Individual Quality Indicators Research Articles

Quality indicators prospectively associated with falls in inpatient rehabilitation facilities.

Retrospective studies suggest quality indicators (QI) are associated with falls in inpatient rehabilitation facilities (IRFs), but this claim has not yet been validated prospectively. The aim of this study was to analyze the associations between QI codes and falls in a prospective sample. For this prospective observational cohort study, we followed 658 patients from 4 IRFs who were consecutively admitted and discharged over a 6-month period. On admission, we collected patients' QI codes, and then, tracked whether they fell during their IRF stay. Univariable logistic regressions revealed that most individual QI items for communication, self-care, and mobility were significantly associated with falls. In a multivariable model with 6 different QI items, only patients' performance going up and down 1 step was significantly associated with falls. To explain this finding, we investigated the relationships between these QI items and found 3 of them to be highly correlated. Most individual QI items appear prospectively associated with falls. Patients with lower QI codes are more likely to fall. Combining QI items (such as expression and toileting) may improve fall-risk assessment, but some QI items may be too interrelated to use together.

A survey and analysis of peri-operative quality indicators promoted by National Societies of Anaesthesiologists in Europe: The EQUIP project.

To capture preventable peri-operative patient harm and guide improvement initiatives, many quality indicators (QIs) have been developed. Several National Anaesthesiologist Societies (NAS) in Europe have implemented quality indicators. To date, the definitions, validity and dissemination of such quality indicators, and their comparability with validated published indicators are unknown. The aim of this study was to identify all quality indicators promoted by NAS in Europe, to assess their characteristics and to compare them with published validated quality indicators. A cross-sectional study with mixed methods analysis. Using a survey questionnaire, representatives of 37 NAS were asked if their society provided quality indicators to their members and, if so, to provide the list, definitions and details of quality indicators. Characteristics of reported quality indicators were analysed. The 37 NAS affiliated with the European Society of Anaesthesiology and Intensive Care (ESAIC) at the time. Data collection, translations: March 2018 to February 2020. Representatives of all 37 NAS completed the survey. QIs reported by NAS. Only 12 (32%) of the 37 NAS had made a set of quality indicators available to their members. Data collection was mandatory in six (16.2%) of the 37 countries. We identified 163 individual quality indicators, which were most commonly descriptive (60.1%), anaesthesia-specific (50.3%) and related to intra-operative care (21.5%). They often measured structures (41.7%) and aspects of safety (35.6%), appropriateness (20.9%) and prevention (16.6%). Patient-centred care (3.7%) was not well covered. Only 11.7% of QIs corresponded to published validated or well established quality indicator sets. Few NAS in Europe promoted peri-operative quality indicators. Most of them differed from published sets of validated indicators and were often related to the structural dimension of quality. There is a need to establish a European-wide comprehensive core set of usable and validated quality indicators to monitor the quality of peri-operative care. No registration.

A Cluster-Randomized Control Study Comparing a New Cue “Two Compressions per Second” with “100–120 Compressions per Minute” in Training of Bystander Cardiopulmonary Resuscitation

BackgroundChest compression at a rate of 100–120 compressions per minute (cpm) during cardiopulmonary resuscitation (CPR) is associated with the highest survival rates. Performing compressions at a faster rate may exhaust the rescuers. ObjectivesTo compare a new cue of ‘two compressions per second’ to the traditional cue of ‘100–120 compressions per minute’ on compression rate in CPR training. MethodsIn this cluster-randomized study, students from two senior high schools were assigned into two groups. For the experimental group, the cue for the compression rate was ‘two compressions per second’. For the control group, the cue was ‘100–120 cpm’. Except the different cues, all participants underwent the same standardized CPR training program. Verbal compression rate-related feedback was not obtained during practice. Quality indicators of chest compressions were recorded by a sensorized manikin. The primary outcome measure was mean compression rate at course conclusion. The secondary outcome measures were individual compression quality indicators at course conclusion and 3 months after training. ResultsWe included 164 participants (85 participants, experimental group; 79 participants, control group). Both groups had similar characteristics. The experimental group had a significantly lower mean compression rate at course conclusion (144.3 ± 16.17 vs. 152.7 ± 18.38 cpm, p = 0.003) and at 3 months after training (p = 0.09). The two groups had similar mean percentage of adequate compression rate (≥ 100 cpm), mean compression depth, and mean percentage of complete recoil at course conclusion and 3 months after training. ConclusionThe new cue of ‘two compressions per second’ resulted in participants having a lower compression rate, although it still exceeded 120 cpm.

