Stepwise Multiple Linear Regression Research Articles

Clinical practice and standard discrepancies in aspiration prevention among advanced practice nurses in geriatrics: A cross-sectional survey

AimTo investigate the discrepancies between clinical practices and aspiration prevention standards among advanced practice nurses (APNs) in geriatrics and provide a basis for risk evaluation and prevention strategies for older adults. MethodsUsing convenience sampling from November 20 to December 30, 2023, we surveyed 227 APNs in geriatrics from Guangdong Province, China. Data were collected using demographic forms and questionnaires focused on aspiration prevention strategies for older adults. Univariate and multivariate linear stepwise regression analyses were conducted to identify factors that influenced the effectiveness of aspiration prevention by APNs. ResultsThe mean score of APNs in geriatrics for older adult aspiration prevention was 94.9 ± 17.4. The multivariate regression analysis identified hospital level, evidence-based practice, and job satisfaction as significant factors. ConclusionThis study highlights the essential contribution of APNs to geriatric care and emphasizes the need for sustained professional development and adherence to evidence-based protocols to optimize aspiration prevention strategies.

Estimating soil salinity level by pedotransfer functions

Abstract In this study, the electrical conductivity (EC) of cultivated fields were predicted by pedotransfer functions (PTFs) using basic soil properties as variables in stepwise analyses. Before using PTFs, 207 soil samples were divided into development and validation datasets. This division was done 10 times to assess the accuracy and reliability of the PTFs. According to the principal component analysis (PCA), the EC values had higher load in PC1 and PC2 with clay, exchangeable Na, Ca, Mg and K contents. The EC values had significant positive correlations with pH, clay, exchangeable Ca, Mg, K, Na content, and negative correlations with silt and sand content. According to the stepwise analyses, 10 PTFs or linear multiple regression models were obtained using development data sets. The accuracy in development data sets and reliability in the validation data sets for these PTF models were assessed with R2 and RMSE values. The higher mean R2 and the lower mean RMSE values were obtained in the development data set when compared to the validation data set. The PTF-7 including clay, exchangeable Na, Mg and Ca was suggested to predict soil EC values of cultivated fields. It was determined that clay and exchangeable Na, Mg and Ca content were the most effective soil properties on predicting the EC values of cultivated fields. Keywords: Salt, EC, exchangeable cations, soil texture

Relationship between personal meaning organisations and psychological and personal well-being in a Chilean sample.

The aim of this study was to evaluate the relationship between personal meaning organisations (PMO) and aspects of psychological and personal well-being in an adult population. The sample consisted of 104 adults (36.52±14.85 years, 56 women). Sociodemographic variables, well-being and PMO were evaluated. The following instruments were used: Mini Questionnaire of Personal Organization (MQPO), Personal Wellbeing Index (PWI) and Psychological Well-Being Scale (PWB). The statistical analysis included summary measures, internal consistency (Cronbach’s alpha), Pearson’s correlation coefficient, and stepwise multiple linear regression models; a significance level of p<.05 was adopted. Significant negative correlations between PMO scores and levels of psychological and personal well-being were found. In the regression models, strongest predictor was Detached PMO, followed by Contextualised PMO, which had a negative influence on well-being. Detached PMO had a negative impact on levels of personal well-being and especially on psychological well-being.

Medical School Curricular Changes and Their Impact on Mental Health during the Onset of the COVID-19 Pandemic

