Low Reserve Research Articles

Cognitive reserve and its impact on cognitive and functional abilities, physical activity and quality of life following a diagnosis of dementia: longitudinal findings from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) study.

The concept of cognitive reserve may explain inter-individual differences in susceptibility to neuropathological changes. Studies suggest that experiences over a lifetime impact on cognitive reserve, and it is hypothesised that following a dementia diagnosis, greater reserve levels are linked to accelerated disease progression. To investigate the longitudinal impact of cognitive reserve on cognitive and functional abilities, physical activity and quality of life in people with dementia. Longitudinal cohort design. Participants were 1537 people with mild-to-moderate dementia at baseline, 1183 at 12 months follow-up and 851 at 24 months follow-up, from the IDEAL study. A comprehensive latent measure of cognitive reserve incorporated domains from all stages of life: education, occupational attainment and later-life engagement in leisure activities. The impact of cognitive reserve on cognition, functional abilities, physical activity and quality of life at baseline and over time was investigated using latent growth curve modelling. Higher cognitive reserve was associated with better cognition, fewer functional difficulties, more physical activity and better quality of life at baseline but was associated with accelerated cognitive decline and greater dependence over time. After 2 years, those with higher initial reserve were estimated to still have better cognition than those with low reserve. Cognitive reserve may be important in initially delaying dementia progression but is linked with accelerated deterioration once dementia becomes clinically evident, likely because of the more advanced neuropathological stage of the condition. Engagement in leisure activities is a potentially modifiable domain of cognitive reserve warranting further investigation.

Freezing of oocytes as fertility preservation for benign medical and social indication

Cryopreservation of oocytes as a way of preserving fertility for future use can be considered for certain benign diseases and conditions. Benign ovarian cysts, BRCA 1/2 mutation carriers, genetic conditions such as Turner syndrome and Fragile X mutation carriers, and even a low ovarian reserve of unknown origin are examples of such conditions. However, the evidence of the advantage of the procedure is sparse in terms of live births. In general, the recommendation is to freeze oocytes before the age of 38 and preferably >15-20 oocytes.

Macroeconomic Problems of Pakistan: Impacts and Way Forward

This paper assesses the significant macroeconomic challenges faced by Pakistan amidst its ongoing economic crisis. It identifies major issues that have contributed to the economic meltdown. These issues encompass high inflation/stagflation, low foreign exchange reserves, a substantial fiscal deficit, and mounting public debt. Additionally, Pakistan has experienced sluggish economic growth, marked by low productivity and declining exports. The study further delves into the underlying causes of these problems, attributing them to factors such as poor governance, corruption, and political instability. The study sheds light on the current economic turmoil by employing a descriptive approach with a mix of quantitative and qualitative data analysis. To address these pressing challenges, the paper proposes a comprehensive reform agenda encompassing some vital measures. The article also provides policy recommendations that will help policymakers tackle the economic challenges in theory and practice.

Morphology-controlled mesoporous core–shell carbon nanospheres decorated with Cu nanoparticles as highly efficient and reusable catalyst

Environmental pollution caused by industrial waste has recently become a serious issue. Therefore, effective pollutant removal using nanotechnology is required, in which catalysts based on precious metals, such as Pt, Ag, Au, and Pd, are widely utilized. However, the manufacturing costs of precious metal catalysts are high. In this study, copper, a promising metal for catalysis, is evaluated as an alternative to precious metal catalysts because of its low cost, high efficiency, and abundant natural reserves. However, nanoparticle agglomeration is problematic when evaluating the catalytic performance of isolated metal nanoparticles. To solve this problem and maintain a high catalytic activity of Cu, in this study, Cu was loaded on a mesoporous carbon support derived from a carbon precursor with a core–shell structure. The core–shell-structured carbon precursor was obtained by coating resorcinol-formaldehyde polymer spheres as the core with a 50 nm thick polydopamine shell with 10 nm mesopores through π–π stacking interactions. A copper precursor was used to form Cu(OH)2 on the surface of the support, and then the nanocomposite was synthesized at 500 °C for 2 h. The synthesized copper-carbon nanocomposite exhibits high catalytic activity owing to its high specific surface area, porosity, and accessible internal space. It exhibits excellent catalytic activity and stability, along with excellent reusability, in the reduction of 4-nitrophenol to 4-aminophenol using NaBH4. Moreover, excellent catalytic activity, exceeding 99 %, was achieved in the reduction of another organic dye, methylene blue.

