Multifactorial Model Research Articles

Pathophysiology of primary hypertension in children and adolescents.

The progress in research on the physiology of the cardiovascular system made in the last 100years allowed for the development of the pathogenesis not only of secondary forms of hypertension but also of primary hypertension. The main determinants of blood pressure are described by the relationship between stroke volume, heart rate, peripheral resistance, and arterial stiffness. The theories developed by Guyton and Folkow describe the importance of the volume factor and total peripheral resistance. However, none of them fully presents the pathogenesis of essential hypertension. The multifactorial model of primary hypertension pathogenesis developed by Irving Page in the 1940s, called Page's mosaic, covers most of the pathophysiological phenomena observed in essential hypertension. The most important pathophysiological phenomena included in Page's mosaic form a network of interconnected "nodes". New discoveries both from experimental and clinical studies made in recent decades have allowed the original Page mosaic to be modified and the addition of new pathophysiological nodes. Most of the clinical studies confirming the validity of the multifactorial pathogenesis of primary hypertension concern adults. However, hypertension develops in childhood and is even perinatally programmed. Therefore, the next nodes in Page's mosaic should be age and perinatal factors. This article presents data from pediatric clinical trials describing the most important pathophysiological processes associated with the development of essential hypertension in children and adolescents.

Age and liver graft: a systematic review with meta-regression

Increasing organ shortage results in extended criteria donors (ECD) being used to face the growing demand for liver grafts. The demographic change leads to greater use of elderly donors for liver transplantation, historically considered marginal donors. Age is still considered amongst ECD in liver transplantation as it could affect transplant outcomes. However, what is the cutoff for donor age is still unclear and debated. A search of PubMed, Scopus and Cochrane Library was performed. The primary outcome was 1-year graft survival (GS). The secondary outcome was overall biliary complications and 3–5 years of graft and overall survival. A meta-regression model was used to analyse the temporal trend relation in the survival outcome. The meta-analysis included 11 studies. Hazard ratios for 1-year (age cutoff of 70 and 80,) and 5-year GS (I2:0%) were similar irrespectively of the age group. The meta-regression analysis showed a significant correlation between the 1-year graft survival and the year of publication. (coef. 0.00027, 95% CI − 0.0001 to − 0.0003 p = 0.0009). Advanced-age donors showed an increased risk of overall biliary complications with an odd ratio (OR) of 1.89 (95% CI 1–3.65). Liver grafts potentially discharged because of high-risk failure show encouraging results, and GS in ECD has progressively improved with a temporal trend. Currently, the criteria of marginality vary amongst centres. Age alone cannot be considered amongst the extended criteria. First of all, because of the positive results in terms of septuagenarian graft survival. Moreover, the potential elderly donor-related adjunctive risk can be balanced by reducing other risk factors. A prospective multicentre study should investigate a multi-factorial model based on donor criteria, recipient features and new functional biomarkers to predict graft outcome, as proper donor–recipient matching seems to be the critical point for good outcomes.

ПЕРСОНИФИЦИРОВАННЫЙ ПОДХОД К ОЦЕНКЕ РИСКА РАЗВИТИЯ ПОВТОРНЫХ СЕРДЕЧНО-СОСУДИСТЫХ СОБЫТИЙ И ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА И ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК

Introduction: AKI (acute kidney injury) is a common comorbid condition in patients with AMI (acute myocardial infarction), complicating its course and treatment. In the future, the prognosis of these patients after discharge from the hospital, as well as the incidence of recurrent cardiovascular events (CVS) and chronic kidney disease (CKD) are not known. The purpose of the study: to study the predictors of the development of recurrent cardiovascular events (CVS) in patients with myocardial infarction (MI) with acute kidney injury (AKI). Develop a calculator - a risk meter for repeated CCC. Materials and methods: the study was performed in the Altai Regional Cardiological Dispensary. 193 patients with MI and PCI (percutaneous coronary intervention) were included, divided into 2 groups: the first - 123 patients aged 62.8±1.1 years with MI and AKI, the second - 70 patients without AKI, age 61.3± 1.6 years. Upon admission and before discharge, the level of the KIM-1 molecule (Kidney Injury Molecule-1) and IL-18 (interleukin-18) was studied by ELISA in the urine. All patients underwent coronary angiography using low-osmolar contrast. One year after discharge, the frequency of development of repeated CCC was assessed. Statistical calculations were carried out using statistical packages STATISTICA 12.0. The level of statistical significance was taken equal to 0.05. Results. The level of KIM-1 (at admission) in the first group was statistically higher than in the second: 1998.9±147.6 versus 1289.8±126.1 pg/ml p=0.001, and IL-18 in the AKI group exceeded the corresponding parameter of the group without AKI: 179.0±12.9 versus 114.9±11.5 pg/ml p=0.007, respectively. A year later, it was found that the frequency of recurrent cardiovascular events was higher in the group with AMI and AKI: unstable angina was diagnosed in 26 (21.1%) patients in the group with AKI and 5 (7.1%) patients without AKI in history, p=0.010; 19 (15.4%) and 2 (2.8%) patients, p=0.006, 20 (16.2%) and 3 (4.2%), p=0.013 patients, respectively, had repeated myocardial infarction and progression of CHF in a year . Progression of renal dysfunction during the year was observed 5 times more often in patients with MI and AKI: CKD C2 was diagnosed in 49 (39.8%) patients of the first group and 16 (22.8%) of the second, p = 0.01; CKD C3a and C3b stages - in 34 (27.6%), p˂0.001 and 19 (15.4%) patients, p=0.002, respectively, CKD stage C4 was detected in 4 (3.2%) patients of the group with AMI and AKI in the early postinfarction period. As a result of constructing a multifactorial logistic regression model, predictors were identified that have a multiplicative effect on the development of recurrent CV events: BMI over 25 kg/m2 increases the risk of recurrent CV events by 0.91 [0.83; 0.99] times, p=0.028, history of prior MI in 3.32 [1.24; 9.86] times, p=0.022. Increase in CRP by 1.01 [1; 1.03] times, p=0.045, troponin I, 0.97 [0.94;1] times, p=0.037, and IMT-1, 1 [1;1] times, p=0.030. On the development of CKD: an increase in age is associated with an increase in the chances of developing CKD by 1.18 [1.1; 1.29], p ˂0.001; troponin I by 0.96 times [0.92; 1], p=0.030; systolic blood pressure in 1.03 [1; 1.07] times, p = 0.029. A calculator has been developed for risk stratification of the development of recurrent CV events and an algorithm for managing this category of patients after discharge from the hospital. Conclusions: thus, the identified predictors make it possible to calculate the risk of developing recurrent CV events and CKD using the developed calculator and allocate these patients to a separate group for personalized observation, taking appropriate measures of secondary prevention.

Evidence-Based Practice Competency of Registered Nurses in the Greek National Health Service.

Nurses' competency toward evidence-based practice (EBP) has been extensively investigated by several studies worldwide. However, factors affecting the competence of Greek nurses working in the NHS have not been fully investigated in terms of EBP. Thus, this study aimed to explore the impact of the individual qualifications of nurses on their competence toward EBP. Data from 473 registered nurses working in 10 hospitals in the Greek National Health Service (NHS) were collected between October and December 2020 using a convenience sampling method in a cross-section design. The Greek version of the 35-item (five-point Likert scale) Evidence-Based Practice Competency Questionnaire for Professional Registered Nurses (EBP-COQ Prof) was used to assess the competence level of nurses, focusing on attitudes, skills, and knowledge, as well as the utilization of EBP in clinical practice. One-way ANOVA and Pearson coefficient tests were applied to compare the possible differences among variables (two or more groups) as appropriate. A multi-factorial regression model was applied to explore participants' qualifications, including demographics (MSc degree, gender, English language knowledge, etc.) as independent variables, and to control for potential confounding effects toward EBP competency. The p-values < 0.05 were considered statistically significant. The mean age of the 473 participants (402 women and 71 men) was 44.7 ± 9.2 years old. The mean value of competence subscales was found as follows: attitudes 3.9 ± 0.6, knowledge 3.7 ± 0.6, skills 3.1 ± 0.8, and utilization 3.4 ± 0.7. A multivariate regression analysis revealed that associates of "Master's degree" (t = 3.039, p = 0.003), "Writing an academic article" (3.409, p = 0.001), "Working in a University clinic" (2.203, p = 0.028), and "Computer Skills" (2.404, p = 0.017) positively affected "Attitudes", "Knowledge", "Skills", and "Utilization", respectively. The research data suggest that nurses working in the Greek NHS were limited in competence regarding EBP in comparison with other European countries. Therefore, vocational, educational, and training programs tailored to EBP enhancement are crucially important. This study was not registered.

