Multinomial Regression Models Research Articles

Impact of hysterectomy on opioid use in patients with adenomyosis: A nationwide register study

Introduction Dysmenorrhea and heavy menstrual bleeding are the most common symptoms in adenomyosis, in addition to infertility and chronic pelvic pain. Hysterectomy is a common treatment for adenomyosis symptoms with curative effect on heavy menstrual bleeding but with less studied effects on pain reduction. Material and methods This is a nationwide retrospective register-based cohort study including all hysterectomized patients with pathology-verified adenomyosis between 1 January 2012 and 31 December 2015 with a long-term follow-up three years pre- and three years postoperatively. Two national registers were linked in order to describe the primary outcome of proportion with use of opioids among hysterectomized patients with and without adenomyosis pre- and postoperatively. Logistic and multinomial regression models were used. Results A total of 2,228 (15%) patients had pathology-verified adenomyosis. Overall opioid use was 18.6% and 21.1% three years before and three years after surgery, respectively. Results showed a significantly increased risk of opioid use three years after hysterectomy in patients with preoperative use of opioids and antidepressants (adjusted Odds Ratio (aOR) 5.7, 95% Confidence Interval (CI) 4.5–7.2 and aOR 1.4, 95% CI 1.1–1.8). The risk of needing long-term opioids was higher among patients with smaller uteri (<300g, aOR 2.8, 95% CI 1.7–4.7) compared to women with uterine sizes ≥600g. Conclusions Hysterectomy does not reduce opioid use among adenomyosis patients in long-term follow-up, although the subjective reduction of pain was not investigated in this study. Women with preoperative use of opioids/antidepressants and uterine size <300g are at increased risk for chronic opioid use.

Socioeconomic and behavioural factors that contribute to the co-occurrence of risk factors for noncommunicable diseases

It is observed that the global burden of diseases had shifted from infectious diseases to Non-Communicable Diseases (NCDs), with an accumulative trend in developing countries. NCDs share key modifiable behavioral risk factors like unhealthy diet and lack of physical activity that are typically established during adolescence or young adulthood and will set the stage for NCDs development later in life. Therefore, this paper aimed to explore factors contributing to the co-occurrence of risk factors for NCDs among persons aged 30 years and above in selected urban areas of Namibia. Specifically, the paper focused on examining the social, economic and behavior characteristics of people living with NCDs and how they contribute to the relative risk of the co-occurrence of NCDs. The study is based on secondary data and analysis is based on a total sample of 1527 which was successfully interviewed. The dependent variable was co-occurrence of NCD risk factors per respondent with the following groups: No co-occurrence, at most two risk factors, 3–4 risk factors, and 5–6 risk factors. The risk factors included excessive alcohol consumption, smoking of tobacco, insufficient physical activeness, insufficient intake of fruits, and insufficient intake of vegetable and unhealthy dietary pattern. Descriptive statistics were obtained using frequencies and averages. Pearson Chi-square was used to assess the association between co-occurrence of risk factors and socio-economic and behavioural variables using cross-tabulation. A multinomial regression model was also used to predict the effects of factors contributing to the co-occurrence of risk factors. The significance of variables was tested using 5% level. The results showed that overall, co-occurrence of risks was more prevalent among respondents with HBP than those with diabetes or HRD. Notably, age and education level positively contribute to co-occurrence of risk factors of NCDs. Increased co-occurrence of risks was also relatively high among respondents with NCD who did not take medication and those who did not go for follow up. The paper concluded that taking medication, regular check-up and following healthy diet significantly reduce the risk of co-occurrence of NCD risk factors. The study recommends for infrastructural developments in urban areas that promotes health lifestyles including provision for cycling, walking paths and participation in urban agriculture.