Low-concentration atropine for controlling myopia onset and progression in East Asia.

Over the past few years, there has been a rapid accumulation of data on the use of low-concentration atropine for myopia control, especially in East Asian children, with its effectiveness varying in different studies. This review aims to evaluate the current evidence surrounding the efficacy and safety of low-concentration atropine in the management of myopia onset and progression in East Asia. Clinical trials involving atropine for myopia control in East Asia were reviewed. Atropine has been shown to reduce myopia progression in East Asian children, compared with placebo. Its efficacy is concentration-dependent, with 1 % atropine yielding the greatest effect in slowing myopia progression by over 70 %, but it is associated with significant rebound and side effects. Lower concentrations also confer significant myopia-control effects while maintaining a more acceptable safety profile, with relative reductions of 67 % and 43 % reported for 0.05 % and 0.025 % atropine, respectively. While 0.01 % atropine showed the least effect compared to 0.05 % and 0.025 %, it still yielded a significant efficacy in slowing myopic refraction. Over two years, 0.05 % atropine reduced the incidence of myopia by nearly 50 %, demonstrating greater effectiveness than 0.01 % atropine. This effect was particularly notable in children with low hyperopic reserves (< +0.75 D), but not in those with higher reserves. The current evidence shows that low-concentration atropine plays a crucial role in managing myopia in East Asian children and demonstrates satisfactory safety profiles. Timely administration of the most effective and safest concentration can potentially prevent sight-threatening complications and subsequent vision loss.

Systematic Review of the Gonadotoxicity and Risk of Infertility of Soft Tissue Sarcoma Chemotherapies in Pre- and Postpubertal Females and Males.

Increasing awareness of gonadotoxicity in cancer treatments and infertility risk is essential for counseling young cancer patients. While fertility preservation options are available in many countries, limited data on gonadotoxicity hinder recommendations, especially for soft tissue cancers. This review, part of the FertiTOX project (www.fertitox.com), organized by FertiPROTEKT (www.fertiprotekt.com), aims to address this knowledge gap to improve fertility preservation guidance. We performed a systematic literature search on gonadotoxicity in soft tissue sarcoma (STS) cancer treatments. Only patients without metastases or recurrent disease were considered. "Suspected infertility" was defined based on low ovarian reserve parameters, low inhibin B levels, high gonadotropin concentration, gonadal dysfunction, amenorrhea, oligomenorrhea, azoospermia, or oligozoospermia due to limited infertility data. The study quality was assessed using the Newcastle-Ottawa Scale. The search yielded 3309 abstracts, with 138 undergoing full-text analysis. Eight studies on STS were included. Suspected infertility was observed in 20 of 28 females (71.4%, range 0-100%) and 38 of 63 males (60.3%, range 34.8-100%) with STS. Six of the eight studies received high-quality scores on the NOS, while two received a fair score. Our data suggest a high risk of infertility from chemotherapy in pre- and postpubertal STS survivors. This underscores the importance of considering fertility preservation measures when counseling these patients.

Structural regulation and sodium storage mechanism of high-performance non-graphitic carbon derived from semi coke

Non-graphitic carbon (NGC) is considered as one of the most promising anodes for sodium-ion batteries (SIBs) because of its low cost and abundant reserves. Nevertheless, there is significant debate regarding the contribution mechanism of sloping and plateau capacity. Herein, a series of NGC with adjustable defect concentration, carbon phases and pore structure are synthesized with semi-coke as precursor to explore the sodium storage mechanism and an “adsorption-insertion-filling” model is proposed based on the in-depth analysis of microstructure and electrochemical behaviors. The very attraction about this work is that the entire discharge curve is divided into three regions for analysis, and the corresponding cause for each region is traced. To be specific, the defects and disordered structure contribute to the surface-controlled absorption behavior in the sloping region >0.1 V, the pseudo-graphitic structure shows diffusion-controlled insertion behavior in the plateau region between 0.1 and 0.05 V, and the closed pores formed by curved graphite-like structure provide plateau capacity (<0.05 V) through the filling of quasi-metallic sodium. This study provides theoretical education for the optimization of NGC anode structure and a novel approach for the excessive value-added utilization of semi coke.

