Independent Relationship Research Articles

Design and Analysis of High Speed Phase Frequency Detector with Zero Dead Zone in PLL

This paper presents a proposed phase frequency detector(PFD) designed by using the 180-nm CMOS process. Adding an extra buffer to the typical D flipflop-based PFD solves the dead zone(DZ) problem, however the frequency of operation is reduced. The proposed design of PFD eliminates the dead zone(DZ) and reduces the blind zone(BZ) significantly by developing the independent relationship between the blind zone(BZ) and the dead zone(DZ). Moreover, the proposed architecture helps to increase the operating frequency compared to the conventional architecture. The reset time of the proposed PFD requires one NAND gate, one AND gate, and an OR gate, whereas conventional PFDs require one D flipflop, one AND gate, and a delay element, which limits the frequency of operation in conventional architecture. The proposed architecture achieves 135 ps of reset time and 95 ps of delay time at the maximum operating frequency of 4.3 GHz. The phase noise of the proposed architecture is −143.2 dBc/Hz with 1 MHz offset at 4 GHz. The PLL is designed using the proposed PFD architecture with an reference frequency of 4 GHz and the phase noise is −110 dBc/Hz at a 1.5 MHz offset frequency.

Social Determinants, Mental Well-Being, and Disrupted Life Transitions Among Young Adults with Disabling Mental Health Conditions.

This study sought to understand how young adults (age 18-25) with histories of mental health disorders are coping with disrupted transitions to adulthood during the COVID-19 pandemic. A cross-sectional web survey was conducted in March-June 2021 of 967 US young adults with pre-pandemic psychiatric disability to assess their current psychiatric status, interrupted transitions, and associations with social determinants including income, community participation, and social context. Mental health was assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and PTSD Checklist-Civilian Version. Social determinants were identified with the Epidemic-Pandemic Impacts Inventory. Interrupted transitions were measured with the Young Adult Disrupted Transitions Assessment. Multivariable logistic regression models predicted four types of transition disruptions and associations with current mental health, social determinants, and demographic factors. Disruptions were reported by 81.1% including interrupted education completion (38.3%), employment careers (37.6%), residential independence (27.7%), and intimate partner relationships (22.9%). Many screened positive for major depressive disorder (81.7%), PTSD (85.5%), or GAD (58.6%). Disruption in establishing intimate partner relationships was associated with depression, anxiety, and PTSD. Interrupted residential independence was associated with anxiety. Interrupted education completion was associated with PTSD. Interrupted employment was associated with anxiety. Social determinants significant in these models included social connections, community participation, income, and racial/ethnic identification. Results illuminate ways that current mental health and social determinants affect transition interruptions during the pandemic. Findings suggest the need for interdisciplinary approaches, integrated models of care, and assistance accessing treatment, rehabilitation, and community support services from adult service systems.

Exploring the association between caffeine intake and benign prostatic hyperplasia: results from the NHANES 2005–2008

BackgroundCoffee is a physiologically active food component prevalent throughout the world, but the association between caffeine intake and benign prostatic hyperplasia (BPH) has been limited in extensive epidemiological studies.MethodsWe conducted a cross-sectional study to evaluate the association between caffeine intake and BPH in adults in the United States using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2008. Caffeine intake (mg/day) was evaluated based on a 24-h dietary recall. Multivariate logistic regression was used to analyze the independent relationship between caffeine intake and BPH, and the results are presented as odds ratio (OR) and 95% confidence interval (CI), subgroup analysis was also performed.ResultsA total of 2,374 participants were analyzed. After fully adjusting for potential confounders, logistic regression analysis revealed that higher caffeine intake was associated with a greater risk of BPH (ORT3vs1 = 1.52, 95% CI: 1.01–2.27; p = 0.04). In addition, this relationship was consistently observed across different subgroups, including individuals with lower education levels, a poverty income ratio (PIR) of 1.5 to 3.5, former smokers, married/living with partner individuals, those with uric acid levels of 5.5 to 6.5 mg/dL, those with hypertension, and those without cardiovascular disease (CVD).ConclusionThis study is the first to find a positive correlation between caffeine intake and BPH, but further research is needed to determine the exact causal relationship between these factors.