Analysis of hemodynamic changes in vertebral arteries and veins during functional tests with ultrasound monitoring

Aim to evaluate the correlation between the course of vertebral arteries and veins and the results of calculations of hemodynamic parameters during ultrasound with functional tests.&#x0D; Material and methods. In the observation, 252 volunteers were examined using Samsung SonoAce R7 and GE Logiq F6 equipment. The hemodynamics was studied at the level of the second segment of the vertebral arteries and veins at rest, when turning, tilting and lifting the head. The results were processed using Microsoft Excel 2007 with subsequent statistical analysis.&#x0D; Results. 504 vascular complexes were analyzed without taking into account the visualization side. When assessing the arteries, the highest maximum blood flow velocity was registered when lifting the head in women with a rectilinear course of the vessels. In the group of men with non-rectilinear course of vessels, the lowest average blood flow velocity was registered when tilting the head. The highest volume flow was recorded in case of non-rectilinear vascular course in women when lifting the head.&#x0D; For vertebral veins, the highest indicators of maximum and minimum venous blood flow rates were observed in men with a rectilinear course of vessels when lifting the head. The highest values of the average flow velocity and volume flow were noted in men who had a rectilinear course of the vessels.&#x0D; The maximum values of the calculated venous volume flow were registered in groups with rectilinear vascular course: in men up to 19.4214.85 ml/min. (Me 12.45 ml/min.), in women 18.52 15.30 ml/min. (Me 10.50 ml/min.).&#x0D; Conclusion. The data obtained by the study contributes to improving the software and analysis of individual changes during patient examination, helps to evaluate the effectiveness of treatment and rehabilitation, as well as to analyze multifactorial models.

The relationship between musicianship and pain. Is chronic pain and its management a problem for student musicians only?

The neuro-biological side of chronic pain research has presented reliable evidence of distinct cortical and spinal alteration compared to healthy individuals. Furthermore, research suggests that musicians are especially vulnerable to pain, and recent neurological investigations into musicians' brain plasticity support this hypothesis. However, chronic pain is not acute pain plus time, but a separate condition, and little is known about musicians' chronic pain-related emotions and behaviors. This knowledge, however, is a crucial step in understanding how chronic pain is processed by musicians. This study investigated pain catastrophizing as a critical pain-related behavior and emotional concept alongside six complementary variables: anxiety, depression, depersonalisation, burnout, coping strategies and professional identity. 103 under- and postgraduate students from various higher education institutions participated in an online survey. Students were allocated into three groups according to their main study subject and type of institution: music college musicians, university musicians and university non-musicians. A tree model confirmed the current chronic pain multifactorial model, suggesting a combination of several variables before catastrophizing pain. Group testing, however, showed that university non-musicians' pain catastrophizing was significantly worse especially when compared to music college musicians. Music college musicians and university musicians were less prone to maladaptive pain processes, despite perceiving pain for significantly longer. This novel finding indicates that chronic pain does not inevitably lead to dysfunctional pain processing for musicians and should be reflected accordingly to optimize pain-control. The biopsychosocio model of chronic pain provides a robust framework for future research in this population.

Can Emotional or Physical Abuse Be a Risk Factor of Chronic Musculoskeletal Conditions in Professional Dance?