Theory Guided Discovery of Superior Ru-Based Electrocatalyst for Durable Acidic Oxygen Evolution Reaction

Water electrolysis (WE) using hydrogen evolution reaction is widely recognized as a promising method for clean and sustainable hydrogen production. The currently dominant alkaline-based water electrolysis encounters several challenges including high ohmic resistance, limited current density, low efficiency, and poor long-term stability. Proton exchange membrane (PEM) electrolysis can tackle these challenges by providing efficient proton transfer. However, sluggish oxygen evolution reaction (OER) in acid has been a major long-existing obstacle in PEM systems and, therefore, has attracted great research interest.Due to its high activity and durability, IrO2 is currently considered the only practical OER electrocatalyst in PEM devices. However, Ir’s high cost and low global reserve limit its large-scale applications. Hence, less-expensive catalysts for acidic OER are in great demand. RuO2 has been recognized as an attractive alternative to IrO2 because Ru is ~100x abundant and costs ~10x less. Although RuO2 presents higher activity than IrO2, it deteriorates severely in a few hours due to its dissolution under oxidizing conditions. Its long-term stability remains a big challenge.To overcome the challenge of improving the stability of Ru-based oxides, in this work we provide a rigid theoretical framework of RuO2 dissolution under the influence of other metal species. We show that the stability of Ru-based oxides could be controlled by varying the properties of incorporated metal oxides as well as the synergy to form a complex oxide. Surveying the Materials Project database led to the rationalization of a series of metal elements that could positively improve the stability of RuO2. Guided by our theoretical approach, we conducted high-throughput screening and experimental evaluation of Ru-based oxides for acid OER.Our study discovered a novel Ru-based oxide with superior performance in acid OER application. A new wet-impregnation method was developed to synthesize the desired phase. The as-obtained product were uniform nanoparticles with diameters less than 5 nm in a single rutile structure. The new catalyst showed significantly better performance than pristine RuO2. In the rotating-disk-electrode experiment, our catalyst delivered a current density of 10 mA·cm-2 at an overpotential of less than 170 mV in 0.1 M HClO4. The catalyst exhibited a low degradation rate smaller than 25 μVh-1 for over 200 hours of operation at 10 mA·cm-2. Our results show great promise of Ru-based oxides as Ir-free electrocatalysts for acidic OER in PEM water electrolysis.

Assessing natural carbonation and service life prediction of supersulfated cement

An intensive investigation is being conducted on alternative binders due to the significant environmental impact of carbon dioxide emissions in the Portland cement (PC) manufacturing sector. Supersulfated cement (SSC) stands as an alternative cement composed of 70–90 % granulated blast furnace slag (GBFS), 10–20 % calcium sulfate (CS), and 5 % alkaline activator (AA). Hence, investigating durability, particularly under natural conditions like carbonation, is essential for understanding the performance of SSC, primarily due to its low alkaline reserve. This study assessed the compressive strength, void index, and natural carbonation of two SSC formulations composed of (i) 85 % GBFS and 10 % CS, and (ii) 75 % GBFS and 20 % CS, both with 5 % PC as AA. The alterations induced by carbonation in the mineralogy of SSC were further examined by X-ray diffraction (XRD) and thermogravimetric analysis (TGA). Moreover, an assessment of service life prediction adopting the Tutti model for carbonation was carried out. The SSC concrete samples exhibited 28-d compressive strength values of approximately 20 MPa. The SSC concretes exhibited a high susceptibility to carbonation, with carbonation depths of up to 7.3 mm after 28 weeks of exposure. The higher CS content in the SSC 75:20 sample resulted in the formation of gypsum and a lower content of ettringite, and after 28 weeks of exposure, the total carbonation of ettringite was observed, leading to a reduction in compressive strength of 25.7 %. By adopting a 50-year life cycle for initiating the corrosion process, elements with SSC concrete should be designed with a cover thickness of 60 mm, representing very high thicknesses for practical applications, which can make the material economically unfeasible.

