 12.5±4.1 vs 10.3±2.9, p = 0.002 in year 5, respectively). Furthermore, log UACR at baseline showed significant correlation with E/e’ at year 5 (p = 0.02, r = 0.21) and normo-, micro-, and macroalbuminuria (UACR&amp;lt;30, 30-300, and &amp;gt;300mg/gCre, respectively) at baseline showed elevated E/e’ at year 5 in this order ( p = 0.01 for UACR&amp;lt;30 vs. 30-300mg/gCre, and p = 0.04 for UACR&amp;lt;30 vs. &amp;gt;300mg/gCre, reapectively ). The prevalence of incident diastolic dysfunction increased greater in patients with albuminuria throughout the follow-up period and the difference reached statistical significance at year 5 (Fig2: 18.5% vs. 9.2%, p = 0.28 for year 3, and 25.9% vs. 8.4%, p = 0.009 for year 5, respectively). Conclusion In the patients with cardiovascular risk factors, albuminuria was associated with development and progression of diastolic dysfunction over subsequent 5 years. Future prospective study is warranted to investigate the effectiveness of albuminuria-directed care to prevent development of HFpEF.