Composite Measure Research Articles

Hybrid deep learning and similarity measures for requirements-driven composition of semantic web services

Hybrid deep learning and similarity measures for requirements-driven composition of semantic web services

Common Genetic Factors May Play a Role in the Relationships Between Body Composition, Adipokines, and Low-Back-Pain-Related Disability

In this study, we evaluated the contribution of the putative genetic factors into the established associations between selected circulating adipokine levels, body composition measurements, and low-back-pain-related disability scores (LBP_DS). A total of 1078 individuals from 98 nuclear families (with 1 to 11 siblings per family) were examined. A detailed self-report questionnaire was used to collect LBP disability data; body composition (fat, skeletal muscle mass, and extracellular water (ECW)) was assessed using the bioimpedance method; plasma levels of adipokines were measured by ELISA. Pedigree-based statistical analysis methods were used, including family-based variance component analysis (VCA) and principal phenotype analysis (PPA), to estimate the contribution of potential genetic and environmental factors. The VCA revealed a significant additive genetic component in LBP_DS and for the selected body composition phenotypes and adipokines. The study also revealed that both adipokines (GDF-15, chemerin, and follistatin) and body composition variables (BMI, fat mass/weight, waist circumference, and ECW) were genetically correlated with LBP_DS. Next, PPA generated two synthetic phenotypes: PPCT (combining cytokines) and PPBC (combining body composition variables). There was no significant correlation between the putative genetic factors underlying the created PPs. However, each of them displayed a significant genetic correlation with LBP_DS. These findings indicate that genetic factors that are assumingly common for several adipokine variations and several body composition measurements, respectively, presumably have a pleotropic genetic influence on the LBP_DS variation, independently from one another. This, in turn, suggests that the alleged genetic factors employing pleiotropic effects on LBP_DS have a complex and probably non-overlapping composition.

Trending in the right direction: critical access hospitals increased adoption of advanced electronic health record functions from 2018 to 2023.

We analyzed trends in adoption of advanced patient engagement and clinical data analytics functionalities among critical access hospitals (CAHs) and non-CAHs to assess how historical gaps have changed. We used 2014, 2018, and 2023 data from the American Hospital Association Annual Survey IT Supplement to measure differences in adoption rates (ie, the "adoption gap") of patient engagement and clinical data analytics functionalities across CAHs and non-CAHs. We measured changes over time in CAH and non-CAH adoption of 6 "core" clinical data analytics functionalities, 5 "core" patient engagement functionalities, 5 new patient engagement functionalities, and 3 bulk data export use cases. We constructed 2 composite measures for core functionalities and analyzed adoption for other functionalities individually. Core functionality adoption increased from 21% of CAHs in 2014 to 56% in 2023 for clinical data analytics and 18% to 49% for patient engagement. The CAH adoption gap in both domains narrowed from 2018 to 2023 (both P < .01). More than 90% of all hospitals had adopted viewing and downloading electronic data and clinical notes by 2023. The largest CAH adoption gaps in 2023 were for Fast Healthcare Interoperability Resources (FHIR) bulk export use cases (eg, analytics and reporting: 63% of CAHs, 81% of non-CAHs, P < .001). Adoption of advanced electronic health record functionalities has increased for CAHs and non-CAHs, and some adoption gaps have been closed since 2018. However, CAHs may continue to struggle with clinical data analytics and FHIR-based functionalities. Some crucial patient engagement functionalities have reached near-universal adoption; however, policymakers should consider programs to support CAHs in closing remaining adoption gaps.

Volumetric body composition analysis of the Cancer Genome Atlas reveals novel body composition traits and molecular markers Associated with Renal Carcinoma outcomes

Clinically, the body mass index remains the most frequently used metric of overall obesity, although it is flawed by its inability to account for different adipose (i.e., visceral, subcutaneous, and inter/intramuscular) compartments, as well as muscle mass. Numerous prior studies have demonstrated linkages between specific adipose or muscle compartments to outcomes of multiple diseases. Although there are no universally accepted standards for body composition measurement, many studies use a single slice at the L3 vertebral level. In this study, we use computed tomography (CT) studies from patients in The Cancer Genome Atlas (TCGA) to compare current L3-based techniques with volumetric techniques, demonstrating potential limitations with level-based approaches for assessing outcomes. In addition, we identify gene expression signatures in normal kidney that correlate with fat and muscle body composition traits that can be used to predict sex-specific outcomes in renal cell carcinoma.