Feasibility and Improved Diagnostic Yield of Intracoronary Adenosine to Assess Microvascular Dysfunction With Bolus Thermodilution.

Bolus thermodilution and intravenous adenosine are established methods for coronary microcirculatory assessment. Yet, its adoption remains low, partly due to procedural time and patient discomfort associated with intravenous adenosine. We investigated differences between intracoronary and intravenous adenosine using bolus thermodilution in terms of microcirculatory indices, procedural time, and side effects associated with adenosine in patients with myocardial ischemia and nonobstructive coronary arteries. In this prospective, observational study, 102 patients with suspected myocardial ischemia and nonobstructive coronary arteries underwent measurements of mean transit time, coronary flow reserve, index of microcirculatory resistance, procedure time and patient tolerability with low-dose intracoronary adenosine, high-dose intracoronary adenosine (HDIC), and intravenous adenosine. HDIC induced greater hyperemia compared with low-dose intracoronary IC adenosine and intravenous adenosine with a shorter hyperemic mean transit time, P<0.0001. Coronary flow reserve was higher and index of microcirculatory resistance lowest with HDIC, compared with low-dose intracoronary IC adenosine and intravenous adenosine, P<0.05. Low coronary flow reserve was downgraded from 21% with intravenous adenosine to 10% with HDIC adenosine (P=0.031); high index of microcirculatory resistance was downgraded from 23% with intravenous adenosine to 14% with HDIC (P=0.098). Intracoronary adenosine was associated with lower procedural times (P<0.0001). More patients experienced chest pain with intravenous adenosine (P<0.01) and the chest pain intensity was higher compared with intracoronary adenosine (P<0.0001). In patients with suspected myocardial ischemia and nonobstructive coronary arteries undergoing coronary microcirculatory assessment with bolus thermodilution, the use of HDIC compared with intravenous adenosine was associated with enhanced induction of hyperemia. The use of intracoronary adenosine allowed for a shorter procedure time and was better tolerated. URL: clinicaltrials.gov; Unique Identifier: NCT04827498.

Occipital hypoperfusion and motor reserve in Parkinson's disease: an early-phase 18F-FP-CIT PET study.

Individual variability exists in parkinsonian motor symptoms despite a similar degree of nigrostriatal dopamine depletion in Parkinson's disease (PD), called motor reserve. We enrolled 397 patients newly diagnosed with PD who underwent dual-phase 18F-FP-CIT PET upon initial assessment. Individual motor reserve was estimated based on initial parkinsonian motor symptoms and striatal dopamine transporter availability using a residual model. Patients with low motor reserve (the lowest quartile group, n = 100) exhibited decreased uptake in the occipital region compared to those with high motor reserve (the highest quartile group, n = 100) on early-phase 18F-FP-CIT PET images. Patients with high motor reserve had a lower risk of conversion to dementia than the those with low motor reserve, whereas the effect of PD groups on the risk of dementia conversion was not mediated by occipital hypoperfusion. These findings suggest that cerebral hypoperfusion in the occipital region is associated with low motor reserve in patients with PD.

Gender differences in reservation wages: New evidence for Germany

Generally, women set lower reservation wages than men what may translate into substantial gender pay gaps in the labor market. This paper compares both parametric and semiparametric estimators to analyze unexplained gender gaps in reservation wages among non-employed individuals in Germany. We examine these estimators using both conventional and data-driven model specifications. The results suggest substantial unexplained gaps in favor of men (up to 8%). In addition, we show that the gaps are larger at the top of the reservation wage distribution as well as among individuals with children and with a high educational attainment. The estimates are robust across the various estimators and model specifications. These findings imply that pronounced unexplained gender gaps in reservation wages do exist in Germany. As they are likely to result in actual gender pay gaps, gender gaps in reservation wages should be on the political agenda.