Clinical utility of the Fibrosis-4 index for predicting mortality in patients with heart failure with or without metabolic dysfunction-associated steatotic liver disease: a prospective cohort study

BackgroundThe liver-heart axis potentially influences the risk of mortality in patients with heart failure. We aimed to identify the clinical utility of the fibrosis-4 (FIB-4) index in patients with heart failure in the context of metabolic dysfunction-associated steatotic liver disease (MASLD). MethodsPatients with heart failure and a subsample of healthy participants were enrolled in the MyoVasc study (NCT04064450) and followed for nine years. Participants with excessive alcohol consumption were excluded. The Fatty Liver Index (FLI) and FIB-4 index were used to classify MASLD and hepatic fibrosis, respectively. Data were adjusted for potential confounders. The primary endpoint was all-cause mortality. Findings2726 participants, including 172 healthy individuals, were included in the study. The participants had a mean age of 64·4 ± 11·2 years and a median FIB-4 index of 1·59 (interquartile range [1·17; 2·17]). There were 532 deaths. The FIB-4 index was predictive for all-cause mortality (hazard ratio (HR) 1·341, 95% confidence interval (CI) [1·273; 1·412], p<0·0001). The HRs and 95% CIs for the FIB-4 index in FLI categories were 1·597 [1·256; 2·031] (p=0·00013, FLI<30), 1·802 [1·519; 2·138] (p<0·0001, FLI 30 to 60), and 1·292 [1·215; 1·374] (p<0·0001, FLI≥60). The interaction term for the FIB-4 index with FLI≥60 (reference FLI<30) was HR 0·774 [0·617; 0·972] (p=0·027), indicating a smaller impact of the FIB-4 index in FLI≥60 than in FLI<30 (HR 1·664 [1·333; 2·077], p<0·0001). Multivariable linear regressions revealed relevant independent relationships between the FIB-4 index and N-terminal pro-B-type natriuretic peptide, systolic dysfunction, diastolic dysfunction and left ventricular hypertrophy in participants with a FLI below 60. InterpretationIn patients with heart failure, the FIB-4 index predicts all-cause mortality and relates to cardiac functional and structural changes, especially in those without MASLD. FundingJohannes Gutenberg-University Mainz

Systemic immunoinflammatory indexes in albuminuric adults are negatively associated with α-klotho: evidence from NHANES 2007–2016

Background Systemic Immune-Inflammation Index (SII) is a novel inflammatory biomarker closely associated with the inflammatory response and chronic kidney disease. Klotho is implicated as a pathogenic factor in the progression of kidney disease, and supplementation of Klotho may delay the progression of chronic kidney disease by inhibiting the inflammatory response. Our aim is to investigate the potential relationship between SII and Klotho in adult patients in the United States and explore the differences in the populations with and without albuminuria. Methods We conducted a cross-sectional study recruiting adult participants with complete data on SII, Klotho, and urine albumin-to-creatinine ratio (ACR) from the National Health and Nutrition Examination Survey from 2007 to 2016. SII was calculated as platelet count × neutrophil count/lymphocyte count, with abnormal elevation defined as values exceeding 330 × 10^9/L. Albuminuria was defined as ACR >30 mg/g. Weighted multivariable regression analysis and subgroup analysis were employed to explore the independent relationship between SII and Klotho. Results Our study included a total of 10,592 individuals. In all populations, non-albuminuria population, and proteinuria population with ACR ≥ 30, participants with abnormally elevated SII levels, as compared to those with SII less than 330 × 10^9/L, showed a negative correlation between elevated SII levels and increased Klotho, which persisted after adjusting for covariates. Conclusions There is a negative correlation between SII and Klotho in adult patients in the United States. This finding complements previous research but requires further analysis through large prospective studies.