Abstract Objectives The main objectives were to identify and categorize the curricular changes that occurred in U.S. medical schools during the onset of the coronavirus disease 2019 (COVID-19) pandemic, and to identify the relationship between curricular changes and COVID-19 surges and student mental health. Methods This Institutional Review Board-approved study consisted of a voluntary online survey of U.S. medical students. A convenience sample of students was reached through Facebook groups, medical student organizations, and administrators. The survey consisted of questions about demographics, curricular changes, and mental health. Univariate and backward stepwise multivariate linear regression were used to assess associations between mental health outcomes and demographic characteristics, curricular changes, and stressors. Results Four-hundred and nine medical students completed the survey from 21 states between May 29, 2020, and August 29, 2020. Seventy-nine percent of respondents reported continuing their basic science curricula virtually. Forty-five percent reported that rotations continued virtually; those reported being offered virtually included internal medicine (77%), family medicine (78%), surgery (70%), obstetrics/gynecology (73%), pediatrics (74%), and psychiatry (76%). The majority of students reported that core clerkships (78%) and subinternships (86%) were not allowed, and away rotations were universally canceled. In univariate linear regression, having in-person subinternships and core clerkships allowed, as well as not relocating for coursework or residence (experienced by 35% of students), was associated with improved mental health outcomes, while experiencing graduation changes (15%) or being from the Southern region was associated with worse outcomes (p < 0.001). Conclusion During the early COVID-19 pandemic, students reported that their medical schools adapted by converting to virtual platforms for basic science and core clerkships. Allowing in-person rotations and limiting relocation were associated with improved mental health outcomes among students. Limitations included sample size, selection bias, and student perceptions.

Prediction of preoperative peritoneal cancer index for pseudomyxoma peritonei by multiple linear regression analysis

BackgroundThe aim of the present study was to establish a predictive model to predict the peritoneal cancer index (PCI) preoperatively in patients with pseudomyxoma peritonei (PMP).MethodsA total of 372 PMP patients were consecutively included from a prospective follow-up database between 1 June 2013 and 1 June 2023. Nine potential variables, namely, gender, age, Barthel Index (BAI), hemoglobin (Hb), albumin (Alb), D-dimer, carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA 125), and CA 19-9, were estimated using multiple linear regression (MLR) analysis with a stepwise selection procedure. The established MLR model was internally validated using K-fold cross-validation. The agreement between the predicted and surgical PCI was assessed using Bland–Altman plots and intraclass correlation (ICC). A p-value of less than 0.05 was considered statistically significant.ResultsSix independent predictors were confirmed by the stepwise MLR analysis with an R2 value of 0.570. The predicted PCI formula was represented as follows: PCI = 19.567 + 2.091 * Gender (male = 1, female = 0) − 0.643 * Alb +4.201 * Lg (D-dimer) + 2.938 * Lg (CEA) + 5.441 * Lg (CA 125) + 1.802 * Lg (CA 19-9). The agreement between predicted and surgical PCI was assessed using Bland–Altman plots, showing a limit of agreement (LoA) between −15.847 (95%CI: −17.2646 to −14.4292) and +15.847 (95%CI: 14.4292–17.2646).ConclusionThis study represents the first attempt to use an MLR model for the preoperative prediction of PCI in PMP patients. Nevertheless, the MLR model did not perform well enough in predicting preoperative PCI. In the future, more advanced statistical techniques and a radiomics-based CT-PCI-participated MLR model will be developed, which may enhance the predictive ability of PCI.

Status quo and influencing factors of posttraumatic growth of nurses exposed to nurse-to-nurse horizontal violence: a cross-sectional multicenter study

BackgroundPost-Traumatic Growth (PTG) relieves physical and psychological stress symptoms in nurses who exposed to nurse-to-nurse horizontal violence (HV), has great intervention potential to reverse the negative effects of HV events. Therefore, in-depth exploration of the overall characteristics of PTG in HV-exposed nurses and its influencing factors are of great practical significance to provide them with precise psychological adaptive interventions.ObjectiveThis study aims to describe the current state of PTG of HV-exposed nurses and its influencing factors.MethodsThe staged cluster sampling method used to recruit nurses. Nurses completed the Chinese version of the nurse-to-nurse Negative Acts Questionnaire (NAQ-R), the Posttraumatic Growth Inventory-Short Form (PTGI-SF), Colquitt’s Organizational Justice Measure (OJM), Inclusive Leadership Scale (ILS), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Dysexecutive Questionnaire (DEX) and provided their sociodemographic characteristics. Data were collected between February, 2023 ~ March, 2024, and were analyzed using correlation analysis, t-test, ANOVA, and multivariate linear stepwise regression analyses.ResultsThe prevalence of HV within eight tertiary hospitals in Shandong Province amounted to 45.03%. On average, nurses scored 18.30 ± 14.33 in PTGI-SF. There were significant differences in PTGI-SF score according to departments (F = 2.589, p < 0.01), and educational background (F = 4.587, p < 0.01). The results of correlation analysis showed that there was a significant correlation between score in CD-RISC-10 (r = 0.120, p < 0.01), DEX (r=-0.069, p < 0.05), and PTGI-SF. The results of multivariate linear stepwise regression showed that resilience, dysexecutive, educational background, and type of department might be the influencing factors of PTG in HV-exposed nurses (R2 = 0.045).ConclusionsExposure to HV posed a moderate risk for nurses, while PTG levels among HV-exposed nurses were low to moderate. Overall, the current study suggests that educational background, department type, resilience, and dysexecutive were the main factors influencing PTG in HV-exposed nurses. The study found that resilience had a positive effect on PTG, while dysexecutive had a slight negative effect. Consolidation of resilience and alleviation of dysexecutive, while dialectically looking at educational background and department type, is necessary to improve PTG in HV-exposed nurses.