Efficient hydrogen evolution reaction in alkaline seawater and urea using flower-like Co-NiP@VP/NF electrocatalyst

With the depletion of global energy, increasingly severe environmental problems and the pursuit of renewable energy and clean energy, electrocatalytic water splitting has become well-known as an efficient, stable and simple method of hydrogen production. In this paper, M−NiP@VP/NF (M=Co, Mo and Cr) composites were synthesized on nickel foam with low cost, abundant reserves, high conductivity and supportive properties by simple hydrothermal and phosphating methods. Among them, Co-NiP@VP/NF has excellent electrochemical catalytic activity for hydrogen evolution reaction (HER) in seawater electrolyte containing 1.0 M KOH and urea solution containing 1.0 M KOH due to its abundant active sites, dense nanoflower-like structures and accelerated electron transfer rate. The material has a very rich nanoflower-like structure that exposes many contact areas and provides active sites, which also provides the basis for its superior catalytic properties. Notably, the Co-NiP@VP/NF catalyst present overpotential of only 164 mV at 100 mA cm−2 in 1.0 M KOH + seawater electrolyte solution and has the lowest Tafel slope (65.41 mV dec-1) for HER. In addition, we also carried out a durability measurement for 15 h, and the result showed a sharp decline at first and then relatively stable. Finally, we also compared the study with other literature, and the catalytic activity of this catalyst is much better than that of most other catalysts. This paper provides a reasonable synthesis method with excellent performance, which provides a possibility for the subsequent extensive application and popularization of seawater.

Abstract 4137186: No Room for Chronotropic Incompetence in Living Fontan Patients: Enhanced Heart Rate Increase in Response to Exercise to Compensate Low Stroke Volume Reserve

Background: Fontan patients reveal decreased peak exercise performance in combination with low peak heart rate (HR), which is frequently interpreted as chronological incompetence. This is counterproductive as HR increase has to be enhanced to compensate limited stroke volume increase in Fontan physiology. Methods: Cardiopulmonary exercise testing (CPET) data in asymptomatic Fontan patients and age-matched control subjects were retrospectively studied. Peak and submaximal CPET parameters were obtained by cycle ergometer. Chronotropic capacity was assessed by peak HR/peak [WR/kg] and submaximal slope of HR/[work rate (WR)/kg] (ΔHR/Δ[WR/kg]) for males and females, separately. Results: Table 1 presents CPET data of Fontan patients (51) and controls (65). Fontan patients showed significantly lower peak HR, peak WR, peak oxygen consumption (VO2)/kg, %predicted maximum VO2, and peak oxygen pulse (pOP)/kg than controls in both sexes whereas peak HR/peak [WR/kg] was significantly higher in Fontan patients, indicating higher HR at the maximum effort in Fontan patients than in controls. Fontan patients showed higher ΔHR/Δ[WR/kg], a marker for HR-dependency, and lower Δ[VO2/kg]/ΔHR, a surrogate of stroke volume, suggesting higher HR was compensating lower stroke volume during submaximal phase of exercise in Fontan patients. Figure 1 demonstrates a linear relationship between ΔHR/ΔWR and peak HR/peak WR in both sexes. Male Fontan patients revealed a comparable trend with controls, whereas female Fontan patients showed higher HR increase at the peak exercise effort than controls with the same ΔHR/ΔWR, suggesting more limited stroke volume reserve than male Fontan patients. Conclusions: Fontan patients showed higher HR-response to exercise than controls in both sexes due to limitation in stroke volume increase. Our data indicate that lower peak HR in Fontan patients results from early exhaustion due to limited stroke volume reserve rather than primary chronotropic incompetence.