Association of cognitive performance with overall, dosage, intensity, and domain physical activity in aging: NHANES 2011–2014

BackgroundThe specific relationship between PA in detailed types and cognition is still unclear due to limited evidence. Our study aimed to investigate the relationship between cognitive performance and various aspects of physical activity, including overall activity, dosage, intensity levels [moderate physical activity (MPA), vigorous PA], and different domains of activity [occupational PA (OPA), transportation PA (TPA), and leisure-time PA (LTPA)] in older adults using data from the NHANES database.MethodsThis cross-sectional analysis used data from 2 cycles of NHANES (2011–2014). PA was determined through participants' self-reports using the Global Physical Activity Questionnaire (GPAQ). Cognitive performance was evaluated by the presence of psychometric mild cognitive impairment (p-MCI), identified based on a composite measure derived from three cognitive tests including the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the Animal Fluency test, and the Digit Symbol Substitution test (DSST). Logistic regression models were used to evaluate the association.ResultsA total of 2588 participants aged 60 years or older were included, with an average age of 69.4 years and 48% being male. In the fully adjusted model, compared to no PA, performing 300 min of PA, and MPA were associated with 44%, and 33% reductions in the prevalence of p-MCI, respectively. Additionally, engaging in 1–149 min/week [OR 0.56, 95% CI (0.33–0.92)] and ≥ 300 min/week [OR 0.66, 95% CI (0.44–0.96)] of OPA, as well as ≥ 300 min/week [OR 0.56, 95% CI (0.36–0.86)] of LTPA, were also associated with a lower prevalence of p-MCI. Additionally, engaging in a diverse range of PA had better outcomes.ConclusionsOur results suggested a positive association between higher levels of PA and enhanced cognitive performance. Different intensities and domains of PA have varying impacts on cognition. Future exploration, such as objectively measured PA and longitudinal studies were needed to validate our conclusion.

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.

Deferiprone in Alzheimer Disease

Interventions that substantially slow neurodegeneration are needed to address the growing burden of Alzheimer disease (AD) to societies worldwide. Elevated brain iron observed in AD has been associated with accelerated cognitive decline and may be a tractable drug target. To investigate whether the brain-permeable iron chelator deferiprone slows cognitive decline in people with AD. This phase 2, double-masked, placebo-controlled randomized clinical trial of 12-month duration was conducted at 9 sites in Australia between August 2, 2018, and April 1, 2023. Patients older than 54 years with amyloid-confirmed mild cognitive impairment or early AD (a Mini-Mental State Examination score of 20 or higher) were screened. Randomization was 2:1 and masked to participants and all study staff. Deferiprone 15 mg/kg twice a day or placebo administered orally for 12 months. The primary outcome was a composite cognitive measure assessed at baseline, 6 months, and 12 months using a neuropsychological test battery (NTB) of memory, executive function, and attention tasks. Secondary outcomes included change in brain iron burden measured by quantitative susceptibility mapping (QSM) magnetic resonance imaging (target engagement), brain volume changes (secondary efficacy measure), and adverse events (safety analysis). Of 167 patients screened for eligibility, 81 were included, with 53 randomly assigned to the deferiprone group (mean [SD] age, 73.0 [8.0] years; 29 male [54.7%]) and 28 to the placebo group (mean [SD] age, 71.6 [7.2] years; 17 male [60.7%]); 54 participants completed the study (7 [25.0%] withdrew from the placebo group and 20 [37.7%] from the deferiprone group). In an intention-to-treat analysis, participants in the deferiprone group showed accelerated cognitive decline on the NTB primary outcome (β for interaction = -0.50; 95% CI, -0.80 to -0.20) compared with placebo (change in NTB composite z score for deferiprone, -0.80 [95% CI, -0.98 to -0.62]; for placebo, -0.30 [95% CI, -0.54 to -0.06]). Secondary analysis revealed that this result was driven by worsening performance on executive function tests. The QSM confirmed that deferiprone decreased iron in the hippocampus compared with placebo (change in hippocampal QSM for deferiprone, -0.36 ppb [95% CI, -0.76 to 0.04 ppb]; for placebo, 0.32 ppb [95% CI, -0.12 to 0.75 ppb]; β for interaction = -0.68 [95% CI, -1.27 to -0.09]). Longitudinal hippocampal volume loss was not affected by deferiprone, but exploratory analysis of other brain regions revealed increased volume loss with deferiprone in frontal areas. The frequency of the adverse effect of neutropenia (4 participants [7.5%] in the deferiprone group) was higher than in similar studies (1.6%-4.4%). These trial findings show that deferiprone 15 mg/kg twice a day decreased hippocampal QSM and accelerated cognitive decline in patients with amyloid-confirmed early AD, suggesting that lowering iron with deferiprone is detrimental to patients with AD. ClinicalTrials.gov Identifier: NCT03234686.

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?

