Composite Measure Research Articles

TCellR2Vec: efficient feature selection for TCR sequences for cancer classification

Cancer remains one of the leading causes of death globally. New immunotherapies that harness the patient’s immune system to fight cancer show promise, but their development requires analyzing the diversity of immune cells called T-cells. T-cells have receptors that recognize and bind to cancer cells. Sequencing these T-cell receptors allows to provide insights into their immune response, but extracting useful information is challenging. In this study, we propose a new computational method, TCellR2Vec, to select key features from T-cell receptor sequences for classifying different cancer types. We extracted features like amino acid composition, charge, and diversity measures and combined them with other sequence embedding techniques. For our experiments, we used a dataset of over 50,000 T-cell receptor sequences from five cancer types, which showed that TCellR2Vec improved classification accuracy and efficiency over baseline methods. These results demonstrate TCellR2Vec’s ability to capture informative aspects of complex T-cell receptor sequences. By improving computational analysis of the immune response, TCellR2Vec could aid the development of personalized immunotherapies tailored to each patient’s T-cells. This has important implications for creating more effective cancer treatments based on the individual’s immune system.

Cognitive, affective and sociological predictors of school performance in mathematics

Mathematics is a key school subject for some of the most lucrative and economically important careers. Low mathematics performance in school is associated with low psychometric intelligence, family socioeconomic status (SES), specific mathematical abilities, and high mathematics anxiety. We used a sample of Hungarian schoolchildren (N = 102, mean age = 12.3 years) to directly compare the predictive power of general intelligence, specific mathematical abilities measured by the Pedagogical Examination of Dyscalculia (DPV), mathematics anxiety, and socioeconomic status for mathematics grades. Mathematics grades correlated with IQ, specific mathematic ability, mathematics anxiety, and a composite measure of family SES. The WISC-IV showcased a manifest correlation of 0.62 and a latent correlation of 0.78 with the DPV and high manifest (r=-0.53) and latent (r=-0.59) correlations with mathematics anxiety. IQ alone accounted for 52% of the variance in mathematics grades. IQ, specific mathematical ability, family SES and mathematics anxiety jointly accounted for 56% of the variance in grades, with a non-significant contribution of specific mathematical ability and family SES over IQ and a marginal contribution of mathematics anxiety. Our results show that psychometric intelligence is the most important predictor of mathematics grades, while family SES and specific mathematical abilities are only associated with grades to the extent they reflect psychometric intelligence. The results, however, confirmed a small role of mathematics anxiety over intelligence in predicting grades.

Professional Male Soccer Players' Perspectives of the Nutrition Culture Within an English Premier League Football Club: A Qualitative Exploration Using Bourdieu's Concepts of Habitus, Capital and Field.

Professional soccer players' self-reported dietary intakes often do not meet recommended sport nutrition guidelines. Although behaviour change models have previously explored barriers and enablers to nutritional adherence, the cultural factors influencing players' nutritional habits also warrant investigation. Accordingly, we aimed to explore players' perceptions of the nutrition culture within the professional soccer environment. An interpretivist paradigm, which emphasises that reality is subjectively and socially constructed, underpins this study. Qualitative, face-to-face semi-structured interviews (comprising open-ended questions) were conducted with purposively sampled male soccer players from the English Premier League (EPL) (five British, five migrant; mean age: 26 ± 6years; mean EPL appearances: 106 ± 129). Data were abductively analysed using thematic analysis according to Bourdieu's concepts of habitus, capital, field and doxa practices. This study revealed five key themes: (1) players' habitus, as shaped by familial, ethnic and religious backgrounds, influences their dietary habits; (2) social capital, via managers (head coaches), teammates and online influences, impact players' dietary practices; (3) the increase in both soccer clubs' and players' economic capitals has advanced nutrition provision; (4) an unequal distribution of economic capitals has led to hierarchical practice in the performance nutrition field with personalised nutrition being somewhat enacted at the higher levels; and (5) body composition measurement is a 'doxic' practice in professional soccer that warrants challenge. Soccer players' habitual nutritional practices are influenced by personal upbringing and the club context, including economic resources and social capital from managers. The performance nutrition field within professional soccer is also shaped by stakeholders' doxic beliefs surrounding the perceived optimal body composition of players, with managers exerting social capital.