Estimation of Actual Evapotranspiration and Crop Coefficient to Improve Water Use Efficiency of Sesamum (Sesamum indicum L.) in Kharif Season Using Digital Weighing Lysimeter

The study was conducted on Estimation of Actual Evapotranspiration and Crop Coefficient to Improve Water Use Efficiency of Sesamum (Sesamum indicum L.) in Kharif Season Using Digital Weighing Lysimeter,” was conducted during the 2023-24 Kharif season with the aim of enhancing sesamum water use efficiency. For estimation of actual evapotranspiration and crop coefficient following are the objectives were to calculate and compare reference evapotranspiration (ETr) using various methods, measure crop evapotranspiration (ETc) using a digital weighing lysimeter, estimate crop coefficient (Kc) value. ETr was calculated using six different methods: Penman-Monteith, Modified Penman-Monteith, FAO Radiation, Priestly-Taylor, Hargreaves-Samani, and Pan Evaporation. The result obtained from that is the seasonal ETr was found 328.53, 395.47, 369.37, 430.26, 416.04, 372.90 mm respectively. While calculating or estimating reference evapotranspiration it is observed that The Modified Penman Monteith method had the highest correlation (R²=0.98) with the standard Penman-Monteith method, while the FAO Radiation and Pan Evaporation methods also performed well. crop Evapotranspiration (ETc) of Sesamum crop, measured using a digital weighing lysimeter, ranged from 0.61 to 5.65 mm/day, with a total of 244.94 mm for the season and the Crop coefficients (Kc) values were calculated by ratio of crop Evapotranspiration (ETc) with Reference Evapotranspiration (ETr), from that polynomial regression models were developed to estimate daily Kc values based on the crop growth ratio (t/T). The daily Kc values determined by using the best fit polynomial equations were averaged over initial, development, mid-season and end-season stage, the Kc values developed by using different methods i.e (Penman-Monteith method) are 0.58, 0.77, 1.00, and 0.36; Kc values (Modified Penman Monteith method) were 0.48, 0.64, 0.84 and 0.32; Kc values (FAO Radiation method) were 0.61, 0.73, 0.91 and 0.33; Kc values (Priestly Taylor method) were 0.26, 0.61, 0.98 and 0.33; Kc values (Hargreaves Samani method) were 0.36, 0.58, 0.92 and 0.28; and Kc values (Pan Evaporation method) were 0.48, 0.65, 0.93 and 0.32, respectively. On an average Kc determined by Penman Monteith method, Modified Penman Monteith method, FAO Radiation method and Pan Evaporation method overestimated the Kc by 26.17, 7.00, 21.92 and 9.38 per cent, respectively compared to FAO-56 values. However, Priestly-Taylor method and Hargraves-Samani method underestimated Kc by 5.55 and 5.78 per cent, respectively.

Influence of Visual Quality and Cultural Background on Consumer Apple Preferences: An Eye-Tracking Study with Chinese and Hungarian Consumers

Using eye-tracking technology, the proposed study investigates how customers visually evaluate apples varieties and apple defects and how these evaluations affect their purchasing decisions. Three aspects were examined in this study: apple variety, defect severity, and cultural background. Idared, Golden Delicious Yellow, and Golden Delicious Green apple varieties with increasing degrees of bruising were shown to Chinese and Hungarian participants. The findings show that apple variety had no significant effect on gaze patterns, whereas cultural background had a considerable impact on visual attention measures. The most important element in grabbing and retaining customer attention was the severity of the defect, which was measured by area. The “Threshold of Rejection”, which characterizes consumer tolerance for Apple defects, is introduced in the study. Furthermore, a polynomial regression model was created to predict the probability of repurchasing an apple depending on its visual quality (level of bruising). These results provide useful information for marketing plans, quality assurance, and comprehending customer behavior in the fresh produce sector.

Awareness of Sexual Partner's HIV Status Among Men Who Have Sex With Men in China: Cross-Sec. tional Survey Study.