Early therapeutic efficacy of condoliase chemonucleolysis for lumbar disc herniation

BackgroundLow back pain is often caused by lumbar disc herniation (LDH). Treatment of LDH is possible using chemonucleolysis of the nucleus pulposus with condoliase injection. However, onset of the therapeutic effect varies among patients, with improvement from an early stage to 3 months post-injection. This study was performed to identify the characteristics of early responders to condoliase therapy.MethodsA retrospective cohort study was performed in 371 consecutive patients (259 males, 112 females; age, 49.9 ± 18.7 years; follow-up period, 13.1 ± 7.4 months) treated with condoliase injection for LDH between August 2018 and January 2024. Chemonucleolysis was performed with 1 mL of condoliase (1.25 U/mL) injected into the intervertebral nucleus pulposus. Clinical assessments were made before injection and 1 day, and 1, 4 and 12 weeks post-injection. Pain was measured on a visual analogue scale. Herniation parameters were evaluated on axial MRI. The herniated disc volume was measured on plain lumbar radiography. Demographic and clinical data were taken from medical charts. Multivariate logistic regression analysis was used to identify factors with independent relationships with treatment efficacy.ResultsImprovement of leg pain from baseline by ≥ 50% occurred in 21% of cases within one day after condoliase treatment. Patients with this improvement at 1 week post-injection were defined as early responders (n = 142, 38.3%). In multivariate analysis, age < 40 years (p = 0.022, odds ratio (OR): 1.71, 95% confidence interval (CI): 1.12–4.35), Pfirrmann Grade II or III at baseline (p = 0.032, OR: 1.86, 95% CI: 1.17–5.41), and a high intensity MRI signal in the herniation (p = 0.041, OR: 1.87, 95% CI: 1.06–5.27) were significantly associated with early improvement. No patients had anaphylactic shock or neurologic sequelae.ConclusionsThis study confirms the safety and efficacy of chemonucleolysis with condoliase for treating patients with painful LDH. Age, high-intensity MRI signals, and baseline Pfirrmann grade were significant factors associated with early improvement.

Prevalence and risk factors of pre-frailty and frailty in hemodialysis patients in central China

The current study was to explore the prevalence and risk factors elements of pre-frailty and frailty among patients undergoing hemodialysis (HD) in central China. A cross-sectional, multi-institutional investigation was conducted. From March to May 2024, using the convenience sampling method, a total of 408 HD patients from four hospitals in Xiangyang, China, were recruited for this study. The participants’ demographics, lifestyle factors, factors related to dialysis treatment, the FRAIL scale, psychological resilience, and medical coping modes were assessed using a questionnaire. Multi-categorical logistic regression was performed to examine factors associated with pre-frailty and frailty in this population. Furthermore, to evaluate the independent relationship between frailty and psychological resilience, multiple regression analysis was used to adjust potential confounders and obtain odds ratios (OR) and 95% confidence intervals (CI). Pearson correlation analysis was used for correlation analysis among various scales. Among the 408 participants, the prevalence of pre-frailty and frailty among participants for all ages was 26.2% and 38.5%. Multivariate logistic regression analysis showed that smoking status, falls, heart disease, and psychological resilience are all associated with pre-frailty and frailty. The Pearson correlation analysis showed that resignation was positively related to frailty and negatively related to psychological resilience in patients. Confrontation and avoidance were positively related to psychological resilience. Frailty was negatively related to psychological resilience. Psychological resilience was independently linearly associated with pre-frailty (OR 0.49, 95% CI 0.32–0.75, p < 0.001) and frailty (OR 0.53, 95% CI 0.35–0.80, p = 0.003). Our findings point to the necessity for active screening prevalence and risk factors for pre-frailty (26.2%) and frailty (38.5%) in adult HD patients of all ages. Pre-frailty and frailty among HD patients are associated with lower psychological resilience and a higher likelihood of using negative coping mechanisms.

