Stepwise Multiple Regression Model Research Articles

Estimating the proportion of in situ rumen-undegraded crude protein from chemical crude protein and fiber fractions in tropical forage grasses and legumes

Advanced methods exist to estimate dietary crude protein (CP) degradation in the rumen from the concentrations and/or proportions of chemical nutrient fractions. These methods have been developed primarily for feeds in temperate climates. Therefore, their accuracy and precision to predict proportions of rumen-undegraded CP (RUP) in tropical forages is uncertain. The objectives of the present study were (1) to assess the accuracy and precision of the estimates of in situ RUP proportions from CP fractions using established algorithms, and (2) to identify chemical nutrient fractions that accurately and precisely predict RUP proportions of tropical forages. The proximate nutrients, CP and fiber fractions of 23 unconserved forage grasses and 15 forage legumes commonly used as feeds for ruminants in the Tropics and Subtropics were analyzed. Their RUP proportions were determined at ruminal passage rates (Kp) of 2%, 5%, and 8%/hour using the in situ method (i. e., reference) and were also estimated from the analysis of the CP and fiber fractions using established equations. The RUP proportions determined with the in situ and the chemical method were evaluated using error index and dimensionless parameters. The nutritional composition variables that can predict RUP proportions of tropical forages (proximate nutrients, fiber, and CP fractions and their ratios) were selected using stepwise multiple linear regression models. The CP concentrations of our sample set ranged from 46 to 212 g/kg dry matter with in situ RUP proportions from 73 to 596 g/kg CP across all Kp. Previously established equations could not predict accurately and precisely RUP proportions of all forages. The concentrations of CP and fiber fractions and Kp were able to predict the proportion of RUP estimated in situ for tropical forages at Kp of 2%, 5%, and 8%/hour with an adjusted coefficient of determination ranging from 0.79 to 0.82 and a root mean square error ranging from 13% to 15% of the mean in situ RUP proportion. While equations established for temperate forages either over- or underestimate RUP proportions, algorithms developed in the present study might allow for an accurate and precise prediction of RUP proportions in forages commonly used in ruminant feeding in the Tropics and Subtropics.

Longitudinal association between serum uric acid level and carotid atherosclerotic plaques in patients with new cases of hypertension

Abstract Objective To reveal the relationship between uric acid level and carotid atherosclerotic plaques in hypertensive subjects in randomized urban population according to 10-years prospective study. Design and methods A 10-years prospective study included 3,500 randomized individuals living in the district of Vitebsk (2007/2008 - 2017/2018). The coverage of the survey was 97,9% (3427 participants). There was revealed 2170 persons with normal blood pressure. 1862 of them were examined on the second stage in 2012/2013 (coverage of the survey was 85,8%). 286 new cases of hypertension were revealed and they had significant positive relationship with the IV quartile of uric acid level (≥339 μmol/l). A 10-years prospective analysis was provided in 2017/2018 and included 145 randomized subjects with hypertension diagnosed on the second stage of the study. Specially developed registration form was filled in for all the participants and it included socio-demographic data, standard questionnaires for detection of cardiovascular risk factors, anthropometry, blood pressure measurements, electrocardiography, blood chemistry, ultrasound examination of brachiocephalic arteries and echocardiography. Results According to the results of 10-years prospective study serum uric acid level ≥339 μmol/l, revealed at the start of the study, is a predictor of the detection of carotid atherosclerotic plaques in 2017/2018 in subjects with new cases of hypertension (df=1; χ2 Wald=6,63; p<0,05) adjusted for age and gender. Cross-sectional analysis of these subjects showed that the level of uric acid, regardless of age and gender, is associated with the level of triglycerides (p<0,001), apo B (p<0,001), apo A1 (p<0,05), LDL (p<0,05), VLDL (p<0,05), HDL (p<0,05), non-HDL-C (p<0,05), total cholesterol (p<0,05), high-sensitivity CRP (p<0,05), TNF-α (p<0,05), apoB/apoA1 ratio (p<0,05), glycated hemoglobin percentage (p<0,05), body mass index (p<0,001), waist circumference (p<0,05), metabolic syndrome (p<0,05) and alcohol abuse (p<0,05). In stepwise multiple linear regression model the most significant of these factors were the level of triglycerides (β=0,23, p<0,05), alcohol abuse (β=0,18, p<0,05), body mass index (β=0,18, p<0,05), apoB/apoA1 ratio (β=0,17, p<0,05) and level of high-sensitivity CRP (β=0,15, p<0,05). Conclusions Serum uric acid level ≥339 μmol/l predicted detection of carotid atherosclerotic plaques in patients with new cases of hypertension in 10-years prospective study. The most significant factors, regardless of age and gender, associated with serum uric acid levels in these patients were level of triglycerides, alcohol abuse, body mass index, apoB/apoA1 ratio and level of high-sensitivity C-reactive protein. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Republican Scientific and Practical Centre of Cardiology

