Large Population Research Articles

How can digital citizen science approaches improve ethical smartphone use surveillance among youth: Traditional surveys versus ecological momentary assessments.

Ubiquitous use of smartphones among youth poses significant challenges related to non-communicable diseases, including poor mental health. Although traditional survey measures can be used to assess smartphone use among youth, they are subject to recall bias. This study aims to compare self-reported smartphone use via retrospective modified traditional recall survey and prospective Ecological Momentary Assessments (EMAs) among youth. This study uses data from the Smart Platform, which engages with youth as citizen scientists. Youth (N = 77) aged 13-21 years in two urban jurisdictions in Canada (Regina and Saskatoon) engaged with our research team using a custom-built application via their own smartphones to report on a range of behaviours and outcomes on eight consecutive days. Youth reported smartphone use utilizing a traditional validated measure, which was modified to capture retrospective smartphone use on both weekdays and weekend days. In addition, daily EMAs were also time-triggered over a period of eight days to capture prospective smartphone use. Demographic, behavioural, and contextual factors were also collected. Data analyses included t-test and linear regression using Python statistical software. There was a significant difference between weekdays, weekends and overall smartphone use reported retrospectively and prospectively (p-value = <0.001), with youth reporting less smartphone use via EMAs. Overall retrospective smartphone use was significantly associated with not having a part-time job (β = 139.64, 95% confidence interval [CI] = 34.759, 244.519, p-value = 0.010) and having more than two friends who are physically active (β = -114.72, 95%[CI] = -208.872, -20.569, p-value = 0.018). However, prospective smartphone use reported via EMAs was not associated with any behavioural and contextual factors. The findings of this study have implications for appropriately understanding and monitoring smartphone use in the digital age among youth. EMAs can potentially minimize recall bias of smartphone use among youth, and other behaviours such as physical activity. More importantly, digital citizen science approaches that engage large populations of youth using their own smartphones can transform how we ethically monitor and mitigate the impact of excessive smartphone use.

Fried Chocolate Bread with Panir Flour untuk Tumbuh Kembang Anak Pada Pondok Pesantren Wihdatul Ulum Di Desa Bontokassi Kecamatan Parangloe Kabupaten Gowa

Indonesia has a large population, especially children. Chocolate is almost liked by all groups. In addition to being delicious, chocolate also has various benefits forthe body, from improving mood to maintaining heart health. Starting from children, teenagers, to adults, many like to eat chocolate. In addition to its distinctive and delicious taste, chocolate also has health benefits. Chocolate is a processed cocoa bean that is roasted, ground, then formed into a liquid, paste, or in block form. Dark chocolate or dark chocolate contains antioxidants, vitamins, and minerals that are good for the body. Now there are many chocolates that are processed with the addition of sugar, milk, and so on. Instead of getting the health benefits of chocolate, consuming this type of chocolate is dangerous for health. Therefore, if you want to feel the benefits of chocolate, consume dark chocolate without adding excess sugar. because this product has an affordable price and has great benefits.

Association of the distance travelled, and the call to hospital arrival time with early neonatal mortality in neonates born to mothers using emergency medical services at term gestation: a retrospective observational study

BackgroundMost neonatal deaths in India occur due to a lack of timely and proper care just before and during delivery. Timely availability of an ambulance for institutional delivery has led...

Celiac risk doubles in patients with alopecia areata: a nationwide case -control study.

Both alopecia areata (AA) and celiac disease are common immune-mediated diseases. Despite accumulating evidence of bi-directional associations between the two disorders, data remains unclear and inconsistent. In this study we explored the association between alopecia areata and celiac disease in a large representative population cohort. Patients with alopecia areata diagnosed during 2005-2019 were compared with age and gender matched healthy controls for celiac autoimmunity. A total of 33,401 patients with alopecia areata and 66,802 controls were included in the analysis. Overall, 754 patients (0.85) had celiac disease. Compared to controls, celiac prevalence increased twofold among AA patients (1.1% Vs 0.6%, Odds ratio (OR) 1.95, 95% Confidence Interval (CI) 1.69-2.25). Higher prevalence rates were observed among all age groups, with the highest risk in AA patients older than 40 years and older. Alopecia areata may be associated with a significant increased risk for celiac disease, suggesting early diagnostic and preventive measures.