Associations of Serum Cystatin C, DNAm Cystatin C, Renal Function, and Mortality in U.S. Adults

Serum cystatin C is a well-established marker of renal function and a valuable predictor of health risks and mortality. DNA methylation-predicted cystatin C (DNAmCystatinC), an advanced epigenetic biomarker, serves as a proxy for serum cystatin C levels. However, the relationships between serum cystatin C, DNAmCystatinC, renal function, and mortality outcomes have not been previously examined. This study aimed to examine the associations between serum cystatin C, DNAmCystatinC, renal function, and their joint and independent relationships with mortality in U.S. adults. We analyzed data from 1642 participants aged 50 and older from the National Health and Nutrition Examination Survey (NHANES) 1999–2002, linked to mortality information from the National Center for Health Statistics (NCHS), with follow-up through 2019. Our analysis demonstrated a positive association between ln-DNAmCystatinC and ln-serum cystatin C (Adjusted β (SE) = 0.773 (0.267), p = 0.007), while ln-DNAmCystatinC was negatively correlated with ln-Estimated glomerular filtration rate, calculated using both creatinine and cystatin C (eGFRcr-cys) (Adjusted β (SE) = −1.123 (0.449), p = 0.018). In a weighted Cox regression model, a one-unit increase in ln-serum cystatin C was linked to an increased hazard ratio (HR) of 2.87 (95% CI: 1.938–4.26, p &lt; 0.001) for all-cause mortality and 3.04 (95% CI: 1.34–6.88, p = 0.010) for cardiovascular mortality. Additionally, a one-unit increase in ln-DNAmCystatinC was associated with an HR of 135.86 (95% CI: 5.51–3349.69, p = 0.004) for all-cause mortality. This association was particularly pronounced in participants without chronic kidney disease (CKD), with a p-value for the interaction between DNAmCystatinC and CKD on all-cause mortality of 0.002. Furthermore, individuals with serum cystatin C and DNAmCystatinC levels above the 50th percentile showed the highest all-cause mortality risk when compared to other subgroups. In conclusion, our findings demonstrate that DNAmCystatinC is a stronger predictor of all-cause mortality than serum cystatin C, with potential additive effects when both biomarkers are considered together. These results suggest their utility as valuable clinical indicators for risk stratification and early intervention. Future research should validate these findings and further explore the clinical and public health implications of epigenetic biomarkers.

Have new post-pandemic perspectives affected collaboration, sharing and risk decision-making in the supply chain?

PurposeTo explain the perception of post-pandemic managers concerning two critical factors of collaborative management in the supply chain – information exchange and risk sharing – and how these factors affect risk management (RM) and decision-making.Design/methodology/approachThis study used correlational research supported by information collected through a survey applied to 243 companies. We analysed adherence to a theoretical model proposed through structural equation modelling. This method made it possible to examine multiple dependency and independence relationships between latent variables through observed variables.FindingsCollaborative management was strongly perceived as influencing the exchange of information, while risk sharing demonstrated only a weak influence. Exchanging information about the consequences of RM had a representative impact, while risk sharing indicated little influence. Risk sharing should thus possibly be viewed more carefully in terms of its relationship with supply chain management, as it had a restrictive impact on decision-making.Originality/valueThe experience of the COVID-19 pandemic may have changed the perception and ways companies relate to and manage their risks. This change may have affected collaboration, sharing and RM while imposing new perspectives and transforming managers’ decision-making behaviour. Given the limitations of research with this focus, the moment is opportune to explore and better understand the effects of this event on management.

New perspectives on markers implicated in signalling pathways that advance diabetic nephropathy and its therapeutic approaches

Diabetic nephropathy is the chronic loss of kidney function occurring due to diabetes mellitus. Due to increased sugar levels, there is disfunctioning of glomeruli, loss of protein in urine, and decrease in the levels of serum albumin that mainly leads to edema. The progression of renal disfunctioning starts when glomerular filtration rate is greater than 90ml/min. A large body of evidence indicates that oxidative stress is the main attributor involved in the progression of macro-vascular complications of diabetes. (ROS), NAD(P)H oxidase, advanced glycation end products (AGE), polyol pathway, uncoupled nitric oxide synthase (NOS), mitochondrial respiratory chain via oxidative phosphorylation, protein kinase C, mitogen-activated protein kinases, cytokines and transcription factors eventually cause increased expression of extracellular matrix (EC) genes with progression to fibrosis and end stage renal disease. Apart from these well-established pathways, major markers in the kidney disease which could work as potential targets has been explored like MCP-1, BMP-7, p38 MAPK, MiR-130b, HSP-27, AKT which further needs more research as they have shown promising results in their early level of studies. The present review aims to investigate the molecular targets involved in diabetic nephropathy, and to comprehend the intricate signalling pathways, such as JAK/STAT, BMP-7–Smad1/5/8 pathway, RhoA/ROCK, caspases, to which the aforementioned markers have either an independent or dependent relationship. If these signalling pathways are properly studied, these markers may aid in the treatment of the disease and its associated secondary effects such as nephropathy.

