Multiple Regression Models Research Articles

Modelling and optimization for material removal rate while processing bio-compatible Ti-6Al-7Nb using wire electric discharge machining (WEDM)

Abstract This study utilizes machine learning methodologies, such as artificial neural networks (ANN) and TLBO (teaching Learning Based optimisation), to develop a model and Optimisation of the Material Removal Rate (MRR) in wire electrical discharge machining (WEDM) of Ti-6Al-7Nb. The material removal rate was determined by conducting WEDM experiments with different levels of control parameters, including spark on time, spark off time, peak current, servo voltage, and wire feed rate using a Full Factorial approach through 81 runs. The most effective architecture for the ANN model was 4–10–1, and the parameters were adjusted depending on R2. The Artificial Neural Network (ANN) predictions were compared to those produced by the Multiple Linear Regression (MLR) model. The performance of these models was assessed by calculating the correlation between the experimental values and predicted values by models (R2). MRR value is optimised using TLBO (Teaching Learning Based Optimisation), keeping the relation developed by MLR as the objective function and leading to an improved material removal rate. The proposed method ANN & TLBO would help accurately predict and optimise MRR while processing Ti-6Al-7Nb. These machine learning-based methods significantly enhance complex machining processes by providing predictive capabilities & optimizing parameters, hence playing a vital role in achieving higher efficiency, quality, and adaptability in manufacturing environments.

Establishing Optimal Machine Learning Models for Monitoring Water Quality in Vietnam’s Upper Ma River

This study aims to establish the optimal regression model for predicting total suspended solids (TSS) and Turbidity based on in situ data and spectral regions of Sentinel-2 images. Various machine learning models were evaluated, including Multilayer Perceptron Regression (MLPR), Random Forest Regression (RFR), AdaBoost Regression (ABR), Multiple Linear Regression (MLR), and K-Nearest Neighbors Regression (KNNR). These models were applied to different band combinations of spectral regions: visible (VIS), near-infrared (NIR), shortwave-infrared (SWIR), VIS+NIR (VNIR), and VIS+NIR+SWIR (VNIR+SWIR). The study results revealed that the MLR model, while not the best performer during training (R2 = 0.89 for TSS and R2 = 0.66 for turbidity), did not exhibit overfitting, with corresponding R² values in testing being 0.80 and 0.42, respectively. Variable selection for MLR models identified optimal spectral bands: B3, B5, B6, B8, B11, and B12 for TSS, and B4, B8, B11, and B12 for Turbidity. The final no-intercept multiple linear regression models achieved R2 = 0.88 for TSS and R2 = 0.62 for turbidity. Performance metrics for TSS were superior, with lower MAE, MSE, and RMSE compared to Turbidity. This study underscores the efficacy of using MLR models with selected spectral bands for accurate and generalizable predictions of TSS and turbidity.

The Influence of X Chromosome Parent-of-Origin on Glycemia in Individuals with Turner syndrome

Introduction: The cause of increased diabetes mellitus (DM) risk in individuals with Turner syndrome (TS) is poorly understood. Parent-of-origin effects related to whether the maternal or paternal X chromosome (Xchr) remains intact have been found for several TS phenotypes, including hypercholesterolemia. Therefore, Xchr parent-of-origin may impact DM risk in TS. The aim of this study was to determine whether Xchr parent-of-origin affects glycemia, as measured by oral glucose tolerance test (OGTT), in TS. Methods: A total of 81 individuals with 45,X karyotype from the TS: Genotype Phenotype study had Xchr parent-of-origin assessment and completed a 3-hour OGTT. Parallel-slopes multiple linear regression modeling was used to test whether Xchr parent-of-origin, age, and/or body mass index (BMI) significantly predicted incremental area under the glucose curve (iAUC). A second analysis included 62 additional individuals with 45,X mosaicism. Results: All three factors predicted iAUC glucose in the 81 individuals with 45,X karyotype (age: B = 0.36, p = 0.0004; BMI: B = 0.33, p = 0.001; Xchr parent-of-origin: B = 0.21; p = 0.01). The overall model remained statistically significant when including individuals with 45,X mosaicism, but Xchr parent-of-origin was no longer significant. Conclusions: Maternal Xchr monosomy predicts higher glucose concentration than paternal Xchr monosomy in response to oral glucose in 45,X individuals. This effect is obscured when including individuals who are mosaic, potentially due to the presence of both parent Xchrs in the non-45,X cell line.