Formation of adaptive potential and level of physical condition in disabled people during the course of labor

А person with a disability that has begun to work is forced to pay the "physiological price of adaptation". Materials and methods: The monitoring of the level of physical condition (LPC) by E.A. Pirogova and the adaptive potential (AP) by R.M. Baevsky was carried out on 130 disabled people during their work hours. Their working period lasted 2 weeks. Results: An increase in LPC and a decrease in AP were revealed in people with childhood and psycho-neurological disabilities. In movement disabled people, the indicators of LPC decreased after the end of their work period. Conclusions: Monitoring of indicators has determined a favorable impact of labor on people with childhood disabilities and low reserves of adaptive potential in movement disabled people. The determinative factors of LPC and AP in disabled people during the course of work have been established.

Entrapping polyiodide by using highly N, P co-doping porous carbon framework towards high performance zinc‑iodine batteries

Rechargeable aqueous zinc‑iodine batteries (ZIBs) with low environmental impact and abundant natural reserves have become promising electrochemical energy storage devices. However, the shuttle effect and low conductivity lead to poor electrochemical performance, hindering their practical applications. Herein, a (NH4)3PO4-activated ZIF-8-derived porous carbon (NPPC) is proposed for entrapping iodine species in ZIBs. Benefiting from its abundant porous structure and highly conductive framework, the iodine loading and electron transport of NPPC is greatly enhanced. In addition, the in-situ doping multiple heteroatoms (N, P and O) in the carbon framework can also establish chemical anchoring with iodine species and hence mitigate the shuttle effect. As a result, the ZIBs prepared by the NPPC-1.5/I2 electrode achieves an ultra-high specific capacity of 175 mAhg−1 at 0.1 A g−1, and a specific capacity of 95 mAh g−1 at a high current density of 10 A g−1. An extremely stable cycle performance of 97 % capacity retaining after 6000 cycles at 10 A g−1 is also obtained. This study provides a new strategy for realizing aqueous ZIBs with high capacity and long cycling life.

Spatial patterns of high-risk biomechanical metrics in plaques with abnormal vs. normal physiological flow indices

BackgroundPlaques associated with abnormally low physiological flow reserve indices are appropriate for percutaneous coronary intervention (PCI). However, recent trials demonstrate that PCI of ischemia-producing lesions does not reduce major adverse cardiac events (MACE). Low endothelial shear stress (ESS) or high ESS gradient (ESSG) are associated with MACE wherever they occur along the plaque. This study aims to determine the presence of high-risk ESS metrics in obstructive coronary plaques with high-risk (<0.80) vs. borderline-risk (0.80–0.89) vs. normal Instantaneous Wave-free Ratio (iFR) (>0.89). MethodsWe included 50 coronary arteries (50 patients) with variable iFR values who underwent coronary angiography and optical coherence tomography (OCT), followed by 3D reconstruction and computational fluid dynamics calculations of ESS/ESSG. The cohort was divided into 3 groups: iFR < 0.80, iFR 0.80–0.89, and iFR > 0.89. Spatial distribution of ESS metrics was reported along the course of each plaque, and high-risk ESS metrics and their location were compared among the 3 iFR subgroups. ResultsHigh-risk ESS features (Minimal ESS, Maximum ESSG) were similarly distributed along the course of the atherosclerotic plaque in the three iFR subgroups, both in absolute value and in location: Min ESS: 0.5 ± 0.3 vs. 0.4 ± 0.2 vs. 0.4 ± 0.2 Pa respectively (p = 0.60); Max ESSG any direction: 13.7 ± 9.4 vs. 10.4 ± 10.6 vs. 10.0 ± 7.8 Pa/mm respectively (p = 0.30). ESS metrics were spatially located up to ≥18 mm from the plaque minimal luminal area (MLA) in both directions. ConclusionHigh-risk ESS metrics are similarly observed in plaques with normal or abnormal iFR, both in absolute value and spatial location in reference to the MLA. Utilizing iFR to identify plaques likely to cause MACE would miss the majority of plaques mechanistically at high-risk to destabilize and cause future adverse cardiac events.

