Lower Average Rate Research Articles

A Mobility Handover Decision Method Based on Multi-Topology

With the emergence of new applications in mobile networks, users demand higher network stability and lower data transmission delays. When the network address of a mobile user changes, the data transmission path in the wired network may need to be switched to maintain service continuity. Traditional mobility support methods typically rely on a single switching path for all mobile data flows. However, if this path cannot meet the requirements of all the flows, it may lead to network congestion or a decline in user experience. To overcome this limitation, this paper proposes a mobility handover decision method based on multi-topology. It enables the dynamic allocation of mobile data flows across different switching paths within multiple logical topologies. The method models a multi-topology selection problem aimed at minimizing average packet transmission delay and packet loss rate, while considering network conditions and the Quality of Service (QoS) requirements for each flow. By solving the dual problem of the original optimization, a near-optimal solution is achieved. The proposed scheme and algorithm were implemented and tested using the Mininet network simulator. Results show that the proposed approach achieves low average packet transmission delay, low average packet loss rate, and high throughput, compared to traditional single-path switching methods and existing multipath routing methods.

Low average shoreline change rate in 51 years on the raised Aldabra Atoll

Atolls are at risk of losing their ability to physically adapt due to rising sea levels and coral reefs’ reduced sediment supply, resulting in faster erosion of reef islands. This research examines Aldabra, a raised atoll and UNESCO World Heritage Site in the Indian Ocean with diverse coastal ecosystems, to track shoreline changes against a regional sea level rise of 2–3 mm yr−1. Aerial and satellite images in 1960 and 2011 were used to study 85% of the atoll’s shoreline through a Digital Shoreline Analysis System. Over 51 years, 61% of the shoreline remained unchanged, while 24% changed at an average rate of 0.25 ± 0.36 m yr−1, a low rate compared to global atoll changes. Among the areas that did change, rates of accretion and erosion in absolute values were nearly balanced and affected similar percentages (12%) of the shoreline. However, localized changes were pronounced: for example, part of the lagoon shoreline transformed from a sandy beach to a mangrove habitat, accreting by 214 m over the period. Erosion occurred at crucial turtle nesting sites and the research station. The lagoon shoreline underwent more rapid changes than the erosion-resistant ocean shoreline, particularly in areas exposed to wind and waves. Despite its dynamic shoreline, Aldabra maintained its net shoreline and likely total land area over the past 51 years, akin to other Indo-Pacific atolls—underscoring its adaptive capacity. Our research suggests that current knowledge of geomorphological processes of low reef islands is transferable to the raised Aldabra Atoll, reconfirming similar mechanisms of island-building processes at the island crest. These insights highlight an urgent need to minimize local impacts on sediment availability and transfer that might alter the natural dynamics of the shoreline of reef islands and hence limit adaptation potential. Ongoing shoreline monitoring will remain crucial for informing timely adaptation strategies for the conservation of Aldabra’s unique ecosystem.

Are family firms less audit-risky? Analysing audit fees, hours and rates

We examine differences in audit scope between publicly-listed family and non-family firms in Israel, using a unique dataset that includes external and internal audit hours, audit fees and billing rates. We find that external auditors charge lower average hourly rates for family firms than for non-family firms. However, audit effort, measured as the number of audit hours, is lower in family firms than in non-family firms, but the difference is not statistically significant. Moreover, the number of internal audit hours is smaller, on average, in family firms than in non-family firms. Our findings suggest family ownership affects audit mainly when the family is actively involved in the firm's management. We also examine a subsample of eponymous family firms and obtain similar results. Analysis of a sub-sample of firms that switched from family to non-family status or vice-versa shows that audit fees and hourly rates decrease (increase) when a firm changes its status from non-family (family) to family (non-family) status. Lastly, we find that the reporting quality of family firms is higher than that of non-family firms. Overall, our results suggest that auditors perceive family firms to be less audit-risky.

Assessing the Feasibility and Acceptability of Virtual Reality for Remote Group-Mediated Physical Activity in Older Adults: Pilot Randomized Controlled Trial.