Audit independence and customer relationship marketing: an ethical conflict or an ethical mutual effect?

Independence in financial auditing is a topic with extensive research, due to the ethical values expected from accountants and the conflicts with agency pressures and commercial interests. However, there is a lack of research on the benefits of ethical behaviors in the dynamic interactions between auditors and clients. This study aims to achieve through a qualitative approach an in-depth understanding of the self-perceived auditor independence and how it intervenes in the relationship with clients. Ten semi-structured interviews with auditors from the five major audit offices in the city of Porto were conducted. The results explore conflicts of interest between auditor independence and customer relationships. However, the findings highlight that improving auditor’s independence allows at the same time the development of a better professional relationship with the client, mitigating the conflicts of interests identified in previous literature. This paper presents a formula in which audit firms can leverage the concept of independence when they promote communication, transparency, and an open market. Regulation and supervision should work in favour for the same goal.

Relationships between neurodivergence status and adverse childhood experiences, and impacts on health, wellbeing, and criminal justice outcomes: findings from a regional household survey study in England

BackgroundEvidence indicates that neurodivergent (ND) populations may be more at risk of experiencing adverse childhood experiences (ACEs), compared to neurotypical (NT) populations. However, this evidence has typically not examined a comprehensive set of ACEs and has only included ND individuals on the basis that they have a diagnosis. Very little research has examined the impacts of ACEs on negative adulthood outcomes for ND populations. The current study aimed to examine the associations between neurodivergence and experiences of ACEs, and the impact of being ND and experiencing ACEs on health, wellbeing, and criminal justice outcomes.MethodsFrom November 2023 to April 2024, a household survey using representative sampling was undertaken with 5395 residents of an English region aged 18 + years. Neurodivergence status was measured using one self-report item. Nine ACEs were measured using validated self-report items. Outcome measures included: poor general health, low mental wellbeing, ever being arrested, and ever being incarcerated. Multinomial regression models were used to examine relationships between neurodivergence status and ACEs. Binary logistic regression models were used to examine independent relationships between neurodivergence status and ACE count and each outcome measure. Generalised linear models with an estimated marginal means function were used to estimate the increased risk of each outcome for different combinations of neurodivergence and ACE count status (NT less than four ACEs (reference group), NT 4 + ACEs, ND less than four ACEs, ND 4 + ACEs).ResultsA higher proportion of ND individuals experienced each ACE type than NT individuals. While controlling for sociodemographics, ND individuals were more likely to experience a greater number of ACEs than their NT peers. While controlling for sociodemographics, each outcome measure was more likely amongst those who were ND, and each outcome measure except for poor general health was more likely amongst those with higher ACE counts.ConclusionsThe combination of being ND and experiencing ACEs could additively increase risks of experiencing poor wellbeing and criminal justice outcomes by a greater extent than expected. Preventing and responding to ACEs in ND populations should be a priority to reduce risks of poor health, wellbeing, and criminal justice outcomes in this population.

Associations between multimorbidity and kidney function decline in old age: A population-based cohort study.