Men who have sex with men (MSM) constitute a significant proportion of individuals living with human immunodeficiency virus. Over the past few years, China has implemented various strategies aimed at increasing the rate of HIV testing and reducing HIV transmission among MSM. Among these, the disclosure of HIV serostatus is an effective prevention strategy. This study aimed to assess HIV serostatus disclosure and identify factors associated with awareness of sexual partners' HIV status among MSM to provide a scientific basis for promoting HIV testing and reducing HIV transmission. A cross-sectional study based on a large-scale web-based survey was conducted among MSM in Zhejiang province, China, between July and December 2023. MSM who were HIV-negative or had an unknown HIV status were recruited from the Sunshine Test, a web-based platform that uses location-based services to provide HIV prevention services. Participants were required to complete a questionnaire on demographic characteristics, sexual behavior, rush popper use, awareness of sexual partners' HIV status, and knowledge of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). A multinomial regression model was used to identify the factors associated with awareness of sexual partners' HIV status. A total of 7629 MSM participated in the study, with 45.2% (n=3451) being aware, 35.4% (n=2701) being partially aware, and 19.4% (n=1477) being unaware of their sexual partner's HIV status. The multinomial logistic regression analysis revealed the following results. Compared to those who were unaware of their sexual partner's HIV status, participants who were students (adjusted odds ratio [aOR] 1.43, 95% CI 1.09-1.86), had a monthly income of more than US $1400 (aOR 1.36, 95% CI 1.03-1.80), had insertive anal sex (aOR 1.35, 95% CI 1.12-1.63), had only male sexual partners (aOR 1.53, 95% CI 1.28-1.82), had 1 sexual partner in the past 3 months (aOR 2.36, 95% CI 2.01-2.77), had used condoms for the past 3 months (aOR 1.72, 95% CI 1.33-2.22), had frequently used rush poppers in the past 3 months (aOR 2.27, 95% CI 1.81-2.86), were aware of HIV PrEP (aOR 2.04, 95% CI 1.68-2.48), were aware of HIV PEP (aOR 1.69, 95% CI 1.39-2.06), used mail reagent self-testing (aOR 1.19, 95% CI 1.04-1.36), and had previously undergone HIV testing (aOR 1.40, 95% CI 1.16-1.69) were associated with increased odds of being aware of their sexual partner's HIV status. Overall, 45.2% of MSM who were HIV-negative or had an unknown status were aware of their sexual partners' HIV status in China. We suggest strengthening targeted interventions through web-based platforms and gay apps to promote the disclosure of HIV serostatus and reduce HIV transmission among MSM.

Implications of climate‐smart agriculture technology adoption on women's productivity and food security in Tanzania

AbstractGender gaps in productivity and food security persist in the face of climate change, necessitating effective strategies for empowering women and reducing their vulnerability. This study examines the gender‐specific impacts of climate‐smart agriculture (CSA) adoption on productivity, food security, and resilience to climate shocks in Tanzania. Using panel data from the World Bank's Tanzanian Living Standard Measurement Survey (LSMS) spanning 2008–2013, we employ a multinomial switching regression model (MSRM) approach to identify the effects of CSA adoption on agricultural outcomes. Our findings reveal that CSA non‐adoption exacerbates the gender gap in yields and food security, favoring men. However, CSA adoption leads to more equitable outcomes, bridging the gender gap and improving productivity and food security for both men and women. Additionally, adopters of CSA techniques exhibit greater resilience to climate shocks, experiencing smaller yield declines during periods of low rainfall. This study contributes to the literature by providing empirical evidence on the gendered impacts of CSA adoption, testing the risk reduction capacity of CSA technologies, and addressing the limited research on Tanzania. The findings emphasize the importance of gender‐responsive CSA policies in promoting agricultural resilience and food security in the face of climate change.

Cardiopulmonary exercise testing in children and adolescents at moderate altitude: New normative valuesh.