Physical inactivity represents a major health concern for older adults. Most social, at-home physical activity (PA) interventions use videoconference, email, or telephone communication for program delivery. However, evidence suggests that these platforms may hinder the social connection experienced by users. Recent advancements in virtual reality (VR) suggest that it may be a rich platform for social, at-home interventions because it offers legitimate options for intervention delivery and PA. This pilot study aims to determine the feasibility and acceptability of VR compared to videoconference as a medium for remote group-mediated behavioral intervention for older adults. The information generated from this investigation will inform the use of VR as a medium for intervention delivery. Nine low-active older adults (mean age 66.8, SD 4.8 y) were randomized to a 4-week home-based, group-mediated PA intervention delivered via VR or videoconference. Feasibility (ie, the total number of sessions attended and the number of VR accesses outside of scheduled meetings) and acceptability (ie, the number of participants reporting high levels of nausea, program evaluations using Likert-style prompts with responses ranging from -5=very difficult or disconnected to 5=very easy or connected, and participant feedback on immersion and social connection) are illustrated via descriptive statistics and quotes from open-ended responses. None of the participants experienced severe VR-related sickness before randomization, with a low average sickness rating of 1.6 (SD 1.6) out of 27 points. Attendance rates for group meetings were 98% (59/60) and 96% (46/48) for the VR and videoconference groups, respectively. Outside of scheduled meeting times, participants reported a median of 5.5 (IQR 5.3-5.8, range 0-27) VR accesses throughout the entire intervention. Program evaluations suggested that participants felt personally connected to their peers (VR group: median 3.0, IQR 2.5-3.5; videoconference group: median 3.0, IQR 2.7-3.3), found that goals were easy to accomplish (VR group: median 3.0, IQR 2.8-3.3; videoconference group: median 3.0, IQR 2.6-3.4), and had ease in finding PA options (VR group: median 4.0, IQR 3.5-4.3; videoconference group: median 2.0, IQR 1.6-2.4) and engaging in meaningful dialogue with peers (VR group: median 4.0, IQR 4.0-4.0; videoconference group: median 3.5, IQR 3.3-3.8). Open-ended responses regarding VR use indicated increased immersion experiences and intrinsic motivation for PA. These findings suggest that VR may be a useful medium for social PA programming in older adults, given it was found to be feasible and acceptable in this sample. Importantly, all participants indicated low levels of VR-related sickness before randomization, and both groups demonstrated very high attendance at meetings with their groups and behavioral coaches, which is promising for using VR and videoconference in future interventions. Modifications for future iterations of similar interventions are provided. Further work using larger samples and longer follow-up durations is needed. ClinicalTrials.gov NCT04756245; https://www.clinicaltrials.gov/study/NCT04756245.

Longitudinal analyses (2018-2022) of the COVID-19 impact on Swiss pediatric healthcare utilization

Abstract Background The impact of COVID-19 on healthcare utilization in the early pandemic is well documented. However, studies on changes in both primary and tertiary pediatric healthcare utilization that considered data beyond the first pandemic year is lacking. Methods National health insurance data (primary care) and pediatric emergency department data (tertiary care) from Jan. 2018 - June 2022 and on 0-18-year-olds were analyzed with interrupted time series. The first lockdown was used to differentiate between pre-pandemic and pandemic periods. Results Several healthcare services yielded significantly lower average utilization rates during the pandemic vs. the pre-pandemic period, particularly in the youngest age groups. In primary care, the relative utilization, compared to the pre-pandemic mean, dropped in regards to regular (0-5y: 0.760 [0.644-0.896]; 6-10y: 0.850 [0.742-0.974]), well-child (0-5y: 0.871 [0.765-0.992]), and urgent visits (0-5y: 0.638 [0.500-0.813]; 6-10y: 0.810 [0.665-0.985]), and for the vaccination against measles/mumps/rubella (MMR; 0-5y: 0.841 [0.729-0.971]). Similarly, in tertiary care, this pattern emerged for non-urgent (Zurich: 0.55 [0.482-0.627]; Geneva: 0.526 [0.435-0.636]; Ticino: 0.502 [0.436-0.578]) and urgent visits (Zurich: 0.573 [0.498-0.659]; Geneva: 0.487 [0.375-0.632]; Ticino: 0.676 [0.57-0.802]). The utilization rates of most services dropped markedly after the lockdown and recovered to some extent over the pandemic phase. However, no recovery was found for the MMR-vaccination. In primary care, higher average utilization rates during the pandemic were identified for telephone consultations (0-5y: 1.394 [1.218-1.594]; 6-10y: 1.547 [1.387-1.726]; 11-15y: 1.578 [1.430-1.741]; 16-18y: 1.831 [1.614-2.076]). Conclusions The pandemic’s effect on utilization seemed to have occurred temporarily, but it cannot be ruled out that some children have not fully caught up on preventative measures (well-child visits and MMR-vaccinations). Key messages • Pediatric healthcare utilization dropped considerably immediately after the lockdown, with the most pronounced decrease observed in the youngest children. • The heterogenous recovery over the pandemic period points to the necessity to continue to monitor utilization rates, catch-up visits, and vaccination statistics.