POST-DESIGN MONITORING OF THE IRRIGATION IMPACT ON THE ENVIRONMENT

Approaches to conducting post-design monitoring of the impact of irrigation on soil condition are highlighted on the example of an individual agricultural farm of LLC "Granex-Cherkasy". The results of the implementation of the five-year post-design monitoring program under the conditions of irrigation by groundwater using sprinkling and drip methods proved the need to develop both unified general approaches to the formation of monitoring programs, as well as the mandatory consideration of the peculiarities of its management under different irrigation methods and hydrogeological-ameliorative conditions on the irrigation sites. As a basis for the development of a system of post-design monitoring of the impact of irrigation on the state of environmental components, it is proposed to use approaches to the organization and performance of local (on-site) monitoring of irrigated lands based on the requirements of current regulatory and methodological documents. The observation system, based on previous studies, included periodic determination of irrigation water quality indicators in storage ponds or in the places of watering and routine observations of soil conditions at permanent monitoring points (observation points), which are recommended to be taken as coordinate points of the previously conducted testing study (at the stage of the preparation of the environmental impact assessment report). The results of the post-design monitoring proved the ecological admissibility of the impact of irrigation within the farm with the groundwater of I and II quality classes (suitable and limitedly suitable according to individual quality indicators). Based on the results of monitoring, it was established that the soils under irrigation did not undergo significant classification changes in terms of deterioration for 5 years. The lack of manifestations of secondary (irrigation) salinization, sodification, and alkalinization of soils under the influence of irrigation indicates the environmental safety of the latter following the accepted standards for indicators of the degree of development of the specified soil degradation processes.

Methods of accounting for measurement uncertainty and semantic uncertainty in the classification of the state of objects according to quality indicators

The paper proposes methods of accounting for measurement uncertainty and semantic uncertainty when consistently using measurement and classification procedures to classify the state of objects according to their quality indicators. Methods of accounting for uncertainty are distinguished by two approaches: the first one is based on accounting for measurement uncertainty when constructing a classification scale, and the second one is based on presenting the result of measuring a quality indicator as a fuzzy number, the carrier of which is the expanded measurement uncertainty. Using these methods, the state of the object can be classified according to one or more categories of the classification scale, indicating the degree of belonging to these categories. Recommendations for the application of two approaches to account for measurement uncertainty in the subsequent classification are given. The use of one or more fuzzy classification scales is recommended when classifying the state of an object by a single quality indicator or by several quality indicators that are combined into a group indicator after classification using the fuzzy logic operators, such as arithmetic mean, as well as pairwise volume operators. When using single and group quality indicators, measurement uncertainty may be accounted for when constructing a classification scale, that is, when using a fuzzy scale. At the same time, the components of the measurement uncertainty preceding the classification and the vagueness of the expert information that may be used in the classification can be accounted for. In this way, the following components of the uncertainty can be defined: instrumental uncertainty and semantic uncertainty. The use of a clear classification scale when presenting the measurement result as a fuzzy number is recommended when classifying the state of the object according to a complex quality indicator that is related to individual quality indicators by a certain dependence or by accounting for the weighting factors of individual quality indicators. It is shown that when accounting for the measurement uncertainty, the state of the object may be classified into one or several categories of the classification scale, indicating the degree of belonging to each category.