Association between serum folate levels and migraine or severe headaches: A nationwide cross-sectional study.

Migraine and severe headaches are common neurological disorders with significant societal impact. Previous research indicates a potential link between serum folate levels and migraine occurrence, yet there is a lack of sufficient relevant studies and more are required. This study aimed to determine the association between a severe headache or migraine and serum folate levels in large populations. Using data from the National Health and Nutrition Examination Survey, we conducted a cross-sectional study. Using multivariable logistic regression models, we investigated the association between serum folate and severe headache or migraine. In a subsequent subgroup analysis, several confounding factors were also explored to investigate the association between migraine and serum folate. A total of 13,351 individuals participated in the study, with 2742 reporting severe headache or migraine in the previous 3 months. Serum folate was negatively associated with severe headache or migraine (odds ratio [OR] = 0.5, 95% confidence interval [CI] = 0.28-0.89, P = .018). The stratified analysis revealed this association persisted among female (OR = 0.38, 95% CI = 0.18-0.82, P < .001), individuals aged 20 to 50 years (OR = 0.53, 95% CI = 0.28-0.99, P < .001), and non-Hispanic White participants (OR = 0.38, 95% CI = 0.17-0.87, P < .001). We found that greater levels of serum folate were significantly related to a decreased likelihood of migraine onset, especially among women, young and middle-aged populations, and non-Hispanic White participants. Further research is required to validate and expand upon our results.

Time trends in maternal hypertensive disorder incidence in Brazil, Russian Federation, India, China, and South Africa (BRICS): an age-period-cohort analysis for the GBD 2021

ObjectivesMaternal hypertensive disorder (MHD) is a leading cause of significant maternal and fetal mortality and morbidity. The BRICS nations are crucial in the global MHD landscape, given their large populations and varied healthcare infrastructures. This investigation evaluates the incidence trends of MHD in BRICS countries from 1992 to 2021.Study design and methodsData on the number, all-age rate, age-standardized rate (ASR), and the relative change of MHD incidence from this study were sourced from the Global Burden of Disease (GBD) 2021 public dataset to investigate temporal trends in MHD incidence over three decades globally and in BRICS countries. The age-period-cohort (APC) model was used to estimate net drift, local drift, age-specific curves, and period (cohort) relative risks.ResultsA 15.87% increase in global MHD cases, alongside a 13.40% decrease in age-standardized incidence rates from 1992 to 2021. MHD incidence rates are declining across various BRICS age groups, except in China and Russian Federation, where most groups exhibit increasing trends. Annual net drift in MHD incidence ranges from − 4.25% in India to 2.38% in China. A shift in the age distribution of MHD cases from younger to older within the childbearing age range is observed in all BRICS nations. Countries exhibit similar age-effect patterns, with decreasing risk with increasing age, and varying period and cohort effects, indicative of differential control measures and temporal incidence trends.ConclusionsGlobal and BRICS-specific reductions in MHD incidence vary in magnitude. Customized preventive strategies, leveraging existing resources, are advisable for BRICS nations to address pregnancy complications. Enhancing primary healthcare and maternal care quality, particularly for older mothers, is imperative.

Assessment of Perceived Effort Through On-Field Hydration Monitoring: A Case Analysis