Synergistic Interaction of Strongly Polar Zinc Selenide and Highly Conductive Carbon Nanoframeworks Accelerates Redox Kinetics of Polysulfides.

Lithium-sulfur batteries (LSBs) have become strong competitors in secondary battery systems because of their superior theoretical capacity and energy density. However, due to the serious shuttle effect of soluble long-chain lithium polysulfides (LiPSs) and the slow solid-solid reaction kinetics, LSBs face some specific challenges, such as a short cycle life and low rate performance. The introduction of selenide/carbon composites derived from zeolite imidazolate frameworks (ZIFs) into separator coatings is a direct and effective solution to the aforementioned problems. Here, a zinc selenide/carbon catalyst material (ZnSe@C) was constructed and employed to modify commercial polypropylene (PP) separators to accelerate the conversion of intermediates. The highly polar ZnSe effectively fixes the active material on the cathode side by transferring electrons between elements with LiPSs and improves the utilization rate of sulfur. Concurrently, the highly conductive carbon nanoskeleton generated following the pyrolysis of ZIF-8 ensures the rapid transfer of charges during the catalytic reaction. The prepared ZnSe@C has a large specific surface area (250.07 m2 g-1) and mesoporous ratio (78.03%), which not only enhances adsorption and catalysis but also promotes the penetration of the electrolyte and the transport of Li+. Based on this, ZnSe@C/PP separator cells exhibit a low average capacity decay rate of 0.051% per cycle after 500 cycles at 1 C.

Mimicking Urinary Tract Infections Caused by Uropathogenic Escherichia coli Using a Human Three-Dimensional Tissue Engineering Model.

Uropathogenic Escherichia coli are the main causal agent of urinary tract infections. These diseases can affect more than half of women during their lifetime. Moreover, recurrent urinary tract infections can affect up to 30% of patients, leading to higher social and economic costs for the community. No efficient treatment against the recurrent form of the disease has been discovered. Due to the low average rate of successful translation from 2D cell culture and in vivo animal models into clinical trials, new models that mimic pathologies, such as those produced by tissue engineering, are needed. A model of human-derived 3D bladder mucosa was produced by tissue engineering techniques using collagen gels and organ-specific primary human stromal and epithelial cell populations. This model was used to mimic the different steps of a urinary tract infection: adhesion, invasion, intracellular bacterial community and quiescent intracellular reservoir formation and, finally, bacteria resurgence after umbrella cell exfoliation through chitosan exposure to mimic the recurrent infection. The uropathogenic strain UTI-89-GFP was used as infectious bacteria and BL-21-GFP strain as a control. Our model is unique and is the first step toward mimicking the different phases of a UTI in a human context.

The rise of the walking dead: Zombie firms around the world

We build a comprehensive new dataset spanning listed and private nonfinancial zombie firms across Advanced Economies and Emerging Markets over the past two decades. Our findings reveal a global rise in the prevalence of these unproductive and unviable firms, particularly since the Global Financial Crisis and the Covid-19 pandemic. We show that private firms exhibit lower zombification rates due to their lower average survival rates. Our paper also offers a new perspective on zombie lending drivers: lenders may rationalize zombie lending based on overly optimistic expectations of a recovery in zombies’ future earnings. We then document that macroprudential policies targeting bank capital and loan restrictions can effectively mitigate the adverse effects of zombification. However, strengthening the banking sector alone may not suffice without robust insolvency frameworks prepared to manage firm restructuring and insolvency.

