Longitudinal Study Research Articles

Neuroinflammatory activation in sensory and motor regions of the cortex is related to sensorimotor function in individuals with low back pain maintained by nociplastic mechanisms: A preliminary proof-of-concept study.

Chronic pain involves communication between neural and immune systems. Recent data suggest localization of glial (brain immune cells) activation to the sensorimotor regions of the brain cortex (S1/M1) in chronic low back pain (LBP). As glia perform diverse functions that impact neural function, activation might contribute to sensorimotor changes, particularly in LBP maintained by increased nervous system sensitivity (i.e., nociplastic pain). This preliminary proof-of-concept study aimed to: (i) compare evidence of neuroinflammatory activation in S1/M1 between individuals with and without LBP (and between nociceptive and nociplastic LBP phenotypes), and (ii) evaluate relationships between neuroinflammatory activation and sensorimotor function. Simultaneous PET-fMRI measured neuroinflammatory activation in functionally defined S1/M1 in pain-free individuals (n = 8) and individuals with chronic LBP (n = 9; nociceptive: n = 4, nociplastic: n = 5). Regions of S1/M1 related to the back were identified using fMRI during motor tasks and thermal stimuli. Sensorimotor measures included single and paired-pulse transcranial magnetic stimulation (TMS) and quantitative sensory testing (QST). Sleep, depression, disability and pain questionnaires were administered. Neuroinflammatory activation was greater in the lower back cortical representation of S1/M1 of the nociplastic LBP group than both nociceptive LBP and pain-free groups. Neuroinflammatory activation in S1/M1 was positively correlated with sensitivity to hot (r = 0.52) and cold (r = 0.55) pain stimuli, poor sleep, depression, disability and BMI, and negatively correlated with intracortical facilitation (r = -0.41). This preliminary proof-of-concept study suggests that neuroinflammation in back regions of S1/M1 in individuals with nociplastic LBP could plausibly explain some characteristic features of this LBP phenotype. Neuroinflammatory activation localized to sensorimotor areas of the brain in individuals with nociplastic pain might contribute to changes in sensory and motor function and aspects of central sensitization. If cause-effect relationships are established in longitudinal studies, this may direct development of therapies that target neuroinflammatory activation.

How Do Quantitative Videofluoroscopy Measures Differ Between People With Amyotrophic Lateral Sclerosis and Age-Matched Healthy Adults?

Dysphagia is a leading cause of morbidity in people with amyotrophic lateral sclerosis (PwALS). Previous videofluoroscopic swallowing studies (VFSS) in PwALS do not account for the influence of senescence. We aimed to compare swallowing in PwALS and an age- and sex-matched control group using healthy reference data to define typical and atypical values. We conducted retrospective analysis of VFSS data from 19 PwALS (10 male, Mage = 63 years, range: 47-82) compared to control data from a cohort of healthy adults. Participants swallowed 20% w/v liquid barium from thin to extremely thick consistency. Blinded duplicate VFSS analysis using the ASPEKT (Analysis of Swallowing Physiology: Events, Kinematics and Timing) method yielded descriptive statistics for 16 quantitative VFSS parameters by consistency. Mann-Whitney U tests were used to identify significant cohort differences. Additionally, the frequencies of atypical values (in the 25% tails of the reference distribution) were tabulated by cohort and compared using odds ratios. PwALS showed increased frequencies of multiple swallows per bolus, incomplete laryngeal vestibule closure, and reduced hyoid speed across consistencies. By contrast, similar frequencies of atypical values for pharyngeal constriction and residue in both cohorts suggest that age-related changes may contribute to the presence of these features in PwALS. This analysis builds on previous descriptions of swallowing pathophysiology in amyotrophic lateral sclerosis (ALS) by clarifying the extent to which aging may account for some of the atypical findings seen in this patient population. Longitudinal studies are recommended to further differentiate the effects of ALS from age-related changes in swallowing over the course of disease progression.

