Logistic Regression Procedures Research Articles

Risk of frailty and associated factors among community older adults during the COVID-19 pandemic

Introduction: Functional decline represents the main determinant of negative outcomes in the health of older adults, such as the development of other disabilities, which may result in frailty, institutionalization, hospitalization and death. Aim: To determine the prevalence of risk of frailty among community older adults during the covid-19 pandemic and identify its association with health risk behaviors. Methods: An epidemiological screening type research, with cross-sectional design and sample representative of the Federal District, Brazil, was carried out. Data were collected through electronic questionnaire. In order to answer the problem question, the Clinical-Functional Vulnerability Index – IVCF-20 instrument was used (with risk ≥7 points), complemented by questions about demographic factors, socioeconomic factors and health risk behaviors. For data analysis, descriptive (frequency distribution and confidence interval) and association (crude and adjusted binary logistic regression) procedures were used. Results: Data from 1,363 older adults were analyzed (66.0%=female; 34.0%=male), the majority aged 60-74 years (82.2%), with higher education level (50.1%), who did not live alone (76.6%). There was high prevalence of older adults exposed to risk of frailty (30.7%; CI 95%=26.3-35.1), insufficiently active (45.6%; CI 95%=41.7-49.5) and who did not practice physical exercises before (30.2%; CI 95%=25.8-34.6) and during the physical distancing resulting from the covid-19 pandemic (53.4%; CI95%=49.8-57.0). Risk of frailty was associated with insufficient level of physical activity (OR=3.37; 95% CI 2.59-4.39) and with not practicing physical exercise before (OR=1.54; 95% CI 1. 17-2.03) and during physical distancing resulting from the covid-19 pandemic (OR=2.07; 95% CI 1.58-2.69). Conclusions: Considering the relevance and potential of physical exercise for older adults in contributing to functional improvement and health conditions, strategies to maintain active habits, even in periods of physical distancing as imposed by the covid-19 pandemic, are needed.

Incidence, risk factors and treatment of central nervous system immune reconstitution inflammatory syndrome in non-HIV patients with tuberculous meningitis: a multicentre observational study.

Immune reconstitution inflammatory syndrome (IRIS) affecting the central nervous system (CNS) is associated with poor outcomes. To report on risk factors for CNS-IRIS following tuberculous meningitis (TBM) in HIV-negative patients. In this retrospective multicentre study, all HIV-negative adult patients admitted between 2003 and 2021 with microbiologically proven TBM were included. The primary outcome measure was IRIS onset over follow-up. Characteristics of patients who developed IRIS were described. Factors associated with IRIS were identified using a multivariable logistic regression procedure. Fifty-six patients (33.0 (27.0-44.3) years, 39 (69.6%) men) with microbiologically proven TBM were studied. All patients received antituberculosis treatment and 48 (n = 48/56; 85.7%) steroids at TBM diagnosis. During a median follow-up of 18.0 (12.0-27.3) months, IRIS occurred in 28 (n = 28/56, 50.0%) patients, at a median time of 2.0 (1.0-3.0) months after antituberculosis treatment was started. IRIS involved the CNS in all but one case. Imaging revealed new (n = 23/28, 82.1%) and/or worsening (n = 21/28; 75.0%) of previously recognised lesions. Multivariable analysis showed that meningeal enhancement on brain magnetic resonance imaging (MRI) (odds ratio (OR): 15.3; 95% confidence interval (CI): (1.19-1193.5)) at TBM diagnosis and high blood albumin level (OR: 1.21; 95% CI: (1.02-1.60)) were associated with the occurrence of CNS-IRIS during follow-up. CNS-IRIS following TBM in non-HIV patients appears frequent and severe. Meningeal enhancement on brain MRI at tuberculosis diagnosis is a risk factor for CNS-IRIS.