Cardiopulmonary exercise tests (CPETs) measure cardiovascular exercise response. Altitude alters exercise parameters, so standard normative datasets (Cooper, Bruce, Burstein) may not accurately predict exercise parameters for data collected at moderate altitude. This study aimed to: 1) establish modern normative exercise values for children/adolescents at moderate altitude and 2) compare these values against the Cooper, Burstein and Bruce models. Maximal CPETs in children/adolescents aged 6 to 18 years were evaluated retrospectively (n = 1154, mean age 13.92 ± 2.70 years, 49.7 % female). Separate analysis and modeling were completed for the cycle ergometer (n = 907) and treadmill (n = 247). Polynomial regression models were developed for each exercise variable. A validation cohort of tests on the treadmill and cycle ergometer (n = 100, 50 cycle ergometer, 50 treadmill, mean age 14.44 ± 2.57 years, 47.0 % female) were evaluated with our polynomial models. On the cycle ergometer, the Burstein dataset had improved root mean square error (RMSE, 7.4) compared to the Cooper dataset (RMSE 9.6) for peak oxygen consumption (VO2 peak), while our model demonstrated even better RMSE (5.5). Our model had improved RMSE compared to the Burstein equations for all parameters (except resting systolic blood pressure) indicating an improved model. We present new normative data and predictive equations based on a relatively large population of healthy children/adolescents tested at moderate altitude that outperforms sea-level-based models. Among other variables (age, gender, BMI, ethnicity), altitude must be considered when reporting exercise data so that normal CPET values at moderate altitude are not misinterpreted as pathological CPET findings.

Influence of prenatal hexachlorobenzene, PCB and selenium levels on growth trajectories in the first year of life: Findings from the NEHO birth cohort.

Prenatal exposure to endocrine-disrupting chemicals (EDCs) may impact postnatal growth trajectories, increasing the risk of various diseases later in life. This issue is of particular concern in industrially contaminated areas, where environmental matrices contain mixtures of pollutants. This study aimed to evaluate the associations between cord serum concentrations of organochlorine pollutants (hexachlorobenzene-HCB and polychlorinated biphenyls-PCBs) and essential elements (EEs), and weight growth trajectories during the first year of life. We analyzed data from 237 infants enrolled in the Neonatal Environment and Health Outcomes (NEHO) cohort. Using the Group-Based Multivariate Trajectory modeling approach, we identified three distinct growth trajectories from birth to 12months, classified as "Higher," "Normal," and "Lower." Multinomial regression models were then applied to the whole sample and stratified by sex to assess the associations between individual exposures and the identified child growth trajectories. HCB exposure was associated with an increased risk of reduced growth during the first year of life in both the overall sample and among males [higher vs normal: ORMale=0.33 (95% CIMale:0.12;0.87); lower vs normal: ORMale=2.17 (95% CIMale:0.94;5.00)]. Conversely, PCB-180 exposure was linked to higher growth only in females [higher vs normal: ORFemale=24.10 (95% CIFemale:1.33;438.24)]. Elevated levels of selenium in cord serum were negatively associated with excessive growth [higher vs normal: OROverall=0.50 (95% CIOverall: 0.26;0.97)]. These findings suggest sex-specific effects on the growth profile during the first year of life, with different chemical exposures contributing to different outcomes.

A Missed Opportunity? Exploring Changes in Influenza Vaccination Coverage During the COVID-19 Pandemic: Data From 12 Countries Worldwide.