The relationship between myopia progression and axial elongation in children wearing orthokeratology contact lenses

PurposeTo investigate the relationship between myopia progression and axial length (AL) elongation in orthokeratology (ortho-k) patients. MethodsThis study investigated 184 patients (baseline age 9.0 ± 1.6 years), who underwent overnight ortho-k treatment for 12 to 72 months, and stopped lens wear for 1 to 2 months. Refractive sphere and cylinder after cycloplegia, corneal curvatures along both meridians, and AL were compared before the commencement and after discontinuation of ortho-k treatment. The effects of AL change, baseline AL, corneal curvature change, baseline age, and duration of ortho-k treatment on the change in spherical equivalent refractive error (SER) were analysed. ResultsMyopia significantly progressed and AL increased following 32.8 ± 13.0 months of ortho-k lens wear and 1 to 2 months washout period, as compared to baseline (all P < 0.001). Corneal curvature along the flat meridian (FK) became significantly flatter (P < 0.001) and corneal curvature along the steep meridian (SK) became steeper (P = 0.036). In the first stepwise multiple linear regression model (R2 = 0.696), the change in SER over time (ΔSER) is significantly correlated to the change in AL (ΔAL, P < 0.001), baseline AL (P < 0.001), baseline age (P = 0.028), change in SK (P = 0.002), and the duration of ortho-k lens treatment before discontinuation (P = 0.010). In a more simplified model (R2 = 0.628), the regression equation using ΔAL to predict ΔSER is: ΔSER = -0.094–1.608*ΔAL. ConclusionsThe change in SER was significantly correlated to the change in AL, change in SK, baseline AL, baseline age, and the duration of treatment among children undergoing ortho-k therapy. The ratio of axial elongation to myopia progression was approximately 1:1.6 between the ages of 6 to 14 years. A simplified equation was derived for clinical use to estimate myopia progression from repeated AL measurement in ortho-k patients.

Using Climate Factors to Estimate Flood Economic Loss Risk

Estimation of economic loss is essential for stakeholders to manage flood risk. Most flooding events are closely related to extreme precipitation, which is influenced by large-scale climate factors. Considering the lagged influence of climate factors, we developed a flood-risk assessment framework and used Hunan Province in China as an example to illustrate the risk assessment process. The main patterns of precipitation—as a connection between climate factors and flood economic losses—were extracted by the empirical orthogonal function (EOF) analysis. We identified the correlative climate factors through cross-correlation analysis and established a multiple stepwise linear regression model to forecast future precipitation patterns. Risk assessment was done based on the main precipitation patterns. Because the economic dataset is limited, a Monte Carlo simulation was applied to simulate 1000-year flood loss events under each precipitation regime (rainy, dry, normal years) to obtain aggregate exceedance probability (AEP) and occurrence exceedance probability (OEP) curves. We found that precipitation has a strong influence on economic loss risk, with the highest risk in rainy years. Regional economic development imbalances are the potential reason for the varying economic loss risks in different regions of Hunan Province. As the climate indices with at least several months prediction lead time are strong indicators in predicting precipitation, the framework we developed can estimate economic loss risk several months in advance.