Individual chronic conditions have been linked to kidney function decline; however, the role of multimorbidity (the presence of ≥2 conditions) and multimorbidity patterns remains unclear. A total of 3094 individuals from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed for 15 years. Multimorbidity was operationalized as the number of chronic conditions and multimorbidity patterns identified using latent class analysis (LCA). Joint models and Cox regression models were used to explore the associations between multimorbidity, and subsequent absolute and relative (≥25% decline from baseline) changes, respectively, in the estimated glomerular filtration rate (eGFR) calculated using the creatinine-based Berlin Initiative Study equation. Mean age of the sample was 73.9, and 87% had multimorbidity. There was an independent dose-response relationship between the number of chronic conditions, and absolute (β [95% confidence interval, CI] = -0.05 [-0.07; -0.03]) and relative (hazard ratio, HR [95% CI] = 1.23 [1.17; 1.29]) declines in eGFR. Five patterns of multimorbidity were identified. The Unspecific, low burden pattern had the lowest morbidity burden and was used as the reference category. The Unspecific, high burden, and Cardiometabolic patterns showed accelerated absolute (β [95% CI] = -0.15 [-0.26; -0.05] and -0.77 [-0.98; -0.55], respectively) and relative (HR [95% CI] = 1.45 [1.09; 1.92] and 3.45 [2.27; 5.23], respectively) declines. Additionally, the Cognitive and Sensory pattern showed accelerated relative decline (HR [95% CI] = 1.53 [1.02; 2.31]). No associations were found for the Psychiatric and Respiratory pattern. Multimorbidity is strongly associated with accelerated kidney function decline in older age. Individuals with cardiometabolic multimorbidity exhibit a particularly increased risk. Increased monitoring and timely interventions may preserve kidney function and reduce cardiovascular risks in individuals presenting with conditions that are characteristic of high-risk multimorbidity patterns.

Cyberchondria and quality of life: a cross-sectional study in Brazilian individuals

Introduction: Cyberchondria is a newly described entity in which patients recurrently search health information on the internet developing distress and suffering with the obtained information. Objective: To study cyberchondria in a sample of the Brazilian population: its association with epidemiological variables and interference with quality of life. Methods: This is a cross-sectional observational study, with 948 participants. Three questionnaires were applied through the internet: one epidemiological; the Cyberchondria Severity Scale (CSS) questionnaire and the SF-12 (12-Item Short-Form Health Survey) quality of life (QoL) questionnaire. Results: CSS was weakly and negatively correlated with the age of participants in the subscale “compulsion” (r=-0.08, p=0.01) and “distress” (r=-0.12, p&lt;0.0001). Men had higher scores on “compulsion” (p=0.02). A weak and negative correlation was found between the subscales of “compulsion,” “distress,” “excessiveness” and “reassurance seeking” of CSS and SF-12-physical domains and the subscales of “compulsion” and “distress” with SF-12 mental domain. An independent relationship was found between the male sex (p=0.009), living in rural areas (p=0.002), having less than 10 years of formal education (p&lt;0.0001), and earning less than 5 minimal wages/month (p=0.0002) with the subscale “mistrust of medical professional”. Conclusion: Males and younger individuals have higher levels of compulsion in the CSS than females and the elderly. Mistrust of medical professionals was less common in females, in those living in urban areas, and in those with better education and higher income. Cyberchondria interferes with mental and physical QoL.

Visceral adiposity index, cardiorespiratory fitness, and fasting plasma glucose associations in adolescents.

The global rise in the prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is partly linked to the increasing rates of childhood obesity and physical inactivity. To explore the independent relationships of visceral adiposity index (VAI) and cardiorespiratory fitness (CRF) with fasting plasma glucose (FPG) in adolescents. This descriptive cross-sectional study included 403 adolescents (202 boys and 201 girls) aged 11-19 years. Participants were evaluated for VAI, CRF, and FPG. Regression models, adjusted for age and maturity status, were used to assess the associations between VAI, CRF, and FPG. The prevalence of T2DM risk was 15.3% (girls = 7.4%; boys = 7.9%). In boys, high VAI was positively associated with FPG (β = 0.190, P = 0.009), while low CRF was negatively associated with FPG (β = -0.206, P = 0.010). These associations persisted even after adjusting for CRF and VAI. However, no significant associations between VAI, CRF, and FPG were observed in girls (P > 0.05). Adolescents with high VAI and low fitness levels demonstrated poorer glycemic profiles. Among boys, both VAI and CRF were independently associated with T2DM risk, with CRF showing a stronger association. These associations were not observed in girls. Promoting regular aerobic exercise and healthy diets may serve as essential public health promotion strategies in preventing and managing T2DM risk in adolescents.