Acceptance of advance care planning and influencing factors from the perspective of the life cycle: a cross-sectional study

BackgroundAdvance care planning is an important part of palliative care. Public acceptance is a prerequisite for the widespread development and implementation of advance care planning. However, little is known about the level of public’s acceptance and influencing factors of advance care planning across different life cycles.MethodsA cross-sectional study in mainland China was conducted from June 20 to August 31, 2022. We used multi-stage sampling strategy to recruit participators. A stepwise linear regression analysis was used to examine the influencing factors in different life cycles (nonage, mature age, middle age and old age).ResultsThe final sample size was 18,002. The average acceptance score of advance care planning of the public throughout the entire life cycle was 64.03. The average score in nonage was 67.13, which is the highest. The average score in mature age was 63.87, in middle age was 63.51, and in old age was 63.54. Multiple linear stepwise regression results indicated that death education support level, well-being index, neighbor relations, health literacy, family social status, and siblings were influencing factors in nonage. Medical insurance, injury events, multiple properties, death education support level, health literacy, family social status, neighbor relation, social support, family health, media contact, and well-being index were influencing factors in mature age. In middle age, region, living alone, depression, debt, houses, death education support level, health literacy, social support, and family social status were influencing factors. In old age, injury event, death education support level, neighbor relation, well-being index, siblings and children were influencing factors.ConclusionsThis study is the first to compare the Chinese people with different life cycles. It found that the public’s acceptance and influencing factors of advance care planning varied across different life cycles. Governments and health care personnel should emphasize autonomy and initiate advance care planning based on different life cycles and individual approaches, then introduce appropriate public health policies into newer and broader fields.

Early motor developmental milestones and health outcomes in preadolescent children

IntroductionThe prevalence of depression and anxiety in children has risen in recent years, while childhood obesity and sedentary behavior continue to be a major public health concern. Existing evidence suggests early motor development and locomotor experiences contribute to psychosocial and physical development. By further understanding the far-reaching effects of early motor development, early life interventions aimed at preventing physical and mental health adversity may benefit from investigating early motor developmental milestones (MDM) attainment. The current study is the first to assess the longitudinal association between parent-reported gross MDM timing with objective measures of mental health, cardiorespiratory fitness (CRF), subcutaneous abdominal (SAAT), and visceral adipose tissue (VAT) outcomes later in childhood.MethodIn total, 131 children aged 8–11 years (46% female) were recruited. The parents of these children reported the age of attainment for five MDMs: holding their head unsupported, rolling over, sitting unsupported, standing, and walking independently. The study encompassed a comprehensive assessment, including measures of mental health, CRF (VO2 max), body–mass index (BMI), SAAT, and VAT. Data were analyzed using multiple stepwise linear regressions, adjusting for demographic and parental factors in Step 1 and including each MDM individually in Step 2.ResultsOur findings indicated earlier rolling over and walking were associated with higher CRF during preadolescence. Earlier rolling over was also linked to healthier BMI and lower levels of VAT, lower levels of trait anxiety, and fewer symptoms of depression.ConclusionThis study provides further evidence with potential clinical implications that parent-reported MDM age of attainment is related to later preadolescent physical and mental health. The age at which a child first rolls over emerges as a particularly predictive factor for various preadolescent health outcomes, highlighting the multi-finality of MDM timing in understanding developmental trajectories.