Mental health status and influential factors of employees of Chinese enterprises in Ethiopia

Objective To understand the mental health status and its influential factors of staff of Chinese enterprises in Ethiopia. Methods This study selected employees of Chinese enterprises still in Ethiopia to conduct the mental health questionnaire survey from June 27 to 28, 2020, and multiple linear stepwise regression model is performed to analyze the influential factors of the mental health. Results Among 671 employees, 38.75% had mental health problems. The anxiety and depression of the employees in the last 2 weeks was relatively prominent. The results of multivariate logistic regression analysis showed that the epidemic had an impact on the plan of returning home (OR=3.293, 95%CI: 1.897–5.714), employees worried about being in Africa and unable to take care of their family members in China (OR=2.329, 95%CI: 1.198–4.528), and the company did not take any measures (OR=4.697, 95%CI: 1.080–20.435) were risk factors of mental health. Employees had no physical symptoms in the past month (OR=0.305, 95%CI: 0.171–0.543), worked normally (OR=0.517, 95%CI: 0.322–0.831), the company guaranteed the necessities of life supply (OR=0.609, 95%CI: 0.371–1.000) and conducted COVID-19 knowledge promotion (OR=0.335, 95%CI: 0.183–0.614) were the protective factors of mental health. Conclusion The mental health status of employees of Chinese enterprises in Ethiopia is poor, and their mental health is affected by various factors. We should attach importance to their mental health and take various mental health interventions to reduce their anxiety and depression and other negative emotions.

Factors affecting water quality and shrimp production in the mixed mangrove‐shrimp systems in the Mekong Delta of Vietnam

The aim of the study was to identify key factors of water environmental parameters affect shrimp productivities in the mixed mangrove-shrimp system using multivariate approach. Water quality assessment was conducted at four mangroves stand ages (MAs) of 2–4, 5–7, 9–12 and >12 years old, with two water level (WLs) regimes in the ponds at 0–20 cm and 20–40 cm, and at every interval of 15-day grow-out cycle of shrimp in the systems based on the moon. Water quality in the study farms was within the appropriate range for shrimp growth. Mangrove ages affected alkalinity, pH, COD, N-NO2, N-NO3 and H2S, but did not influence the rest of water quality parameters. Shrimp productivity had moderate-to-fair positive correlation (rp = >0.36 and <0.5; and rp > 0.5) with N-NH4, N-NH3, water level on the platform and water level regimes management in the shrimp ponds respectively. The stepwise multiple regression model fitted very well with 19 independent variables (p = 0.0000; R2 = 0.63) and shrimp productivity. The equation of the fitted model is given as: Shrimp productivity = 18.4552 + 2.34394*DO - 1.01044*Salinity - 1.49646*H2S + 2.97012*Water level.

Predictors of Voriconazole Trough Concentrations in Patients with Child-Pugh Class C Cirrhosis: A Prospective Study.

This prospective observational study aimed to clinically describe voriconazole administrations and trough concentrations in patients with Child–Pugh class C and to investigate the variability of trough concentration. A total of 144 voriconazole trough concentrations from 43 Child–Pugh class C patients were analyzed. The majority of patients (62.8%) received adjustments. The repeated measured trough concentration was higher than the first and final ones generally (median, 4.33 vs. 2.99, 3.90 mg/L). Eight patients with ideal initial concentrations later got supratherapeutic with no adjusted daily dose, implying accumulation. There was a significant difference in concentrations among the six groups by daily dose (p = 0.006). The bivariate correlation analysis showed that sex, CYP2C19 genotyping, daily dose, prothrombin time activity, international normalized ratio, platelet, and Model for end-stage liver disease score were significant factors for concentration. Subsequently, the first four factors mentioned above entered into a stepwise multiple linear regression model (variance inflation factor <5), implying that CYP2C19 testing makes sense for precision medicine of Child–Pugh class C cirrhosis patients. The equation fits well and explains the 34.8% variety of concentrations (R2 = 0.348). In conclusion, it needs more cautious administration clinically due to no recommendation for Child–Pugh class C patients in the medication label. The adjustment of the administration regimen should be mainly based on the results of repeated therapeutic drug monitoring.

The cascade of care of HIV after one year of follow-up in a cohort of HIV-positive adult patients in three health settings of Morrumbene in rural Mozambique.