Association between serum phosphate level and mortality of patients with aneurysmal subarachnoid hemorrhage.

Disorders of serum phosphate, including hyperphosphatemia and hypophosphatemia, have been confirmed to be related to the poor prognosis of specific critically ill patients. No study analyzes the relationship between continuous serum phosphate level and mortality from aneurysmal subarachnoid hemorrhage (aSAH). This study was performed to explore this relationship. aSAH patients were divided into four groups based on serum phosphate quartiles. Significant factors discovered in the univariate Cox regression were included in the multivariate Cox regression to explore the independent relationship between serum phosphate and mortality of aSAH. Kaplan-Meier survival analysis was performed to compare the difference in survival between the four groups. The 60-day mortality of overall aSAH patients was 20.7%. The mortality of the group with the 1st quartile (29.4%) and the 4th quartile (24.7%) had higher mortality than others (p = 0.028). Univariate Cox regression showed the 2nd quartile (p = 0.020) and 3rd quartile (p = 0.017) were associated with lower mortality risk than the 1st quartile. Compared with the 1st quartile, the 4th quartile was not associated with lower mortality risk (p = 0.458). After adjusting confounding effects, multivariate Cox regression showed only the 4th quartile was significantly associated with higher mortality risk (p = 0.009) than the 1st quartile. The unadjusted relationship between serum phosphate and mortality of aSAH is U-shaped. While high serum phosphate even within the normal range is independently related to the mortality of aSAH. Low serum phosphate may be just a marker for the severity of aSAH. Evaluating the initial serum phosphate is useful for risk stratification of aSAH.

Systemic Oxidative Stress Correlates with Sarcopenia and Pruritus Severity in Primary Biliary Cholangitis (PBC): Two Independent Relationships Simultaneously Impacting the Quality of Life—Is the Low Absorption of Cholestasis-Promoted Vitamin D a Puzzle Piece?

Background: Unlike other chronic liver disorders, in primary biliary cholangitis (PBC), systemic oxidative stress (SOS) worsens along with liver disease progression status (DPS), influencing muscle metabolism, muscle quantity (MQ), and itch pathways. Synergistically, cholestasis contributes to reduced vitamin D absorption, with a negative impact on MM and SOS. Despite this evidence, the prevalence of sarcopenia in PBC, and the SOS-MQ relationship comparing PBC with other CLDs, has never been investigated. Moreover, the relationship between vitamin D and MQ-SOS, and the correlation between SOS and pruritus severity, remains unexplored in PBC. Methods: A total of 40 MASLD, 52 chronic HBV infections, 50 chronic HCV infections, and 41 ursodeoxycholic acid/antioxidant-naïve PBC patients were enrolled. Biochemical, nutritional, and liver stiffness (LSM) data were collected, and sarcopenia was assessed after a normalizing 3-month dietetic–physical exercise regimen. The d-ROMs/BAP tests evaluated SOS. The validated “PBC-40 questionnaire” estimated pruritus and quality of life (QoL). Results: Unlike other CLDs, in PBC patients, sarcopenia was more prevalent in initial mild fibrosis (PBC: 57.10% vs. MASLD: 30.76%, HBV: 22.60%, HCV: 20.70%, all p &lt; 0.0001), and SOS significantly correlated with MQ (dROMs-ASM/h2, p: 0.0002; BAP-ASM/h2: p: 0.0092). PBC patients presented lower vitamin D levels and a significant correlation of these with SOS and MQ (all p &lt; 0.0001). SOS also correlated with pruritus severity (dROMs, R: 0.835; BAP, R: −0.775, p &lt; 0.0001). QoL impairment was significantly more represented in PBC individuals with sarcopenia, SOS imbalance, and relevant pruritus (p: 0.0228). Conclusions: In PBC, SOS correlates with MQ impairment and pruritus severity, configuring two independent relationships simultaneously impacting QoL.

Lumbar Spinal Fusion Outcomes in Patients With Cancer Compared to Matched Peers Without Cancer.