Effects of Adapted Physical Activity on White Matter Integrity in Patients with Schizophrenia

Schizophrenia is associated with changes in white matter (WM) integrity and with reduced life expectancy, in part because of the cardiometabolic side effects of antipsychotics. Physical activity (PA) has emerged as a candidate lifestyle intervention that is safe and effective. The study aimed to assess how an adapted PA program delivered remotely by web (e-APA) improved WM integrity in patients with schizophrenia (SZPs) and healthy controls (HCs) and to evaluate associations among WM integrity, cardiorespiratory fitness, and symptom severity. This longitudinal study was conducted over 16 weeks with 31 participants (18 SZPs and 13 HCs). Diffusion tensor imaging and tract-based spatial statistics were employed to assess WM integrity. Cardiorespiratory fitness was measured by maximal oxygen uptake (VO2max), and assessments for clinical symptoms included the Positive and Negative Syndrome Scale, Self-evaluation of Negative Symptoms and the Brief Negative Syndrome Scale (BNSS). Only the SZPs had significantly increased WM integrity after the e-APA program, with increased fractional anisotropy and decreased radial diffusivity in fasciculi involved in motor functions and language process. Furthermore, decreased negative symptoms assessed with BNSS were associated with greater WM integrity following the program. These findings suggest that e-APA may improve WM integrity abnormalities and support e-APA as a promising therapeutic strategy.

The bidirectional association between the disability in activities of daily living and depression: a longitudinal study in Chinese middle-aged and older adults

AimDepression and disability in activities of daily living (ADL) are common in middle-aged and older adults. This study investigated the bidirectional relationship between depression and disability in ADL in Chinese middle-aged and older adults.MethodsData from a baseline study of 17,596 participants from the China Health and Retirement Longitudinal Study (CHARLS) and two follow-up visits at 4 and 7 years were included. We designed Study A and Study B to explore the interaction between depression and disability in ADL in middle-aged and older people.ResultsIndividuals with disability in ADL at baseline had adjusted odds ratios (ORs) of 1.331 (1.118, 1.584) and 1.969 (1.585, 2.448) for developing depression compared with those without disability in ADL at the 4- and 7-year follow-ups, respectively. Individuals with depression at baseline had adjusted ORs of 1.353 (1.127, 1.625) and 1.347 (1.130, 1.604), respectively, for developing disability in ADL 4 and 7 years later.ConclusionsThere was a bidirectional relationship between depression and disability in ADL. Depression increased the risk of disability in ADL, but this risk did not increase with time, whereas the effect of disability in ADL on depression increased with time.

Declines in social–emotional skills in college students during the COVID-19 pandemic

IntroductionThe present study investigated whether social–emotional skills in first year college students differed before and after the coronavirus disease (COVID-19) lockdowns.MethodsParticipants (N = 1,685) consisted of first year college students (mean age 18.53 years) selected from a broader cohort enrolled in a longitudinal study on college mental health at liberal arts colleges in the United States. In a cohort-sequential design, participants completed an online survey assessing social–emotional skills in January of 2018, 2019, 2020, and 2022. Using analysis of covariance, we examined mean differences in social–emotional skills between students who were first years before (January 2018–2020) and after the lockdowns (January 2022), controlling for sociodemographic variables.ResultsThe post-lockdown group scored significantly lower on emotional control and expressivity and marginally higher on social sensitivity compared to the pre-lockdown group. No group differences in social/emotional expressivity or social control were detected.DiscussionThese findings indicate that the COVID-19 lockdowns impaired some, but not all, social–emotional skills in first year college students. Addressing social–emotional skills in college may help to reduce the COVID-19 mental health burden.

Relative rDNA copy number is not associated with resistance training-induced skeletal muscle hypertrophy and does not affect myotube anabolism in vitro.

Ribosomal DNA (rDNA) copies exist across multiple chromosomes and inter-individual variation in copy number is speculated to influence the hypertrophic response to resistance training. Thus, we examined if rDNA copy number was associated with resistance training-induced skeletal muscle hypertrophy. Participants (n=53 males, 21±1 years old; n=29 females, 21±2 years old) performed 10-12 weeks of full-body resistance training. Hypertrophy outcomes were determined, as was relative rDNA copy number from pre-intervention vastus lateralis (VL) biopsies. Pre- and post-intervention VL biopsy total RNA was assayed in all participants, and mRNA/rRNA markers of ribosome content and biogenesis were also assayed in the 29 females prior to training, 24 hours following training bout 1, and in the basal state after 10 weeks of training. Across all participants, no significant associations were evident between relative rDNA copy number and training-induced changes in whole body lean mass (r = -0.034, p=0.764), vastus lateralis thickness (r = 0.093, p=0.408), mean myofiber cross-sectional area (r = -0.128, p=0.259), or changes in muscle RNA concentrations (r = 0.026, p=0.818), and these trends were similar when examining each gender. However, all Pol-I regulon mRNAs as well as 45S pre-rRNA, 28S rRNA and 18S rRNA increased 24 hours following the first training bout in females. Follow-up studies using LHCN-M2 myotubes demonstrated a reduction in relative rDNA copy number induced by bisphenol A (BPA) did not significantly affect insulin-like-growth factor-induced myotube hypertrophy. These findings suggest relative rDNA copy number is not associated with myofiber hypertrophy.