Objective: To assess the state of the retention in care of HIV patients in three health settings in Morrumbene, a rural district of Inhambane Province, Mozambique. We evaluated potential factors associated with early loss to follow‐up (LTFU), retention in care and ART adherence during the first year of follow‐up. Material and methods: Retrospective, cross‐sectional, observational study. We collected data on patients diagnosed with HIV infection in 2017 in two permanent clinics and one mobile clinic. Demographic, clinical, immunological and therapeutic data were retrieved up to December 31st, 2018. Data on follow‐up were collected at 6 and 12 months for medical visits and for ART adherence and analysed for factors associated with LTFU, retention in care and adherence to ART by Stata Version 14 and univariate and stepwise multiple unconditional logistic regression models. Results: In 2017, 960 patients were diagnosed with HIV infection. At 6‐month follow‐up, 49% attended the medical visit and 157 (25%) adhered to ART. After one year, 34% of patients were available for follow‐up, and only 72 patients adhered to ART. In multivariate analysis, factors associated with early LTFU were male sex (p = 0.036) and immediate prescription of ART (p = 0.064). Older age (p < 0.001) and being followed in the mobile clinic (p = 0.001) favoured retention in care. Advanced WHO status (p = 0.005) and being pregnant or breastfeeding showed a negative correlation with adherence to treatment (p = 0.068). Conclusions: Only one‐third of patients were available for follow‐up after one year, and only 13% adhered to ART. Young individuals, men and pregnant/breastfeeding women seem to be particularly at risk for LTFU and non‐adherence to treatment.

Multi-informant Implementation and Intervention Outcomes of Opioid Overdose Education and Naloxone Distribution in New York City

Overdose Education and Naloxone Distribution (OEND) is an effective public health intervention to reduce opioid overdose fatalities (McDonald and Strang, Addiction 111:1177–1187, 2016). However, we know little about OEND implementation outcomes (i.e., indicators of implementation success), specifically the fidelity of training delivery, and how these may relate to intervention outcomes (i.e., indicators of the success or effectiveness of an intervention), such as overdose knowledge and attitudes. This study evaluated 16 OEND trainings conducted at different Opioid Overdose Prevention Programs in New York City. Trainees (N = 75) completed the Opioid Overdose Knowledge and Attitude Scales before and after training (intervention outcomes). Implementation outcomes were fidelity (competence and adherence of the trainer, N = 10; modified Fidelity Checklist) and acceptability of OEND (Acceptability of Intervention Measure), assessed from multiple perspectives (trainees, trainers, and an independent observer). Trainees’ overdose knowledge, t(71) = − 8.12, p < 0.001, 95% CI [− 6.54, − 3.96], and attitudes, t(65) = − 6.85, p < 0.001, 95% CI [− 0.59, − 0.33], improved significantly from pre- to post-training. Stepwise multiple regression models indicated that adherence of the trainer rated from the observer perspective added significantly to the prediction of changes in overdose knowledge, F(1, 67) = 9.81, p = 0.003, and explained 13% of the variance in outcome. However, fidelity measures from the perspective of trainees or trainers and acceptability of OEND were not associated with changes in trainees’ overdose knowledge or attitudes. OEND implementation outcomes and their relationship with intervention outcomes differed depending on the role of the fidelity rater in relation to the intervention. Specifically, our findings indicate that fidelity should be measured from an independent perspective (i.e., an individual who is experienced with fidelity rating but not directly involved in the intervention).