In professional dance, the injury rate is extremely high and dancers have a great chance to experience at least one injury during their careers. Since the #metoo campaign, many abuse cases showed up in the dance industry, resulting in media coverage. Results indicate that dancers had a significantly higher distribution of post-traumatic stress disorder (PTSD) compared to the broad population. In this study, we investigate pathological dissociation, quantify chronic musculoskeletal conditions and evaluate abusive experiences. Questionnaire-based dataset filled out online by Hungarian professional dancers (n = 168). The statistical analysis contains descriptive results, risk assessment, Kaplan Meier curve, and hazard ratios. Dancers scored in the pathological dissociation values, reported several cases of emotional and physical abuse, and were represented by elevated chronic musculoskeletal conditions. We found a statistically significant relationship between abusive experiences and musculoskeletal conditions, so as with dissociation. We conclude that emotional abuse might be one of the factors in a multifactorial model that plays a role in the pathomechanism of chronic pain, inflammation, and tendinopathy. It is important to raise awareness about the importance of emotional factors of pedagogy and the working atmosphere among professional dancers since it might have a role in higher injury rates.

Almost Forgotten Research Contexts: William Stern's Giftedness Research.

This article examines the concept of intelligence and giftedness of the German psychologist and philosopher William Stern, the leading intelligence and giftedness researcher in Germany from the early 20th century to 1933. Stern developed a multifactorial giftedness model that integrated empirical and philosophical perspectives and was thus far ahead of his time. This concept was not taken up for a long time-not least because of the break that the research on giftedness suffered in Germany in 1933-and has not yet been presented with the required complexity and interdisciplinarity. In the USA, Stern's research has so far been reduced to the IQ formula he created. The author presents Stern's concept of giftedness in the context of the particular scientific-historical and educational-political situation in Germany in the first third of the 20th century. The pedagogical conclusions that Stern associated with the research on giftedness, and which essentially referred to the requirement to support all gifted children, regardless of social class, are also illuminated.

Association between dietary magnesium intake and peripheral arterial disease: Results from NHANES 1999-2004.

Magnesium has been found to have a strong association with peripheral arterial disease (PAD), and dietary magnesium intake shows promise as a predictor of the condition. However, the relationship between low dietary magnesium intake and an increased risk of PAD remains uncertain, and further research is needed to clarify this relationship. This study analyzed data from 5969 participants in the National Health and Nutrition Examination Survey (NHANES) of the United States from 1999 to 2004. Multifactorial logistic regression models were used to investigate the association between dietary magnesium intake and PAD. Participants with PAD had lower dietary magnesium intake compared to those without PAD. After adjusting for all covariates, dietary magnesium intake remained negatively associated with PAD (OR: 0.999, 95% CI: 0.998, 1.000). When dietary magnesium intake was divided into quartiles, compared with the fourth quantile, the first quartile is associated with a higher incidence rate of PAD (OR: 1.560, 95%CI: 1.019, 2.386). Subgroup analysis revealed that the link between dietary magnesium intake and PAD remained significant among specific subgroups, including non-white, never or former smokers, and non-hypertensive, non-diabetic individuals (P < 0.05). Our study provides evidence that dietary magnesium intake is negatively associated with the incidence of PAD. Therefore, people with inadequate dietary magnesium intake, particularly those with excessively low intake, should increase their magnesium intake to reduce the risk of PAD.

Factor Model for The Migration Processes Development in Kazakhstan

Migration, being a reflection of socio-economic processes, processes in society, highlights issues related to the identification of the phenomena that cause it. The purpose of the article is to build a multifactorial model for the development of infectious processes. In the course of the study, the main factors affecting the interaction of processes in Kazakhstan in 1991-2021 were identified, a theoretical and methodological justification was given for the dependence (independence) of the regulation of processes on wages, formal and informal employment, assessment of the standard of living of the population, cultural and educational level development of the Kazakhstan population in their morbidity-temporal aspect. Correlation coefficients were calculated and the degree of analysis of indicators was estimated based on calculations of pairwise regression between variables using the SPSS 23 program.