Factors Associated with Treatment Receipt in Medicare Beneficiaries Diagnosed with Acute Myeloid Leukemia

Background: The treatment a patient with AML receives may be influenced by where the patient is diagnosed and the physician making the initial diagnosis. Such factors could be targeted for intervention to help ensure patients receive optimal treatment; however, data constraints have previously limited a complete examination of patient, physician and hospital factors associated with treatment for AML. This study aimed to investigate the association of patient, hospital, and physician factors with treatment receipt for patients diagnosed with AML. Treatment receipt included allogeneic hematopoietic cell transplant (alloHCT) or chemotherapy without alloHCT among patients who received a National Marrow Donor Program (NMDP) donor search (search). Methods: Centers for Medicare and Medicaid (CMS) Medicare administrative claims data from 2010 to 2018 were linked to NMDP Donor Search data and to publicly available CMS and National Provider Identifier physician and hospital datasets. Patients aged 65-74 diagnosed with AML between 2010 and 2017 and enrolled in fee-for-service (Part A and B) Medicare for at least one year after diagnosis or until death, were included. The treatment groups (alloHCT and search) were identified using diagnosis and procedure codes. A multivariable hierarchical logistic regression procedure was performed to determine factors associated with treatment receipt, with hospital as a random effect. Models were adjusted for patient, hospital and physician characteristics identified at the time of diagnosis. Patients missing physician and hospital characteristics were excluded. Individuals with a racial/ethnic background of Black/African-American, Asian/Pacific Islander, Hispanic, American Indian/Alaska Native, and Other were grouped due to small numbers. All analyses were performed using Statistical Analysis Software (SAS ®) Enterprise Guide 7.1. Results: A total of 916 patients met eligibility criteria: 554 (60%) received alloHCT; 362 (40%) received search. The majority of patients in both groups were Non-Hispanic White and were age 65-69 years. A multivariable model demonstrated the variables associated with receipt of alloHCT (Figure 1). Characteristics significantly associated with decreased odds of receiving alloHCT were sex (male compared to female), race/ethnicity (a combined category of Black/African-American, Asian/Pacific Islander, Hispanic, American Indian/Alaska Native, and Other compared to Non-Hispanic White), living in an area with a lower percentage of population with a college education, age (71-75 compared to 65-69 years), and chemotherapy provision (chemotherapy not compared to provided by staff). Conclusion: This study used novel linked datasets to identify the association of patient, hospital, and physician characteristics at time of diagnosis with receipt of alloHCT, compared to patients who received a search but not an alloHCT. Notably, patient characteristics, and the hospital characteristic of provision of chemotherapy by hospital staff were associated with alloHCT receipt. Donor availability may contribute to the decreased odds of alloHCT by race/ethnicity, but studies to increase HLA-mismatched unrelated alloHCT are helping to decrease this barrier. Neighborhood education attainment was used as a proxy for socioeconomic status (SES), and SES has been associated with access to care. Ensuring treatment information is accessible and available in plain language may help patients considering different treatment options. Claims data is not collected for research, and has some inherent limitations, including the lack of disease severity, cytogenetics, patient preferences, and an algorithm was used to identify diagnosing physician and hospital. Additionally, this analysis includes patients who were able to access a transplant center to receive a search or alloHCT. Next steps will compare characteristics of those who received chemotherapy but did not receive a search to those who received a search and those who received an alloHCT. Study results will be used to help inform strategies aimed at improving access to treatment for patients diagnosed with AML.

Detecting differential item functioning with multiple causes: A comparison of three methods

Differential item functioning (DIF) often arises from multiple sources. Within the context of multidimensional item response theory, this study examined DIF items with varying secondary dimensions using the three DIF methods: SIBTEST, Mantel-Haenszel, and logistic regression. The effect of the number of secondary dimensions on DIF detection rates was investigated with several test conditions such as the percentage of DIF items, item loadings, the correlation between primary and secondary dimensions, and DIF magnitude. Results indicate that both the Mantel–Haenszel and logistic regression procedures performed effectively in detecting DIF when multiple secondary dimensions were present.

Lifestyle and Health Behaviors Associated with Metabolic Syndrome and Cardiovascular Disease.

Background: As the prevalence of cardiovascular disease increases, the socioeconomic burden is expected to increase further. This study aimed to investigate lifestyle and health behaviors related to metabolic syndrome (MetS), myocardial infarction (MI), and stroke prevalence in men and women 50-79 years of age to assess clustering of risk factors. Methods: This study used raw data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES) in 2021. Collected data were analyzed using SPSS 29.0 program. Complex Samples General Linear Model procedure and Complex Samples Logistic Regression procedure were performed. Results: Body mass index of more than 25.0 kg/m2, being a woman, having a middle school education or less, reporting a lower middle economic status, and performing exercise for less than 150 min a week were associated with MetS prevalence. Stress was associated with MI prevalence in men and women. Depression was associated with stroke prevalence in men. Conclusions: This study found that an education on obesity control in men and women is needed to reduce the prevalence of MetS. To reduce the prevalence of MI, stress management is required for men and women. To decrease stroke prevalence, depression management is needed for men.