Analysis of a promising composite quality measure for management of advanced ovarian cancer: Is there a textbook outcome?

Analysis of a promising composite quality measure for management of advanced ovarian cancer: Is there a textbook outcome?

Allometric fat mass index and alanine aminotransferase attenuate the associations of platelet parameters with lung cancer risk

We have previously shown that body mass index attenuates a positive association of platelet count (PLT) and inverse of mean platelet volume (MPV) with lung cancer risk in men. It is unclear whether fat mass, lean mass, or liver function tests (LFTs) show similar attenuations. Using bioelectrical impedance measurements (UK Biobank cohort) and multivariable Cox proportional hazards models, we examined the associations of allometric fat-mass index (AFI, fat mass adjusted for height), allometric lean-mass index (ALI, fat-free mass adjusted for height and fat mass), and LFTs with lung cancer risk and their multiplicative and additive interactions with platelet parameters. Based on 1573 lung cancer cases in men and 1473 in women with body composition measurements (1541 in men; 1428 in women with biomarker measurements), AFI in women, ALI in both sexes, alanine aminotransferase (ALT) and total bilirubin in men were inversely associated, while gamma-glutamyl transferase in men and alkaline phosphatase in both sexes were positively associated with lung cancer risk. Only AFI and ALT interacted inversely with PLT and positively with MPV in men. The attenuation of the associations of platelet parameters with lung cancer risk by high-AFI and high-ALT in men suggests that adiposity-related factors hinder lung-cancer-related platelet associations.

Spatially resolved plasma composition evolution in a solar flare – The effect of reconnection outflow

Context. Solar flares exhibit complex variations in elemental abundances compared to photospheric values. These abundance variations, characterized by the first ionization potential (FIP) bias, remain challenging to interpret. Aims. We aim to (1) examine the spatial and temporal evolution of coronal abundances in the X8.2 flare on 2017 September 10, and (2) provide a new scenario to interpret the often observed high FIP bias loop top, and provide further insight into differences between spatially resolved and Sun-as-a-star flare composition measurements. Methods. We analyzed 12 Hinode/Extreme-ultraviolet Imaging Spectrometer (EIS) raster scans spanning 3.5 hours, employing both Ca XIV 193.87 Å/Ar XIV 194.40 Å and Fe XVI 262.98 Å/S XIII 256.69 Å composition diagnostics to derive FIP bias values. We used the Markov Chain Monte Carlo (MCMC) differential emission measure (DEM) method to obtain the distribution of plasma temperatures, which forms the basis for the FIP bias calculations. Results. Both the Ca/Ar and Fe/S composition diagnostics consistently show that flare loop tops maintain high FIP bias values of > 2–6, with peak phase values exceeding 4, over the extended duration, while footpoints exhibit photospheric FIP bias of ∼1. The consistency between these two diagnostics forms the basis for our interpretation of the abundance variations. Conclusions. We propose that this variation arises from a combination of two distinct processes: high FIP bias plasma downflows from the plasma sheet confined to loop tops, and chromospheric evaporation filling the loop footpoints with low FIP bias plasma. Mixing between these two sources produces the observed gradient. Our observations show that the localized high FIP bias signature at loop tops is likely diluted by the bright footpoint emission in spatially averaged measurements. The spatially resolved spectroscopic observations enabled by EIS prove critical for revealing this complex abundance variation in loops. Furthermore, our observations show clear evidence that the origin of hot flare plasma in flaring loops consists of a combination of both directly heated plasma in the corona and from ablated chromospheric material; and our results provide valuable insights into the formation and composition of loop top brightenings, also known as EUV knots, which are a common feature at the tops of flare loops.

Incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Uganda: a prospective cohort study

BackgroundHigh rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda.Materials and methodsThis was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05.ResultsOf the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194–2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859–3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394–2.584, p-value < 0.001).ConclusionsThe study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.