PTFE-based antistatic coatings by incorporating modified carbon black

A kind of antistatic coatings which were applied to nonconductive surfaces were prepared with Polytetrafluoroethylene (PTFE) as matrix, modified carbon black (CB) as conductive filler. Compared to sodium dodecyl sulfate, poly(vinyl pyrrolidone), the TMN-10 modified CB has better wettability, dispersion, stability and re-disperse. When CBTMN-10content is 5 wt.%, the surface resistivity of coating reach to 106Ω*cm, which denotes the coating performance good antistatic behavior. The antistatic coating of 5 wt.% CBTMN-10content is found to exhibit excellent hydrophobicity and high HV hardness. Meanwhile, the low average friction coefficients and wear rate were achieved in antistatic coating of 5 wt.% CBTMN-10content. Furthermore, compared to MXene, reduced graphene oxide, carbon nanotube, the modified CB as conductive material in PTFE antistatic materials could be an useful way not only excellent properties but also large-scale production as well as a reduction in unit cost in antistatic materials.

Exploring Trade-Offs for Online Mental Health Matching: Agent-Based Modeling Study.

Online mental health communities (OMHCs) are an effective and accessible channel to give and receive social support for individuals with mental and emotional issues. However, a key challenge on these platforms is finding suitable partners to interact with given that mechanisms to match users are currently underdeveloped or highly naive. In this study, we collaborated with one of the world's largest OMHCs; our contribution is to show the application of agent-based modeling for the design of online community matching algorithms. We developed an agent-based simulation framework and showcased how it can uncover trade-offs in different matching algorithms between people seeking support and volunteer counselors. We used a comprehensive data set spanning January 2020 to April 2022 to create a simulation framework based on agent-based modeling that replicates the current matching mechanisms of our research site. After validating the accuracy of this simulated replication, we used this simulation framework as a "sandbox" to test different matching algorithms based on the deferred acceptance algorithm. We compared trade-offs among these different matching algorithms based on various metrics of interest, such as chat ratings and matching success rates. Our study suggests that various tensions emerge through different algorithmic choices for these communities. For example, our simulation uncovered that increased waiting time for support seekers was an inherent consequence on these sites when intelligent matching was used to find more suitable matches. Our simulation also verified some intuitive effects, such as that the greatest number of support seeker-counselor matches occurred using a "first come, first served" protocol, whereas relatively fewer matches occurred using a "last come, first served" protocol. We also discuss practical findings regarding matching for vulnerable versus overall populations. Results by demographic group revealed disparities-underaged and gender minority groups had lower average chat ratings and higher blocking rates on the site when compared to their majority counterparts, indicating the potential benefits of algorithmically matching them. We found that some protocols, such as a "filter"-based approach that matched vulnerable support seekers only with a counselor of their same demographic, led to improvements for these groups but resulted in lower satisfaction (-12%) among the overall population. However, this trade-off between minority and majority groups was not observed when using "topic" as a matching criterion. Topic-based matching actually outperformed the filter-based protocol among underaged people and led to significant improvements over the status quo among all minority and majority groups-specifically, a 6% average chat rating improvement and a decrease in blocking incidents from 5.86% to 4.26%. Agent-based modeling can reveal significant design considerations in the OMHC context, including trade-offs in various outcome metrics and the potential benefits of algorithmic matching for marginalized communities.

Abundance measurements reveal the balance between lysis and lysogeny in the human gut microbiome.

The human gut contains diverse communities of bacteriophage, whose interactions with the broader microbiome and potential roles in human health are only beginning to be uncovered. Here, we combine multiple types of data to quantitatively estimate gut phage population dynamics and lifestyle characteristics in human subjects. Unifying results from previous studies, we show that an average human gut contains a low ratio of phage particles to bacterial cells (~1:100), but a much larger ratio of phage genomes to bacterial genomes (~4:1), implying that most gut phage are effectively temperate (e.g., integrated prophage, phage-plasmids, etc.). By integrating imaging and sequencing data with a generalized model of temperate phage dynamics, we estimate that phage induction and lysis occurs at a low average rate (~0.001-0.01 per bacterium per day), imposing only a modest fitness burden on their bacterial hosts. Consistent with these estimates, we find that the phage composition of a diverse synthetic community in gnotobiotic mice can be quantitatively predicted from bacterial abundances alone, while still exhibiting phage diversity comparable to native human microbiomes. These results provide a foundation for interpreting existing and future studies on links between the gut virome and human health.