This case report examines the correlation between hydration, weight variation, and perceived effort in a 43-year-old amateur athlete during a self-supported 81.5 km crossing of Death Valley, completed over 3 days with significant elevation changes. Studies have shown that a body mass loss greater than 2–3% can lead to an increased perception of effort and a decline in performance. Specifically, during passive and active heat exposures, the average body mass loss was found to be 1.4 ± 0.3% and 4.1 ± 0.7%, respectively. Salivary osmolarity has demonstrated a sensitivity of 86% and specificity of 91% in diagnosing dehydration of ≥ 2%, suggesting its potential as a non-invasive indicator of hydration status. The subject monitored their own body weight, hydration (via salivary osmolarity), and perceived effort using a rate of perceived exertion (RPE) scale. Nutritional intake included isocaloric meals and nutritional bars, and hydration was managed using water and a hydroelectrolytic solution. Key bioimpedance parameters were measured to assess body composition and hydration status. A progressive decrease in body weight correlated with an increase in perceived effort (RPE score) and salivary osmolarity. Resistance (Rx) remained stable, while reactance (Xc) showed a biphasic trend and was inversely correlated with the sodium/potassium ratio (NAK). There were significant linear correlations between perceived effort and both weight loss and salivary osmolarity, indicating that salivary osmolarity is a potential early predictor of these changes. The findings highlight a linear correlation between weight loss, perceived effort, and salivary osmolarity, suggesting that monitoring salivary osmolarity would be useful for the field assessment of hydration and exertion. Further research with larger populations is necessary to validate these observations.

Agricultural Absentee Land Ownership Rules: Problem or Solution for Farmers on Food Resilience Program?

Abstract: Food resilience is a critical aspect of national sustainability programs. with large and diverse population, Indonesia needs to prioritize food resilience as a primary focus of government programs. Empowering Indonesia's predominantly farming population is one way to achieve food resilience. In this regard, the government can utilize absentee land to achieve food resilience goals and improve the welfare of farmers. However, regulations restricting land ownership to civil servants under Article 3 of Government Regulation No. 224 of 1961 hinder the utilization of absentee land. These regulations pose a significant obstacle to farmers who seek to engage in or expand agricultural endeavors. The conflicts arising from these regulations constitute the most substantial barrier to farmers' efforts to realize food resilience programs in Indonesia. This research uses a normative legal research method, focusing on the absent land through statutory and case approaches. The results of this research suggest that absentee land regulations are no longer relevant given the current state of affairs, as they impede the maximization of food resilience, particularly for farmers in the agricultural sector. Keywords: Absentee Land, Farm Land, Food Resilience

The Validation of Whole β-Globin Gene Sequencing for Detecting β-Thalassemia Mutations Found in Thailand Using Next-Generation Sequencing (NGS)

Beta-thalassemia is an inherited disorder prevalent in Thailand and Southeast Asia. Several molecular techniques for identifying β-thalassemia mutations have been reported. Next-generation sequencing (NGS) is a type of effective molecular testing with high throughput and accuracy. Hence, this study aims to evaluate a novel barcode-tagged NGS approach based on a short-read assay. A total of 258 samples with 54 different β-thalassemia genotypes related to 32 mutations were gathered and evaluated. A library was constructed with the BTSeqTM kit and sequencing was performed on the Illumina NGS machine. The validation results showed 98.45% concordance with conventional genotypes. Less discordant results (1.55%) were limited to insertional mutations and included one case of each of the following: HBB:c.27dupG, HBB:c.85dupC, HBB:c.216dupT, and HBB:c.440_441dupAC. Five single-nucleotide polymorphisms that derived from the NGS results were also analyzed in terms of allele frequency and revealed significant differences between the wild types and other β-genotypes. Furthermore, this paper is the first to describe rare single-nucleotide polymorphisms including IVS II-109 (C/T), IVS II-258 (G/A), IVS II-613 (T-C), and IVS II-806 (G/C). Interestingly, the C allele of IVS II-806 was found to have 100% linkage with two cases of Hb Tak. The haplotype and phylogenetic analysis was also constructed based on variants and revealed three clusters in the Hb variants, which represented their evolution and genetic background. Finally, NGS with the barcode-tagged method has a high throughput, which is suitable for large population screening. Its cost effectiveness and less complicated process promote its application in further works.