The dynamic increment of epicardial adipose tissue is associated with reverse remodeling after guideline-directed medical treatment in dilated cardiomyopathy patients

Abstract Background/Introduction Epicardial adipose tissue (EAT) accumulation is associated with adverse prognosis in patients with HFpEF and a better prognosis in HFrEF patients. Whether EAT is playing a protective role in dilated cardiomyopathy (DCM) patients have been described sparingly. Purpose Aim to explore whether the epicardial fat would change along with the dynamic changes in cardiac function and volumes after receiving guideline-directed medical therapy (GDMT) in patients with DCM. Methods We prospectively enrolled 232 DCM patients who underwent complete baseline and follow-up Cardiac magnetic resonance (CMR) examinations. The measurement of the epicardial fat composition includes epicardial fat thickness, paracardial fat thickness, and paracardial fat volume, while the measurement of body fat composition includes subcutaneous and visceral abdominal fat, while We used univariable and multivariable logistic regression to evaluate the association between different body and cardiac fat depots with the changes in bi-ventricular structure (delta indexed EDV) and function (delta EF). Results The study included 232 patients (mean age 46.1±14.1 years, 157 (67.7%) males). After GDMT, we found that the visceral fat thickness and EAT (thickness and volume) tend to significantly increase. The increase in the (left ventricular reverse remodeling) LVRR group was significantly higher compared with the non-LVRR group. Independently with the changes of BMI and body fat depots, the increment of EAT was associated with the improvement in bi-ventricular function and volumes (significantly positively correlated with the improvement of LVEF (r = 0.499, p &amp;lt; 0.001), and RVEF (r = 0.482, p &amp;lt; 0.001), negatively correlated with delta LVEDVi (r = -0.407, p &amp;lt; 0.001), delta RVEDVi (r = -0.305, p &amp;lt; 0.001)). Conclusions After GDMT, the increment of EAT was positively correlated with the improvement of bi-ventricular structure and function, independent of the changes in BMI and body fat depots.Graphic Abstract

Japanese Performance Profile on the WAIS-IV and Purported Cultural Influences.

The present exploratory study aimed to examine the potential impact of culture on cognitive skills and intelligence by comparing the Japanese Wechsler Adult Intelligence Scale-IV (WAIS-IV) (JW) subtests, IQs, and index scores to those of the U.S. WAIS-IV (USW). JW raw scores corresponding to a scaled score of 10 for each subtest were scored with USW norms. Subtest, index, and IQ scores were then calculated for each age range. The impact of education on scores was evaluated through ratio of educational attainment for each cohort of the Japanese and US samples. Japanese and US data were compared using one-sample t-tests. Correlations between subtest, index, and IQ scores and education were calculated. The USW sample performed higher than the JW sample on verbal comprehension subtests, while the JW sample demonstrated stronger performances in processing speed and perceptual reasoning subtests. However, all scores with the exception of Block Design, Matrix Reasoning, and Figure Weights were significantly associated with differential educational attainment between the two countries. Educational differences were linearly associated with age with the higher educational attainment for younger Japanese age groups and higher attainment for the older US cohorts. The present study demonstrates cognitive differences between Japan and the USA. Performance on the WAIS-IV subtest and composite measures are highly correlated with education. Cultural factors impacting the cognitive profile of the Japanese sample such as differences in worldview, customs, educational systems, and writing system, were proposed. Clinical neuropsychologists should take these aspects into account when administering and interpreting test results.

Similarities and Differences in the WAIS-IV Performances in Korean and U.S. Populations.

This exploratory study examines the cognitive profiles of South Koreans using the WAIS-IV. It compares scores from the original U.S. version (USW) with those from the Korean version (KW) to identify potential cultural influences on performance. Raw scores corresponding to a scaled score of 10 for each subtest of the KW were used to compare the performances of South Koreans and Americans across subtests and composite indices. The impact of education was assessed through correlations with educational attainment ratios from both countries. When combined across all age groups, the scores of the South Korean sample were significantly lower than those of U.S. sample on the Similarities, Comprehension, and Picture Completion subtests, and Verbal Comprehension Index. However, younger South Koreans scored significantly higher on Block Design, Matrix Reasoning, Visual Puzzles, Figure Weights, Digit Span, Arithmetic, Letter-Number Sequencing, Symbol Search, and Coding and all composite scores except Verbal Comprehension. Older South Koreans scored significantly lower on Similarities, Vocabulary, Comprehension, Matrix Reasoning, Visual Puzzles, Picture Completion, and the composite scores of Verbal Comprehension and Perceptual Reasoning, compared to their U.S. counterparts. All subtest and composite scores were highly correlated with education. The South Korean and U.S. samples demonstrated distinct cognitive profiles on the WAIS-IV when comparing relative performances on subtests and composite measures. Cultural factors including socioeconomic changes, education quality, nuances in language characteristics, and implicit differences in cognitive processing were discussed as possible contributors to the unique cognitive profile of the South Korean sample.