The Impact of Work Conflict and Work Stress on Organizational Commitment: The Mediating Role of Motivation

Aims: This study examines the influence of job conflict, work-related stress, and employee motivation on organizational commitment, addressing their critical importance to organizational sustainability and employee commitment levels. Study Design: This is a quantitative research study. Methodology: Data were collected through surveys from a diverse sample of employees. Structural Equation Modeling (SEM) was applied using tools such as SPSS, Partial Least Square (PLS), and the Sobel Test to analyze the data. Results: The findings indicate that job conflict directly influences organizational commitment, whereas work stress does not have a direct impact. However, work stress significantly affects employee motivation, which subsequently impacts organizational commitment. Motivation serves as a mediator between job stress and organizational commitment, a relationship not observed with job conflict. Conclusion: This study contributes to the literature by elucidating the complex relationships among job stress, workplace conflict, and motivation, highlighting the mediating role of motivation in the link between job stress and organizational commitment. Future research should consider longitudinal designs and a broader range of industries to enhance the generalizability of these findings.

Impact of pericardial calcification on early postoperative outcomes after pericardiectomy: a retrospective observational study

BackgroundOwing to the lack of understanding of the clinical significance of pericardial calcification during pericardiectomy, whether pericardial calcification should be considered when determining the optimal timing for pericardiectomy is debatable. We aimed to investigate the effect of pericardial calcification on early postoperative outcomes in patients who underwent pericardiectomy for constrictive pericarditis.MethodsAltogether, 44 patients who underwent pericardiectomy for constrictive pericarditis were enrolled. After excluding three patients who underwent concurrent surgeries, a total of 41 patients were categorized into two groups based on the presence of pericardial calcification as determined by preoperative computed tomography and pathological examination. Preoperative clinical and imaging characteristics, intraoperative data, and early postoperative outcomes were compared between the two groups. A multivariable analysis was performed to identify the factors associated with postoperative complications.ResultsThe group with and without PC comprised 21 and 20 patients, respectively. No significant differences were observed in 30-day mortality (n = 1 [5%]) in the group with pericardial calcification and no mortality in the group without pericardial calcification (p > 0.999). Other early postoperative outcome variables did not demonstrate any significant differences between the two groups. However, the use of cardiopulmonary bypass was associated with postoperative complications (p < 0.009, odds ratio: 63.5, 95% confidence interval: 5.13–3400).ConclusionsPericardial calcification did not significantly affect the postoperative outcomes after pericardiectomy. Further comprehensive studies, including those with larger sample sizes and longitudinal designs, are necessary to determine whether pericardial calcification can significantly influence the timing of surgical intervention.

Protocol for a longitudinal study examining the trajectory of COVID-19, post-COVID, multidimensional disadvantage and health-related quality of life in India: the IndiQol Project

IntroductionThe COVID-19 pandemic has raised concerns about the persistence of symptoms after infection, commonly referred to as ‘post-COVID’ or ‘long-COVID’. While countries in high-resource countries have highlighted the increased risk...

Investigating grey matter volumetric trajectories through the lifespan at the individual level

Adolescents exhibit remarkable heterogeneity in the structural architecture of brain development. However, due to limited large-scale longitudinal neuroimaging studies, existing research has largely focused on population averages, and the neurobiological basis underlying individual heterogeneity remains poorly understood. Here we identify, using the IMAGEN adolescent cohort followed up over 9 years (14–23 y), three groups of adolescents characterized by distinct developmental patterns of whole-brain gray matter volume (GMV). Group 1 show continuously decreasing GMV associated with higher neurocognitive performances than the other two groups during adolescence. Group 2 exhibit a slower rate of GMV decrease and lower neurocognitive performances compared with Group 1, which was associated with epigenetic differences and greater environmental burden. Group 3 show increasing GMV and lower baseline neurocognitive performances due to a genetic variation. Using the UK Biobank, we show these differences may be attenuated in mid-to-late adulthood. Our study reveals clusters of adolescent neurodevelopment based on GMV and the potential long-term impact.