Emerging Directions in Leveraging Machine Intelligence for Explainable and Equity-Focused Simulation Models of Mental Health

Simulation models support policymakers, clinicians, and community members in identifying and evaluating interventions to improve population health. While these models are particularly valuable to measure the fairness of interventions, such measurements may require simulating massive populations in order to isolate effects for specific groups (e.g., by race and ethnicity, gender, age). This can create a computational bottleneck, forcing tradeoffs such as simplifying a model (thus potentially losing accuracy) or running fewer simulations (thus accepting wider confidence intervals) in exchange for sufficiently large populations. In addition, policymakers, clinicians, and community members can be involved at the design stage of a simulation model but its complex set of rules often tends to preclude participation at later stages. This discussion considers the use of Machine Intelligence to tackle both challenges, by automatically scaling up simulations and explaining them to stakeholders. This potential is illustrated through the public health challenge of mental health, focusing on agent-based models for suicide prevention.

Differentiation of Providencia species bloodstream infections: A population-based analysis

BackgroundAlthough Providencia species are recognised as important causes of bloodstream infections (BSI), their epidemiology is not well defined due to their infrequent occurrence. Our objective was to determine the overall incidence, determinants, and outcomes of Providencia species BSI, and compare the epidemiology of P. stuartii and P. rettgeri in a large population. MethodsAll patients within Queensland, Australia with Providencia species BSI between 2000-2019 were included with clinical and outcome data collected from state-wide datasets. ResultsAmong 268 residents, there was 273 incident episodes of Providencia species BSI; with 118 cases (43.2%) due to P. rettgeri, 150 cases (55.0%) due to P. stuartii, for age and sex adjusted incidence rates of 1.5, and 2.1 per million respectively. Five cases (<2.0%) were due to other Providencia species. The median age was 73.9 years, 80% were male, and most episodes were of community onset. As compared to P. rettgeri, patients with P. stuartii BSI were more likely to have dementia, peptic ulcer disease, and hemiplegia but less likely to have comorbid liver disease. The overall distribution of infection foci were different with P. stuartii more commonly associated with lower respiratory tract source and P. rettgeri with urinary source. All cause 30-day case fatality was significantly higher for P. rettgeri versus P. stuartii (35; 29.7% vs. 24; 16%; p=0.007). ConclusionsProvidencia species are important causes of community onset BSI especially in older males. Although they share similar incidence, P. stuartii and P. rettgeri BSI differ on many clinical aspects.

Hazardous Effects of Battery Waste and Role of the Battery Waste Management Rule 2022 in Enhancing Energy Efficiency

Replacing batteries in present world is challenging because they are extensively utilised in every facet of human existence. These batteries contain a variety of toxic heavy metals, including as cadmium, copper, lead, mercury, nickel, and zinc, all of which pose risks to human health and the environment. Improperly disposing of used batteries in landfills leads to the infiltration of toxic heavy metals and other dangerous compounds into the soil and water over time. India’s long-term development has significant challenges in both reducing CO2 emissions and meeting the energy demands of its large population. This has significantly bolstered the electric vehicle (EV) and renewable energy industries. Battery-based energy storage systems can enhance the management of operational and energy evacuation challenges associated with renewable energy. Consequently, the effective disposal of battery waste is more crucial than battery production. However, it is neglected often, specially in developing and impoverished nations. Three established methods exist for preventing and managing the issues arising from the inappropriate disposal of used batteries. The three R’s are: decrease, replenish, and reuse. This article initially analyses the health and environmental consequences of battery waste, and subsequently highlights the potential of new regulations on battery waste management to effectively handle huge amounts of battery waste and encourage energy conservation.