Optimization of the cooperative electronic commerce model for sustainable development in the context of ecological environment conservation

AbstractThis study aims to explore how to optimize the cooperative electronic commerce model in a sustainable ecological environment to meet the needs of consumers while maximizing social and economic benefits. The empirical research method is adopted, which mainly includes a literature review, case analysis, and questionnaire. Firstly, through a literature review, this study introduces and analyses the concept of sustainable ecological environment and the development and optimization direction of cooperative electronic commerce model in detail, providing a theoretical basis and thought guidance for subsequent research. Secondly, this study selects several representative cooperative electronic commerce platforms for case analysis. It explores their operation mode, product characteristics, service quality, and social benefits to summarize the experience and lessons of optimizing cooperative electronic commerce model. Finally, a questionnaire is designed to sample the consumers of cooperative electronic commerce. By analysing the results of questionnaire, the following conclusions are drawn. (1) 54.3% of respondents said they had used the cooperative electronic commerce model, with agricultural products purchasing (23.5%) and community service (18.9%) using it more frequently. (2) The cognition level of sustainable development was high overall, with 62.6% believing that it was essential for the future. (3) A multiple linear regression model explored the relationship between using the cooperative electronic commerce model and sustainable development cognition. The results reveal that adopting cooperative electronic commerce model has a significant positive impact on the cognition of sustainable development, which indicates that the promotion and use of this model can promote cognition and practice of sustainable development.

Characteristics of hospital pediatricians and obstetricians/gynecologists working long hours in Tokushima, Japan: A cross-sectional study

Background This study aimed to determine the actual working conditions, including working hours and desired future working styles of hospital pediatricians and obstetricians/gynecologists (OB/GYNs) in Tokushima Prefecture. Method This cross-sectional study used a self-administered questionnaire. Pediatricians and OB/GYNs (n = 96) working at 14 hospitals in Tokushima Prefecture were surveyed. The questionnaire included items related to working hours, working status, number of medical institutions, task-shifting/task-sharing status, and preferred work style. Factors associated with work hours were analyzed. Results Approximately 40% and 10% of pediatricians and OB/GYNs worked ≥60 h/week and ≥80 h/week, respectively. Their weekly working hours were significantly positively associated with the number of nights and holidays worked and concurrent medical facilities they worked at. Multiple regression models showed that weekly working hours were significantly associated with working at night and day-off duties and the number of working medical institutions being worked at concurrently. Pediatricians and OB/GYNs who worked ≥60 h/week were not implementing a “multiple attending physician system” or “on-call system,” and task-shifting/task-sharing was inadequate. A significantly higher proportion of physicians who worked long hours (≥60 h/week or ≥80 h/week) wanted to reduce the number of night and day-off duties and work hours compared with those who did not. Conclusions The results of this study suggest that many pediatricians and OB/GYNs work long hours, and it is essential to improve their work environment, including task-shifting/task-sharing. Further enhanced recruitment and retention of hospital pediatricians and OB/GYNs is required. A detailed and large-scale study of pediatricians and OB/GYNs’ working environments is essential in the future.

Effect of Selected Board Attributes on Tax Aggressiveness of Quoted Insurance Companies in Nigeria

The main objective of this study is to examine the effect of selected board attributes on tax aggressiveness of quoted insurance companies in Nigeria. Specifically, the study examines the combined effect of female directors and board financial expertise on tax aggressiveness of quoted insurance companies in Nigeria. Tax aggressiveness was measured using effective tax rate while female directors and financial expertise were measured using proportion of female directors on the board to the total number of independent directors and proportion of financial experts on the board to the total number of independent directors respectively. This study uses the longitudinal research design. The population of the study is the entire twenty-three listed companies in the Nigerian insurance sector. The sample size of twenty-two was selected after eliminating one without complete data. Data were sourced from the annual financial statements of the listed insurance companies for the period 2011-2022. To be able to examine the effect of female directors and financial expertise on tax aggressiveness, the study used panel multiple regression model for the analysis. The result of the study shows that female directors have negative and insignificant effect on tax aggressiveness. However, the study finds statistical evidence which suggests that boards financial expertise has significant effect on tax aggressiveness in the insurance sector. From the findings, it was concluded that board attributes have strong explanatory power on tax aggressiveness. The study recommends that since management could aspire to avoid more taxes, because they estimate the tax benefits too high, more external board members with accounting and corporate reporting knowledge should be admitted on the boards to curtail managerial aggressive tax planning.