Vaccination is a key measure in influenza control, yet global coverage rates remain low, although previous research reported an increase in influenza vaccination coverage rates (VCR) after the onset of the COVID-19 pandemic. This study aims to assess whether these changes were sustained over time by analyzing VCR trends from 2012 to 2023 in the countries included in the FluCov project. Data on influenza VCR from 2012 to 2023 for different age and risk groups were extracted from national health organizations and international sources for countries included in the FluCov project. For coverage rates in the older adults, segmented regression models were used to test if 2020 marked a significant change in VCR trends. Moreover, polynomial regression models were fitted for each country with VCR in the period 2012 to 2020 to predict coverage rates for 2021 to 2023 and to compare these to the actual coverage rates for 2021 to 2023. For the elderly, we retrieved influenza VCR data for 12 countries. In 2020, VCR among elderly increased in 10 countries, but the increase was statistically significant in Spain and England only. Moreover, all countries except Spain reverted to levels within the confidence intervals of trends modeled using pre-2020 data. Although influenza VCR increased in 2020, these changes were statistically significant in only two out of 12 countries, and no consistent, sustained increase was observed afterward, except in Spain. The findings suggest the need for continuous monitoring of VCR and the implementation of strategies to promote and maintain high vaccination coverage rates.

Illustrating How Health Policy May Perpetuate Coverage and Access Disparities for Undocumented Immigrants

Background and Objectives: Evidence indicates significant disparities in access to health care for immigrants, but few studies have focused on changes in patterns of access to care by immigration status over time. We examined patterns of change in access and health indicators before and after the Affordable Care Act (ACA) for the undocumented and compared to US-born, naturalized, and documented residents. Methods: We examined indicators of usual source of care, service use, delays and self-reported health from 2005 to 2018 using a California Health Interview Survey sample of non-elderly adults (n = 207,652). We used multinomial and logistic regression models to assess changes in access and health status within each immigration category and across ACA periods. Results: From early- to post-ACA periods, we found a widening gap in insurance coverage of undocumented vs. US-born residents, and a shift toward use of public settings as usual source of care for both groups. From the pre- to early-ACA periods, there was a greater reduction of delayed medical care, and an increase in any mental health visits for US-born vs. undocumented residents. Discussion: Findings portend exacerbation of disparities in access for undocumented residents due to the economic consequences of events such as the pandemic and continued exclusion of undocumented residents from federally-funded coverage.

Fuel choices for cooking and heating and gender empowerment: Implications for promoting gender equality and sustainable rural development

This study evaluates the impact of fuel choices for cooking and heating on gender empowerment using rural household survey data from China. We investigate rural households' fuel-stacking behaviors by classifying fuels into non-clean, clean, and mixed categories and distinguish an incomplete energy transition (i.e. switching from non-clean fuels to mixed fuels) from a complete energy transition (i.e. switching from non-clean to clean fuels). The decision-making power of men and women measures gender empowerment. We use the multinomial endogenous switching regression model to address the endogeneity issue associated with rural households' fuel choices. The results show that incomplete and complete energy transitions for heating significantly increase men's decision-making power, while the same transitions for cooking have no significant impact. Incomplete and complete energy transitions for cooking significantly empower rural women, while a complete energy transition for heating also significantly empowers women. These findings suggest that promoting a complete energy transition supports broader rural development by empowering women to participate more actively in household decision-making. We also find that a complete energy transition for cooking and heating reduces the decision-making power gap between men and women more than an incomplete one, highlighting that a complete energy transition contributes more to gender equality. Therefore, fostering complete energy transitions is essential for closing gender disparities and establishing a foundation for sustainable rural development through enhanced female empowerment.

Drug Overdose Deaths in Mexican-Heritage Arizonans: An Examination of Mortality Rates, Demographics, Drugs Involved, and Place of Death