DIABETES OR OBESITY; MAJOR EFFECTOR OF ALTERED LEVELS OF GHRELIN AND LEPTIN

Background: Ghrelin and leptin are the key hormones involved in the energy homeostasis and plays a relevant role in regulating hunger and satiety stimuli afferent to the brain. Abnormalities in the levels of ghrelin and leptin are often associated with the obesity and type 2 diabetes complications. However, there are no studies clarifying whether ghrelin and leptin levels have stronger association with obesity or Type 2 diabetes (T2DM). Aims:To evaluate and compare the independent effect of major dening factors of obesity and diabetes on ghrelin and leptin concentrations. Materials And Methods: Anthropometric measures such as height, weight, waist (WC) and hip circumference (HC), Body mass index (BMI), Basal metabolic rate (BMR), fat percentage, lean body mass, were taken. Assessed daily physical activity and energy intake. Biochemical parameters such as fasting glucose, postprandial glucose, HBA1c, ghrelin, leptin and insulin levels were measured. Statistical Analysis: One-way analysis of variance (ANOVA), Chi-square (χ2) test Pearson's correlation coefcients, Multiple stepwise linear regression model analysis were performed. Result: The diabetic subjects irrespective of obesity showed signicantly higher waist to hip ratio, HOMAIR levels of fasting blood glucose, postprandial glucose and signicantly lower levels of Ghrelin than non-diabetics. Similarly, obese subjects irrespective of diabetes have signicantly higher BMR and higher levels of Leptin than non-diabetics. Asignicantly higher BMI, fat mass percentage and lower lean body mass percentage were observed in obese subjects irrespective of diabetes than non-obese subjects. Among non-obese, diabetics have higher BMI, Fat mass percentage and lower lean body mass percentage. The levels of insulin were signicantly higher in diabetic obese subjects. HOMAIR (P≤0.0001) and Postprandial glucose (P≤0.05) showed negative independent effect and QUICKI (P≤0.0001) showed positive independent effect on the levels of ghrelin. BMI (P≤0.05) showed a positive effect and lean body mass percentage (P≤0.0001) showed an inverse effect on levels of leptin. Conclusion: It is evident from the study that low levels of ghrelin are predominantly associated with diabetes parameters when compared to parameters of obesity and on the contrary increased leptin levels have much stronger association with measures of obesity than diabetes. Evidence of altered leptin and ghrelin levels in these disorders infers vice versa, their respective roles in obesity and lean diabetes.

Environmental Effects on Normalized Gross Primary Productivity in Beech and Norway Spruce Forests

The strong effects of climate change are expected to negatively impact the long-term resilience and function of forest ecosystems, which could lead to changes in forest carbon balance and productivity. However, these forest responses may vary with local conditions and forest types. Accordingly, this study was carried out to determine gross primary productivity (GPP) sensitivity to changes in environmental parameters. Central European beech (at Štítná) and spruce species (at Bílý Kr̆íz̆ and Rájec), growing under contrasting climatic conditions, were studied. The comparative analyses of GPP were based on a five-year-long dataset of eddy covariance fluxes during the main growing season (2012–2016). Results of forest GPP responses with changes in environmental factors from a traditional Stepwise multiple linear regression model (SMLR) were used and compared with Random forest (RF) analyses. To demonstrate how actual GPP trends compare to potential GPP (GPPpot) courses expected under near-optimal environmental conditions, we computed normalized GPP (GPPnorm) with values between 0 and 1 as the ratio of the estimated daily sum of GPP to GPPpot. The study confirmed the well-known effect of total intensity of the photosynthetically active radiation and its diffuse fraction on GPPnorm across all the forest types. However, the study also showed the secondary effects of other environmental variables on forest productivity depending on the species and local climatic conditions. The reduction in forest productivity at the beech forest in Štítná was presumed to be mainly induced by edaphic drought (anisohydric behaviour). In contrast, reduced forest productivity at the spruce forest sites was presumably induced by both meteorological and hydrological drought events, especially at the moderately dry climate in Rájec. Overall, our analyses call for more studies on forest productivity across different forest types and contrasting climatic conditions, as this productivity is strongly dependent on species type and site-specific environmental conditions.

Use of Low-Flow Flowmeter to Titrate the FiO2 Delivered in Neonatal Resuscitation

Introduction: The oxygen concentration used in neonatal resuscitation has been a matter of debate with higher oxygen concentrations posing many adverse outcomes. Recent guidelines recommend use of blender to titrate FiO2 delivered during resuscitation. However, blender being unaffordable and unavailable at many peripheral institutions, we tried to use a low-flow flowmeter to titrate the oxygen and measure FiO2 delivered at different flow rates. Methods: From a central oxygen supply, oxygen flow was titrated using a low-flow flowmeter which was connected to a self-inflating bag and oximeter. Three variables were taken—volume of self-inflating bag, flow rate, and number of compressions per minute. FiO2 delivered with each variable, keeping the other two constant, was recorded. Results: The data obtained was analyzed by fitting the study variables into a stepwise multiple linear regression model and a linear equation was obtained. The model R square obtained suggested strong linear relationship between flow rate and FiO2 delivered. The model showed statistically significant association between flow rate and FiO2 delivery, whereas association with other variables was statistically insignificant. Discussion: Our study suggests that 76.57% of change in FiO2 is determined by change in flow rate. The major advantage of this study would be at resource poor settings where a low-flow flowmeter which is more cost effective can be used to titrate the FiO2 delivered during neonatal resuscitation.