Hospital variation in quality indicators for patient blood management in total knee and hip arthroplasty: a retrospective cohort study

BackgroundAnaemia, blood loss, and blood transfusion are critical aspects of patient care in major orthopaedic surgery. We assessed hospital adherence to guideline-recommended Patient Blood Management (PBM) care, analysed variations between hospitals, and validated two composite indicators of hospital PBM performance in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). MethodsThis retrospective cohort study included all primary TKA and THA procedures performed during 2021 across 39 hospitals in Spain. We assessed hospital adherence to key guideline-recommended PBM interventions using nine individual quality indicators and two types of composite quality indicators (cQIs): opportunity-based (cQI1) and all-or-none (cQI2). We validated these cQIs by analysing their associations with the adjusted total transfusion index using linear regression. ResultsWe included 8561 patient episodes from 33 hospitals in the analysis. Delivery of PBM care was similar for TKA and THA. Patients received 62% of the analysed PBM interventions and only 12% of patients underwent the full PBM pathway. Higher hospital cQIs scores were associated with a lower adjusted total transfusion index, both in TKA and THA. The greatest association was found for cQI1 in THA patients (β=−1.18 [95% confidence interval −2.00 to −0.36]; P=0.007). ConclusionsHospital adherence to guideline-recommended patient blood management care in total hip and knee arthroplasty was suboptimal and varied across centres. Using data that are widely available in hospitals, quality indicators and composite scores could become valuable tools for patient blood management monitoring and comparisons between healthcare organisations.

Prediction of individual differences in non-iridescent structural plumage colour from nanostructural periodicity and regularity.

Non-iridescent structural plumage reflectance is a sexually selected indicator of individual quality in several bird species. However, the structural basis of individual differences remains unclear. In particular, the dominant periodicity of the quasi-ordered feather barb nanostructure is of key importance in colour generation, but no study has successfully traced back reflectance parameters, and particularly hue, to nanostructural periodicity, although this would be key to deciphering the information content of individual variation. We used matrix small-angle X-ray scattering measurements of intact, stacked feather samples from the blue tit crown to estimate the sex-dependence and individual variation of nanostructure and its effects on light reflectance. Measures of nanostructural periodicity successfully predicted brightness, ultraviolet chroma and also hue, with statistically similar effects in the two sexes. However, we also observed a lack of overall effect of the nanostructural inhomogeneity estimate on reflectance chromaticity, sex-dependent accuracy in hue prediction and strong sex-dependence in position estimation error. We suggest that reflectance attributes are modified by other feather structures in a sex-specific manner, and that within-individual variation in nanostructural parameters exists within or among feathers and this confounds the interpretation of structure-reflectance relationships at the plumage area level.

Variation in care and outcome for fragile hip fracture patients: a European multicentre study benchmarking fulfilment of established quality indicators.

Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was (1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries. This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients. A large variation both within and between hospitals were seen regarding adherence to the individual QIs. QIs with the lowest overall adherence rates were the administration of systemic steroids (5.4%) and tranexamic acid (20.1%). Indicators with the highest adherence rates (above 95%) were pre-operative (99.3%) and post-operative haemoglobin level assessment (100%). The overall median time to surgery was 22.6h (range 15.7-42.5h). The median LOS was 9.0 days (range 5.0-19.0 days). The most common complications were delirium (23.2%) and postsurgical constipation (25.2%). The present study shows large variation in the care for fragile patients with hip fractures indicating room for improvement. Therefore, hospitals should invest in benchmarking and knowledge-sharing. Large quality improvement initiatives with longitudinal follow up of both process and outcome indicators should be initiated.

Qualimetric assessment of the quality of cold-formed pipes.