Association between D-dimer-to-albumin ratio and 28-days all-cause mortality in patients with sepsis.

We aimed to investigate the correlation between the serum D-dimer (D-D) to albumin (ALB) ratio (DAR) and 28-day all-cause mortality in patients with sepsis. Data from sepsis patients admitted to the intensive care unit (ICU) of Wuhan Fourth Hospital from October 2021 to January 2024 were collected. Univariate cox analysis was performed for mortality factors in sepsis patients, and multiple cox regression models were used to analyze independent mortality risk factors. The receiver operating characteristics (ROC) curve was used to analyze the value of DAR in predicting sepsis mortality, and the Kaplan-Meier method was used to plot the survival curve. A total of 833 patients with sepsis in the ICU of our hospital were selected and divided into alive group (n = 574) and death group (n = 171) according to their 28-day survival. In the death group, D-D and DAR levels were higher, while ALB levels was lower than in the alive group. Spearman analysis found that DAR level were positively correlated with APACHE II and SOFA scores. Multivariate cox regression analysis showed that DAR was an independent predictor of all-cause mortality within 28 days of admission for sepsis patients (HR = 17.956, 95% CI 3.435-93.851, p < 0.001). The ROC curve results showed that the cut-off value of DAR was 0.068, with a sensitivity of 78.4% and a Youden index of 0.375, predicting mortality in sepsis patients, with an area under curve (AUC) of 0.767 (95% CI 0.744-0.790, P < 0.001). Further analysis divided patients into low DAR (DAR < 0.068) and high DAR (DA ≥ 0.068) groups based on the optimal cut-off value. Kaplan-Meier analysis found higher mortality in the high DAR group. DAR is an independent predictor of all-cause mortality within 28 days of admission in sepsis patients. Combining these two indicators can improve clinical treatment guidance and reduce the risk of death.

Copper and zinc status in cord blood and breast milk and child's neurodevelopment at 18months: Results of the Italian PHIME cohort.

Trace elements, including zinc (Zn) and copper (Cu), although toxic at higher concentrations are known to play important roles in the maintenance of human health and neurodevelopment. Few epidemiological studies have investigated the association between prenatal or early postnatal Cu and Zn levels and child neurodevelopment. The aim of this research is to assess the association between child neurodevelopment at 18 months of age and cord blood and breast milk concentrations of Cu and Zn in Italian mother-child pairs enrolled in the Italian Northern Adriatic Cohort II (NAC-II), a part of the "Public health impact of long-term, low-level, mixed element exposure in susceptible population strata" project PHIME. The study population consisted of 632 children, and their mothers, born within the NAC-II, who were tested with the Bayley Scales of Infant and Toddler Development third edition (BSID-III) at age 18 months. Cu and Zn concentrations were measured in cord blood and breast milk samples. Only children born at term (≥37 gestational week), who completed the BSID-III test and had at least 1 measure of Cu and Zn concentrations were included in the analysis. Information about socio-demographics and lifestyles were collected through questionnaires at different phases of follow-up. Cu and Zn concentrations were log2 transformed because of their skewed distribution. Multiple linear regression models were performed to study the association between each BSID-III composite score (cognitive, motor and language) and each metal concentration. Separate models were applied for each biological sample. The β coefficient (β) and its 95% confidence interval (95% CI) were estimated. Stratified analyses by child's sex were also conducted. The mean±standard deviation (SD) of cognitive, motor and language composite scores were respectively: 106±8, 101±5 and 97±8. The mean±SD of Cu and Zn concentrations (ng/g) were respectively 699.2±129.0 and 2538±589 in cord blood and 607±498 and 3226±1428 in breast milk. No association between metal concentration and cognitive composite score was found. A higher motor composite score was associated with higher Cu concentrations in cord blood (β=4.31 95% CI 2.03; 6.59). No associations were found between language composite score and metal concentrations. The effect of Cu cord blood concentration on motor composite score was confirmed when stratified by sex: males (β=5.49 95% CI 2.15; 8.36) and females (β=3.11; 95% CI 0.00; 6.22). A direct association, in females only, was found between language composite score and Cu concentration in cord blood (β=5.60 95% CI 0.63; 10.57) and in breast milk (β=3.04 95% CI 1.06; 5.03), respectively. The results from this cohort study showed a strong direct association between prenatal Cu levels and child motor neurodevelopment at 18 months. However, for generalizability, future research on the effects of Zn and Cu on neurodevelopment should include a larger range of early-life concentration of trace elements.