Efficacy of an automated technology at detecting early postpartum estrus events: Can we detect resumption of cyclicity?

The objective of this observational study was to evaluate the efficacy of a neck-mounted automated activity monitor (AAM) at detecting early postpartum resumed ovarian cyclicity. A total of 192 lactating cows (primiparous = 73 and multiparous = 119) were enrolled in this study. Cows were continuously monitored by a neck-mounted AAM early postpartum (7 to 30 d in milk; DIM). Calving was classified as assisted (forced extraction of a calf) or unassisted (normal calving). Retained fetal membrane, metritis, hyperketonemia, clinical mastitis, and milk production were recorded. Cows were classified as healthy (i.e., no disease events) or sick (i.e., any disease event). Estrus events were alerted by the AAM using a proprietary algorithm set by the AAM company. Blood samples, from the coccygeal vein, were collected at 15, 18, 21, 24, 28, and 30 DIM for progesterone (P4) analysis. Resumption of cyclicity was considered when P4 concentration was ≥1 ng/mL on any collection day. Cows were considered anovular when P4 concentration was <1 ng/mL on all collection days. Cows were classified as true positive: P4 ≥ 1 ng/mL and at least one estrus alert; false positive: P4 < 1 ng/mL and at least one estrus alert; true negative: P4 < 1 ng/mL and no estrus alerts; and false negative: P4 ≥ 1 ng/mL and no estrus alerts. Statistical analyses were performed by frequency distribution and mixed effects logistic regression procedures on SAS (SAS Institute Inc.). The specificity, sensitivity, accuracy, and positive predictive value of the sensor to detect cows that had resumed cyclicity were 84.0%, 34.1%, 52.1%, and 79.2%, respectively. Out of the 192 cows, 35.9% (69/192) were anovulatory and 37.5% (72/192) had no estrus events between 7 to 30 DIM. Healthy cows were more likely to resume cyclicity in early lactation compared with cows that were sick (78.3 ± 1.9 vs. 32.8 ± 3.1%, respectively) independent of parity. In conclusion, the sensor had a high specificity for detecting anovular cows, but it had lower sensitivity, and thus was not effective at detecting cyclic cows, perhaps due to silent ovulation early postpartum.

Advance care planning and outpatient visits among older adults across cognitive levels

Advance care planning (ACP) can help reduce end-of-life care challenges for persons with Alzheimer's disease and related dementia and their care partners. Building on our previous work, we examined the impact of ACP on outpatient/doctor visits in older adults with dementia/impaired cognition and normal cognition. Using datasets from the 2014 Health and Retirement Study (HRS), we conducted a cross-sectional study of 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. Our findings indicated that having at least one ACP measure was significantly associated with a higher mean number of outpatient visits in both cognition groups. Based on our findings, we recommend considering healthcare access and use as an intervening variable in future ACP research.

Distinctive Features of Organized Rescue Volunteering in Russia

Introduction. This article presents the results of the first comprehensive study on volunteer participation in the field of rescue work in modern Russia. The study utilized data collected through an online survey of volunteers from rescue organizations to examine the socio-demographic characteristics of volunteers, their motives and values, the experiences they gained, and their perspectives on various aspects of volunteering and rescue activities. The objective of this study is to identify the distinct features of civic participation in this field. Materials and Methods. The study has relied on the findings of a large-scale online survey of Russian volunteers. Descriptive statistical methods were employed to analyze the data, including frequency analysis and contingency tables using the Chi-square criterion. These methods were particularly useful in characterizing the socio-demographic profile of volunteers, their most common practices, and their motivational structure. Additionally, the method of value portraiture by S. Schwartz was used to identify the value structure of rescue volunteers, while a comparison of average values was conducted. To investigate the predictors of volunteer activity termination, the study applied binary logistic regression procedures. Results. The study has identified several characteristics of volunteers in the field of rescue work. Volunteers tend to have a higher social status, holding positions in the professional hierarchy comparable to mid- and top-level specialists. They also tend to have a university degree, an above-average income, a family, children, and personal transportation. The study has also found that the organization plays a significant role in the continued participation and self-identification of volunteers. Conflicts within the community emerge as the primary predictor of volunteer disengagement, along with factors such as income decrease, family circumstances, and changes in personal interests. Discussion and Conclusion. The study has highlighted the challenge of distinguishing between collective and reflexive styles of participation in rescue volunteering. Further research is needed to understand the role of the organizational factor in shaping the professional and moral development of rescue volunteers, by analyzing entry into and continuation of volunteer participation over time, as well as exploring qualitative data on participation in rescue organizations. Practically, the findings presented in this article can be utilized by volunteer and rescue organizations to engage volunteers in rescue work, enhance motivation among existing volunteers, and establish guidelines and recommendations for collaboration between volunteers and official services.