To quantify product quality, complex indicators using the principles of qualimetry are increasingly used. The use of complex indicators makes it possible to evaluate and compare product quality for various technological process options, but a unified methodological approach to quality assessment and management has not been formulated. The article lists examples of complex indicator definition in various works and presents an approach to assessing the quality of cold-deformed stainless pipes according to GOST 9941. The results of the analysis of GOST requirements for these products are presented, 15 individual indicators are identified. The values of eight individual quality indicators are defined as the probability of falling into a given interval; for seven individual indicators, the probability calculation was carried out for a quantitative characteristic. The calculated complex indicator is assessed according to the Harrington desirability scale: the range of values 0.37–0.63 is a satisfactory level of quality. To improve the complex criterion to values within the range of “acceptable and good quality level”, recommendations have been formulated in the direction of improving technology

Shelterbelt effects on soil redistribution on an arable slope by wind and water

Soil erosion is the most severe form of land degradation globally. Farmland shelterbelts are important for reducing erosion, especially erosion caused by the co-occurrence of water and wind. However, few studies have focused on how the distance from the shelterbelt associated with farmland topography affects the redistribution of soil quality indicators. The aims of this study is to reveal the relative importance of these two factors to soil quality under typical wind and water erosion conditions concurrent with the Songnen Plain, China. Topsoils (0–10 cm) were sampled at seven distances from the shelterbelt with three replicates, where topography heterogeneity was also considered. We found that the silt/clay content and soil nutrients at sites farther from the shelterbelt were significantly greater than those at sites closer to the shelterbelt (P < 0.05). Similarly, deposition was dominant at sites farther from the shelterbelt and downslope positions, while erosion was dominant at sites closer to the shelterbelt and upslope positions. Moreover, we discovered that the relative influence of distance from the shelterbelt and farmland elevation varied with individual soil quality indicators. Soil nutrients increased through the deposition of more fine-textured soil (silt/clay) positions farther from the shelterbelt. The downslope region responds to soil deposition by enhancing the plough pan thickness and lowering the bulk density and pH. Overall, distance from the shelterbelt and farmland elevation had interactive effects on soil quality, and erosion was primarily affected by distance from the shelterbelt (63.4 %), followed by elevation (22.7 %). Furthermore, the sites closer to the shelterbelt (i.e., 20 to 420 m) warrant particular attention due to the deposition of coarse-texture materials here. This work is crucial for an improved understanding of the synergistic effects of long-term water and wind co-occurrence on soil quality evolution.

Research of geospatial variability of quality indicators of Zlobychi alluvial ilmenite deposit

The paper assesses the geospatial variability of quality indicators of the Zlobychi alluvial ilmenite deposit of the Irsha group of deposits. The variability of quality indicators was also studied. Based on the use of statistical methods, the dependencies between individual quality indicators were established. A close correlation between the ilmenite content and the thickness of the formation, the thickness of the sole and the thickness of the peat, and an average correlation between the thickness of the formation and the thickness of the sole were found. The main result of the research is the construction of complex placer models, which are used to clarify the structure and conditions of the deposit formation, and to identify conditioned and unproductive areas. The correlation between the distribution of ilmenite and the value of the thickness of the ventilation crust was established. The data for determining the optimal development directions are presented and the zones of mineralization are identified.

Incidence, Quality of Care, and Mortality in Hip Fracture Patients in the Course of the COVID Pandemic: A Population-Based Cohort Study.

We assessed the incidence, quality of in-hospital care, and mortality for hip fracture (HF) patients in Denmark before and during the coronavirus disease (COVID) pandemic. We obtained data from the Danish registries in the COVID period (March 11, 2020 to January 27, 2021, overall and in 5 periods) and compared it to a pre-COVID period (March 13, 2019 to March 10, 2020). We calculated the proportion of patients (%) that have fulfilled all the relevant quality indicators (a composite score of 100%) and adjusted hazard ratios (HR) with a 95% confidence interval (CI) for 30-day mortality. The incidence of HF was 5.7 per 1000 person-years both in pre-COVID and COVID periods. About 35% of patients had a composite score of 100% in the COVID period compared to 28% in the pre-COVID period (proportion ratio 1.23 [95% CI: 1.17-1.30]). Fulfillment of all individual quality indicators was similar or higher in the COVID period. 30-day mortality was 9.5% in pre-COVID period, compared to 10.8% in the COVID period (HR 1.15 [95% CI: 1.02-1.30]). HRs varied from 1.07 (95% CI: 0.89-1.29) to 1.31 (95% CI: 1.06-1.62) in 5 COVID periods. In-hospital mortality was 4% in pre-COVID versus 4.4% in COVID period. The incidence of HF in Denmark remained unchanged. The quality of in-hospital care was higher in the COVID compared to pre-COVID period. Unfortunately, 30-day mortality was also higher, highlighting the importance of recognizing diversity of social networks, home support, and digital health intervention after discharge for outcome of HF patients.