Sociodemographic Characteristics and Leisure Participation through the Perspective of Leisure Inequalities in Later Life

This study examined the relationship between sociodemographic characteristics and leisure involvement in various meaningful activities under the political economy of aging and life course. The stepwise multiple and ordinal regression model revealed that the individual factors of older adults were significantly associated with leisure involvement: age (younger adults), gender (men), education level (higher education), perceived economic satisfaction (higher satisfaction with their financial condition), and perceived health (higher satisfaction with their health) variables were significantly related to more frequent participation in domestic leisure travel. Additionally, gender and education level were associated with leisure-time exercise; the four variables (gender, education level, economic activity, and perceived financial satisfaction) were related to leisure-time social activities. Contrary to our expectation, older adults who are older and with lower education were more likely to participate in volunteering activities. The results suggested that older adults’ sociodemographic characteristics play an essential role in leisure behavior. The extent to which these characteristics affect leisure participation varies with different types of activities and cultural contexts.

Quantifying diurnal and seasonal variation of surface urban heat island intensity and its associated determinants across different climatic zones over Indian cities

ABSTRACT Surface urban heat island (SUHI) is a major anthropogenic alteration of Earth’s surface and can influence the local thermal environment by altering the surface energy flux balances. Researchers have paid much attention to SUHI studies in the last decades; still, its geospatial variability over a larger area is poorly understood. Detailed research is required to understand the mechanism and dynamics of SUHI along with its different driving variables. Hence in this study, we quantified the diurnal, seasonal, and interannual variation of SUHI intensity (SUHII) over 150 major Indian cities situated over different climatic zones using MODIS data from 2003 to 2018. The results reveal urban cool islands occurrence over the hot desert, hot steppe, and tropical monsoon climatic zone during daytime in both summer (−0.25 to −0.17°C) and winter (−0.33 to 0.17°C) season. In contrast, nighttime SUHII shows clear evidence of positive urban heat island irrespective of climatic region and seasonal variation of 0.48–1°C in summer and 0.46–1.32°C in winter is seen. The Mann–Kendall and Sen’s slope estimator tests are used to detect the trend of the SUHII during the study period, which suggests a higher percentage of cities showing an increasing trend of SUHII for urban heat islands than the cities of the urban cool island. Pearson’s correlation and stepwise multiple linear regression model determine the possible SUHII controlling variable over different climatic zones. During the daytime, the SUHII’s distribution is controlled by vegetation, evapotranspiration, and thermal inertia in the summer/winter season. Whereas, it is linked tightly to built-up intensity, white sky albedo, and thermal inertia in both seasons during nighttime. Overall, we found that the stepwise multiple linear regression model can explain the SUHII variance more in the daytime (>0.8) than in nighttime (>0.7, except for tropical cities) and more in understanding the SUHII behaviors for cool cities as compared to hot cities. Moreover, this study also quantifies the significant control of thermal inertia and soil moisture in understating urban heat and cool island behavior over different climatic zones.

Long-term variation of boundary layer height and possible contribution factors: A global analysis

Boundary layer height (BLH) plays an important role in regulating global weather/climate, as well as the dispersion and transportation of pollutants. Until now, however, the attribution and contributions of different controlling factors to BLH long-term variability and trends have not been quantified on a global scale. The long-term radiosonde dataset was used in this study to retrieve global BLH climatology; seasonal, diurnal, long-term variation and trends were analyzed over a 39-year period (1980–2018). Statistical results show that the global distribution of the BLH and its trend have apparent day-night differences. BLH during daytime is deeper during clear-sky conditions compared to cloudy sky conditions, indicating a significant effect of clouds; BLH during nighttime is deeper under cloudy conditions. BLH was also found to vary over different land types; dry and hot soil exhibits a deeper BLH than those of wet and cool soil. The long-term variation and trend of BLH are highly influenced by near-surface meteorological parameters. In particular, based on multiple linear stepwise regression models and the contribution calculation method, this investigation initiatively quantifies the influences of meteorological parameters on global BLH long-term variation and trend. Our results emphasized that a 10 m wind speed (WS) and low tropospheric stability (LTS) have significant contributions to long-term BLH variation; WS and LTS anomalies alternately dominated the contribution of the diurnal cycle of the BLH anomaly. Annual BLH recorded an average increasing trend (38.9–42.1 m/decade), and LTS is more dominant than WS from a contribution perspective, especially for increased BLH anomaly. Contributions from near-surface temperature (T) and relative humidity (RH) also play important roles. However, a decreasing WS trend dominated the decreased trends of BLH anomaly, accounting for nearly 40% of the total contribution.