Objective This study examined drug overdose deaths in Mexican-heritage Arizonans, with the goal of informing tailored overdose prevention programs for this community. Methods We analyzed death certificate data (from the Arizona Department of Health Services) for drug overdose deaths among Arizona residents from 2018-2022. We compared deaths in US-born and foreign-born Mexican-heritage Arizonans and, as a frame of reference, Non-Hispanic (NH) White Arizonans. We compared demographics, circumstances of death, and mortality rates, using descriptive statistics, multinomial logistic regression models, and age-standardized mortality rates and ratios. Results The age-standardized drug overdose mortality rate (per 100,000) was lower in the overall Mexican-heritage population (28.0) than in the NH White population (35.9). Nonetheless, the rate in the US-born Mexican-heritage male subgroup (59.5) was higher than in US-born NH White males (49.9) or any other subgroup examined. Synthetic opioids such as fentanyl were involved in higher proportions of deaths among US-born (64.6%) and foreign-born (65.1%) Mexican-heritage Arizonans than among NH White Arizonans (48.5%). In multinomial regression models, the risk of a medical place of death, relative to death at home, was significantly higher in the foreign-born (adjusted Relative Risk Ratio [aRRR] 1.82; 95% Confidence Interval [CI], 1.38-2.42) and US-born (aRRR 1.85; 95% CI, 1.62-2.11) Mexican-heritage groups than the NH White group, adjusting for age, sex, marital status, county of residence, overdose intent, and drugs involved. Conclusions Findings highlight disparate rates of overdose mortality in US-born Mexican-heritage Arizona men, also underscoring racial/ethnic/nativity-based differences in overdose circumstances and decedent characteristics.

Relationship between cardiorespiratory fitness and falls in older adults: A population-based study.

The present study investigated the relationship between cardiorespiratory fitness (CRF) and episodes and severity of falls in older adults. This cross-sectional study drew on data from the Brazilian 2019 National Health Survey. The sample consisted of 18 991 older adults (aged ≥60 years). CRF was obtained through a non-exercise model for estimating VO2max, and the people were classified as low, moderate or high CRF. Logistic and multinomial regression models were used. Odds ratios (ORs) and their respective confidence intervals (95% CIs) were calculated. Older adults with strong CRF are 29% (OR 0.69, 95% CI 0.52-0.92) less likely to suffer falls than those with poor CRF. High levels of CRF were also associated with non-severe falls. However, no associations were found between CRF and severe falls with fractures and medical intervention. Although good CRF levels can reduce the chance of falls, this protection does not extend to falls with more severe consequences, such as fractures and the need to seek medical care. Geriatr Gerontol Int 2024; ••: ••-••.

Quantifying the impact of land surface temperature on vegetation moisture for drought monitoring in Tamil Nadu

Drought significantly threatens agriculture, water resources, and ecosystems, particularly in Tamil Nadu, India. This study explores the link between Land Surface Temperature (LST) and the Normalized Difference Water Index (NDWI) to evaluate their effectiveness for drought monitoring across Tamil Nadu’s districts from 2014 to 2023. Utilizing MODIS MOD11A2 for LST and MOD09A1 for NDWI, the analysis examines the influence of temperature variations on vegetation moisture levels. The Pearson correlation analysis identified substantial spatial differences, with strong correlations in districts such as Perambalur, Namakkal, and Dindigul (up to 0.91), suggesting higher temperatures are closely associated with reduced vegetation moisture content, heightening drought risk. Nonetheless, weaker correlations in regions like the Nilgiris and Tirunelveli suggest that temperature exerts a lesser influence on vegetation moisture in those areas. Further quantification was achieved through linear and polynomial regression models. The linear model explained 52.7% of NDWI variation due to LST (R-squared = 0.527) and was validated as the most robust model via cross-validation. While polynomial models accounted for slight non-linearities, they offered limited predictive improvement, confirming that a linear relationship generally describes the NDWI-LST dynamics adequately. The results indicate that LST is a valuable indicator for drought monitoring in strongly correlated areas. In contrast, additional variables like rainfall and soil moisture may be essential for accurate predictions in regions with weaker correlations. Overall, this study demonstrates the potential of remote sensing for drought monitoring and emphasizes the need to consider local environmental factors to refine predictive models across Tamil Nadu’s diverse landscapes.