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A methodical approach to choosing a rational variant of building a border guard detachment management system is proposed, taking into account its ability to function under martial law. This approach will make it possible to choose a rational variant of building a management system under martial law, to study certain properties of the management system, and also to clarify the requirements for both the management system as a whole and its individual subsystems on the basis of a generalised quality indicator or individual quality indicators of the main properties inherent in the management system even before the start of operational activities (combat operations).

Investigating the Nexus between Stock Market and Institutional Quality in Emerging Markets and Developing Countries: A Panel Data Analysis

Purpose: This study empirically explores the impact of institutional quality on the stock market in Emerging Markets and Developing Countries (EM&amp;DC), study utilizes individual institutional quality indicators as well as aggregated in the form of an institutional quality index and checks their impact on the stock market.&#x0D; Methodology: The study employs a sample of 43 Emerging Markets and Developing Countries for the time duration from 1996 to 2022. By applying the Generalized method of moments (GMM) and Principal Component Analysis (PCA).&#x0D; Findings: The result shows that Institutional quality is not good in these countries and plays a detrimental role in association with the stock market. Mostly individual indicators of institutional quality have a negative and significant impact on the stock market except voice and accountability have a positive and significant impact on the stock market. We also construct an Institutional quality index by applying Principal component analysis (PCA), which also has a negative impact on the stock market.&#x0D; Implications: The findings underscore the importance of institutional factors in shaping the financial development of nations. Through our analysis, it becomes evident that emerging markets and developing countries (EM&amp;DCs) should prioritize enhancing their institutional frameworks, as these play a pivotal role in influencing financial development.

Monitoring of individual indicators of safety and quality of water and fish of Khadzhibey estuary

Water significantly influences the quality and safety of fish because it is the environment for the life and cultivation of fish. A study of hydrochemical and microbiological indicators of the water of Khadzhibey estuary was conducted; the content of heavy metals in it was determined. In the Khadzhibey estuary, from 2022 to 2023, the water acidity indicator was stable, did not exceed the established hygienic standards for fish farms, and was within the range of 7.6 ± 0.4–8.4 ± 0.3 mg/L, which completely meets the requirements for fish farming. The maximum salinity in the estuary is observed in summer and is 15 % higher compared to winter and spring indicators. The water type of the estuary is mixed with moderate mineralization. It was established that the zinc content in water samples from the estuary exceeds the maximum permissible concentration by 2.6 %. The content of Cadmium, Lead, Copper, and Mercury is constant and does not exceed the maximum allowable concentration for fish farms. An increase in zinc content in water is a stress factor and affects the quality of fish meat. The research results showed that the content of mesophilic aerobic and facultative anaerobic organisms does not exceed the maximum permissible level in muscle tissue cultures of common carp and round bull caught by commercial fishing from the Khadzhibey estuary. Escherichia coli bacteria, Staphylococcus aureus, Listeria monocytogenes, and pathogenic microorganisms were not detected in the samples of the fish subject to the study. According to the microbiological indicators of water and fish, common carp and Round goby caught by industrial fishing in the Khadzhibey estuary are safe and allowed for further consumption by humans and animals.

Identifying and locating carotenoids in supra-orbital combs of male black grouse (Lyurus tetrix) using Raman and transmission electron microscopy: A histological study using rehydrated tissue samples.