Can acoustic measurements predict gender perception in the voice?

To determine if there is an association between vocal gender presentation and the gender and context of the listener. Quantitative and transversal study. 47 speakers of Brazilian Portuguese of different genders were recorded. Recordings included sustained vowel emission, connected speech, and the expressive recital of a poem. Subsequently, four scripts were used in Praat to extract 16 acoustic measurements related to prosody. Voices underwent Auditory-Perceptual Assessment (APA) of the gender presentation by 236 people [65 speech and language pathologist (SLP) with experience in the area of the voice (SLP), 101 cisgender people (CG), and 70 transgender and non-binary people (TNB)]. Gender presentation was evaluated by visual analogue scale. Agreement analyses were executed among quantitative variables and multiple linear regression models were generated to predict APA, taking the judge context/gender and speaker gender into consideration. Acoustic analysis revealed that cis and transgender women had higher median fundamental frequency (fo) values than other genders. Cisgender women exhibited greater breathiness, while cisgender men showed more vocal quality deviations. In terms of APA, significant differences were observed among judge groups: SLP judged vowel samples differently from other groups, and TNB judged speech samples differently (both p<0.001). The predictive measures for the APA varied based on the sample type, speaker gender, and judge group. For vowel samples, only SLP judges had predictive measures (fo and ABI Jitter) for cisgender speakers. In number counting samples, predictive measures for cisgender speakers included fomed and HNR for CG judges, and fomed for both SLP and TNB judges. For transgender and non-binary speakers, predictive measures were fomed for CG and SLP judges, and fomed, CPPs, and ABI for TNB judges. In the poem recital task, predictive measures for cisgender speakers were fomed and HNR for both SLP and CG judges, with additional measures of cvint and sr for CG judges, and fomed, HNR, cvint, and fopeakwidth for TNB judges. For transgender and non-binary speakers, the predictive measures included a wider range of acoustic features such as fomed, fosd, sr, fomin, emph, HNR, Shimmer, and fo peakwidth for SLP judges, and fomed, fosd, sr, fomax, emph, HNR, and Shimmer for CG judges, while TNB judges considered fomed, sr, emph, fosd, Shimmer, HNR, Jitter, and fomax. There is an association between the perception of gender presentation in the voice and the gender or context of the listener and the speaker. Transgender and non-binary judges diverged to a higher degree from cisgender and SLP judges. Compared to the evaluation of cisgender speakers, all judge groups used a greater number of acoustic measurements when analyzing the speech of transgender and non-binary individuals in the poem recital samples.

Renewable realities: Charting a greener course for the world's high‐emitting nations through information technology insights

AbstractCarbon dioxide (CO₂) is the most abundant gas among all greenhouse gas emissions, severely impacting global warming. This study examines the impact of Information and Communication Technology (ICT), population dynamics, Per Capita Gross Domestic Product (PGDP), and Renewable Energy Consumption (REC) on CO₂ on a global scale, representing 38 countries selected using the Pareto principle. Results from the panel regression model indicate a significantly positive relationship between ICT, PGDP, and population on CO₂ emissions. In contrast, REC exhibits a negative relationship. The Multiple Linear Regression model shows that an increase in PGDP leads to higher CO₂ emissions, except in Uzbekistan. ICT increases emissions in the United States, Argentina, Australia, Canada, and Egypt. Population growth raises emissions, except in the United States, France, Germany, and Russia. REC reduces CO₂ emissions in most countries. Policymakers in individual countries can gain a precise understanding of how these variables impact CO₂ emissions, enabling them to mitigate the risks associated with global warming.