Monitoring the level of health and inequality over time using the Population Health Performance Index

Abstract Background The Population Health Performance Index (PHPI) is a composite measure that combines average health outcomes and their distribution within a population, thereby allowing for a comprehensive assessment of population health and inequality. The aim of this study is to examine the extent to which the PHPI adds value to monitoring of health and inequality over time in comparison to absolute and relative inequality. Methods Data from the WHO Equity Monitor database on under-5 mortality disaggregated by wealth quintiles for Nepal, Ethiopia, Peru, Rwanda, and Zimbabwe were analysed using different years between 1994 and 2020. Descriptive comparative statistics were employed to assess trends in the PHPI and conventional pairwise measures of absolute and relative inequalities, with consideration of different weights for inequality aversion. Results PHPI trends correspond to the trend of absolute inequality in all five countries, although they exhibit less volatility over time. Relative inequality follows the trend of the PHPI in only two of the five countries (Ethiopia and Zimbabwe), reflecting the methodology utilised for the PHPI. PHPI scores vary based on different inequality aversion weights, highlighting the sensitivity of the index to methodological adjustments. Conclusions The PHPI demonstrates notable convergence of trends with conventional methods, thereby substantiating its utility as a comprehensive tool for the simultaneous measurement of health and inequality. As it is able to consider both absolute and relative inequality within its own calculations, the PHPI allows for independent analysis of its two key components. The PHPI facilitates a more nuanced understanding of population health and may be more easily understood by policymakers and other stakeholders. As it does not address the underlying causes of changes in health inequalities, further research is necessary to supplement monitoring activities. Key messages • PHPI is a valuable tool for health and inequality monitoring by integrating both average health and disparity in a single index, facilitating communication of trends over time. • The dual focus complements conventional methods with its multidimensionality and may enable stakeholders to assess health and inequalities in alignment with broader health policy objectives.

Social disconnectedness and the rate of medical conditions: a Danish population-based cohort study

Abstract Background Lack of social connections has a serious impact on health, increasing the risk of medical conditions such as depression, dementia, and coronary heart disease. However, evidence is limited by a disease-specific focus. We aimed to provide a comprehensive overview of differences in incidence rates of a broad range of medical conditions according to social disconnectedness (i.e., loneliness, social isolation, and low social support). Methods We conducted a cohort study using data on loneliness, social isolation, low social support, and a composite measure from the 2013 and 2017 Danish National Health Survey. Survey data was linked with register data on 11 categories of medical conditions through 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs), incidence rate differences, and explore interaction with pre-existing mental disorders. Results Among 162,497 survey participants, 7.6%, 3.5%, and 14.8% were identified as lonely, socially isolated, and with low social support, respectively. Lonely individuals and individuals with low social support had a higher incidence rate of all 11 categories of medical conditions (interquartile range of IRRs, loneliness 1.22-1.49 and low social support 1.10-1.14), whereas this was the case for nine categories among socially isolated individuals (interquartile range of IRRs, 1.01-1.31). Applying the composite measure, the highest IRR was 2.61 (95% CI, 2.34-2.88) for a mental disorder and the lowest 1.03 (95% CI, 0.95-1.10) for cancer. We found neither major sex differences nor substantial interaction with pre-existing mental disorders. Conclusions Our study confirms and extends the available evidence on social disconnectedness and the risk of medical conditions. The attained knowledge may be of significance for mapping group-specific preventative needs and guiding interventions and health practitioners aiming to reduce the disease burden among socially disconnected individuals. Key messages • Based on survey and register data from 162,497 individuals, our study suggests that social disconnectedness, especially loneliness, is a determinant of a broad range of medical conditions. • The findings may be of importance for identifying and targeting the disease burden among socially disconnected individuals.