Validity and reliability of the short-form adolescent health promotion scale among adolescents and young adults in Ghana: methodological study

Background and aimAssessing health promotion among adolescents and young adults is vital to identify healthy and unhealthy behaviours as well as to evaluate health promotion interventions. However, there is no valid and reliable scale to assess health promotion among Ghanaians. For the first time, this study determined the validity and reliability of the original version of the Short‐Form Adolescent Health Promotion (AHP) scale among adolescents and young adults in Ghana.MethodThis cross-sectional methodological study included 617 adolescents and young adults within Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana. A well-structured questionnaire was used to collect sociodemographic data from study participants. The AHP-Scale was also used to collect data on participants health promoting behaviors. The scale’s validity was evaluated using Kaiser-Meyer-Olkin (KMO), Bartlett’s test of sphericity and Exploratory Factor Analysis (EFA), whilst the reliability was assessed using the Cronbach’s ɑ coefficient. Statistical analysis was performed using SPSS software version 26.ResultsThe KMO and the Bartlett’s test of sphericity were reported to be 0.899 and χ2 (276) = 6682.338 respectively, allowing for EFA with orthogonal rotation. The EFA revealed five factors covering 54.62% of the total variance. The factor loading order of the items did not exactly correspond to the order obtained in the original version of the scale’s validity analysis as the original scale had six factors. This six-factor loading scale was valid in regards to construct validity. The obtained factors included: life appreciation, exercise, stress management, nutrition, and social support. In this current study, Cronbach’s ɑ was calculated at 0.87 for the whole scale and between 0.71 and 0.92 for its subscales. Thus, indicating the current scale reliable.ConclusionThe six-factor loading scale of the Adolescent Health Promotion scale developed in the present study is acceptable for the validity and reliability assessment. However, the construct validity of this scale should be checked in other samples as it did not cover a large variance of the population. Large population wide studies are also needed to augment the current study findings with additional modifications for the adopted AHP scale.

Statin prescription disparities in patients with breast cancer and diabetes for primary cardiovascular disease prevention

BackgroundThis brief report examines statin prescription trends for primary cardiovascular disease (CVD) prevention in breast cancer (BC) survivors with diabetes, a large population at particularly high CVD risk.MethodsA population-based, retrospective cohort study was conducted using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked to Medicare claims. We identified women with preexisting diabetes who were diagnosed with stage 0–III primary BC between 2008 and 2017 without preexisting CVD. We assessed statin prescription rates over time and also examined differences in statin prescription rates according to patient sociodemographic characteristics. Using a multivariate logistic regression adjusted for sociodemographic and clinical variables, independent predictors of statin prescription were identified.ResultsOf 8,423 BC patients with diabetes without preexisting CVD, 5,698 (68%) had a statin prescription. Statin prescriptions increased over time (BC diagnosis year 2008–2009: 65%, 2010–2011: 67%, 2012–2013: 66%, 2014–2015: 69%, 2016–2017: 70%; p = 0.01) and differed by age (66–69: 66%, 70–74: 70%, 75–79: 69%, ≥80: 65%; p &amp;lt; 0.01) and race (White: 68%, Black: 62%, Latina: 66%, Other: 72%; p &amp;lt; 0.01). In a multivariate analysis, race (Black vs. White: OR 0.80, 95% CI: 0.68–0.95) remained a predictor of statin prescription.ConclusionIn older early-stage BC survivors, statin prescriptions increased over time and varied by age, race, and BC stage. These findings can potentially inform strategies to improve guideline-concordant statin prescriptions in a group at high risk for CVD and reduce disparities.

Mobile stroke units services in Germany: A cost-effectiveness modeling perspective on catchment zones, operating modes, and staffing.

Investigating the cost-effectiveness of future mobile stroke unit (MSU) services with respect to local idiosyncrasies is essential for enabling large-scale implementation of MSU services. The aim of this study was to assess the cost-effectiveness for varying urban German settings and modes of operation. Costs of different operating times together with different personnel configurations were simulated. Different possible catchment zones, ischemic stroke incidence, circadian distribution, rates of alternative diagnoses, as well as missed cases were incorporated to model case coverage and patient numbers. Based on internationally reported clinical outcomes of MSUs, a 5-year Markov model was applied to analyze the cost-effectiveness for the different program setups. Compared with standard stroke care, MSUs achieved an additional 0.06 quality-adjusted life years (QALYs) over a 5-year time horizon. Assuming a catchment zone of 750,000 inhabitants and 8 h/7 day operation resulted in an incremental cost-effectiveness ratio (ICER) of €37,182 per QALY from a societal perspective and €45,104 per QALY from a healthcare perspective. Lower ICERs were possible when coverage was expanded to 16 h service on 7 days per week and larger populations. Sensitivity analyses revealed that missing ischemic strokes significantly deteriorated economic performance of MSU. Major determinants of cost-effectiveness should be addressed when setting up novel MSU programs. Catchment zones of more than 500,000-700,000 inhabitants and operating times of at least 12-16 h per day, 7 days per week could enable the most cost-effective MSU services in the German healthcare system.