Comparison between consumer-oriented and laboratory benchtop near-infrared spectrometers for total soluble solids measurement in grape

Portable near-infrared (NIR) spectrometers are gaining interest as a non-destructive tool for fruit quality determination in the decade. In this study, the performance of the portable NIR spectrometer for TSS prediction of grapes was evaluated and compared to the benchtop spectrometer. A total of 105 table grapes were individually measured NIR spectra at short-wavelength (740 – 1070 nm) and long-wavelength NIR region (1000 – 2500 nm) using SCiO and NIRFlex N-500 spectrometers, respectively. Partial least square (PLS) regression analysis was performed on berry spectra from both devices afterward significant wavelengths were identified and used to develop multiple linear regression (MLR) models. The best PLS prediction model was obtained from SNV pretreating spectra for both devices and spectral data acquired from SCiO showed better prediction performance (= 0.854, SEP = 0.452°Brix) than NIRFlex N-500 spectra (= 0.667, SEP = 0.675°Brix). Low predicting ability was gained for the MLR calibration model for both device with an RPD of about 1.70. From the results, a pocket-size spectrometer has the potential to be a non-destructive sorting and screening tool in fruit industries.

Association between sleep duration and three obesity indicators among middle-aged and elderly adults: findings from the NHANES 2005–2014

ObjectiveObesity has emerged as a worldwide problem. In recent years, it has been verified that there is an association between sleep duration and obesity indicators. This provides a new approach to control obesity. In this study, the relationship between duration of sleep and body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) among Americans ≥45 years old was investigated.MethodsData was collected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2014. The link between sleep duration and obesity indicators was analysed using multiple regression models and weighted smoothed curve fitting. Subgroup analysis was conducted to assess the consistency of the connection between sleep duration and obesity indicators across various groups.ResultsThis study involved 7,118 males and 7,265 females, with an average age of 62.09. After total adjustment, sleep duration was negatively correlated with BMI (β = −0.19, 95%CI: −0.26, −0.12), WC (β = −0.36, 95%CI: −0.53, −0.19) and WHtR (β = −0.27, 95%CI: −0.38, −0.17). Subgroup analyses revealed more significant negative associations between sleep duration and BMI, WC, and WHtR among non-Hispanic White participants, and those without diabetes and hypertension.ConclusionSleep duration was significantly negatively associated with BMI, WC, and WHtR, suggesting that longer sleep duration may contribute to lower obesity indicators in middle-aged and elderly Americans. Subgroup analysis showed that their negative correlation differed between races, diabetes, or hypertension status. However, additional prospective studies are required to validate these findings and investigate potential causal relationships.

Grazing and food addiction: Associations between varied patterns of overconsumption and addictive-like eating.

Food addiction (FA) research has primarily concentrated on binge eating as a symptom of this condition. However, FA may encompass various overeating behaviours, including compulsive grazing - the repetitive consumption of small amounts of food with loss of control. This study extends our previous research by including a clinical sample to investigate whether compulsive grazing exists in a population with higher prevalence and severity of FA. It also examines whether weight or sex moderates the severity or frequency of FA. Adults between the ages of 20 and 50 years with obesity were recruited from a weight-management clinic (n=437). Participants completed an online questionnaire to assess various eating behaviours (binge eating, compulsive grazing, reward-based eating) and related personality measures (impulsivity, addictive personality traits). Multiple and logistic regression modelling were used with the Yale Food Addiction Scale symptom count and diagnosis as the dependent variables, respectively. A chi-square test of independence and an analysis of variance were used to determine sex differences. Compulsive grazing was a significant factor in FA diagnosis and symptom severity, confirming earlier work. Binge eating was a significant factor in FA symptom severity. Additionally, females from a weight-management clinic sample were more likely to receive an FA diagnosis than females from the general population. No sex differences were found in males or in the symptom score option for FA. These findings suggest that various compulsive overeating patterns encompass FA. Individuals with obesity and co-morbid FA may require specialized treatments, which may benefit from sex-specific differentiations.

Symptom Screening for Hospitalized Pediatric Patients With Cancer: A Randomized Clinical Trial.