Effects of a Six-Month Physical Activity Program on Health Risk Factors and Body Composition Among Overweight and Obese Middle-Aged Adults

Introduction. Physical activity is vital for preventing and managing lifestyle-related diseases, which pose significant health and socio-economic challenges. This study aimed to evaluate the effects of a six-month supervised physical activity program on health risk factors and body composition in middle-aged individuals with overweight or obesity. Methods. The study involved 166 men and women aged 30 to 65 years, with a body mass index (BMI) ranging from 26 to 35 and moderate to severe health risks. Participants of the study were engaged in a six-month physical activity training program designed in accordance with World Health Organization guidelines. Comprehensive assessments were performed at baseline and after the intervention, including measurements of various anthropometric and body composition parameters, as well as evaluations of functional performance. Fitness tests were also conducted to assess participants’ physical capacity and to monitor improvements throughout the training period. Results. Baseline measures of body mass composition and age demonstrated a strong positive correlation with visceral fat rating (VFR) in both men (r = 0.364, p &lt; 0.001) and women (r = 0.420, p = 0.002). Following the six-month training program, participants exhibited an average improvement of 30% (p &lt; 0.001) in their Cooper endurance test results. The physical activity intervention positively impacted body mass index (BMI) and various body composition metrics, including fat mass, VFR, and muscle mass, across all participants and most subgroups (gender, BMI, and age). In males, training at higher maximum heart rate (HRmax) zones significantly contributed to a reduction in the percentage of fat mass (80–89% HRmax) and an increase in the percentage of muscle mass (70–79% and 80–89% HRmax). Conclusions. The study indicates that a six-month supervised physical activity program significantly improves health risk factors and body composition (visceral fat reduction and improvement in percent of fat and muscle mass) among middle-aged individuals with overweight or obesity. Therefore, we advocate for the integration of structured physical activity interventions into healthcare practices to effectively enhance health outcomes in this population.

Nitisinone attenuates progression of aortic stenosis in patients with alkaptonuria: an analysis of the SONIA 2 study

Abstract Background/introduction Alkaptonuria (AKU) is a rare metabolic disorder caused by a defective enzyme, resulting in deposition of unmetabolised homogentisic acid in various connective tissues throughout the body (also termed "ochronosis"). Ochronosis of the aortic valve leading to progressive aortic stenosis is a rare but serious complication. Nitisinone decreases urinary and serum homogentisic acid levels and has been shown to improve morbidity and slow disease progression in AKU but the effects of this treatment on the progression of aortic stenosis have not yet been described. This review extrapolated from the data set of the SONIA 2 study, a 4-year multi-centre, randomised controlled trial investigating the effect of nitisinone on a composite clinical measure of AKU disease activity, but looked more specifically at measures of aortic stenosis disease progression. Methods Data was obtained from echocardiograms performed on 138 patients at baseline, 12, 24, 36 and 48 months of follow-up. In measuring the degree of aortic stenosis, the peak trans-aortic velocity (Vmax) was examined. A linear mixed effects regression model was used to assess the association between treatment and Vmax and to ascertain the difference in this measure at baseline and 48 months between the treatment and control groups. The mixed effects model incorporated both fixed effects for population parameters (age, sex, baseline Vmax, follow-up time) and treatment; and random effects, to account for intra-subject correlation of longitudinal observations of Vmax, inter-subject variability of baseline measurements of Vmax, and centre. Results At baseline, 19/138 patients (13.8%) had aortic stenosis, as classified by echocardiogram findings in accordance with the European Society of Cardiology (ESC) guidance on valvular heart disease, with 9/19 having mild aortic stenosis, 6/19 having moderate aortic stenosis and 4/19 having severe aortic stenosis. 25/138 had aortic sclerosis (see figure 1). The prevalence of aortic valve disease increased with age. From the 4-year follow-up period, 613 longitudinal observations of 138 subjects across all sites were obtained. At baseline, the difference in Vmax between the control and treatment groups was 0.063 m/s [95% CI: -0.054 m/s to 0.18 m/s] and did not reach statistical significance (p=0.23). At the end of the 4-year treatment period, the difference in Vmax was 0.10 m/s [95% CI: -0.0007 m/s to 0.20 m/s] and was statistically significant (p=0.05) (see figure 2). Conclusion Nitisinone slowed progression of aortic stenosis in patients with AKU. This may be grounds for timely initiation of nitisinone in those deemed to be at high risk, as identified by echocardiography. Of note, this is the first time that any medical therapy has ever been shown to affect the natural history of aortic stenosis.