Effect of progestin-based contraceptives on HIV-associated vaginal immune biomarkers and microbiome in adolescent girls.

Adolescent girls bear a disproportionate burden of both the HIV epidemic and unintended pregnancies; yet important questions remain unanswered regarding the effects of hormonal contraceptives on the vaginal immune microenvironment, which can impact HIV susceptibility in this group. Multiple studies report genital immune alterations associated with the progestin-based contraceptive Depot medroxyprogesterone acetate (DMPA) in adult women, but there is little available data in adolescents. The objective of this longitudinal cohort study was to evaluate the effects of short-term use of three progestin-based contraceptives, levonorgestrel intrauterine device (LNG-IUD), subdermal etonogestrel (ETNG), and injectable DMPA, on HIV-associated vaginal immune biomarkers and microbiome in adolescent girls. Fifty-nine sexually active, HIV-uninfected girls aged 15-19, were recruited from the Washington DC metro area and self-selected into Control (condoms only), combined oral contraceptive pills, LNG-IUD, ETNG and DMPA groups. Vaginal swabs were collected at baseline prior to contraceptive use and at 3-month follow-up visit. Vaginal secretions were tested for pro-inflammatory (IL-1α, IL-1β, TNF-α, IL-6, IL-8, MIP-3α, IP-10, RANTES, MIP-1α, MIP-1β) and anti-inflammatory/anti-HIV (Serpin-A1, Elafin, Beta-Defensin-2, SLPI) immune biomarkers using ELISA and for anti-HIV activity using TZM-bl assay. Vaginal microbiome was evaluated using 16S rRNA gene sequencing. Data were analyzed using SAS Version 9. Among the 34 participants who completed both visits, no significant changes in median biomarker concentrations, HIV inhibition and microbiome composition were observed between baseline and follow-up visits for any of the contraceptive groups. IL-8 (p<0.01), MIP-3α (0.02), Elafin (p = 0.03) and RANTES (p<0.01) differed significantly by race whereas IL-6 was significantly different by age (p = 0.03). We conclude that 3-month use of LNG-IUD, ETNG and DMPA have minimal effects on adolescent vaginal immune microenvironment, and therefore unlikely to impact HIV risk. Future studies with larger sample size and longer follow-up are recommended to continue to evaluate effects of contraceptives on the lower genital tract immunity and susceptibility to sexually transmitted infections.

Practical Experience with the Use of Electronic Headache Diaries and Video Consultations in Migraine Care from a Longitudinal Cohort Study.

Background: Telemedicine offers a promising solution to enhance the delivery and personalization of headache care. Integrating electronic (e-)tools enables the objective monitoring of migraine. Objectives: This study aims to demonstrate the relevance of e-tools for personalized headache care, assess patient and caregiver compliance and satisfaction, and present their use in enhancing care. Methods: Firstly, a systematic review was performed to validate the diagnostic accuracy of e-diaries for diagnosing migraine. Secondly, we collected e-diary data prospectively from diagnosed adult migraine patients at the Leiden Headache Center. Finally, questionnaires were sent to evaluate satisfaction of patients and health care providers with the Leiden e-headache diary and video consultations. Results: In the systematic review, the Leiden Headache Center's e-diary was the only validated tool. Patients (n = 1,009) were followed for a median of 181 days (interquartile range [IQR] 84-240). Compliance was 96.4% (IQR 85.2 - 99.1%), with 10.8% of days missing. Factors positively associated with compliance were older age (p < 0.001), female sex (p < 0.001), higher e-diary grade (p < 0.001), and clinical use (p = 0.04). The e-diary received a median score of 8/10 and was well-liked by patients (n = 535) and providers (n = 23). Video consultations were a good alternative for physical visits according to 76.9% of patients and 84.6% of providers. Conclusion: Validated e-headache diaries and video consultations in telemedicine enhance headache care accessibility, providing convenient care at preferred times and locations.

Quality of life and family functioning 12 months after diagnosis of childhood brain tumour: A longitudinal cohort study.