Pediatric patients with cancer experience severely bothersome symptoms during treatment. It was hypothesized that symptom screening and provision of symptom reports to the health care team would reduce symptom burden in pediatric patients with cancer. To determine if daily symptom screening and provision of symptom reports to the health care team was associated with lower total symptom burden as measured by the Symptom Screening in Pediatrics Tool (SSPedi) compared to usual care among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days. This randomized clinical trial enrolled participants from July 2018 to September 2023 from 8 Canadian tertiary care centers that diagnose and treat pediatric patients with cancer. Patients aged 8 to 18 years with cancer expected to be in a hospital or clinic daily for at least 5 consecutive days were eligible for inclusion. Participants were randomized to intervention (n = 176) vs control (n = 169) groups. Data were analyzed from November 2023 to December 2023. Intervention participants completed the SSPedi once daily for 5 days. Printed symptom reports were provided daily to the health care team, and email alerts were distributed for severely bothersome symptoms. Control participants received usual care. The primary outcome was self-reported total SSPedi score on day 5. Secondary outcomes were individual SSPedi symptoms, pain, quality of life, symptom documentation, and intervention provision. The primary analysis compared the day 5 total SSPedi scores between randomized groups using a multiple linear regression model. For the secondary analysis comparing individual SSPedi symptom scores, the odds ratio for the intervention was estimated using a proportional odds model. Pain and quality of life were analyzed using the same approach as the primary outcome. Fisher exact test was used to compare symptom documentation, any intervention, and symptom-specific intervention between groups. A total of 345 participants were enrolled; median (range) participant age was 13.8 (8.0-18.8) years, and 150 participants (43.5%) were female. Day 5 SSPedi score was significantly better with symptom screening compared to usual care (adjusted mean difference, -2.5; 95% CI, -3.8 to -1.2). Symptom screening reduced the odds of higher individual symptom scores; 8 of 15 symptom reductions were statistically significant. There were no significant differences in pain or quality of life scores between groups. Five symptoms were documented or treated significantly more often with symptom screening than usual care. In this randomized clinical trial, among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days, symptom screening with SSPedi improved total symptom scores compared to usual care. ClinicalTrials.gov Identifier: NCT03593525.

Linking Non-Financial Performance Determinants with IPO Underpricing: Evidence from Indonesia

Study Background/Rationale: This study aims to investigate the determinants that may influence the underpricing in Initial Public Offerings (IPO), a phenomenon found in stock exchange markets globally. Underpricing occurs when the intrinsic value is higher than the offer price set by the issuing firm. As a result, the share’s price skyrockets upon its market debut, offering an instant profit to investors, but potential damage to the company itself. Method: The focus of this study is the Indonesian stock market, which is seen as one of the leading growth economies among emerging markets and other developing economies, with accelerated GDP and having topped the list of Southeast Asian (ASEAN) countries regarding the number of IPOs. This research utilises multiple linear regression models and samples of firms that engaged in IPO in the Indonesia Stock Exchange (IDX) between 2018 and 2022. Findings: Using prospectus’ non-financial performance determinants, this study finds that underwriter reputation, public ownership, and firm size have a positive influence on underpricing; additionally, offering size and firm age have a negative and statistically significant influence on underpricing. Furthermore, this study adds to the existing research by emphasising how various determinants are linked to IPO underpricing in Indonesia. In addition, this study demonstrates that prospectuses provide relevant information to minimise information asymmetry and ex-ante uncertainty between firms and shareholders. Conclusion: Considering the present shortage of studies on the determinants of IPOs underpricing as a starting point, this empirical research can be valuable since it could enhance the existing research by providing latest data for comparisons across nations.

Collaborative Care to Improve Quality of Life for Anxiety and Depression in Posttraumatic Epilepsy (CoCarePTE): Protocol for a Randomized Hybrid Effectiveness-Implementation Trial.