Factor Model for The Migration Processes Development in Kazakhstan

Migration, being a reflection of socio-economic processes, processes in society, highlights issues related to the identification of the phenomena that cause it. The purpose of the article is to build a multifactorial model for the development of infectious processes. In the course of the study, the main factors affecting the interaction of processes in Kazakhstan in 1991-2021 were identified, a theoretical and methodological justification was given for the dependence (independence) of the regulation of processes on wages, formal and informal employment, assessment of the standard of living of the population, cultural and educational level development of the Kazakhstan population in their morbidity-temporal aspect. Correlation coefficients were calculated and the degree of analysis of indicators was estimated based on calculations of pairwise regression between variables using the SPSS 23 program.

A novel immunohistochemical score predicts the postoperative prognosis of gastric cancer patients

Background and aimImmunohistochemistry indicators are increasingly being used to predict the survival prognosis of cancer patients after surgery. This study aimed to combine some markers to establish an immunohistochemical score (MSI-P53-Ki-67[MPK]) and stratify postoperative patients with gastric cancer according to the score.MethodsWe used 245 patients who underwent surgery at one center as the training cohort and 111 patients from another center as the validation cohort. All patients were treated between January 2012 and June 2018. The training cohort was screened for prognostic factors, and MPK scores were established using univariate and multifactorial COX risk proportional models. Patients were prognostically stratified according to the MPK score after gastrectomy for gastric cancer. Overall survival (OS) and recurrence-free survival (RFS) rates were compared among low-, intermediate-, and high-risk groups using the Kaplan–Meier method, and survival curves were plotted. Finally, the MPK score was validated using the validation cohort.ResultsIn the training group, there were statistically significant differences in OS and RFS in the low, medium, and high-risk groups (P < 0.001). Thirty patients were in the high-risk group (12.2%). The median survival times of the three groups were 64.0, 44.0, and 23.0, respectively, and median times to recurrence were 54.0, 35.0, and 16.0 months, respectively. In the validation group, the prognosis in the three risk groups remained significantly different (P < 0.001).ConclusionsThe novel MPK score could effectively predict the postoperative OS and RFS of gastric cancer patients, risk-stratify postoperative patients, and identify postoperative high-risk patients for refined management.

Decontextualized Utterances Contain More Typical and Stuttering-Like Disfluencies in Preschoolers Who Do and Do Not Stutter.

Stuttering-like disfluencies (SLDs) and typical disfluencies (TDs) are both more likely to occur as utterance length increases. However, longer and shorter utterances differ by more than the number of morphemes: They may also serve different communicative functions or describe different ideas. Decontextualized language, or language that describes events and concepts outside of the "here and now," is associated with longer utterances. Prior work has shown that language samples taken in decontextualized contexts contain more disfluencies, but averaging across an entire language sample creates a confound between utterance length and decontextualization as contributors to stuttering. We coded individual utterances from naturalistic play samples to test the hypothesis that decontextualized language leads to increased disfluencies above and beyond the effects of utterance length. We used archival transcripts of language samples from 15 preschool children who stutter (CWS) and 15 age- and sex-matched children who do not stutter (CWNS). Utterances were coded as either contextualized or decontextualized, and we used mixed-effects logistic regression to investigate the impact of utterance length and decontextualization on SLDs and TDs. CWS were more likely to stutter when producing decontextualized utterances, even when controlling for utterance length. An interaction between decontextualization and utterance length indicated that the effect of decontextualization was greatest for shorter utterances. TDs increased in decontextualized utterances when controlling for utterance length for both CWS and CWNS. The effect of decontextualization on TDs did not differ statistically between the two groups. The increased working memory demands associated with decontextualized language contribute to increased language planning effort. This leads to increased TD in CWS and CWNS. Under a multifactorial dynamic model of stuttering, the increased language demands may also contribute to increased stuttering in CWS due to instabilities in their speech motor systems.

Polygenic scores in cancer.