Microdroplet Pull-out Testing: Significance of Fiber Fracture Results

Fiber reinforced composites are used in structural materials that required light weight and stiffness. The properties of the fibers or matrix are important, but the interfacial properties have a significant impact on the properties of fiber reinforced composite. In this study, the interfacial shear strength (IFSS) was measured using acrylic resin and epoxy resin as base materials. The chemical composition of acrylic and epoxy matrix materials was analyzed to predict the effects on IFSS. Additionally, IFSS was measured through a microdroplet pull-out test. The reliability of the experimental results was enhanced by applying a statistical analysis to IFSS results. In the case of epoxy, GF/epoxy exhibited higher IFSS to twice and half times than CF/epoxy specimens. It means that the surface treatment of the fibers has a significant impact on the interface. In the case of acrylic, IFSS could be measured for GF. But in the case of CF, IFSS was too low to get accurate results of IFSS. Through this research, methods to improve the accuracy of composite interfacial strength measurement experiments were examined, and the study suggested the need for standardized criteria to evaluate composite interfacial adhesion.

Vitamin D and Cardiovascular Outcomes in Multiple Sclerosis

Background: Vitamin D (25(OH)D) deficiency is linked to increased cardiovascular disease (CVD) risk in the general population, but its implications for people with multiple sclerosis (pwMS) remain unexplored. This study aimed to evaluate the association of 25(OH)D with long-term CVD outcomes in pwMS and the impact of vitamin D supplementation. Methods: This observational cohort study analysed anonymised medical records from 70 healthcare organisations following pwMS for 5-years (2019-2024). PwMS and deficient or inadequate 25(OH)D levels were 1:1 propensity-score matched with pwMS and adequate 25(OH)D levels, for demographics, comorbidities, and cardiovascular care. Cox proportional hazard models analysed the incidence of all-cause mortality, stroke, acute myocardial infarction, heart failure, angina, atrial fibrillation/flutter, and a composite measure of major adverse cardiovascular events (MACE). Propensity-matched pwMS who had deficient or inadequate 25(OH)D levels taking cholecalciferol were compared to pwMS and adequate 25(OH)D levels (not taking supplementation). Results: Amongst 74,372 pwMS, 9% had deficient 25(OH)D levels, 18% inadequate, and 73% adequate. Deficient, or inadequate 25(OH)D levels were associated with an increased rate of MACE (HR, 1.32 [95%CI: 1.19, 1.46], HR, 1.29 [95%CI: 1.20, 1.40], respectively) compared to those with adequate levels. Cholecalciferol supplementation in pwMS and deficient or inadequate 25(OH)D levels did not alleviate the higher CVD rate (HR, 1.39 [95%CI: 1.21,1.60], HR, 1.31 [95%CI: 1.17, 1.47], respectively) in comparison to those with adequate 25(OH)D levels taking no vitamin D supplementation. Conclusions: Deficient or inadequate 25(OH)D levels in pwMS were associated with an increased rate of MACE, which may not be mitigated by vitamin D supplementation.

Genetic characterization of phenotypic traits in endangered Taishu horse breed and their breeding strategy.

The Taishu horse is a native Japanese breed threatened with extinction. It is important to genotype the causative genes of rare phenotypes in endangered breeds because unique genetic traits might be lost unless a breeding strategy for conservation is constructed. In the present study, nine single-nucleotide variants and three indels of nine genes related to coat color, body composition, and gait were genotyped in 56 Taishu horses. Of these, only three genes were polymorphic. The observed coat color phenotypes coincided with the estimated phenotype from the genotypes, whereas black horses showed specific phenotypes that were generally black in winter but turned light brown in summer. No DNA polymorphisms in ligand-dependent nuclear receptor corepressor-like gene and very few polymorphisms in myostatin gene were identified. While means of withers height, chest circumference, cannon circumference, and body length were 122.8, 143.1, 16.9, and 130.2 cm, respectively, no relationship was found between the variants investigated and the body composition measurements. The gaited allele of doublesex and mab-3 related transcription factor 3 gene was not observed and the estimated phenotypes coincided with the observed phenotype, trot. Genotypes of coat color in the Taishu horses are essential for the construction of breeding strategies to conserve black and chestnut horses, which are much less common than bay horses. These results may help breeders construct breeding strategies to conserve rare phenotypic traits in this breed. This initiative will also be beneficial for breeding programs of other native Japanese horses, such as Noma and Miyako, whose numbers are declining.

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.

Area-based composition predictions of materials fabricated using simultaneous wire-powder-directed energy deposition

Functionally graded materials are an emergent method for designing components with programmable site-specific material properties. These materials are typically fabricated using metal additive manufacturing tools by simultaneously feeding multiple wire and/or powder feedstocks at various rates to achieve spatial composition change. The wire-powder-directed energy deposition (WP-DED) technique is of particular interest for many functionally graded material applications by balancing the low raw materials cost of wire with the high resolution of powder. However, feeding wire and powder are inherently different processes since all extruded wire enters the melt pool, while much of the blown powder is scattered, which makes determining the composition of the build challenging. In this study, we devise a simple area-based measurement method for estimating the composition of WP-DED structures. WP-DED single beads are printed using 309L stainless steel wire and commercially pure Fe powder at five wire feed rates (0.5, 0.75, 1.00, 1.25, 1.50 mm/mm) and five powder feed rates (2, 4, 6, 8, 10 rpm). Characteristic defects including interface gaps and macrosegregation (lack of mixing) tendencies are examined. High powder feed rates (8, 10 rpm) result in interface gaps at all wire feed rates, but smooth deposition and complete mixing is achieved at low powder feed rates, particularly with lower wire feed rates as well. The area-based composition measurement method is within ±20% of energy dispersive x-ray spectroscopy measurements for all samples, showing its effectiveness as a rapid composition estimate for WP-DED materials development.