The wellbeing of a child with brain tumour is affected by several factors. We present the first investigation of quality of life and family functioning in a parent and child across the first 12 months after diagnosis, examining potential factors to guide the provision of psychosocial resources to families who most need them. Data were collected from parents/carers in Queensland, Australia, from 2020 to 2023. Child (parent/carer-proxy reported) and carer quality of life was assessed across three timepoints (repeated measures analysis of variance [ANOVA]) and by five potential co-variates (mixed between-within ANOVA). Family functioning was assessed across two timepoints (repeated-measures t-test), and by potential co-variates (repeated measures ANOVA). Univariate relationships were explored with Pearson's correlation coefficient; significant relationships were entered into multiple regression models. Ninety-six diverse families were represented. Quality of life (child, carer) and family functioning did not change across time. Children from households with lower income reported worse cognitive difficulties (p=.023) and pain and hurt (p=.013) than those from a higher income. Caregiver quality of life was poorer for those whose child had received chemotherapy and/or radiation, was aged less than 4 years at diagnosis, and had a lower household income. At 12 months, caregiver quality of life was correlated with family functioning (r=-.45, p<.001), with positive adaptation being a significant key predictor (beta=-.66, p<.005). The following factors indicate a need for increased early psychosocial support: cognitive difficulties, aged<4 years at diagnosis, receiving chemotherapy and/or radiation, and low household income.

Toward a more complete understanding of institutional logic configuration in an merger project

AbstractThe frequency and scale of mergers and acquisitions (M&amp;A) have significantly increased in the last two decades, in spite of continuous reports on their high failure rates. M&amp;A scholars call for insights to be sought on the merger process to help understand the complexity of these operations and decrease their failure rate. M&amp;A scholars advocate paying attention to institutional logics' configuration shaping a firm's decisions to grasp merger process complexity. Institutional studies show how specific logics have a powerful influence on the strategic decisions and priorities of organizations. Yet, few studies have empirically combined multiple levels by framing logics' configuration fostering specific strategic decisions. This study addresses this issue. Using a longitudinal case study, we analyze how institutional logics' configuration at organizational and inter‐organizational levels supports firms' strategic decisions to merge and to end the deal. We demonstrate that despite the alignment of logics at the organizational level, the multiplicity of logics at the inter‐organizational level led to deal failure.

Enabling analytical power calculations for multilevel models with autocorrelated errors through deriving and approximating the precision matrix.

To unravel how within-person psychological processes fluctuate in daily life, and how these processes differ between persons, intensive longitudinal (IL) designs in which participants are repeatedly measured, have become popular. Commonly used statistical models for those designs are multilevel models with autocorrelated errors. Substantive hypotheses of interest are then typically investigated via statistical hypotheses tests for model parameters of interest. An important question in the design of such IL studies concerns the determination of the number of participants and the number of measurements per person needed to achieve sufficient statistical power for those statistical tests. Recent advances in computational methods and software have enabled the computation of statistical power using Monte Carlo simulations. However, this approach is computationally intensive and therefore quite restrictive. To ease power computations, we derive simple-to-use analytical formulas for multilevel models with AR(1) within-person errors. Analytic expressions for a model family are obtained via asymptotic approximations of all sample statistics in the precision matrix of the fixed effects. To validate this analytical approach to power computation, we compare it to the simulation-based approach via a series of Monte Carlo simulations. We find comparable performances making the analytic approach a useful tool for researchers that can drastically save them time and resources.

Roger’s diffusion of innovations theory and the adoption of a patient portal’s digital anamnesis collection tool: study protocol for the MAiBest project

BackgroundGerman hospitals are legally obliged to implement digital patient portals within the next years. Systematic reviews show that the use of patient portals may be associated with improved patient-centeredness and workflows. However, mandatory digital healthcare innovations are sometimes not used by the target group as planned or even completely rejected. Based on Roger's theory of innovation diffusion, it can be assumed that the time factor is of particular importance for the adoption of the patient portal. The aim of the project is to assess determinants of patient portal adoption and to examine whether Roger’s theory can be confirmed.MethodsThe project investigates the use of the patient portal in three different clinics of a large academic teaching hospital in Germany using a longitudinal study design with three cross-sectional time points (pre, post, post). Doctors and patients are surveyed about factors that predict the use of the patient portal and whether the strength of these factors changes over time. They are also interviewed about possible barriers they experience when using the patient portal or about the reasons why the patient portal is not used. Regression models and content analyses are used to answer the research questions.DiscussionDeterminants of patient portal use will be discussed under the light of the temporal component of Roger's theory. At the same time, it is expected that some determinants will remain unchanged over time. Identifying determinants independent of time allows targeting the groups, enabling specific communication strategies to empower these groups to use the patient portal, contributing to an equal health care system.Trial registrationThe study was prospectively registered in the German register of clinical trials (DRKS00033125) in May 2024.