Identification of Factors Associated with Both Frequency and Severity of Deer-Related Motorcycle Crashes.

Motorcyclists are particularly vulnerable to injury when encountering large animals such as deer in the roadway. The frequency of these events, factors associated with their occurrence, and the extent of injuries sustained from such crashes are not yet well described. A review of 10 years (2012-2021) of statewide motorcycle crash reports from a single state with a large deer population was performed to ascertain the frequency of deer-associated motorcycle crashes. Environmental and roadway conditions, as well as motorcyclist age, gender, and helmet usage, were identified to determine if associations exist with the severity of injuries sustained. Statewide, 8.5% of reported motorcycle crashes involved deer. Excluding the two most densely populated counties, this rose to 10.7%, with 24.1% of crashes occurring during non-daylight hours being deer related. Factors associated with increased frequency of more severe injury and death included not wearing a helmet, female gender, and rural county crash location. Death and severe injuries were reported in more than twice as many riders who were unhelmeted compared to those wearing helmets (36.1 vs 16.6%; p < 0.01). In a single midwestern state, deer represent a significant danger to motorcyclists, especially in rural settings during non-daylight hours. A cautious approach to riding during this time, utilizing available safety precautions to minimize risk of severe injury and death, and further exploration of viable interventions to reduce the likelihood of these occurrences should be considered.

Competition and coordination between traditional and internet hospitals

AbstractMotivated by the recent emergence and rapid growth of online healthcare platforms, this paper investigates its impacts on the healthcare ecosystem by taking into consideration of heterogeneous patients, homogeneous service providers and profit-driven hospitals. A game-theoretical model with a queueing framework is developed, and two healthcare systems are considered, including a monopolistic system with either an offline, traditional hospital, or an online, Internet hospital, and a duopolistic system with both kinds of hospitals. Our study finds that in both systems a large population of patients always increases the healthcare supply and demand and the hospital utilization, which leads to an improvement not only in the hospital profitability, but also in the welfare of both patients and service providers. When considering a monopolistic system only, our study suggests that the monopolistic Internet hospital outperforms its counterpart in hospital utilization only when the wait cost is not high (i.e., patients are less sensitive to wait time), especially when the wait cost is medium and the patient-provider ratio is small. When considering a duopolistic system, this study concludes that the decisions of patients, service providers, and hospital managers of both hospitals are interrelated, and that a large population of service providers increases its hospital’s supply, demand, and wage rate, while decreases its wait times. When comparing the two monopolistic with the duopolistic system, the latter outperforms and improves every entity’s utility (i.e., patients, hospital, and society) when there is abundance of service providers with more being allocated to the Internet hospital, whereas the monopolistic system dominates when the patient population is large, and more providers are allocated to the traditional hospital.

First Seroprevalence Study of Feline Leukemia and Feline Immunodeficiency Infections Among Cats in Algiers (Algeria) and Associated Risk Factors

Feline leukemia and feline immunodeficiency virus infections are two widespread diseases that affect the health of domestic cats all over the world. In Algeria, despite the existence of a large population of cats, there are no published data regarding the epidemiological status of feline retroviruses. Therefore, the objective of the present study was to estimate the seroprevalence of FIV and FeLV infections in cats in Algiers and to assess the main factors associated with the infection. A cross-sectional study was conducted in which 71 cats were sampled from several private veterinary clinics, and their obtained sera were tested using an immunochromatography analysis (SNAP Duo FIV/FeLV Test; Virbac Laboratories, France). The seroprevalence was about 32.39% and 22.53% for FIV and FeLV, respectively. Overall, 11.26% were positive for both infections. The present study showed that FIV seropositivity was associated with a younger age and health status (p &lt; 0.05), while FeLV seropositivity was associated with the sex, reproductive status, housing, age, and health status of the cats. This preliminary study, which utilized rapid tests, provides important initial data revealing a relatively high prevalence of retroviruses in cats in Algeria. The results underscore the urgent need for implementing both preventive and management measures to control the spread of these retrovirus diseases. However, to enhance the reliability of future findings, it is essential to expand the sample size and incorporate reference diagnostic methods.