Marketing contracts and technical efficiency of citrus production

PurposeThis study examines the impacts of marketing contracts (written contracts, verbal contracts and no contracts) on technical efficiency, taking citrus production in Jiangxi Province, China, as an example.Design/methodology/approachWe first use a stochastic production frontier (SPF) model to calculate the technical efficiency scores of citrus production at the individual level. Then, we use a multinomial endogenous switching regression (MESR) model, which mitigates selection bias issues arising from observed and unobserved factors, to estimate the treatment effects of marketing contract choices on technical efficiency. Data used in this study were collected from a survey of citrus farmers conducted between October and November 2022 in Jiangxi Province, China.FindingsThe SPF model estimates show that the mean technical efficiency score of citrus production is 0.616, ranging between 0.021 and 0.894. The MESR model estimates reveal that the technical efficiency scores for written and oral contract users are 18.3 and 10.5% higher, respectively, compared to citrus farmers with no marketing contracts. Additionally, the average technical efficiency score for written contract users exceeds that of oral contract users by 2.5%. We also find that farmers with higher household incomes and less farming experience were more likely to use written contracts. At the same time, those endowed with better education, larger farm sizes and better production conditions were more likely to use verbal contracts.Originality/valueFarmers seeking marketing contracts for product sales need to adjust their production behaviour in advance to meet the product attributes required by market buyers. However, little is known about whether marketing contract users are more efficient in farm production than non-users. This study provides the first attempt to investigate the associations between different types of marketing contracts and technical efficiency.

Polynomial Regression-Based Predictive Expert System for Enhancing Hydraulic Press Performance over a 5G Network

In industrial applications, hydraulic presses maintain workloads by controlling the hydraulic cylinder to extend and retract, ensuring optimum tracking performance in terms of position and force. Dealing with nonlinear and multinode systems, such as hydraulic systems, often requires an advanced approach that frequently includes machine learning and artificial intelligence methods. Introducing an adaptive control system to significantly improve the response of hydraulic presses is a challenge. Therefore, a polynomial regression model predictive control (PR-MPC) mechanism is proposed in this paper to compensate for external disturbances such as the forming processes and friction dynamics. Using polynomial regression modeling and least squares optimization, the approach produces highly accurate data-driven models with an R2 value of 0.948 to 0.999. The simplicity of polynomial regression facilitates the integration of smart algorithms into an expert system with additional decision-making rules. Remote adaptive control integrated within a 5G network is based on I 4.0 distributed system guidelines that provide insights into the behavior of the hydraulic press. The results of real-time experiments have shown that the PR-MPC mechanism integrated into the expert system reduces the absolute response error of the hydraulic press by up to 98.7% compared to the initial control system with a PID regulation.

A New Polymeric Hybrid Auxetic Structure Additively Manufactured by Fused Filament Fabrication 3D Printing: Machine Learning-Based Energy Absorption Prediction and Optimization.

The significance of this paper is an investigation into the design, development, and optimization of a new polymeric hybrid auxetic structure by additive manufacturing (AM). This work will introduce an innovative class of polymeric hybrid auxetic structure by the integration of an arrow-head unit cell into a missing rib unit cell, which will be fabricated using fused filament fabrication (FFF) technique, that is, one subset of AM. The auxetic performance of the structure is validated through the measurement of its negative Poisson's ratio, confirming its potential for enhanced energy absorption. A chain of regression, linear, and quadratic polynomial machine learning algorithms are used to predict and optimize the energy absorption capability at variant processing conditions. Amongst them, the polynomial regression model stands out with an R-squared value of 92.46%, reflecting an excellent predictive capability for energy absorption of additively manufactured polymeric hybrid auxetic structure. The optimization technique revealed that the printing speed of 80 mm/s and layer height of 200 µm were the critical values to achieve a maximum amount of energy absorption at 5.954 kJ/m2, achieved at a printing temperature of 244.65 °C. Such results also contribute to the development of AM, since they show not only the potential for energy absorption of polymeric hybrid auxetic structures but also how effective machine learning is in the optimization of the AM process.