Comparison study in inflation and economic development between Egypt and Saudi Arabia: Using data analysis

An increase in total demand over the natural supply causes inflation in Egypt. Currently, the government is not intervening to reduce prices, unlike Saudi Arabia, which does interfere. The government's direct aim is to limit the price rise, known as suppressed inflation. This study discusses the relationship between the inflation indicator and various dimensions of economic development (such as production, agriculture, industry, dependency, health, and education) in Egypt and Saudi Arabia from 1990 to 2022. The study found that inflation in Egypt was at a high rate during the study period, with an average of 9.9 %. This high average negatively affects four dimensions of development in Egypt: agriculture, dependency, health, and education. It positively impacts industry and production, but the positive impact is minimal compared to the adverse effects. The negative impact is powerful on the dimensions of education and health, which are related to the human element and have a primary influence on all other dimensions of economic development. This indicates the failure of the policy to combat inflation in Egypt and reduce its adverse effects on economic development dimensions. On the other hand, Saudi Arabia had a lower average inflation rate of 1.9 % during the study period, which negatively affected the health dimension of economic development but positively affected the dimensions of education and industry. The dependency dimension, measured by the external debt growth rate index, was excluded since there were no external debts with recursion.

Carcinogenic risk to the health of the population of a large industrial city as a result of multi-environmental and multi-route exposure to chemicals

Introduction. Despite the relatively low average annual mortality rate, the increased incidence of cancer in the population of the Omsk region, together with indicators of the quality of oncological care, indicate a tense epidemiological situation. The purpose of the study is to determine priority environments and routes of exposure to chemicals in the formation of long-term carcinogenic risks in the city of Omsk. Materials and methods. There were used results of environmental and social-hygienic monitoring of habitat objects for the period 2017–2022. To assess the cumulative carcinogenic risk, atmospheric air, drinking tap water, open water, soil, food products, and 3 routes of exposure were taken into account: inhalation, oral and cutaneous. The assessment of carcinogenic risks was carried out in accordance with Guideline R 2.1.10.3968–23, taking into account the severity coefficient of malignant neoplasms. Results. The carcinogenic risk to the health of the population of the city of Omsk as a result of multi–environmenal and multi-route exposure to chemicals was assessed as alarming (high in an the engraved script). The structure of contributions to the cumulative carcinogenic risk: drinking water – 63.3%, atmospheric air – 33.1%, food products – 3.3 %, other environments less than 0.5%. The main route of entry of chemical carcinogens is inhalation (77.4%). Alarming carcinogenic risks were formed through the inhalation route of chloroform from drinking water; chromium VI, formaldehyde, benzene, and soot from atmospheric air. Among the target organs of malignant neoplasms, the greatest risk was in the gastrointestinal tract, which was assessed as alarming. Limitations. Not all habitat objects were analyzed, which may reduce the objectivity of the conclusions. Conclusion. An assessment of the long-term cumulative carcinogenic risk made it possible to prioritize the list of chemical pollutants, environmental objects, and routes of exposure to carcinogens. For more accurate planning of sanitary and hygienic measures to reduce public health risks, improve comprehensive monitoring of pollutants in all environments, taking into account all routes of entry into the human body, it is advisable to analyze the total risks for multi-environmental and multi-route exposure with an analysis of the contribution of chemicals, media, routes to their formation.

A Novel Hybrid Model (EMD-TI-LSTM) for Enhanced Financial Forecasting with Machine Learning

Financial forecasting involves predicting the future financial states and performance of companies and investors. Recent technological advancements have demonstrated that machine learning-based models can outperform traditional financial forecasting techniques. In particular, hybrid approaches that integrate diverse methods to leverage their strengths have yielded superior results in financial prediction. This study introduces a novel hybrid model, entitled EMD-TI-LSTM, consisting of empirical mode decomposition (EMD), technical indicators (TI), and long short-term memory (LSTM). The proposed model delivered more accurate predictions than those generated by the conventional LSTM approach on the same well-known financial datasets, achieving average enhancements of 39.56%, 36.86%, and 39.90% based on the MAPE, RMSE, and MAE metrics, respectively. Furthermore, the results show that the proposed model has a lower average MAPE rate of 42.91% compared to its state-of-the-art counterparts. These findings highlight the potential of hybrid models and mathematical innovations to advance the field of financial forecasting.

Paediatric very rare tumours registration and management in European countries with low health expenditure average rates.