Since the publication of the first genome-wide association study for cancer in 2007, thousands of common alleles that are associated with the risk of cancer have been identified. The relative risk associated with individual variants is small and of limited clinical significance. However, the combined effect of multiple risk variants as captured by polygenic scores (PGSs) may be much greater and therefore provide risk discrimination that is clinically useful. We review the considerable research efforts over the past 15 years for developing statistical methods for PGSs and their application in large-scale genome-wide association studies to develop PGSs for various cancers. We review the predictive performance of these PGSs and the multiple challenges currently limiting the clinical application of PGSs. Despite this, PGSs are beginning to be incorporated into clinical multifactorial risk prediction models to stratify risk in both clinical trials and clinical implementation studies.

Mathematical model for assessing the prognostic significance of 25(OH)D deficiency in the progression of diabetic retinopathy in type 2 diabetes patients

Background. In modern medicine, modeling of pathological processes is actively implementing in clinical endocrinology and ophthalmology. This process provides an opportunity to predict the risk of occurrence, course, prognosis and development of complications of type 2 diabetes mellitus (T2DM), in particular diabetic retinopathy (DR). Nowadays, special attention is paid to the course of DR against the background of vitamin D deficiency. But in the scientific literature, there are no mathematical models for assessing the risk of DM progression in patients with type 2 diabetes against the background of vitamin D deficiency. Aim of the study is to develop an adequate mathematical model for assessing the prognostic significance of 25(OH)D deficiency in the progression of diabetic retinopathy in patients with type 2 diabetes. Materials and methods. An open observational single-center one-stage selective study was conducted. It was approved by the Local Ethics Committee. Seventy-one patients (138 eyes) with T2DM and DR (men and women; mean age 61.9 ± 2.4 years; mean HbA1c 8.12 ± 0.91 %) were divided into 3 groups, based on the stage of DR (according to fundus instrumental examination). The inclusion of patients in groups with DR was carried out in accordance with the ETDRS protocol (2019). Statistical processing included ANOVA, MANOVA and regression analysis with the construction of logistic regression models. Results. A statistically significant (p &lt; 0.001) decrease in the risk of a high degree of DR was found with an increasing concentration of 25(OH)D in the blood plasma for each 1 ng/ml (odds ratio = 0.46 (0.32–0.67)). The pseudocorrelation index (Nagelkerke) R2 is 0.54, area under a receiver operating characteristic curve is 0.92 (95% confidence interval (CI) 0.85–0.97), which indicates the presence of a strong relationship between the risk of a high degree of DR and the concentration of 25(OH)D in the blood, gender and HbA1c level. The obtained multifactorial model was represented by the appropriate mathematical formula. The sensitivity (according to the Youden index) of the obtained logistic regression model is 84.4 % (95% CI 73.1–92.2), specificity is 92.3% (95% CI 74.9–99.1). Conclusions. An adequate mathematical model of logistic regression was developed to assess the prognostic significance of total vitamin D deficiency in the progression of DR in patients with T2DM. Its prognostic significance is 96.4 % (95% CI 87.7–99.0).

Multifactorial model for prediction of the development of polymorphic ventricular tachycardia in patients with drug-induced QT interval prolongation induced by class III antiarrhythmic drugs