Advanced repeated structuring and learning procedure to detect acute myocardial ischemia in serial 12-lead ECGs

Objectives. Acute myocardial ischemia in the setting of acute coronary syndrome (ACS) may lead to myocardial infarction. Therefore, timely decisions, already in the pre-hospital phase, are crucial to preserving cardiac function as much as possible. Serial electrocardiography, a comparison of the acute electrocardiogram with a previously recorded (reference) ECG of the same patient, aids in identifying ischemia-induced electrocardiographic changes by correcting for interindividual ECG variability. Recently, the combination of deep learning and serial electrocardiography provided promising results in detecting emerging cardiac diseases; thus, the aim of our current study is the application of our novel Advanced Repeated Structuring and Learning Procedure (AdvRS&LP), specifically designed for acute myocardial ischemia detection in the pre-hospital phase by using serial ECG features. Approach. Data belong to the SUBTRACT study, which includes 1425 ECG pairs, 194 (14%) ACS patients, and 1035 (73%) controls. Each ECG pair was characterized by 28 serial features that, with sex and age, constituted the inputs of the AdvRS&LP, an automatic constructive procedure for creating supervised neural networks (NN). We created 100 NNs to compensate for statistical fluctuations due to random data divisions of a limited dataset. We compared the performance of the obtained NNs to a logistic regression (LR) procedure and the Glasgow program (Uni-G) in terms of area-under-the-curve (AUC) of the receiver-operating-characteristic curve, sensitivity (SE), and specificity (SP). Main Results. NNs (median AUC = 83%, median SE = 77%, and median SP = 89%) presented a statistically (P value lower than 0.05) higher testing performance than those presented by LR (median AUC = 80%, median SE = 67%, and median SP = 81%) and by the Uni-G algorithm (median SE = 72% and median SP = 82%). Significance. In conclusion, the positive results underscore the value of serial ECG comparison in ischemia detection, and NNs created by AdvRS&LP seem to be reliable tools in terms of generalization and clinical applicability.

Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels.

This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8% had normal cognition, and 22% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.

A-trait and risk-taking behavior in predicting injury severity among martial arts athletes.

Trait anxiety (A-trait) can be seen as a multiplicative function of the person-situation interaction. Considering risk-taking behavior (R-TB), literature highlights instrumental and stimulating risk. The aim of the research is to investigate the level of A-trait (in physically dangerous conditions and in new, unusual situations) and the level of R-TB (instrumental and stimulating risk) in athletes, and to verify to what extent A-trait and risk-taking behavior predict injury severity. One hundred and fifty-four senior martial arts athletes from grappling combat sports, striking combat sports and mixed martial artists (MMA) participated in the study. For assessing trait anxiety and risk-taking behavior, the Romanian adaptation of the Endler Multidimensional Anxiety Scales (EMAS), respectively the Romanian adaptation of the Makarowski's Stimulating and Instrumental Risk Questionnaire were used. Using multivariate analysis of variance, significant differences between athletes (according to the sports disciplines practiced), in terms of A-trait and R-TB, were examined. Next, we checked the existing correlations between injury severity, A-trait and R-TB scores in athletes practicing striking combat sports, grappling combat sports and MMA. To verify whether there are significant differences in terms of trait anxiety, stimulating and instrumental risk between athletes who have suffered mild, moderate and/or severe injuries and athletes who have suffered only minor/mild injuries, t-Test for Independent Samples was used. Binomial logistic regression procedures were, also, performed, predicting athletes' likelihood of injury, based on R-TB and A-trait. A moderate or slightly below average level of anxiety in new, unusual situations and a higher level of instrumental risk are linked with a decreased likelihood of severe injuries in athletes. Martial arts athletes (in entire sample) who have suffered more severe injuries are more adrenaline-seeking in competition and use less rational thinking, taking more pleasure in just performing technical executions, regardless of the outcome.