An optimal approach for active power reserve of a de-loaded PV generator operating in coordination with synchronous generators

The de-loading operation of PVs, where PVs are operated with an active power reserve has picked up the interest of the researchers in the last few years. However, in an integrated system, where the PV generators are operated in coordination with the synchronous generators, the estimation of the amount of the active power reserve of the PV generator is crucial. A very high reserve will cause an excessive economical loss and a very low reserve will deteriorate the frequency regulation capability. Therefore, in this paper, the cost function of an integrated system is minimised using the particle swarm optimisation algorithm, and the amount of power reserve of the PV generator and operating power values of synchronous generators are obtained as a result of the minimisation. Further, the frequency response of the system for the obtained power reserve value is investigated by suddenly adding the load in the system. The lowest and highest system costs of 2521.87 and 4474.98 $/h are obtained for the irradiance 1000 and 400 W/m2 respectively, and upon a significant load change, the frequency deviation limits to 0.4513 for a reserve value of 29.0712 MW. System modelling and validation have been carried out in the SIMULINK toolbox of the MATLAB software.

Quantifying brain health in acute ischemic stroke through effective reserve.

To quantify brain health using a measure of reserve that incorporates pre-existing pathology. We analyzed two retrospective ischemic stroke cohorts (GASROS and SALVO) with neuroimaging and 90-day modified Rankin Scores (mRS) available. White matter hyperintensity (WMHv), brain, and intracranial volumes were automatically extracted, and brain parenchymal fraction (BPF) calculated. The latent variable effective reserve (eR) was modeled using age, WMHv, and BPF or brain volume in GASROS. Models were compared using Bayes Information Criterion (BIC). The best model's eR estimates were categorized into quartiles and evaluated in SALVO. GASROS included 476 (median age: 65.8; 65.3% male) and SALVO included 43 (median age: 69.2; 62.8% male) patients. Inverse associations between eR and mRS was seen in both models, with brain volume outperforming BPF (path coefficients: -0.67, -0.48, respectively; p < 0.001; |ΔBIC| = 362). Quartile-based eR stratification in SALVO showed a similar inverse trend, with worse outcomes in the low reserve group (mRS≤2 - highest vs lowest quartile: 85/90% vs 59/45% for GASROS/SALVO). Expanding the concept of eR, highlights its clinical translational potential. The strong link between higher eR and better outcomes underscores its value as a protective brain health metric.

Exploring the association between daily distributional patterns of physical activity and cardiovascular mortality risk among older adults in NHANES 2003-2006

PurposeCardiovascular disease (CVD) is one of the leading causes of death worldwide. Physical activity (PA) has previously been shown to be a prominent risk factor for CVD mortality. Traditionally, measurements of PA have been self-reported and based on various summary metrics. However, recent advances in wearable technology provide continuously monitored and objectively measured physical activity data. This facilitates a more comprehensive interpretation of the implications of PA in the context of CVD mortality by considering its daily patterns and compositions. MethodsThis study utilized accelerometer data from the 2003–2006 National Health and Nutrition Examination Survey (NHANES) on 2816 older adults aged 50–85 and mortality data from the National Death Index (NDI) in December 2019. A novel partially functional distributional analysis method was used to quantify and understand the association between daily distributional patterns of physical activity and cardiovascular mortality risk through a multivariable functional Cox model. ResultsA higher mean intensity of daily PA during the day was associated with a reduced hazard of CVD mortality after adjusting for other higher order distributional summaries of PA and age, gender, race, body mass index (BMI), smoking and coronary heart disease (CHD). A higher daily variability of PA during afternoon was associated with a reduced hazard of CVD mortality, after adjusting for the other predictors, particularly on weekdays. The subjects with a lower variability of PA, despite having same mean PA throughout the day, could have a lower reserve of PA and hence could be at increased risk for CVD mortality. ConclusionsOur results demonstrate that not only the mean intensity of daily PA during daytime, but also the variability of PA during afternoon could be an important protective factor against the risk of CVD-mortality. Considering circadian rhythm of PA as well as its daily compositions can be useful for designing time-of-day and intensity-specific PA interventions to protect against the risk of CVD mortality.