Delta corticomedullary apparent diffusion coefficient on MRI as a biomarker for prognosis in IgA nephropathy

Objectives To explore the association of the cortico-medullary difference in apparent diffusion coefficient (ΔADC) with clinicopathological parameters of disease activity at the time of biopsy, and with the prognositic risk stratification in IgA nephropathy (IgAN) patients. Methods We included 112 patients with biopsy-proven IgAN who measured ΔADC. Patients underwent a kidney biopsy and diffusion-weighted magnetic resonance imaging within one week of the biopsy. Clinicopathological characteristics were compared according to different ΔADC levels. The effect of ΔADC on eGFR and kidney fibrosis was explored using multivariate regression and ROC analysis. An individual’s 5-year risk probability of progressing to ESKD or decreasing of eGFR > 50% was calculated by the guidelines-recommended international risk-prediction tool in IgAN. The effect of ΔADC on prognostic risk stratification was assessed. Net reclassification improvement (NRI) was used to evaluate the model performance. Results The average ΔADC was 168.89 ± 85.1 x10−6 mm2/s. ΔADC levels decreased significantly with increasing chronic kidney disease (CKD) stages (p = 0.0038). Spearman correlation analysis revealed that ΔADC was positively correlated with eGFR, hemoglobin, serum albumin, while negatively correlated with levels of serum creatine (Scr), blood urea nitrogen (BUN), T score of Oxford classification and Lee grades (p < 0.05). Moreover, we showed that ΔADC was independently associated with eGFR (β = 0.04, 95% CI = [0.003, 0.077], p = 0.033) demonstrated by a backward stepwise multivariate linear regression analysis. Besides, ΔADC, a combination of ΔADC and eGFR showed an AUC of 0.776 (60% sensitivity and 85.3% specificity) and an AUC of 0.875 (100% sensitivity and 69.6% specificity) respectively for evaluating kidney interstitial fibrosis (IF) severity. Furthermore, ΔADC showed an AUC of 0.792 (95% CI 0.677-0.906) for differentiating higher progression risk categories from lower categories (specificity = 91.6%, sensitivity = 58.8%). The low-ΔADC group (≤ median value 167.1 × 10−6 mm2/s) was associated with 7.509-fold higher likelihood of higher progression risk compared to the high-ΔADC group (>167.1 × 10−6 mm2/s) in a fully-adjusted model. And reclassification analyses confirmed that the final adjusted model improved NRI. Conclusions ΔADC was significantly associated with kidney function and enabled a reliable evaluation of kidney IF severity in IgAN patients. Low ΔADC can predict a high 5-year kidney progression risk in IgAN, independent of important clinical factors. Moreover, the predictive ability to identify patients at high risk of severe kidney fibrosis and adverse progression estimates with satisfactory accuracy, facilitating ΔADC a promising and noninvasive tool in complementarily evaluating disease activity and the prognostic risk stratification in patients with IgAN.

Associations Between Fundamental Movement Skills, Muscular Fitness, Self-Perception and Physical Activity in Primary School Students.

Background/Objectives: Positive self-perception, physical activity and fundamental movement skill (FMS) proficiency are important aspects of a child's healthy development. The objective of this research was twofold: first, to explore associations between FMS, muscular fitness, self-perception and physical activity in school children; and second, to identify key predictors of FMS proficiency, athletic self-perception, physical activity levels in these participants and the differences between biological sexes. Methods: Primary school-aged children (n = 104; 53.85% female) from 8 to 10 years old (M = 9.04, SD = 0.69) engaged in two days of testing. All students were measured on FMS, standing long jump (SLJ), countermovement jump (CMJ), seated medicine ball chest throw and self-perception, followed by correlation and stepwise multiple linear regression analyses. Results: The findings revealed significant positive correlations between FMS proficiency, lower body muscular fitness (CMJ, SLJ), and athletic self-perception for the entire cohort, with varying results between male and female subgroups. Additionally, athletic self-perception showed strong relationships with other self-perception domains. Notably, forward stepwise regression analysis identified FMS proficiency as a significant predictor of physical activity levels, explaining 12.8% of the variance. SLJ, scholastic perception, and physical activity explained 45.5% of FMS variance for females. In males, FMS proficiency significantly predicted physical activity, accounting for 13.3% of the variance. SLJ and athletic competence self-perception explained 42.1% of FMS variance in males. Conclusions: The study indicates that FMS, self-perception, muscular fitness, and physical activity levels may mutually enhance each other, and that there is a need for biological sex-specific strategies to be considered in physical education programs.