A Preliminary Study of the Efficacy of Using a Wrist-Worn Multiparameter Sensor for the Prediction of Cognitive Flow States in University-Level Students.

Engagement is enhanced by the ability to access the state of flow during a task, which is described as a full immersion experience. We report two studies on the efficacy of using physiological data collected from a wearable sensor for the automated prediction of flow. Study 1 took a two-level block design where activities were nested within its participants. A total of five participants were asked to complete 12 tasks that aligned with their interests while wearing the Empatica E4 sensor. This yielded 60 total tasks across the five participants. In a second study representing daily use of the device, a participant wore the device over the course of 10 unstructured activities over 2 weeks. The efficacy of the features derived from the first study were tested on these data. For the first study, a two-level fixed effects stepwise logistic regression procedure indicated that five features were significant predictors of flow. In total, two were related to skin temperature (median change with respect to the baseline and skewness of the temperature distribution) and three were related to acceleration (the acceleration skewness in the x and y directions and the kurtosis of acceleration in the y direction). Logistic regression and naïve Bayes models provided a strong classification performance (AUC > 0.7, between-participant cross-validation). For the second study, these same features yielded a satisfactory prediction of flow for the new participant wearing the device in an unstructured daily use setting (AUC > 0.7, leave-one-out cross-validation). The features related to acceleration and skin temperature appear to translate well for the tracking of flow in a daily use environment.

Prevalence and risk factors for ototoxicity after cisplatin-based chemotherapy.

Ototoxicity is a prominent side effect of cisplatin-based chemotherapy. There are few reports, however, estimating its prevalence in well-defined cohorts and associated risk factors. Testicular cancer (TC) survivors given first-line cisplatin-based chemotherapy completed validated questionnaires. Descriptive statistics evaluated the prevalence of ototoxicity, defined as self-reported hearing loss and/or tinnitus. We compared patients with and without tinnitus or hearing loss using Chi-square test, two-sided Fisher's exact test, or two-sided Wilcoxon rank sum test. To evaluate ototoxicity risk factors, a backward selection logistic regression procedure was performed. Of 145 TC survivors, 74% reported ototoxicity: 68% tinnitus; 59% hearing loss; and 52% reported both. TC survivors with tinnitus were more likely to indicate hypercholesterolemia (P = 0.008), and difficulty hearing (P < .001). Tinnitus was also significantly related to age at survey completion (OR = 1.79; P = 0.003) and cumulative cisplatin dose (OR = 5.17; P < 0.001). TC survivors with hearing loss were more likely to report diabetes (P = 0.042), hypertension (P = 0.007), hypercholesterolemia (P < 0.001), and family history of hearing loss (P = 0.044). Risk factors for hearing loss included age at survey completion (OR = 1.57; P = 0.036), hypercholesterolemia (OR = 3.45; P = 0.007), cumulative cisplatin dose (OR = 1.94; P = 0.049), and family history of hearing loss (OR = 2.87; P = 0.071). Ototoxicity risk factors included age, cisplatin dose, cardiovascular risk factors, and family history of hearing loss. Three of four TC survivors report some type of ototoxicity; thus, follow-up of cisplatin-treated survivors should include routine assessment for ototoxicity with provision of indicated treatments. Survivors should be aware of risk factors associated with ototoxicity. Referrals to audiologists before, during, and after cisplatin treatment is recommended.

Advance Care Planning Among Older Adults with Cognitive Impairment.

In this study, we used data from the Health and Retirement Study (HRS) to investigate factors associated with older adults' engagement with advance care planning (ACP) across varying levels of cognitive functioning status. Our analysis used a sample of 17,698 participants in the HRS 2014 survey. Survey descriptive procedures (Proc SurveyMeans, Proc SurveyFreq) and logistic regression procedures (Proc SurveyLogistic) were used. Race, ethnicity, level of cognition, education, age, and number of chronic diseases consistently predicted ACP. Participants with lower levels of cognition were less likely to have a living will and durable power of attorney for healthcare (DPOAH). African American and Hispanic participants, younger participants, and those with lower cognition and education levels were less likely to engage in ACP. Marital status and loneliness predicted ACP engagement. Some results varied across the cognition cohorts. Our results indicated that sociodemographic status, together with health and cognitive status, has a significant role in predicting ACP. The results can provide valuable insights on ACP for older adults with or at risk of Alzheimer's disease and related dementia and other cognitive impairments, caregivers, families, and healthcare providers.