Retrospective Matched Cohort Study. Optimization of medical comorbidities is an essential part of preoperative management. However, the isolated effects of individual comorbidities have not been evaluated within a homogenous spine surgery population. This exact matching study aims to assess the independent effects of cancer on outcomes following single-level lumbar fusions for non-cancer surgery. 4680 consecutive patients undergoing single-level posterior-only lumbar fusion were retrospectively enrolled. Univariate statistics and coarsened exact matching (CEM) were computed to evaluate outcomes between cancer patients and those without comorbidities. By logistic regression, malignancy conferred a higher risk of surgical complication (P = 0.016, OR = 2.64, CI = [1.200,5.790]), 30- and 90- day readmission (P = 0.012, OR = 2.025, CI = [1.170-3.510]; P < 0.001, OR = 2.34, CI = [1.430, 3.830], respectively), 90-day reoperation (P < 0.001, OR = 2.16, [1.110, 4.200]), and death at 90-days (P = 0.032, OR = 8.27, CI = [1.200, 56.850]). After matching, malignancy was associated with increased odds of incidental durotomy (6 vs 0 cases, P = 0.048) and death at both 30 and 90 days (both: OR = 8.0, P = 0.020, CI = [1.00, 63.960]). No cases of durotomy occurred in cases with mortality in the matched sample, suggesting independent relationships. There were no differences in length of stay, non-home discharge, ED evaluation, readmission, or reoperations. Among otherwise exact-matched patients undergoing single level lumbar fusion, history of malignancy conferred a higher risk of short-term mortality, but not other outcomes suggestive of surgical failure. Increased mortality after lumbar fusion should be studied further and may play a role in surgical decision-making and patient discussions.

Studi Fenomebilogis: Makna Hidup pada Wanita yang Mengalami Perceraian Akibat KDRT

Post Traumatic growth is a positive change understand experienced by someone after experiencing any traumatic event. This study aims to recognaize how the description of post traumatic growth in women victims of domestic violence. The approach in this study uses a qualitative approach with Interpretative Phenomenological Analysis (IPA) analysis. The data collection techniques used in this study were in-depth interviews. Participants were two female victims of domestic violence and two Significant others (people closest to the participants). The results showed that there are two main themes, the first theme is domestic violence which contains the experience of violence and household dynamics, the impact of domestic violence, and the dynamics of divorce. The second theme is Post Traumatic growth which contains personal growth and meaning of life, support from the closest people, restoration of relationships with children and family, spirituality, involvement with the social environment, self-development, and obstacles in recovery. Researchers also found distinctive themes in participants, namely post-divorce economic independence and new relationships and hopes. This research is expected to be a reference for women victims of domestic violence to understand the potential for positive growth that can be achieved after facing traumatic events and provide inspiration for their self-recovery process.

Improving subject transfer in EEG classification with divergence estimation

Objective. Classification models for electroencephalogram (EEG) data show a large decrease in performance when evaluated on unseen test subjects. We improve performance using new regularization techniques during model training.Approach. We propose several graphical models to describe an EEG classification task. From each model, we identify statistical relationships that should hold true in an idealized training scenario (with infinite data and a globally-optimal model) but that may not hold in practice. We design regularization penalties to enforce these relationships in two stages. First, we identify suitable proxy quantities (divergences such as Mutual Information and Wasserstein-1) that can be used to measure statistical independence and dependence relationships. Second, we provide algorithms to efficiently estimate these quantities during training using secondary neural network models.Main results. We conduct extensive computational experiments using a large benchmark EEG dataset, comparing our proposed techniques with a baseline method that uses an adversarial classifier. We first show the performance of each method across a wide range of hyperparameters, demonstrating that each method can be easily tuned to yield significant benefits over an unregularized model. We show that, using ideal hyperparameters for all methods, our first technique gives significantly better performance than the baseline regularization technique. We also show that, across hyperparameters, our second technique gives significantly more stable performance than the baseline. The proposed methods require only a small computational cost at training time that is equivalent to the cost of the baseline.Significance. The high variability in signal distribution between subjects means that typical approaches to EEG signal modeling often require time-intensive calibration for each user, and even re-calibration before every use. By improving the performance of population models in the most stringent case of zero-shot subject transfer, we may help reduce or eliminate the need for model calibration.