Population size rescaling significantly biases outcomes of forward-in-time population genetic simulations.

Simulations are an essential tool in all areas of population genetic research, used in tasks such as the validation of theoretical analysis and the study of complex evolutionary models. Forward-in-time simulations are especially flexible, allowing for various types of natural selection, complex genetic architectures, and non-Wright-Fisher dynamics. However, their intense computational requirements can be prohibitive to simulating large populations and genomes. A popular method to alleviate this burden is to scale down the population size by some scaling factor while scaling up the mutation rate, selection coefficients, and recombination rate by the same factor. However, this rescaling approach may in some cases bias simulation results. To investigate the manner and degree to which rescaling impacts simulation outcomes, we carried out simulations with different demographic histories and distributions of fitness effects using several values of the rescaling factor, Ǫ, and compared the deviation of key outcomes (fixation times, allele frequencies, linkage disequilibrium, and the fraction of mutations that fix during the simulation) between the scaled and unscaled simulations. Our results indicate that scaling introduces substantial biases to each of these measured outcomes, even at small values of Ʈ. Moreover, the nature of these effects depends on the evolutionary model and scaling factor being examined. While increasing the scaling factor tends to increase the observed biases, this relationship is not always straightforward, thus it may be difficult to know the impact of scaling on simulation outcomes a priori. However, it appears that for most models, only a small number of replicates was needed to accurately quantify the bias produced by rescaling for a given Ʈ. In summary, while rescaling forward-in-time simulations may be necessary in many cases, researchers should be aware of the rescaling procedure's impact on simulation outcomes and consider investigating its magnitude in smaller scale simulations of the desired model(s) before selecting an appropriate value of Ʈ.

Long-Term Cancer Outcomes Following Bariatric Surgery: A Comparative Analysis of Surgical Procedures

Background/Objectives: Metabolic and bariatric surgery (MBS) is known to reduce cancer risk. However, the association between specific bariatric procedures and cancer incidence is not well-studied. This study examined the association between four different MBS procedures and cancer incidence. Methods: Bariatric surgery registry data were linked with statewide cancer registry data from 1979 to 2018. The study included 27,092 adult subjects (aged ≥ 18 years old at surgery) who underwent MBS (BMI ≥ 30 kg/m2 at surgery) from 1979 to 2017. Cancer records were linked to MBS patient records, resulting in 1547 cancer cases. Cox proportional hazards regression was used to examine the association between MBS procedure types and cancer incidence. Results: Of all patients, 75% underwent Roux-en-Y gastric bypass (RYGB), 9% adjustable gastric banding (AGB), 10% sleeve gastrectomy (SG), and 6% duodenal switch (BPD-DS). The overall cancer incidence during the follow-up period was 6.4% for RYGB, 4.6% for AGB, 1.6% for SG, and 5.9% for BPD-DS. The mean follow-up duration from surgery to cancer incidence or censoring was 167 months (standard deviation = 121 months). Compared to RYGB, patients who underwent AGB (Hazard Ratio [HR] = 1.26, p = 0.03) and BPD-DS (HR = 1.91, p &lt; 0.01) had a significantly higher hazard of developing cancer, while SG (HR = 1.17, p = 0.33) showed no significant difference. Conclusions: These findings suggest that AGB and BPD-DS may be associated with higher cancer risks compared to RYGB. Additional large population studies are needed to better understand the long-term cancer risks and mechanisms associated with different MBS types.