Anxiety and depression in people with epilepsy are common and associated with poor outcomes; yet, they often go untreated due to poor mental health specialist access. Collaborative care is an integrated care model with a strong evidence base in primary care and medical settings, but it has not been evaluated in neurology clinics. Evaluating implementation outcomes when translating evidence-based interventions to new clinical settings to inform future scaling and incorporation into real-world practice is important. The Collaborative Care for Posttraumatic Epilepsy (CoCarePTE) trial aims to evaluate the effectiveness (improvement in emotional quality of life) and implementation of a collaborative care intervention for people with anxiety or depressive symptoms and posttraumatic epilepsy. CoCarePTE is a 2-site, randomized, single-blind, hybrid type 1 effectiveness-implementation trial that will randomize 60 adults to receive either neurology-based collaborative care or usual care. Adults receiving neurological care at participating centers with anxiety or depressive symptoms and a history of at least mild traumatic brain injury before epilepsy onset will be enrolled. The collaborative care intervention is a 24-week stepped-care model with video or telephone calls every 2 weeks by a care manager for measurement-based anxiety and depression care, seizure care monitoring, and brief therapy intervention delivery. This is supplemented by antidepressant prescribing recommendations by psychiatrists for neurologists via case conferences and care manager-facilitated team communication. In step 2 of the intervention, individuals with <50% symptom reduction by 10 weeks will receive an added 8-session remote cognitive behavioral therapy program. The study is powered to detect a moderate improvement in emotional quality of life. As a hybrid type 1 trial, effectiveness is the primary focus, with the primary outcome being a change in emotional quality of life at 6 months in the intervention group compared to control. Secondary effectiveness outcomes are 6-month changes in depression, anxiety, and overall quality of life. Implementation outcomes, including fidelity, acceptability, feasibility, and appropriateness, are evaluated before implementation and at 3 months. The primary effectiveness analysis will compare changes in emotional quality of life scores from baseline to 6 months between the intervention and control arms using multiple linear regression modeling, adjusting for study site and using an intent-to-treat approach. Enrollment commenced in 2023, with modifications in the inclusion and exclusion made after the first 6 enrollees due to slow recruitment. Enrollment is expected to continue at least into early 2025. The CoCarePTE trial is novel in its use of a hybrid effectiveness-implementation design to evaluate an evidence-based mental health intervention in epilepsy, and by incorporating seizure care into a collaborative care model. If a significant improvement in emotional quality of life is found in the intervention group compared to usual care, this would support next step scaling or clinical implementation. ClinicalTrials.gov NCT05353452; https://www.clinicaltrials.gov/study/NCT05353452. DERR1-10.2196/59329.

Postpartum Access to Health Care and Opioid Use Treatment: An Evaluation of a Medicaid Population

Background In this study, we aimed to examine postpartum health care utilization and identify gaps in care among a postpartum Medicaid population of patients diagnosed with opioid use disorder (OUD) during pregnancy. Methods We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of OUD during pregnancy from 2015 to 2019. We examined any evidence of postpartum health care utilization and evidence of medications for OUD (MOUD) during postpartum. We also determined the impact that 4 factors may have had on these outcomes: type of Medicaid coverage (Medicaid for Pregnant Women as compared to other types of Medicaid coverage), rurality, race, and the prenatal use of MOUD. Descriptive statistics, Kaplan-Meier curves with log-rank tests, and negative binomial regression were used. Results Of the 6,186 individuals in the study, 84.5% were White, 29.6% lived in rural areas, and 35.0% had MPW coverage. Of the sample, 77.4% sought health care services during the postpartum period. In the multiple negative binomial regression model, individuals who were MPW beneficiaries, non-White, lived in rural areas, and had no evidence of prenatal MOUD all had significantly lower rates of postpartum health care utilization. Of the sample, 53.6% had evidence of MOUD utilization during the postpartum period. We found that patients with MPW continued MOUD at much lower rates compared to patients with other forms of Medicaid (86% versus 93% at 60 days; 57% versus 78% at 180 days, respectively). Limitations Limitations to this analysis are inherent to administrative claims data, such as misclassification of outcomes and covariates, as well as loss to follow-up. Conclusions Significant gaps in health care use remain across type of Medicaid coverage, race, geographic setting, and prenatal care access.

The influence of policy advocacy and education on medical staff’s adaptation to diagnosis related groups payment reform in China: an analysis of the mediating effect of policy cognition

IntroductionIn recent years, China has been carrying out the Diagnosis Related Groups (DRGs) payment reform, which has an impact not only on payment methods and medical expenses, but also on the behaviors of medical staff. Some of these behaviors are unexpected by policymakers, such as turning away critically ill patients, disaggregating hospitalization costs, setting up disease groups with higher points, and so on. This phenomenon attracted the attention of some scholars, who put forward a few positive intervention measures, mainly including policy advocacy and system improvement. The scholars believed that the former was more feasible. However, there is a lack of research on the effects and influencing processes of these interventions. Therefore, this study aims to explore the influence of policy advocacy and education on medical staff’s adaptation to DRGs payment reform in China and the role of policy cognition in this process, in order to provide experiences for the smooth implementation and sustainable development of DRGs payment system.MethodsA questionnaire survey was conducted among 650 medical staff in five large general hospitals in Zhejiang Province, China, to understand their participation and feedback on policy advocacy and education, their adaptation to the current DRGs payment reform, and their cognition of relevant policies. After descriptive statistical analysis, partial correlation analysis, multiple linear regression models and bias correction Bootstrap sampling method were used to analyze the mediating effect of policy cognition factors.ResultsAll respondents had participated in organized collective policy advocacy and education activities in the past year, but the degree of satisfaction and recognition was not very high. 59.5 percent said their adaptation to the DRGs payment reform was average. Nearly half did not regularly pay attention to and participate in the management of the medical costs of patients with DRGs through compliance. And they had a low understanding of the specific rules of DRGs payment and did not form a high policy identity. The mediating effect values of policy cognition were 0.148, 0.152, 0.108, and 0.057, respectively, when the frequency and quality of policy advocacy and education influenced medical staff’s adaptive perception and adaptive behaviors.DiscussionThe organized collective policy advocacy and education can promote medical staff’s adaptation to DRGs payment reform by improving their policy cognition, and the action paths are diverse. Policymakers and hospital managers need pay attention to this phenomenon, and formulate demand-centered, value-oriented whole-process advocacy and education strategies while constantly improving the DRGs payment system. All of these provided a basis for further research and practice of positive intervention in DRGs payment reform.