Colourful signals have long been implicated as indicators of individual quality in animals. Bare-skin signals are an understudied aspect of avian colouration compared with plumage studies, despite displaying rapid changes in size and colour in response to different environmental or physiological stressors. Even fewer studies have focused on the underlying histology of these structures and the importance this plays in the resulting skin colour. Using the Black Grouse (Lyrurus tetrix), we identified the underlying structure of individual dermal spikes, which make up the red supra-orbital comb (a known integumentary signal of male quality), and highlight visual structural differences between combs of different sizes. In addition, we used Raman spectroscopy to indicate the presence of carotenoids within the tissue, something that had previously only been inferred through characteristic reflectance patterns. An increased understanding of the structural basis of colour of featherless parts of the skin opens up exciting new avenues for interpreting the information content of integumentary signals.

Telomere length links with physiological phenotype and breeding patterns in a long-lived seabird

Abstract Telomere length (TL) is known to covary with a suite of physiological traits involved in energy balances that may influence breeding success. Thus, TL may be an indicator of individual quality, influencing mate choice and breeding strategies. In the Brown Booby (Sula leucogaster), a long-lived seabird, we investigated in a total of 72 pairs whether TL may indicate the individual physiological phenotype by examining how it relates to mitochondrial DNA copy number (mtDNAcn) and corticosterone (CORT) levels. Then, we tested if TL is associated with mating patterns by looking for covariation with skin coloration (a condition-dependent sexual trait), whether there is assortative mating by TL, and if the degree of TL similarity between partners influences an individual’s likelihood of changing mates between reproductive seasons. Because environmental conditions can have important effects on the condition and reproductive strategies of individuals, the study was performed in 2 colonies with contrasting breeding conditions. We found that TL was positively related to mtDNAcn (but not CORT levels), suggesting that individuals with shorter telomeres may have a reduced mitochondrial density. TL was reflected in sexual coloration, but only in the colony with good breeding conditions. There was positive assortative mating by TL; however, the degree of assortative mating was unrelated to the probability of mate change, which greatly varied between the 2 colonies. Our results suggest that TL is associated with the physiological phenotype of individuals and their breeding patterns. Importantly, contrasting environmental conditions influenced the link between TL and sexual coloration and the propensity of individuals to change mate, highlighting the importance of environmental variation on mating patterns.

Female state and condition-dependent chemical signaling revealed by male choice of silk trails

Abstract Male mate choice is predicted in systems with high costs of mating, as for those with male nuptial gifts and/or sexual cannibalism. We ask whether males of the nuptial gift-giving spider Pisaura mirabilis exert preferences for mates varying in their reproductive potential based on chemical information during mate search. Males were presented with binary trails consisting of silk lines and substrate-borne chemicals deposited while females were walking, from females varying in 1) body condition (high vs. low), 2) developmental state (subadult vs. adult), and 3) mating state (unmated vs. mated). If female chemical signaling co-varies with individual state, we expect males to choose trails of females that are 1) in higher body condition, indicating higher fecundity, 2) adults, which can successfully reproduce, and 3) unmated, to avoid sperm competition. We show that female signaling is condition-dependent, with males being more likely to follow trails of higher body condition females, but not dependent on female mating state. Males also tended to prefer trails of adults over subadults. Choice did not depend on male individual body condition. Our findings suggest costs to chemical signaling in nutritionally deprived females, often considered negligible, and their potential as reliable indicators of individual quality. Selection may favor male preferences for more fecund partners given the energetic investment nuptial gifts entail. Nutritional and reproductive benefits of multiple mating to females and high share of paternity for males, may instead select against signaling of female mating state, and/or male discrimination and choice.