Within the Paediatric Rare Tumours Network-European Registry (PARTNER) project, we aimed to evaluate the situation on the registration and management of paediatric patients affected by very rare tumours (VRT) in the European low health expenditure average rates (LHEAR) countries. A survey regarding infrastructure, organisation, and clinical decision-making information on VRT was designed. This survey was distributed to the representatives of LHEAR countries involved in the activities of the PARTNER Work Package 7. Eighteen answers from 17 countries were collected regarding the national organisation, methods of registration of VRT cases, the availability of medical experts in VRT, the access to updated diagnostic and therapeutic procedures (such as proton therapy, immunotherapy and, targeted therapies), and research on paediatric VRT. A high variability in the registration and management of patients with VRT has been observed with additional wide inequalities in pathology review, uniformity of clinical decisions, availability of selected procedures, and diagnostic and research tools. In the majority of LHEAR countries, no clinical or research structures have been implemented for children and adolescents with VRT. Therefore, VRT still have an orphan status in these countries. These significant differences on the technology access and use between European regions need to be addressed.

Efficient Jamming Policy Generation Method Based on Multi-Timescale Ensemble Q-Learning

With the advancement of radar technology toward multifunctionality and cognitive capabilities, traditional radar countermeasures are no longer sufficient to meet the demands of countering the advanced multifunctional radar (MFR) systems. Rapid and accurate generation of the optimal jamming strategy is one of the key technologies for efficiently completing radar countermeasures. To enhance the efficiency and accuracy of jamming policy generation, an efficient jamming policy generation method based on multi-timescale ensemble Q-learning (MTEQL) is proposed in this paper. First, the task of generating jamming strategies is framed as a Markov decision process (MDP) by constructing a countermeasure scenario between the jammer and radar, while analyzing the principle radar operation mode transitions. Then, multiple structure-dependent Markov environments are created based on the real-world adversarial interactions between jammers and radars. Q-learning algorithms are executed concurrently in these environments, and their results are merged through an adaptive weighting mechanism that utilizes the Jensen–Shannon divergence (JSD). Ultimately, a low-complexity and near-optimal jamming policy is derived. Simulation results indicate that the proposed method has superior jamming policy generation performance compared with the Q-learning algorithm, in terms of the short jamming decision-making time and low average strategy error rate.

Contrast-free visualization of distal trigeminal nerve segments using MR neurography.

The 3-dimensional cranial nerve imaging (CRANI) sequence may assist visualization of anatomical details of extraforaminal cranial nerves and aid in clinical diagnosis and preoperative planning. In this study, we investigated the feasibility of using a combined CRANI and magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) imaging protocol to comprehensively identify trigeminal nerve projections. We evaluated the detection of distal regions of three branches of the ophthalmic nerve (V1), three branches of the maxillary nerve (V2), and five branches of the mandibular nerve (V3) in seven healthy adult subjects, with and without contrast injection. Nerve branches were rated on a 5-point scale by three observers. Interobserver reliability was studied using weighted kappa statistics and percentage agreement. Among V1 and V2 branches, the frontal nerve and infraorbital nerve were most successfully identified (average rating of 3.9, agreement >80%) in precontrast MPRAGE images. In V3 branches, lingual and inferior alveolar nerves were most successfully identified (average rating of 3.9, agreement >80%) in precontrast CRANI images, with an excellent average rating. In all cases except one, interobserver reliability was rated good to excellent. The buccal nerve was the only branch with a low average interobserver rating. Gadolinium contrast did not improve nerve segment visualization in our study. This may relate to the specific anatomic regions assessed, gadolinium dose, postcontrast image timing, and lack of pathology. A combined CRANI and MPRAGE protocol can be combined to visualize distal branches of V1, V2, and V3 and has potential for clinical use.

Price discounts and cheapflation during the post-pandemic inflation surge

We study how within-store price variation changes with inflation, and whether households exploit it to attenuate the inflation burden. We use micro price data for food products sold by 91 large multi-channel retailers in ten countries between 2018 and 2024. Measuring unit prices within narrowly defined product categories, we analyze two key sources of variation in prices within a store: temporary price discounts and differences across similar products. Price changes associated with discounts grew at a much lower average rate than regular prices, helping to mitigate the inflation burden. By contrast, cheapflation – a faster rise in prices of cheaper goods relative to prices of more expensive varieties of the same good – exacerbated it. Using Canadian Homescan Panel Data, we estimate that spending on discounts reduced the change in the average unit price by 4.1 percentage points, but expenditure switching to cheaper brands raised it by 2.8 percentage points.

Menstrual Irregularity: A Physiological Adaptation to Cope Perceived Stress.