Multidimensional trajectories of Chinese undergraduates’ English speaking self-efficacy: Developmental patterns and influencing factors

This longitudinal study tracked the development of multidimensional English speaking self-efficacy among 335 Chinese college students over one semester, aiming to identify developmental patterns and influencing factors across different dimensions and patterns. Growth Mixture Modeling results revealed distinct patterns of development in different dimensions of English speaking self-efficacy. Regarding self-efficacy for oral tasks, two patterns emerged: “higher initial level with a significant increase” and “lower initial level with a significant increase.” Self-efficacy for complexity showed two patterns as well: “higher initial level with no significant change” and “lower initial level with a significant increase.” Similarly, self-efficacy for self-regulated learning also exhibited two patterns: “higher initial level with an insignificant decrease” and “lower initial level with an insignificant increase.” On the other hand, self-efficacy for accuracy and self-efficacy for fluency displayed a single pattern each, both indicating a “significant increase.” These findings indicate the presence of non-linearity and heterogeneity in the development of English-speaking self-efficacy. Furthermore, the study identified diverse factors that influence the development of English-speaking self-efficacy, including mastery experience, emotional states, and practice, among others. Notably, these influencing factors varied across different dimensions and developmental patterns.

Reliability of dynamic causal modelling of resting-state magnetoencephalography.

This study assesses the reliability of resting-state dynamic causal modelling (DCM) of magnetoencephalography (MEG) under conductance-based canonical microcircuit models, in terms of both posterior parameter estimates and model evidence. We use resting-state MEG data from two sessions, acquired 2 weeks apart, from a cohort with high between-subject variance arising from Alzheimer's disease. Our focus is not on the effect of disease, but on the reliability of the methods (as within-subject between-session agreement), which is crucial for future studies of disease progression and drug intervention. To assess the reliability of first-level DCMs, we compare model evidence associated with the covariance among subject-specific free energies (i.e., the 'quality' of the models) with versus without interclass correlations. We then used parametric empirical Bayes (PEB) to investigate the differences between the inferred DCM parameter probability distributions at the between subject level. Specifically, we examined the evidence for or against parameter differences (i) within-subject, within-session, and between-epochs; (ii) within-subject between-session; and (iii) within-site between-subjects, accommodating the conditional dependency among parameter estimates. We show that for data acquired close in time, and under similar circumstances, more than 95% of inferred DCM parameters are unlikely to differ, speaking to mutual predictability over sessions. Using PEB, we show a reciprocal relationship between a conventional definition of 'reliability' and the conditional dependency among inferred model parameters. Our analyses confirm the reliability and reproducibility of the conductance-based DCMs for resting-state neurophysiological data. In this respect, the implicit generative modelling is suitable for interventional and longitudinal studies of neurological and psychiatric disorders.

National Institute on Aging's 50th anniversary: Advancing cognitive aging research and the cognitive health of older adults.

In celebration of the National Institute on Aging's (NIA) 50th anniversary, this paper highlights the significant advances in cognitive aging research and the promotion of cognitive health among older adults. Since its inception in 1974, the NIA has played a pivotal role in understanding cognitive aging, including cognitive epidemiology, interventions, and methods for measuring cognitive change. Key milestones include the shift towards understanding cognitive impairment and Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD), the development of large-scale longitudinal studies, and the incorporation of AD/ADRD-related biomarkers in cognitive aging cohorts. Additionally, NIA has championed diversifying the scientific workforce through initiatives, such as the Resource Centers for Minority Aging Research and the Butler-Williams Scholars Program. The next 50 years will continue to emphasize the importance of inclusion, innovation, and impactful research to enhance the cognitive health and well-being of older adults.

A Hospital-Based Longitudinal Study of Rubber Band Ligation and Sclerotherapy Treatment for Internal Hemorrhoids From South India

A Hospital-Based Longitudinal Study of Rubber Band Ligation and Sclerotherapy Treatment for Internal Hemorrhoids From South India