Association between lower geriatric nutritional risk index and low cognitive functions in United States older adults: a cross-sectional study

BackgroundWe aimed to explore the association between the Geriatric Nutritional Risk Index (GNRI) and the risk of low cognitive functions among older adults in the United States (US).MethodsUtilizing data from the National Health and Nutrition Examination Study (NHANES) database, a cross-sectional analysis was conducted. The GNRI served as a tool for evaluating the nutritional status of participants, who were categorized into two groups based on their initial GNRI scores: those with scores &amp;gt;98 indicating normal nutrition, and those with scores ≤98 indicating malnutrition. Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer’s disease word list learning test (CERAD W-L), the Digit Symbol Substitution Test (DSST), the Animal Fluency Test (AFT), and the composite-z score which was calculated by summing the z scores of individual tests, respectively. Weighted multiple logistic regression models were used to evaluate the association between GNRI and cognitive function. Interaction and stratified analyses were conducted.ResultsAmong a sample of 2,925 individuals aged 60 years or older, 51.3% were women. Among these individuals, 233 were identified as malnourished. Weighted multivariate logistic regression analyses indicated that individuals with malnutrition had an increased risk of low cognitive function, as evidenced by lower CERAD W-L scores (OR:1.68, 95%CI 1.19–2.36, p = 0.003), AFT scores (OR: 1.74, 95%CI 1.26–2.41, p = 0.009), DSST scores (OR:1.63, 95%CI 1.11–2.38, p = 0.012), or composite z-scores (OR:1.87, 95%CI 1.29–2.71, p = 0.001). According to the variables evaluated, the interaction effects between low GNRI level and the elderly and stroke in specific cognitive domains were significant (P interaction &amp;lt; 0.05).ConclusionLower GNRI level is associated with significantly low cognitive function among older adults, particularly among those who have experienced a stroke or the elderly (aged 70 years and older) population.

Association between Volunteer Activity Participation and Daily Sedentary Time among Adults in Japan: A Cross-sectional Study

Introduction Sedentary behavior, involving low energy expenditure while sitting or reclining, is linked to health risks. Volunteering may help reduce sedentary time through social interaction and physical activity, but this relationship is understudied in non-Western contexts. This study investigated the association between volunteer activity frequency and daily sitting time among adults in Aichi and Kanagawa Prefectures, Japan, regions with higher aging. Methods A cross-sectional study was conducted in two regions of Japan, with a sample of 1,224 adults (585 men and 639 women) from these regions. Data on volunteer activity frequency and daily sitting time were collected using questionnaires. Multiple regression models explored the relationship between volunteer frequency and sitting time, adjusting for confounders. Results The mean daily sitting time was 357.66 ± 240.40 minutes. Participants volunteering four or more times weekly reported significantly shorter sitting times compared to non-participants, with an average difference of 131.96 minutes (95% CI: -253.83 to -10.08) in the multivariable-adjusted model. This association was stronger among males (difference: 180.51 minutes; 95% CI: -353.84 to -7.28) and older adults aged ≥65 years (difference of 142.48 minutes; 95% CI: -272.58 to -12.38). Conclusion Frequent volunteering is associated with shorter sitting times, particularly among males and older adults. However, due to the cross-sectional design, causal inferences cannot be made, and the associations should be interpreted with caution. Compared to Western populations, sitting time was lower, but it still exceeded public health recommendations. Future research should explore the longitudinal effects and identify specific volunteer activities that promote active lifestyles.