Prevalence and predictors of atlanto-axial subluxation in rheumatoid arthritis after 12-years' follow-up (ESPOIR Cohort).

Anterior atlanto-axial subluxation (AAS), defined as an anterior atlanto-dental interval ≥3 mm, can occur in RA and carries a risk of severe neurological impairments. Our objective was to determine the prevalence and predictors of radiographic aAAS after 12 years' follow-up of patients with early polyarthritis. We studied patients enrolled in the early polyarthritis cohort ESPOIR (Study and Monitoring of Early Undifferentiated Arthritis) between 2002 and 2005 (at least two swollen joints for >6 weeks and <6 months, no other diagnosis than RA, and no previous exposure to glucocorticoids or DMARDs). All patients still in the cohort after 12 years had dynamic cervical-spine radiographs taken then read by two blinded observers. To evaluate how well combinations of tests performed at baseline and 10 years predicted aAAS after 12 years, univariate analysis and multiple logistic regression procedure were applied. Of 323 patients followed for 12 years, 15 (4.6%; 95% CI 2.8, 6.4) had aAAS. Among baseline variables, only IgA RFs were associated (P < 0.05) with aAAS (sensitivity 60%, specificity 75%). Among data collected after 10 years, oral CS therapy during the 10-year interval, treatment by DMARDs, CRP (mg/dl) and positive tests for RFs were associated with aAAS after 12 years, but only CRP and RFs remained in a model of logistic regression (combination predicted aAAS with a sensitivity of 60% for a specificity of 90%). In conclusion, the prevalence of aAAS after 12 years was 4.6% in the ESPOIR cohort, with no patients having severe aAAS. Although some factors were found to be statistically associated to AAS, the event is too rare to allow a clinical relevance.

Changes in abdominal adipose tissue depots assessed by MRI correlate with hepatic histologic improvement in non-alcoholic steatohepatitis

Non-alcoholic steatohepatitis (NASH) is prevalent in adults with obesity and can progress to cirrhosis. In a secondary analysis of prospectively acquired data from the multicenter, randomized, placebo-controlled FLINT trial, we investigated the relationship between reduction in adipose tissue compartment volumes and hepatic histologic improvement. Adult participants in the FLINT trial with paired liver biopsies and abdominal MRI exams at baseline and end-of-treatment (72 weeks) were included (n= 76). Adipose tissue compartment volumes were obtained using MRI. Treatment and placebo groups did not differ in baseline adipose tissue volumes, or in change in adipose tissue volumes longitudinally (p= 0.107 to 0.745). Deep subcutaneous adipose tissue (dSAT) and visceral adipose tissue volume reductions were associated with histologic improvement in NASH (i.e., NAS [non-alcoholic fatty liver disease activity score] reductions of ≥2 points, at least 1 point from lobular inflammation and hepatocellular ballooning, and no worsening of fibrosis) (p= 0.031, and 0.030, respectively). In a stepwise logistic regression procedure, which included demographics, treatment group, baseline histology, baseline and changes in adipose tissue volumes, MRI hepatic proton density fat fraction (PDFF), and serum aminotransferases as potential predictors, reductions in dSAT and PDFF were associated with histologic improvement in NASH (regression coefficient= -2.001 and -0.083, p= 0.044 and 0.033, respectively). In adults with NASH in the FLINT trial, those with greater longitudinal reductions in dSAT and potentially visceral adipose tissue volumes showed greater hepatic histologic improvements, independent of reductions in hepatic PDFF. NCT01265498. Although central obesity has been identified as a risk factor for obesity-related disorders including insulin resistance and cardiovascular disease, the role of central obesity in non-alcoholic steatohepatitis (NASH) warrants further clarification. Our results highlight that a reduction in central obesity, specifically deep subcutaneous adipose tissue and visceral adipose tissue, may be related to histologic improvement in NASH. The findings from this analysis should increase awareness of the importance of lifestyle intervention in NASH for clinical researchers and clinicians. Future studies and clinical practice may design interventions that assess the reduction of deep subcutaneous adipose tissue and visceral adipose tissue as outcome measures, rather than simply weight reduction.