Overlapping markets and quality competition among community health centers.

To examine the response of community health center (CHC) quality to quality levels at neighboring CHCs in the presence of non-price competition. A quasi-experimental study of US community health centers. Outcome variables were indices that measured overall quality of CHC care. Using patient flow data, we constructed CHC-specific Hirschman-Herfindahl index (HHI) and competitors' composite quality measure. The plausibly exogenous change in characteristics of "competitors' competitors" was exploited to identify the relationship between competition and quality of care, using a generalized two-stage least square model with instrumental variables. Using the Health Center Program Uniform Data System (2014-2018), linked with American Community Survey and Medical Expenditure Panel Survey, we analyzed 1098 unique federally funded CHCs in 50 states and District of Columbia which had at least one neighboring CHC and had non-missing data for 2015-2018 (4226 CHC-years). Most of CHCs served populations in overlapping geographic markets, with median market concentration decreasing during the study period. A one-percent increase in competitors' quality was associated with a 0.71-percent increase in an index CHC's composite quality (p < 0.01), consisting of a 0.59-percent increase in chronic condition control rates (p < 0.01); a 0.68-percent increase in the screening and assessment rates (p < 0.01); and a 0.78-percent increase in medication management rates (p < 0.01). The association was stronger at CHCs serving a smaller proportion of uninsured patients. No significant quality reaction was observed at CHCs with a percentage of uninsured patients larger than the 75th percentile. We observed no significant associations between HHI and quality. Increasing competition does not harm quality of care at CHCs. A CHC appears to improve its quality if its competitors improved quality. The beneficial quality effect was less pronounced in CHCs providing a significant proportion of care to uninsured patients, suggesting lack of incentives faced by these CHCs.

Timing of Palliative Care, End-of-Life Quality Indicators, and Health Resource Utilization

Despite research supporting the benefits of early palliative care, timely initiation by gynecologic oncology patients is reportedly low, which may limit the effectiveness of palliative care. To investigate the association of the timing of palliative care initiation with the aggressiveness of end-of-life care using established quality indicators among patients with ovarian cancer. This population-based retrospective cohort study of ovarian cancer decedents used linked administrative health care data to identify palliative care provision across all health care sectors and health care professionals (specialist and nonspecialist) and end-of-life quality indicators in Ontario, Canada, from 2006 to 2018. Data analyses were performed July 12, 2024. The primary outcome was the associations between the timing of palliative care and end-of-life quality indicators, including emergency department use, hospital or intensive care unit admission in the last 30 days of life, chemotherapy in last 14 days of life, death in the hospital, and a composite measure of aggressive care. Late palliative care was defined as 3 months or less prior to death. There were 8297 ovarian cancer decedents. Their mean (SD) age at death was 69.6 (13.1) years, and their mean (SD) oncologic survival was 2.8 (3.9) years. Among 3958 patients with known cancer stage, 3495 (88.3%) presented with stage III or IV disease. One-third of patients (2667 [32.1%]) received late palliative care in the final 3 months of life. Results of multivariable regression analysis indicated that any palliative care initiated earlier than 3 months before death was associated with lower rates of aggressive end-of-life care (odds ratio [OR], 0.47 [95% CI, 0.37-0.60]), death in hospital (OR, 0.54 [95% CI, 0.45-0.65]), and intensive care unit admission (OR, 0.46 [95% CI, 0.27-0.76]). Specialist palliative consultation from 3 months up to 6 monts before death was associated with decreased likelihood of late chemotherapy (OR, 0.46 [95% CI, 0.24-0.88]). Findings from this cohort study suggested that early palliative care may be associated with less-aggressive end-of-life care than late palliative care. Implementation strategies for early palliative care initiation are needed to optimize care quality and health resource utilization at the end of life.