Impact of Disease Cyclicity on Quality-of-Life Impairment – A Mixed Method Explanatory Study

BackgroundDisease cyclicity, a composite measure of unpredictable and daily fluctuations of symptoms, strongly predicts quality-of-life (QoL) impairment. ObjectiveTo explore the mechanisms by which cyclicity impacts QoL. Methods1:1 semi-structured interviews were conducted and qualitatively analyzed using grounded theory. Common themes were identified and used to derive a theoretical framework. Results23 adults, (median age 28.5, range 20-72) with a range of chronic inflammatory diseases including eczema, psoriasis and inflammatory arthritis were prospectively recruited. Cyclicity, characterized by unpredictability, uncontrollability, and lability, contributed to a varying productivity and inconsistent ability in performing daily activities. Challenges intensified if external expectations of the patient were inconsistent with their fluctuating ability. Coping abilities, shaped by internal and external factors, moderated the relationship between cyclicity and QoL impairment. LimitationsQualitative interviews assume patients have accurate insights into their own behaviours. The generalizability of findings may be limited in other populations. ConclusionDisease cyclicity defines many inflammatory diseases. This study provides a theoretical framework for understanding and managing the challenges patients with a cyclical condition face.

The association between composite measures of social vulnerability and PICU admission for status asthmaticus.

Current knowledge of the impact of socioeconomic factors on the risk of admission to the pediatric intensive care unit (PICU) for asthma is limited. Using composite measures of social vulnerability-Social Vulnerability Index (SVI) and Child Opportunity Index (COI) 2.0-we compared patients admitted for status asthmaticus to the PICU and pediatric ward at Children's Hospital Los Angeles (CHLA). We hypothesized patients with a high SVI and low COI are at higher risk for PICU admission. Patients were identified using ICD-10 codes for asthma. Primary outcome was admission to PICU versus ward for status asthmaticus. Patient-registered residential street addresses were geocoded and spatially joined to SVI and COI 2.0 data at the census tract level. Univariate and regression analyses using the patient's SVI, COI 2.0, and admission location were conducted. From January 2017 to March 2022, there were 2458 admissions matched to addresses from 1983 distinct patients. The overall median SVI for all patients was 0.86 (IQR 0.6, 0.9). Overall median COI was 25.0 (IQR 10, 50). There was no difference in SVI or COI for admission to the PICU versus the ward. However, children requiring multiple hospital admissions for asthma were associated with higher SVI and lower COI. Children admitted to CHLA for asthma had an elevated SVI and low COI. There was no difference between admission locations based on SVI or COI scores. This indicates we care for children at increased socioeconomic risk, but this did not increase PICU use for asthma.

Biochar as a UV Stabilizer: Its Impact on the Photostability of Poly(butylene succinate) Biocomposites.

In the present study, biocomposite materials were created by incorporating biochar (BC) at rates of 1, 2.5, and 5 wt.% into a poly(butylene succinate) (PBSu) matrix using a two-stage melt polycondensation procedure in order to provide understanding of the aging process. The biocomposites in film form were exposed to UV irradiation for 7, 14, and 21 days. Photostability was examined by several methods, such as Fourier transform infrared spectroscopy (FTIR), which proved that new carbonyl and hydroxyl groups were formed during UV exposure. Moreover, Differential Scanning Calorimetry (DSC) measurements were employed to record the apparent UV effect in their crystalline morphology and thermal transitions. According to the molecular weight measurements of composites, it was apparent that by increasing the biochar content, the molecular weight decreased at a slower rate. Tensile strength tests were performed to evaluate the deterioration of their mechanical properties during UV exposure, while Scanning Electron Microscopy (SEM) images illustrated the notable surface alternations. Cracks were formed at higher UV exposure times, to a lesser extent in PBSu/BC composites than in neat PBSu. Furthermore, the mechanism of the thermal degradation of neat PBSu and its biocomposites prior to and upon UV exposure was studied by Pyrolysis-Gas Chromatography/Mass Spectrometry (Py-GC/MS). From all the obtained results it was proved that biochar can be considered as an efficient UV-protective additive to PBSu, capable of mitigating photodegradation.

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 &gt; 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.