Aim. To develop a multifactorial model for predicting the development of polymorphic ventricular tachycardia (VT) in patients with drug-induced long QT syndrome (LQTS) induced by class III antiarrhythmic drugs (AADs) by identifying electrocardiographic, laboratory and molecular genetic predictors.Methods. The study included 64 patients (37 (57.9%) women and 27 (42.1%) men, mean age 57.2±9.4 years) with ischemic heart disease and/or arterial hypertension. and cardiac arrhythmias, in which drug-induced prolongation of the QTc interval (Bazett) (over 450 ms in men and over 470 ms in women) was noted with the use of class III AADs (amiodarone or sotalol) in a cardiac hospital. Depending on the presence or absence of non-sustained polymorphic VT according to 24-hour ECG Holter monitoring, patients were further divided into two groups: 17 patients with episodes of non-sustained polymorphic VT and 47 patients without such episodes. All patients underwent clinical and laboratory, instrumental and molecular genetic studies, which included taking an anamnesis, recording ECG in 12 leads, biochemical blood test, determining the levels of neuronal NO-synthase (NOS1) and the adapter protein of neuronal NO-synthase (NOS1AP) in blood serum by enzyme immunoassay, determination of nitric oxide synthase gene polymorphisms by polymerase chain reaction. To assess the relationship of the studied parameters with the achievement of the end point, the method of logistic regression with a binary response and the logit function of the connection was used.Results. To assess the risk of developing non-sustained polymorphic VT in patients with drug-induced LQTS while taking class III AADs, a complex binary logistic regression model was developed, including the following indicators: patient gender (p=0.019), relative variance of the QT interval (p=0.002), duration of the Tpeak-Tend interval, (p=0.034), serum magnesium (p=0.004) and NOS1 (p=0.004) levels, as well as the AA genotype of the G84A polymorphism of the NOS1 gene (p=0.049). With the calculated value of the threshold probability p≥0.48, the developed model makes it possible to identify patients at high risk of developing polymorphic VT in patients with drug-induced LQTS with a sensitivity of 94.12%, a specificity of 89.36%, and an area under the ROC curve of 0.977 (0.95-1.0, p&lt;0.001).Conclusion. The developed complex model will allow predicting the risk of proarrhythmic effects in patients with drug-induced LQTS, which will lead to a decrease in the number of cardiovascular events in this category of patients.

Predicting spatiotemporal soil organic carbon responses to management using EPIC-IIASA meta-models

The management of Soil Organic Carbon (SOC) is a critical component of both nature-based solutions for climate change mitigation and global food security. Agriculture has contributed substantially to a reduction in global SOC through cultivation, thus there has been renewed focus on management practices which minimize SOC losses and increase SOC gain as pathways towards maintaining healthy soils and reducing net greenhouse gas emissions. Mechanistic models are frequently used to aid in identifying these pathways due to their scalability and cost-effectiveness. Yet, they are often computationally costly and rely on input data that are often only available at coarse spatial resolutions. Herein, we build statistical meta-models of a multifactorial crop model in order to both (a) obtain a simplified model response and (b) explore the biophysical determinants of SOC responses to management and the geospatial heterogeneity of SOC dynamics across Europe. Using 5600 unique simulations of crop growth from the gridded Environmental Policy Integrated Climate-based Gridded Agricultural Model (EPIC-IIASA GAM) covering 86,000 simulation units across Europe, we build multiple polynomial regression ensemble meta-models for unique combinations of climate and soil across Europe in order to predict SOC responses to varying management intensities. We find that our biophysically-explicit meta models are highly accurate (R2 = 0.97) representations of the full mechanistic model and can be used in lieu of the full EPIC-IIASA GAM model for the estimation of SOC responses to cropland management. Model stratification by means of climate and soil clustering improved the performance of the meta-models compared to the full EU-scale model. In regional and local validations of the meta-model predictions, we find that the meta-models largely capture broad SOC dynamics such as the linear nature of SOC responses to residue application, yet they often underestimate the magnitude of SOC responses to management. Furthermore, we find notable differences between the results from the biophysically-specific models throughout Europe, which point to spatially-distinct SOC responses to management choices such as nitrogen fertilizer application rates and residue retention that illustrate the potential for these models to be used for future management applications. While more accurate input data, calibration, and validation will be needed to accurately predict SOC change, we demonstrate the use of our meta-models for biophysical cluster and field study scale analyses of broad SOC dynamics with basically zero fine-tuning of the models needed. This work provides a framework for simplifying large-scale agricultural models and identifies the opportunities for using these meta-models for assessing SOC responses to management at a variety of scales.