The Surgical Treatment of Deep Infection in the Native Shoulder Joint.

The overall clinical picture surrounding native shoulder infections, and, in particular, the associated long-term functional outcomes of treatment are presently underreported. The purpose of this study is to examine the demographics, diagnostic and treatment strategies, and functional outcomes of isolated shoulder joint sepsis treated with surgical irrigation and debridement (I&D). All patients treated with I&D for native shoulder sepsis between 2007 - 2017 were identified. Those without a minimum of one-year follow-up were excluded. Functional outcomes scores, reoperations, and predictors of poor outcome were evaluated. Twenty-three patients were included in the final study population. Mean age-adjusted CCI score was 4.1 (SD = 3.4, Range = 0 - 10). Twelve patients (52.2%) were treated with open I&D, while 11 patients (47.8%) were treated arthroscopically. Nine patients (39.1%) required multiple I&Ds (mean total number of I&Ds = 1.7, SD = 1.0, Range: 1 - 4). Five patients (21.7%) had at least one documented reinfection after their initial hospitalization, with the initial recurrence of infection occurring 2 - 15 months after the index procedure. Mean ASES score at final follow-up was 55.3 (SD = 26.7, Range: 5.8 - 98.3) and mean SANE score was 53.3 (SD = 30.6, Range: 0 - 100). Stepwise multiple linear regression modeling identified intravenous drug abuse as the most significant predictor for final ASES score [F(1,18) = 6.12, p = .024, adjusted R2 = .254]. Following isolated shoulder joint sepsis, infection clearance and acceptable functional outcomes can be achieved using surgical I&D followed by a course of antibiotics, but outcomes are variable.

Nutritional Assessment Stage 3 Chronic Kidney Disease

Objective: Dietary guidelines from the Kidney Disease Outcomes Quality Initiative (KDOQI) and the United States Department of Agriculture (USDA) are advised to individuals with mid-spectrum (stages G3a and G3b) chronic kidney disease (CKD), yet typical diets in individuals with CKD remain understudied. The purpose of this study is to assess the self-reported dietary pattern of subjects with diagnosed mid-spectrum CKD and compare the normal dietary intakes to the KDOQI and USDA recommendations.&#x0D; Methods: A cross-sectional analysis of 20 participants with mid-spectrum CKD (n = 6 male [M]; n = 14 female [F]) was conducted to assess subjects’ self-reported dietary intakes for an average of 5 days. Micro and macronutrient analyses were compared to the KDOQI and USDA guidelines by sex to assess nutrition, and an exploratory stepwise multiple linear regression model was used to identify predictors of poor renal function;p-values were considered significant at the α = 0.05 level.&#x0D; Results: All subjects met the recommended caloric intake, but the average consumptions of protein (F = 0.86 ± 0.29g/kg body weight/day, M = 1.18 ± 0.45g/kg body weight/day), saturated fat (F = 12.17 ± 2.28%, M = 13.86 ± 1.20%), and sodium (F = 3.78 ± 2.51g, M = 4.21 ± 0.39g) were high (p &lt; 0.05 for all). The average fiber intakewas low (F = 13.64 ± 4.09g, M = 14.82 ± 7.28g) as well as folate, vitamins D and K, zinc, and calcium intakes compared with the recommendations (p &lt; 0.05 for all). The only significant contributor to higher renal function in the exploratory regression analysis was male sex (p = 0.035).