Litter size, litter weight, and lamb survivability of Doyogena sheep managed under community-based breeding program in Ethiopia

Increasing litter size and weight during the marketing time by decreasing mortality among lambs per ewe is the objective of the community-based breeding program (CBBP). This study aims to find out litter size, litter weight per ewe, and preweaning lamb mortality of Doyogena sheep managed under CBBP. The study analyzed the data records of 4530 animals for 8 years from 2013 to 2020. A logistic regression procedure was used to analyze pre-weaning lamb survival rates. Results showed that the overall least-squares means of litter size at birth (LSB), litter size at weaning (LSW), total litter weight at birth (TLWB), and total litter weight at weaning (TLWW) were 1.57 ± 0.02 lambs, 1.50 ± 0.02 lambs, 5.24 ± 0.09 kg, and 24.14 ± 0.69 kg respectively. The incidence of pre-weaning lamb mortality was 4.72%. Year and breeder cooperative vary were observed for pre-weaning lamb losses. Females had lower odds of survival as compared to males. Odds of survival were low for triplets, quadruplets, and low birth weight (≤2 kg) born lambs. The ongoing selection program which aims to improve reproductive and growth performance had a positive influence on the survival rate of lambs. Improvement of the environment in the flock, special care for multiple-born and care for small lambs would lead to further lamb survival improvements.

Clinical and Radiomics-Based Deep Learning Predictive Model for Early Treatment Failure after Neoadjuvant Radiochemotherapy for Rectal Cancer

<h3>Purpose/Objective(s)</h3> As shown in RAPIDO and PRODIGE-23 trials, total neoadjuvant therapy for rectal cancer increases the complete response rate, however, the overall survival benefit remains uncertain. Although postponing surgery assures more time for tumor downstaging, it also increases surgical complications and can worsen prognosis in non-responding tumors. We aimed to develop a clinical and radiomics-based model for early treatment failure (ETF) prediction after neoadjuvant radiochemotherapy (RCHTx) for rectal cancer. <h3>Materials/Methods</h3> We conducted a prospective cohort analysis of 92 consecutive and eligible patients with rectal adenocarcinoma treated with neoadjuvant radiochemotherapy in the years 2018-2020, and followed until February 2022. We defined ETF as postoperative poor pathological response and no MRI-confirmed downstaging; or unresectability after neoadjuvant treatment; or cancer-related or treatment-related death within 18 months since treatment initiation. Collected clinical data included physical examination, grading, staging (before and after RCHTx), biomarker levels, RCHTx prescription details, and pre-operative MRI tumor and nodal characteristics. Radiomic features were extracted from GTV delineated on axial MRI T2 TSE sequences. To develop a predictive model, we followed OmicSelector-based (https://biostat.umed.pl/OmicSelector) feature selection, logistic regression (LR), and artificial deep neural network model development procedure. After splitting into training (60%), testing (20%), and validation (20%) datasets, the final feature set was selected based on the highest average logistic regression accuracy on all sets, while all patients with MRI performed outside our institution were included in the testing set (compensating possible batch effect). <h3>Results</h3> ETF was experienced by 24% of patients and was associated with significantly shorter overall survival (median 12.1 months [95%CI:8.5-16.5] vs. not reached, p<0.0001). None of the clinical factors was significantly associated with ETF (adjusted p value>0.05; AUC ROC range 0.39-0.64). LR model based on clinical factors presented overfitting (accuracy 82% on the training set, 56.2% on testing and 68.8% on validation set). The best feature set included 14 selected radiomic features, patient's weight, T-stage, grading, mesorectal fascia and nodal involvement. LR model based on those features achieved perfect accuracy on training and testing sets and 81.3% accuracy on the validation set. Deep neural network model utilizing selected clinical and radiomic features achieved 87.5% accuracy (80% sensitivity, 91% specificity) on testing and 93.8% accuracy (100% sensitivity, 91% specificity) on validation set. <h3>Conclusion</h3> Combined clinical and radiomics-based deep learning model could predict ETF after RCHTx for rectal cancer with at least 80% sensitivity and 90% specificity. Prediction of ETF after RCHTx could select high-risk patients who may require non-standard treatment.