Predicting the incidence of chronic kidney disease in patients with myocardial infarction and acute kidney injury

Aim. To estimate the incidence of chronic kidney disease (CKD) and develop a calculator to estimate the CKD probability in patients with myocardial infarction (MI) and acute kidney injury (AKI).Material and methods. A total of 193 patients with MI aged 34-79 years were examined: 123 patients with MI and signs of AKI, 70 patients without AKI. In all patients, the levels of C-reactive protein, troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), microalbuminuria (MA), creatinine, and glomerular filtration rate (GFR) were determined. In the presence of AKI criteria on the 3rd day and at discharge, the level of kidney injury molecule-1 (KIM-1) molecule and interleukin-18 was examined in the urine. Six months after discharge, GFR was assessed over time. Patients of both groups underwent coronary angiography with stenting of infarct-related artery.Results. The GFR at admission in patients with AKI was lower than in the group without AKI with normal creatinine levels. Following correlations between AKI and markers of cardiovascular events were revealed: KIM-1 and NT-proBNP (r=0,29 p=0,031), GFR and NT-proBNP (r=-0,22 p=0,015), NT-proBNP and IL-18 (r=0,18 p=0,045), MA with troponin I and CRP (r=0,20 p=0,048 and r=0,29 p=0,001). After six months, persistent renal function decline was more frequently diagnosed in patients with acute MI and AKI on index hospitalization. An equation for a multifactorial model for CKD risk was created: P(CKD)=exp(z)/(1+exp(z)), z=-1,113092e+01 — 4,082006e-02 * troponin I + 8,553826e-04 * NT-proBNP (discharge) + 1,620188e-01 * age + 3,411724e-02 * systolic blood pressure -7,753111e-03 * MA. ROC analysis revealed the most reliable sensitivity of 83% and specificity of 88,2% for the threshold value of CKD probability of 86,1%.Conclusion. Patients with MI and AKI have a significant risk of CKD within 6 months after ACS. The created mathematical model and calculator determine the likelihood of CKD.

Age-related vulnerability of the human brain connectome

Multifactorial models integrating brain variables at multiple scales are warranted to investigate aging and its relationship with neurodegeneration. Our aim was to evaluate how aging affects functional connectivity of pivotal regions of the human brain connectome (i.e., hubs), which represent potential vulnerability ‘stations’ to aging, and whether such effects influence the functional and structural changes of the whole brain. We combined the information of the functional connectome vulnerability, studied through an innovative graph-analysis approach (stepwise functional connectivity), with brain cortical thinning in aging. Using data from 128 cognitively normal participants (aged 20–85 years), we firstly investigated the topological functional network organization in the optimal healthy condition (i.e., young adults) and observed that fronto-temporo-parietal hubs showed a highly direct functional connectivity with themselves and among each other, while occipital hubs showed a direct functional connectivity within occipital regions and sensorimotor areas. Subsequently, we modeled cortical thickness changes over lifespan, revealing that fronto-temporo-parietal hubs were among the brain regions that changed the most, whereas occipital hubs showed a quite spared cortical thickness across ages. Finally, we found that cortical regions highly functionally linked to the fronto-temporo-parietal hubs in healthy adults were characterized by the greatest cortical thinning along the lifespan, demonstrating that the topology and geometry of hub functional connectome govern the region-specific structural alterations of the brain regions.

Medication adherence in leukemia children receiving home-based treatment and its related factors

ABSTRACTObjectives:This study aimed to investigate home-based medication adherence in children with acute leukemia and its related factors.Methods:We examined 132 children with acute leukemia in a tertiary pediatric hospital in Chongqing. A general questionnaire, the MMAS-8 (the eight-item Morisky Medication Adherence Scale), SEAMS (Self-efficacy for Appropriate Medication Use Scale), and a multifactorial logistic regression model were used to analyze the factors related to drug adherence of the children.Results:54.55% of patients showed good medication adherence, while 50.76% either forgot a dose or administered an incorrect dose. The average score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was 32.47.61. The logistic regression analysis revealed that a SEAMS score, the occupation of caregivers, and the patient’s age were predictors of medication adherence among pediatric leukemia patients (P < 0.05).Conclusions:The home-based medication adherence in children with acute leukemia was not favorable. Patients with low SEAMS scores, farmers serving as caregivers, and children under the age of three should arouse more attention. It is expected to strengthen the confidence of patient families in medication by emphasizing the development of their relationships with healthcare professionals. Awareness of breakthroughs in leukemia home-based medication management systems by utilizing Internet technology.