Sleep quality in women with diabetes in pregnancy: a single-center retrospective study

PurposeSleep quality is an important indicator of individual quality of life, which not only affects people’s mental health but is also closely related to the occurrence of many diseases. Sleep disorders associated with diabetes in pregnancy can greatly endanger the health of both mothers and babies, and their hazards are strongly associated with blood glucose levels. This study explored the quality of sleep and sleep disorders in pregnant women with diabetes.MethodsFrom June 2020 to July 2021, a total of 693 patients diagnosed with diabetes during pregnancy in Gansu Provincial Maternal and Child Health Hospital were used as the experiment group, including 626 patients with gestational diabetes mellitus (GDM) and 67 patients with pregestational diabetes mellitus (PGDM). At the same time, 709 women not having diabetes were randomly selected as the control group. To obtain the general situation of the participants, the participants were surveyed using the Pittsburgh Sleep Quality Index (PSQI) and the STOP-BANG (S, Snoring; T, Tiredness; O, Observed apnea; P, high blood Pressure; B, Body mass index > 35 kg/ m2; A, Age > 50 years; N, Neck circumference > 40 cm; G, male Gender) questionnaire. The differences in sleep quality and obstructive sleep apnea-hypopnea syndrome (OSAHS) were analyzed between the experiment group and the control group by using chi-square and t-test, and the clinical features and related factors of sleep disorder were analyzed.ResultsCompared with the control group, the age, pre-pregnancy weight, body mass index (BMI), and neck circumference were larger in the experimental group (P < 0.05). The experimental group had higher PSQI scores for sleep quality, time to fall asleep score, sleep duration, sleep efficiency, sleep disorder, and daytime dysfunction than the control group (all P < 0.001). Specific analysis of the clinical features of sleep disorders indicated that the experimental group scored higher than the control group (P < 0.05). The analysis of the types of daytime dysfunction showed that the experiment group scored higher in terms of frequently feeling sleepy and lack of energy to do things than the control group (P < 0.05). Analysis of STOP-BANG scores indicated that the proportion of patients with GDM or PGDM having fatigue, hypertension, BMI > 35 kg/m2, and neck circumference > 40 cm was higher than that in the control group (P < 0.05). According to regression analysis, sleep quality of patients with GDM was significantly impacted by the increases in age (OR: 1.243, CI:1.197–1.290), neck circumference (OR: 1.350, CI: 1.234–1.476), PSQI score (OR: 2.124, CI:1.656–2.724), and sleep efficiency score (OR: 3.083, CI:1.534–6.195), whereas that of patients with PGDM was impacted by age (OR: 1.191, CI:1.086–1.305), neck circumference (OR: 1.981, CI: 1.469–2.673), and PSQI score (OR: 7.835, CI: 2.383–25.761).ConclusionsPregnant women with diabetes had poorer sleep quality and a higher risk of developing OSAHS than those without diabetes. There may be some link between sleep quality and the onset of diabetic.

Song complexity is associated with habitat quality in an upland passerine

Understanding the influence of intrinsic (genetic and morphological) and extrinsic (geographical, environmental and social) factors on the performance and spatial differentiation of sexual signals, such as bird song, can help identify behavioural indicators of individual quality, habitat degradation and social environment. We used the Iberian Bluethroat Luscinia svecica azuricollis, a migratory bird that breeds in fragmented landscapes dominated by shrublands, as a case study to: (1) assess how a set of acoustic indicators of song performance are driven by intrinsic and extrinsic factors; and (2) contrast deterministic (adaptations to the environmental context and morphological constraints) vs. stochastic (differentiation by geographical isolation) explanations for song differentiation patterns. We explored acoustic indicators of song performance (spectral, temporal and song complexity) in relation to parameters related to genetic structure, body size, habitat type, habitat quality (assessed through a spatially explicit modelling approach) and social context (population abundance and songbird community composition). Then, we explored the contribution of genetic, geographical and environmental dissimilarity to song diversification across space. Our results highlight an association of song spectral variables with genetic structure and a significant connection between song complexity and duration with habitat quality. We found no relationship between social features and acoustic variables, or between song differentiation and genetic or geographical distances. There was, however, a correlation between song differentiation and environmental dissimilarity. We recommend the consideration of song complexity as an indicator of habitat quality.