Sex and age influence on postural sway during sit-to-stand movement in children and adolescents: Cross-sectional study.

We investigated the influence of sex and age in postural sway during sit-to-stand (STS) in children and adolescents of 5-15years. We evaluated sway during STS in 86 typical participants. STS was divided into three phases: preparation, rising, and stabilization. We calculated for each phase: area, anterior-posterior, and medial-lateral velocity of center-of-pressure sway. We applied a stepwise multiple linear regression model to determine if age and sex might be predictors of postural sway during STS. Only age was associated with sway, accounting for between 6.5% and 14.6% of the variability in sway during STS. The age of the subject influences postural sway during STS, but in a small amount. This variable should be taken into account as a variable of control in the assessment of dynamic postural control. Moreover, postural stability during STS was not associated with the sex of the participants.

Increased lipocalin 2 levels in adolescents with type 2 diabetes mellitus.

Bone can act as an endocrine organ through the secretion of bone-specific hormones, i.e.,osteokines. Recent research has demonstrated that lipocalin 2 (LCN2) secreted by osteoblasts are part of an important endocrine system that is finely tuned with other organs to ensure homeostatic balance and health. The aim of this study was to explore the association between bone and glucose metabolism in adolescents with obesity and type 2 diabetes mellitus (DM2). The participants were 8 adolescents with DM2 (5males, 3 females; age: 17.0 (14.0-20.0) years, median (interquartile range)), 14 adolescents with simple obesity (9males, 5 females; age: 13.5 (12.4-15.5) years), and 15 controls (6 males, 9 females; age: 13.3 (11.0-15.0) years). Serum LCN2 and under-carboxylated osteocalcin (un-OC) levels were measured using enzyme-linked immunosorbent assays. The LCN2 levels were higher in patients with DM2 (58.1 (34.2-95.0)ng/mL; median (interquartile range)), but not in those with obesity (30.8 (23.1-38.3)ng/mL), when compared to the controls (18.2 (9.8-25.7)ng/mL). In the whole study group overall, serum LCN2 was positively correlated with the Model Assessment of Insulin Resistance score (r=0.339, p=0.046) and body mass index (r=0.580, p<0.0001), and negatively correlated with adiponectin (r=-0.462, p=0.005). A multiple stepwise regression model showed that serum adiponectin was an independent predictor of serum LCN2. The results of this study indicate that further investigations are warranted to determine whether LCN2 may act as a sensitive indicator of early-stage insulin resistance.

Early markers and predictors of cerebrovascular diseases in a group of young and middle-aged employees of the EMERCOM of Russia

Introduction. Typical basis of chronic cerebral ischemia in young people is small vessel disease (SVD) diagnosed by micro-focal lesions and microstructural damage of cerebral white matter (WM), reduction of fractional anisotropy (FA) in diffusion tensor MRI (DT-MRI). Previous studies showed that increased dopplerographic pulsatility and resistivity indices in middle cerebral artery (MCA PI-RI) correlated with SVD manifestations and cognitive impairment in middle-aged and elderly patients. Aim – to determine early markers and predictors of asymptomatic SVD in young and middle-aged individuals without cognitive impairment. Materials and methods. 52 male employees of the EMERCOM, 47.3±7.6 years, without neurological or cognitive deficits were examined. Duplex scanning with MCA PI-RI calculation, MRI with WM damage assessment according to Fazekas scale, DT-MRI FA definition were completed. Results. All those examed showed MRI signs of SVD. Two groups were formed according to Fazekas: 0 points (n-38) and 1-2 points (n-14). The 2nd group showed higher MCA PI-RI (p&lt;0.002 and p&lt;0.05). Multivariate logistical regression analysis showed significant correlation of PI in MCA (OR: 2.33; 95% CI: 1.13- 4.81; p=0.02) with WM lesion according to Fazekas. The FA in cognitively important tracts was lower in group 2 (p&lt;0,001). A stepwise multiple linear regression model revealed that the strongest predictors of FA reduction were PI and RI. The values of psychomotor speed and attention span were lower in group 2. Conclusion. MCA PI-RI are early markers of focal lesions and microstructural changes in WM and predictors of cognitive impairment in the young and middle-aged with asymptomatic SVD.