Menstrual cycle characteristics are regulated hormonally and are integrated at the level of the hypothalamus. Stress can affect the hypothalamic-pituitary gonadal axis. The objective of the study was to analyse the stress levels of women and compare their autonomic tone and menstrual characteristics. A group of 100 apparently healthy, young, female volunteers were included in this pilot cohort study. Subjects were assessed for perceived stress using the Perceived Stress Scale 14 Item (PSS-14) questionnaire, underwent a heart rate variability (HRV) test on the second, 10th, and 21st days of their menstrual cycle, and their menstrual history was recorded.The statistical analysis was done using Statistical Product and Service Solutions (SPSS, version 21.0; IBM SPSS Statistics for Windows, Armonk, NY) software. Metric data were expressed in terms of numerical value and analysed as mean ± SD. Paired Student's T-test was used to compare the HRV data of all three days of the menstrual cycle separately, and p value<0.05 was considered significant. Menstrual irregularity was complained of by 13 subjects (Group A), and the rest (87 subjects) reported regular menses (Group B). The perceived stress scores of Group A were significantly higher than Group B (32.53±5.062 vs 28.057±7.618; p=0.044). On second day, Group A had higher median R-R interval (714.38±106 vs 656.84±73.50 ms; p=0.015) and lower average heart rate (85.85±12.07 vs 92.39±9.98 bpm; p=0.034) than Group B, suggesting parasympathetic dominance. On the 10th day, Group A had a higher standard deviation of heart rate (7.09±1.88 vs 5.97±1.71 bpm; p=0.032) and a very low-frequency band (1105.94±984.12 vs 730.49±557.41 μs2; p=0.046) than Group B, indicating parasympathetic dominance in Group A. On the 21st day, Group A had a higher standard deviation of R-R interval (58.19±20.46 vs 44.85±14.55 ms; p=0.004), root mean square standard deviation (55.71±29.84 vs 31.89±15.99 ms; p<0.001), percentage of R-R differing by 50 ms (19.20±19.58 vs 10.87±10.31%; p=0.020), total power (3,440.23±2722.29 vs 2,068.28±1,322.49 μs2; p=0.004), high-frequency band (1,247.57±1173.54 vs 539.06±HPO438.92 μs2; p<0.001), standard deviation ratio of the Poincaré plot (0.53±0.19 vs 0.39±0.16; p=0.003), normalised HF (44.0±12.9 vs 35.4±10.6; p=0.009), and a lower LF/HF ratio (1.43±0.80 vs 2.11±1.16; p=0.043) and normalised LF (53.9±14.4 vs 64.1±11.9; p=0.006) than Group B, suggesting higher parasympathetic tone of Group A than Group B. Analysing these results, it can be concluded that, in apparently healthy young women, menstrual irregularity is a physiological adaptation to combat perceived stress and maintain parasympathetic dominance.

Sex, Age, and Patient Experience in Cardiologist Reviews: A Large-Scale Artificial Intelligence-Enabled Analysis

BackgroundPatients are increasingly using online reviews to evaluate cardiologists. Online reviews can provide insights into factors driving patient satisfaction. Little is known about the effects of age and sex on the patient experience with cardiologists. ObjectivesThe purpose of this study was to apply natural language processing techniques on online reviews to determine the factors underlying positive and negative patient experiences and the effects of age and sex on the patient experience with cardiologists. MethodsMixed effects logistic regression and sentiment analysis were applied to online cardiologist reviews from Healthgrades between 1998 and 2023. The results were then analyzed by sex and age to show trends with respect to rating statistics, sentiment analysis, and frequency of 2-word phrases. ResultsThere were 100,334 online reviews of 9,461 cardiologists. Female cardiologists received lower average ratings compared to male cardiologists and were 34.5% less likely to receive a positive review (OR: 0.655; 95% CI: 0.481-0.893; P = 0.015). Older cardiologists received lower average ratings compared to younger cardiologists (4.145 ± 0.908 vs 4.348 ± 0.795; P < 0.01). Positive reviews were associated with time spent with patients (OR: 1.383; 95% CI: 1.251-1.528; P < 0.01), answering questions (OR: 2.622; 95% CI: 2.324-2.959; P < 0.01), and patients feeling they could trust their providers’ decisions (OR: 2.285; 95% CI: 2.053-2.543; P < 0.01). ConclusionsPositive reviews were associated with cardiologists being comprehensive and patients feeling a sense of trust in the relationship. There was a difference in ratings based on age and sex with female and older cardiologists receiving lower ratings.