Assessment of Quality of Sexual Life in Male Patients with Psoriasis

Introduction: Psoriasis is a global burden of disease characterized by the presence of well circumscribed erythematous papule &amp; plaque of various size &amp; shape, covered by silvery scales. It not only hampers the quality of life but also hampers the sexual function. Men who have psoriasis may be more likely to have sexual problems, such as sexual apathy, orgasmic dysfunction, erectile dysfunction (ED), etc. Stress tends to be a triggering or aggravating factor in psoriasis. In addition, the disease itself can generate emotional stress because of its lesions. It is thought that chronic inflammation. Results in metabolic diseases and proinflammatory cytokines give rise to the development of atherogenesis. Pelvic arterial atherosclerosis is another cause of sexual dysfunction. This study was designed to determine the impact of moderate to severe psoriasis on quality of life and sexual dysfunction in male patients. Methods: This case control study was conducted in Department of Dermatology and Venereology, Dhaka Medical College Hospital, among the 100 patients. Group- A was cases (male married patients age between 24 years and 60 years with history of moderate to severe psoriasis) and group-B were control (male married patients age between 24 years and 60 years without psoriasis). Then variables were analyzed and compared. Data was processed and analyzed with the help of computer program SPSS and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Comparison was done by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram &amp; charts etc. Results: It was found that majority of the patients i.e. 46% were between 34-43 years, mean age was found to 41.7±11.3 years. No significant difference in age and other demographic profile was observed between groups. Prevalence of IHD (8.0%), stroke (14.0%), dyslipidaemia (54.0%), neuropathy (26.0%) and PVD (8.0%) were higher in case or psoriatic patients. On evaluation of Dermatology Life Quality Index (DLQI), majority of patients (54%) score was 6-10, followed by 24.0% had score 2-5 and 22.0% of patients had score 11-20 or very large effect on patient’s life. Prevalence of erectile dysfunction was 36.0%, prevalence of orgasmic dysfunction was 24.0%. On multivariate analysis which was done by ordinal logistic regression procedure. The attributes found to be positively associated with sexual dysfunction severity in the multivariate model were patient’s age, disable status, sedentary work, duration of illness, etc. Conclusion: Erectile dysfunction and orgasmic dysfunction are common in psoriatic male patients. There is association with other comorbidities. J Bangladesh Coll Phys Surg 2022; 40: 233-228

Sexual and reproductive health needs and practices of female sex workers in Papua New Guinea: findings from a biobehavioral survey Kauntim mi tu (‘Count me too’)

BackgroundLittle research has explored the sexual and reproductive health (SRH) experience of female sex workers (FSW), including girls aged < 18 years who are commercially sexually exploited (CSE), in Papua New Guinea (PNG). This paper describes the SRH history of FSW and CSE girls and factors associated with their use of moderately or highly effective contraceptive methods in three settings in PNG.MethodsFrom 2016 to 2017, respondent-driven sampling (RDS) surveys were conducted among FSW and CSE girls in Port Moresby, Lae, and Mt. Hagen. FSW and CSE girls who were born female, aged ≥12 years, sold or exchanged vaginal sex in the past 6 months, spoke English or Tok Pisin, and had a valid RDS study coupon were eligible to participate. Interviews were conducted face-to-face and participants were offered rapid routine HIV and syphilis testing. Survey logistic regression procedures were used to identify factors associated with the use of moderately or highly effective contraceptive methods. Weighted data analysis was conducted.ResultsA total of 2901 FSW and CSE girls (Port Moresby, 673; Lae, 709; and Mt. Hagen, 709) were enrolled. The proportion using moderately or highly effective contraceptive methods was 37.7% in Port Moresby, 30.9% in Lae, and 26.5% in Mt. Hagen. After adjusting for covariates, factors significantly associated with the use of moderately or highly effective contraceptive methods in Port Moresby were being age 20–24, being married, being divorced or separated, having one or more dependent children, being away from home for more than 1 month in the last 6 months, and having tested HIV negative. No factors were significantly associated in Lae or Mt. Hagen. ANC attendance amongst FSW and CSE girls who gave birth in last 3 years was highest in Port Moresby at 91.2%. HIV testing was inconsistently and inadequately offered at ANC across the three cities.ConclusionsKauntim mi tu provides much-needed insight into the SRH experiences of FSW and CSE girls in PNG, where their use of moderately or highly effective contraceptive methods is low. We hope to shed light on the complicated reality they face due to illegality of sex work and multitude of complex healthcare experiences.