Designing hypothesis of substituted naphthyridines as anti-HIV agent: A QSAR Approach

HIV-1 Integrase is a validated drug target for anti-HIV therapy. It is an essential enzyme required for replication of the AIDS-virus. 1,3,4-oxadiazole substituted naphthyridine derivatives act against HIV integrase and thus have the potential to become a part of anti-HIV drug regime. In present study, we have carried out QSAR study of 1,3,4-oxadiazole substituted naphthyridine derivatives. Stepwise multiple linear regression analysis was performed to derive QSAR models and was evaluated for statistical significance and predictive power. The best QSAR model was selected for anti-HIV activity, having correlation coefficient (R) = 0.862, standard error of estimation (SEE) = 0.271 and cross validated squared correlation coefficient (Q2) = 0.676. The QSAR model indicates that shape index, partition coefficient and solvent accessible surface area play an important role in the anti-HIV activities of 1,3,4-oxadiazole substituted naphthyridine derivatives. The results of the present study may be useful in designing more potent analogues.

Relationship Between Geriatric Nurses' Spiritual Care Perceptions and Professional Attitudes, a Cross-Sectional Study.

This study, based on the self-determination theory, aims to explore the current situation of geriatric nurses' perceptions of spiritual care and its relationship with their professional attitude. It was conducted from February to May 2022. As the population ages, it is necessary to actively implement coping strategies. Geriatric nurses are important human resources, so we should pay attention to their perception of spiritual care for the elderly and their attitude towards the nursing profession. A cross-sectional survey was conducted. A total of 488 geriatric nurses engaged in elderly care were recruited from different hospitals in China. An online questionnaire was used to assess geriatric nurses' sociodemographics, their perception of spiritual care and their professional attitude. This study's findings indicate that the overall average score of geriatric nurses' perception of spiritual care was at a medium level (173.64 ± 27.87). Geriatric nurses' professional attitude was positively correlated with spiritual care perception (p < 0.001). The multiple stepwise linear regression model (n = 488) had an explained variance (R2 = 0.216), and three factors such as the need to enhance the ability of spiritual care through lectures and other methods were the main predictors of the perception level of spiritual care among geriatric nurses (p < 0.001). The findings demonstrated that the enhancement of professional attitudes among geriatric nurses can effectively augment their perception and implementation of spiritual care. This study's result is helpful for nursing managers to identify the weak links in the overall nursing services for elderly patients, thereby carrying out relevant intervention measures, improving the perception level of spiritual care of geriatric nurses, optimising the quality of elderly care services and achieving healthy aging. No patient or public contribution. The study focused on the current situation of geriatric nurses' perceptions of spiritual care and its relationship with their professional attitude. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives. The reporting of the study was guided by the STROBE checklist.

Development of multistage crop yield estimation model using machine learning and deep learning techniques.

In this research paper, machine learning techniques were applied to a multivariate meteorological time series data for estimating the wheat yield of five districts of Punjab. Wheat yield data and weather parameters over 34years were collected from the study area and the model was developed using stepwise multi-linear regression (SMLR), artificial neural network (ANN), support vector regression (SVR), random forest (RF) and deep neural network (DNN) techniques. Wheat yield estimation was done at the tillering, flowering, and grain-filling stage of the crop by considering weather variables from 46 to 4th, 46 to 8th, and 46 to 11th standard meteorological week. Weighted and unweighted Meteorological variables and yield data were used to train, test, and validate the models in R software. The evaluation results showed a consistent and promising performance of RF, SVR, and DNN models for all five districts with an overall MAPE and nRMSE value of less than 6% during validation at all three growth stages. These models exhibited outstanding performance during validation for the Faridkot, Ferozpur, and Gurdaspur districts. Based on accuracy parameters MAPE, RMSE, nRMSE, and percentage deviation, the RF model was found better followed by SVR and DNN models and, hence can be used for district-level wheat crop yield estimation at different crop growth stages.