BEST-COST project: a scoping review on the use of multiple deprivation indices in Europe

Abstract Background A Multiple Deprivation Index (MDI) is a composite measure designed to comprehensively evaluate the socio-economic status of individuals within a population. While various countries have employed their own versions of MDI to assess deprivation, none have been developed at the European level thus far. The BEST-COST project (www.best-cost.eu) aims to integrate the dimension of social inequalities in the assessment of the burden of environmental stressors, using a new MDI. Therefore, the objective of this study is to conduct a scoping review to identify and assess current MDIs while extracting details on the methodologies employed in their development. Methods We conducted a scoping review on deprivation indices in European countries, encompassing three databases (Medline, Embase and Web of Science). Following screening of all the articles based on inclusion criteria, we specifically examined the methodological choices made across the development of the MDIs, such as the choice of the underlying indicators, geographical scales, data source used, and if and/or how indicator weighting was applied in creating a composite score. Results In total, 22 MDIs were identified from 195 articles. 42% of these indices were developed from census data at the municipality level or finer. About half of them (55%) employed weighting of indicators, thereby reflecting their relative importance within the index’s score. From these 22 MDIs, a total of 156 individual indicators were extracted. These indicators encompass several domains such as basic amenities, crime, education, employment, family structure or income. The extensive variety of indicators can be attributed to cultural differences within the EU, data availability and the specific time period during which each index was developed. Conclusions Several European countries have separately developed their own MDI, showcasing significant variability in both the included individual indicators and the methodologies applied. Key messages • This review highlights the variability of existing indices and which methodologies could be used for the development of a Europe-wide multiple deprivation index. • It further emphasizes the importance of considering cultural differences and data availability across countries in this process.

Plasma cytokines are associated with major adverse cardiovascular events in follow-up of patients undergoing carotid endarterectomy

Abstract Background Patients with carotid artery disease undergoing carotid endarterectomy (CEA) have a high risk of experiencing Major Adverse Cardiovascular Events (MACE) after surgery. The occurrence of MACE in CEA-treated patients is not predicted by common cardiovascular (CV) risk factors. Purpose We aimed to identify the association between plasma and plaque inflammatory cytokines and the incidence of MACE in the follow-up after CEA. We hypothesized that MACE is related to a higher level of circulating inflammatory cytokines at the time of surgery. Methods We prospectively enrolled patients with carotid artery disease undergoing CEA. Plasma and carotid plaques were collected during the surgery. Inflammatory cytokines (MCP-1/CCL2, IL-8/CXCL8, IFN-gamma, IL-10, IL-1beta/IL-1F2, IL-6, PDGF-AA, PDGF-AB/BB, TNF-alpha, VEGF) were measured in plasma and tissue homogenates using a customized 10-plex Luminex assay. Baseline demographics and clinical data for all the patients were extracted from electronic health records. MACE after CEA was defined as a composite measure of nonfatal cardiac events such as myocardial infarction with or without revascularization, cerebrovascular events (ischemic stroke, TIA, and amaurosis fugax), and all-cause mortality. Results Of 107 patients who underwent CEA with a median age of 73 (67-78) years, 57 (53.2%) experienced MACE during a median follow-up of 5.2 [2.2-9.3] years: 23 (40.3%) cardiac events, 9 (15.7%) CVA, and 25 (43.8%) all-cause mortality. Plaque cytokines levels did not differ between the groups with and without MACE in the follow-up after CEA. Instead, plasma cytokines were associated with MACE in the follow-up after CEA, as summarized in Figure 1. In the logistic regression analysis, plasma levels of MCP-1/CCL2, IFN-gamma, and TNF-alpha were independent predictors of MACE in follow-up post-CEA in univariate and multivariable models adjusted for CV risk factors such as age, BMI, systolic and diastolic blood pressure, low-density lipoprotein, high-density lipoprotein, and glucose level: MCP1/CCL2 (HR 1.009 [1.002-1.015]; p=0.007), IFN-gamma (HR 1.368 [1.014-1.845]; p=0.040), and TNF-alpha (HR 1.121 [1.022-1.228]; p=0.015) (Table 1). Conclusions Plasma levels of CCL2, IFN-gamma, and TNF-alpha are associated with the high incidence of MACE in the follow-up after CEA, indicating that these are potential biomarkers of MACE in this patient population and potential therapeutic targets in patients' progression of systemic atherosclerosis.Plasma cytokines and MACE after CEACytokines logistic regression analysis