The influence of asset ownership and e-marketing on households’ dietary diversity in rural South Africa

Integrating rural populations into formal food markets is widely recognized as a key strategy for enhancing dietary diversity. However, there is limited research on the impact of e-marketing on improving household dietary diversity. This study seeks to fill this gap by evaluating how food retailers’ use of text messaging to communicate food offerings affects dietary diversity. Specifically, the study compares the influence of e-marketing, enabled by mobile phone ownership, with the impact of assets such as financial, human, physical, and agricultural capital. Using a multinomial regression model, data from 166 households in the Moretele Local Municipality in South Africa were analyzed. The results indicate that receiving marketing messages from retailers, as well as asset ownership, positively influenced household dietary diversity. This finding underscores the potential of targeted e-marketing in improving diet quality and suggests that text messaging can be an effective tool for promoting healthier food choices. The study also highlights key assets that development programs should prioritize to help rural communities transition to more nutritious diets.

Knowledge Acquisition and Audience Retention in Stroke Education: Results From a Global Study by the World Stroke Organization.

The World Stroke Academy (WSA), the educational platform of the WSO, provides high-quality stroke education to health care professionals worldwide. Understanding the learning needs and preferences of WSA members is crucial for effective knowledge translation. This study aims to (1) assess demographics and professional backgrounds of WSA members, (2) identify preferences in knowledge acquisition, and (3) evaluate audience retention during WSA webinars. A survey was developed using Qualtrics and distributed via email to all WSA members from May 8 to May 23, 2023. The survey included multiple-choice, rating scale, and ranking questions. Audience retention data were obtained from the latest 6 WSA webinars (May 2023-December 2023). Descriptive variables were reported, and χ2 analysis and multinomial regression models were used. A random sample of 1065 WSO members received the survey; 327 initiated it (participation rate, 30.7%), and 236 completed it (completion rate, 72.2%). The mean age (SD) of participants was 46.7 (±11.6) years; 57.2% identified as male. Most respondents were stroke specialist physicians (65.3%) and were based in Europe (35.2%). Online journal articles represented 41.6% of the total time allocated for stroke education, with 17% allocated to webinars. Social media usage patterns showed X (formerly Twitter) as the top choice (34.7%). Age, profession, and location significantly influenced social media platform use. Audience retention was at 50% at the 57-minute mark and 44.3% at the end of webinars. Tailoring WSA webinar content to meet health care professionals' needs and enhancing interactive components can improve audience retention. These insights will guide the future development of the WSA portfolio.

Individual and clinical factors associated with patient acceptance of referrals to social services and community resources at a multi-purpose resource hub.

Emerging evidence suggests that bi-directional communication and referral pathways, when employed strategically, can lead to favorable health outcomes by connecting patients with complex, multi-faceted health and social needs to appropriate services and resources. However, despite these benefits, patient acceptance of referrals via these pathways remains suboptimal. In this study, we describe individual and clinical factors associated with patient acceptance of these referrals. We extracted individual-level demographic and clinical data for patients referred primarily from a large safety-net health system to a multi-purpose resource hub co-located on the campus of its largest hospital, for the period October 2019 to June 2023. Descriptive statistics, Chi-square analyses, and multinomial regression modeling were performed to examine these data. Of 1865 patients in the study sample, 54.2% accepted a referral, 27.4% were lost to follow-up, and 18.4% declined. Most patients who accepted referrals were female (67.1%), Latino (81.5%), and had hypertension and/or prediabetes or diabetes (84.1%). In modeling analyses, those who accepted referrals tended to be female, and were referred from primary care clinics; many were referred for multiple service/resource categories. We found associations between patient acceptance of referrals and gender and source of referral. Drawing upon these results as well as experience implementing these systems, we propose several practical strategies for increasing successful referrals, including identifying and addressing barriers for patients who declined or were lost to follow-up; using standardized screening tools to routinely assess for multi-faceted health and social needs; increasing provider awareness about the benefits and functioning of these pathways; and monitoring progress so mid-course adjustments can be made when necessary.