The Association Between Serum Trimethylamine N-Oxide and Arterial Stiffness in Chronic Peritoneal Dialysis Patients: A Cross-Sectional Study.

Trimethylamine N-oxide (TMAO), a gut microbiome-derived metabolite, participates in the atherogenesis and vascular stiffening that is closely linked with cardiovascular (CV) complications and related deaths in individuals with kidney failure undergoing peritoneal dialysis (PD) therapy. In these patients, arterial stiffness (AS) is also an indicator of adverse CV outcomes. This study assessed the correlation between serum TMAO concentration quantified with high-performance liquid chromatography and mass spectrometry and central AS measured by carotid-femoral pulse wave velocity (cfPWV) in patients with chronic PD. Of the 160 participants included, 23.8% had a cfPWV of ≥10 m/s, which fulfilled the AS criteria. Multivariable logistic regression analysis revealed that TMAO, age, and waist circumference were positively associated with AS. Multivariable stepwise linear regression showed that underlying diabetes, advanced age, waist circumference, systolic blood pressure, and logarithmic-transformed TMAO were independently correlated with cfPWV. The area under the receiver operating characteristic curve for TMAO in differentiating AS from non-AS was 0.737. In conclusion, serum TMAO level was significantly independently correlated with central AS among participants undergoing PD for end-stage kidney failure.

Design of Novel Acat Inhibitors as Potent Anti-Hyperlipidemic Agents Using Chemometric Approaches

Aim: A 2D QSAR study of acyl-coenzyme A (CoA): cholesterol acyltransferase (ACAT) inhibitors revealed that electronic, topological, and steric properties are important structural features required for activity against ACAT. Background: In order to interpret the evidence encrypted by the molecular structure of the compounds, a standard physicochemical descriptors-centered, and Quantitative Structure-Activity Relationship (QSAR) approach was implemented on a data set of Indoline derivatives were reported to be acyl-coenzyme A (CoA): cholesterol acyltransferase ACAT inhibitors. Objective: The ACAT enzyme plays an important role in the absorption of dietary cholesterol. Therefore, the inhibition of ACAT is a key strategy or primary objective for the treatment of hypercholesterolemia and atherosclerosis. Method: Chemo metric models were designed by inserting a battery of statistical techniques in the current study that demonstrate the linear approaches of analysis, including multiple linear regression (MLR), partial least square PLS, and non-linear methods such as artificial neural networks (ANN). Result: The activity contributions of these molecules were analyzed through regression equation, and the best QSAR model was created with an excellent correlative and predictive ability. Significant statistical values S = 0.35, F = 60.30, r = 0.92, r² = 0.85, r² (CV) = 0.82 of the designed models were obtained using stepwise MLR and a comparable PLS and FFNN model with r² (CV) = 0.82, 0.88 and 0.86 respectively and the relevant descriptors like inertia moment 1 size, Kier Chiv4 (cluster) index, Kier Chiv6(ring) index offered important information regarding this model. Conclusion: The model reveals that inertia moment 1 size, Kier Chiv4 (cluster) index, and Kier Chiv6 (ring) index are prerequisite descriptors to determine other promising ACAT antagonists with high and liable potency against the target. Therefore, these characteristics may be used efficiently for the design and evaluation of active compounds as new ACAT inhibitors thanks to their utilization.

Determinats factors self-management barriers: characteristics, spiritual well-being, and religiosity in type 2 diabetes patients

Holistic nursing needs to evaluate barriers to self-management, insight from characteristics, religiosity, and spiritual well-being to understand and address the multifaceted needs of individuals with chronic conditions, such as diabetes mellitus type 2. This study aimed to identify the determining factors that affect the barriers to self-management and the variables affecting them among Indonesian patients with T2DM. A cross-sectional survey was conducted among 101 patients recruited via purposive sampling from March to May 2023. The research instruments used were the Spiritual Well-Being Scale, Islamic Religiosity Scale, and Summary of Diabetes Self-Care Activities. The potential multicollinearity effects among the predictors of the barriers to self-management were also evaluated using multiple linear stepwise regression and collinearity analysis of variable inflation factors (VIFs). Most of the respondents had moderate spiritual well-being (52.2%) and high Islamic religiosity (60.4%) but also had barriers to self-management (55%). The F value of 5.888 with a probability of 0.004 (&amp;lt;0.05) showed that based on their regression coefficients, spiritual well-being, and Islamic religiosity simultaneously affected the barriers to self-management by 10.7%. The determinants that were found to affect the barriers to self-management were spiritual well-being and religiosity. These results suggest that it is necessary to develop an intervention model to improve the self-management of T2DM with a holistic approach.