Body composition trajectories before the diagnosis of type 2 diabetes mellitus in Whitehall II study

Abstract Background The trajectories of anthropometric and body composition measures (important predictors of diabetes) are rarely explored before diabetes diagnosis. Our study aimed to compare trajectories of fat mass (FM), fat-free mass (FFM), body mass index (BMI), and waist circumference (WC) preceding type 2 diabetes mellitus (T2DM) to aging trajectories of individuals without diabetes during follow-up. Methods We used data from the Whitehall II study, a prospective cohort of British civil servants. 5-yearly BMI and WC were available for up to 20 years, while 5-yearly FM and FFM measures were available for up to 10 years. Linear mixed models with a backward timescale (from diabetes diagnosis or end of follow-up) were performed stratified by sex and adjusted for age, occupational grade, ethnicity, and lifestyle factors. Results A total of 1674/990 (anthropometric/body composition analysis) women (233/81 incident diabetes) and 3917/2710 men (479/217 incident diabetes) 49.81 [0.08]/60.91 [0.9] (mean [SE]) years of age at baseline were included. All outcomes were higher in cases compared to controls. Women’s FM, BMI, and WC followed a quadratic increase in both groups with a faster increase among incident diabetes cases (dBMI 0.04 [0.01] kg/m2/year, dFM 0.19 [0.09] kg/year, dWC 0.2 cm/year [0.05]). FFM decreased linearly with similar slopes in cases and controls. Men’s FM, BMI, and WC also showed a quadratic increase with faster increase in incident cases compared to controls (dBMI 0.03 [0.01] kg/m2/year, dFM 0.23 [0.04] kg/year, dWC 0.08 [0.02] cm/year). FFM followed a quadratic decrease in both groups with a slower rate (0.06 [0.03] kg/year) in incident cases. Conclusions Incident diabetes cases have higher anthropometric and body composition measures 10-20 years before diabetes diagnosis compared to controls. Furthermore, incident cases showed faster increases in these measures except for FFM that decreased during follow-up with similar or lower speeds in cases than controls. Key messages • Traditional anthropometric measures do not capture the underlying changes in body composition. • The inclusion of body composition in risk calculators may result in more precise diabetes prediction.

Effect of Endogenous Hormone Levels on Basal Metabolic Rate in Men With Obesity.

Basal metabolic rate (BMR) is an important factor in weight management and is influenced by fat-free mass (FFM), fat mass (FM) and age. Current knowledge of the influence of hormonal levels on BMR is based on studies with small populations, studies that investigate exogenous administration and studies frequently lacking correction for body composition. Cross-sectional study. All men (n = 457) who were referred to our centre for a metabolic work-up were eligible for inclusion. Median age was 47 (18-78) years and the vast majority had obesity (BMI ≥ 30 kg/m², 90.9%). All men had a measurement of BMR, body composition and measurement of testosterone, sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor 1 (IGF-1), thyroid-stimulating hormone (TSH) and free thyroxine (fT4). Men with low, normal and/or high levels of each of these hormones were compared. The association between hormone levels and BMR was assessed through linear regression models. All analyses were controlled for FFM, FM and age. In men with obesity, testosterone (total or free) was not associated with BMR. Linear regression analysis showed that DHEAS was positively associated with BMR in a sample of men with obesity and normal endogenous DHEAS levels, with the following equation: BMR (adjusted R² = 0.72): (BMR [kcal/d] = 513.402 + 18.940 × FFM [kg] + 9.507 × FM [kg] - 3.362 × age [years] + 0.307 × DHEAS [µg/dL]) (p < 0.01). TSH, fT4 and IGF-1 were not associated with BMR. In men with obesity, endogenous DHEAS is positively associated with BMR. Testosterone, TSH, fT4 and IGF-1 were not associated with BMR in men with obesity. Since we examined the specific population of men with obesity and only examined endogenous hormone levels, no extrapolation of results to other populations or the overall population can be made.