Preliminary comparison of net gain in final adult height of girls with early menarche treated with or without gonadotropin-releasing hormone agonist.

Early menarche is associated with both physical and psychosocial problems. Based on psychological and physical health considerations, for girls with early menarche, some parents and physicians may elect to use gonadotropin-releasing hormone agonists (GnRHa) to delay menstruation. This study aimed to explore the effects of GnRHa treatment on the final height of girls with early menarche and build the models to predict the final adult height (FAH). Girls who experienced menarche between the ages of 8 and 10 years and were diagnosed with idiopathic central precocious puberty (ICPP) at Tianjin Medical University General Hospital between July 2017 and August 2023 were included in this study. Participants were divided into two groups based on treatment strategy: GnRHa-treated and GnRHa-untreated groups. Laboratory parameters including growth factors and basal gonadotropins were tested at diagnosis. The heights and weights of the participants were measured every three months. Bone radiographs of the left hand and wrist were assessed by professional appraisers to determine the bone age (BA), which was measured every 6 months after diagnosis. Clinical data of 176 girls who experienced early menarche were retrospectively analyzed. For participants in the GnRHa-treated group (n=87), growth velocity (GV) showed significant differences between the first 6 months and second 6 months of treatment (P=0.01; 5.82±2.3 vs. 4.79±2.31 cm, respectively). The height standard deviation score (SDS) and BA (P<0.001) decreased during treatment. The predicted adult height was higher at the end of treatment, but was not statistically different from that at diagnosis (P=0.73). In the linear regression analysis, no significant relationships were observed between GnRHa treatment and net gain (NG) in final height [Model A, adjusted for BA and chronological age (CA) at baseline: P=0.43; Model B, adjusted for Model A plus HtSDS-BA, HtSDS, and BMISDS: P=0.65; Model C, adjusted for Model B plus LH, FSH, and IGF-1: P=0.82]. The generalized additive model (GAM) for NG in final height in GnRHa-treated participants included three independent risk factors: LH/FSH [estimated degrees of freedom (edf) =5.36, P=0.02], GV (edf =4.11, P=0.007), and the bone maturation ratio (BMR) (edf =4.79, P=0.02). GAM performed better than multivariate linear (stepwise) regression in predicting the FAH in GnRHa-treated girls with early menarche. For girls who experienced menarche between the ages of 8 and 10 years, GnRHa treatment suppressed GV and skeletal maturity. The GAM provides a theoretical basis for pediatric endocrinologists in deciding whether to apply GnRHa treatment, determining the time to withdraw GnRHa treatment, and predicting the FAH of girls with early menarche.

Reaction Time in Fibromyalgia Patients.

Fibromyalgia has unknown aetiology and is associated with reduced information processing speed and therefore prolonged reaction time. However, the processes underlying this are unknown. First, to compare the reaction time in a cohort of fibromyalgia patients and a matched group of normal controls. Second, to assess whether detailed symptoms of pain and autonomic function, as well as measures of tinnitus, fatigue, daytime sleepiness and Mycoplasma pneumoniae infection are predictors of reaction time in fibromyalgia. The between-groups mean serial five-choice reaction time difference was assessed in a cohort of fibromyalgia patients and in a matched group of normal controls in an analytical casecontrolled study. With the mean serial five-choice reaction time as the dependent variable for the fibromyalgia group, a mixed stepwise multiple linear regression was performed with inputs relating to pain, dysautonomia, tinnitus, fatigue, daytime sleepiness and Mycoplasma pneumoniae infection. The mean (standard error) serial five-choice reaction time for the fibromyalgia group was 448.4 (23.0) ms, compared with 386.3 (8.3) ms for the control group (p = 0.007). The final multiple linear regression model (p < 0.001; adjusted R2 = 0.772) contained 13 predictors: eight sensory pain and three affective pain parameters, and Mycoplasma pneumoniae IgG and IgA assay results. Certain sensory and affective pain parameters, as well as Mycoplasma pneumoniae infection, appear to be predictors of reaction time in fibromyalgia. Further research into the pathophysiological mechanisms by which they affect information processing is warranted and may shed light on the aetiology of fibromyalgia.

Methane degassing in global river reservoirs and its impacts on carbon budgets and sustainable water management

Degassing methane (CH4) through reservoir water compromises hydroelectricity's presumed low-carbon status, which has emerged as a critical hotspot for global carbon dynamics. However, a comprehensive understanding of the involved pathways remains elusive, hindering the accurate estimation of global reservoirs' carbon budget (emission-to-burial ratio). This study presents a holistic upscaling approach to assess methane degassing in global river reservoirs and its impacts on carbon budgets. Firstly, a machine learning model is utilized to characterize the contributions of climate and human factors to annual water residence time. Secondly, the stepwise multiple linear regression method is used to calculate CH4 degassing emissions for each reservoir. Finally, to systematically tackle all sources of uncertainty, separate uncertainty analyses are implemented for the estimates of degassing emissions, areal emissions, and organic carbon burial. Analyzing 30-year data from 6695 reservoirs worldwide, our assessment considers water residence time, temperature, catchment area, and reservoir size. Findings indicate that water releases contribute significantly to global CO2 emissions from reservoirs, elevating the carbon budget by 20 % from 2.02 to 2.18 TgC/year, underscoring the previously underestimated significance of CH4 degassing in shaping the carbon cycle impact of river reservoirs. We propose a redefined threshold for low carbon credits, suggesting that reservoirs with power densities exceeding 6.1 MW/km2, instead of the conventional 4 MW/km2, should qualify. This study underscores the need for sustainable water management and reshaping the carbon dynamics associated with hydroelectricity. Future research can advocate Artificial Intelligence (AI) techniques to enhance water management and mitigate carbon emissions by multi-objectively optimizing reservoir operations.

An in-depth multiscale analysis of farmland abandonment and recultivation dynamics in the Yangtze River Delta, China: A landscape ecology perspective empowered by google earth engine

Farmland abandonment represents the extreme utilization of marginal land and results from the interplay between humans and the environment. In the Yangtze River Delta region of China, a significant economic hub, understanding the landscape patterns and driving mechanisms of farmland abandonment and recultivation land is crucial for regional sustainable development. This study aims to map the extent of farmland abandonment in 2020 and recultivation land in 2021 across the Yangtze River Delta, analyze the landscape patterns of farmland abandonment and recultivation land on multiple scales, and explore their driving mechanisms. Utilizing multi-source data and the Land Use Trajectory Change Method on the Google Earth Engine platform, we classified land use and identified farmland abandonment, fallow land, active farmland, and recultivation land. Spatial statistical analysis was conducted to investigate the distribution and patterns of farmland abandonment and recultivation land at Yangtze River Delta, provincial, and municipal scales. Additionally, a stepwise multiple linear regression model was employed to dissect the main driving forces of farmland abandonment and recultivation land. Results revealed that farmland abandonment in the Yangtze River Delta region exceeded an abandonment rate of 10%, with a reclamation rate in the following year of less than 30%. The spatial distribution of farmland abandonment and recultivation land varied significantly across different scales. On the Yangtze River Delta scale, farmland abandonment was positively influenced by altitude, distance to rivers, and temperature, while recultivation land was positively correlated with night light intensity. At the provincial and municipal scales, the driving forces exhibited scaling effects, with different factors becoming significant. Our findings contribute to a deeper understanding of the complexity and diversity of farmland abandonment in the Yangtze River Delta region. The results provide a scientific basis for formulating land use policies, promoting sustainable agricultural development, and ensuring ecological balance. By uncovering the land use status and ecosystem balance influenced by human-environment interactions, this study offers insights into achieving a harmonious coexistence between economy, society, and ecology in the Yangtze River Delta region.