Multiple Factors Research Articles

Diagnosis and Treatment of Postoperative Myocardial Infarction: A Retrospective Cohort Study on 600 Cardiac Surgery Patients

Introduction: Postoperative myocardial infarction (PMI) is a severe complication after cardiac surgery, significantly impacting patient outcomes. Acute PMI after cardiac surgery is an infrequent event that can evolve rapidly and become a potentially life-threatening complication. Multiple factors are associated with acute PMI after cardiac surgery and may vary by the type of surgical procedure performed. Although the criteria defining nonprocedural myocardial ischemia are well established, there are no universally accepted criteria for diagnosing acute PMI. This retrospective study analyzed 600 patients who underwent cardiac surgery at a single center over one year. The incidence, diagnosis, and management of PMI were evaluated, focusing on diagnostic methods, therapeutic interventions, and the role of intra-aortic balloon pumps (IABPs). Our findings provide insights into the anesthesiologist’s role in identifying and managing PMI, highlighting strategies to reduce morbidity and mortality in this high-risk population. Conclusions: Early detection and tailored management of PMI are vital to reducing complications. Anesthesiologists and intensive care teams are key in optimizing outcomes through advanced support measures like intra-aortic balloon pumps. These findings, which provide practical insights to enhance perioperative care, empower us to manage this high-risk population better.

The additional impact of metabolic syndrome on left ventricular deformation and myocardial energetic efficiency impairment in ischemia with nonobstructive coronary arteries patients

BackgroundIschemia with nonobstructive coronary arteries (INOCA) has high morbidity, mortality, and poor quality of life. Metabolic syndrome (MetS) is a complex of multiple cardiac metabolic risk factors, significantly increasing the risk of major adverse cardiovascular events in INOCA patients. The study aimed to investigate the aggravating effect of MetS on left ventricular (LV) deformation and function impairment in INOCA patients.Materials and methods This study collected 104 INOCA patients (INOCA [MetS−]: n = 56; INOCA [MetS+]: n = 48) and 41 sex- and age-matched controls. LV function, indexed myocardial energetic efficiency (MEEI), and LV global peak strains (including radial, circumferential, and longitudinal directions) were measured among the three groups. The independent factors of reduced MEEI and impaired LV function and strain parameters for all INOCA patients were assessed using multivariable linear regression analyses.ResultsIn contrast to the INOCA (MetS-) group, the indexed LV stroke volume (LVSVI) (49.57 ± 11.58 mL/m2 vs. 42.58 ± 12.23 mL/m2, p = 0.007), MEEI [0.85(0.70–1.03) ml/s/g vs. 0.75(0.54–0.91) ml/s/g, p = 0.045] and LV global longitudinal peak strain (GLPS) (− 13.26 ± 2.86% vs. -10.95 ± 3.93%, p = 0.001) reduced in the INOCA (MetS+) group. Compared with the controls, LV GLPS decreased in the INOCA (MetS-) group (− 15.14 ± 2.83% vs. −13.26 ± 2.86%, p = 0.017). MetS was negatively associated with LVSVI, MEEI, and LV GLPS (all p < 0.05). After multivariable adjustment, MetS was found to be an independent factor of decreased LVSVI (β = −0.231, p = 0.012), MEEI (β = −0.262, p = 0.009), and LV GLPS (β = −0.266, p = 0.002) in INOCA patients. Using calcium channel blockers medication (β = 0.320, p = 0.001) and hypertension (β = −0.298, p = 0.002) were also independently associated with impaired MEEI.ConclusionsMetS aggravated LV deformation and function impairment in patients with INOCA. MetS was found to be an independent factor of impaired MEEI and LV GLPS, the further decrease of MEEI and LV GLPS in INOCA patients caused by MetS might involve the synergistic injury mechanism. Early diagnosis and treatment of MetS in patients with INOCA are important.

Not Only Puritans and Snobs: The Dynamic Between the Urban and the Provincial in the Works of Elizabeth Strout

ABSTRACT Elizabeth Strout’s fiction consistently returns to the rural/urban divide in the United States. Although in popular discourse this divide often relies on prejudice and stereotypes, Strout provides a comprehensive depiction of the conflict, noting the multiple factors that contribute to it, particularly in terms of economic and cultural differences, varying approaches to consumption, and communal ties. I argue that by scrutinizing these issues, Strout deconstructs the common view of the rural/urban divide, revealing the incongruence of the self-perception of both inhabitants of cities and provincial areas with reality, uncovering deeper underlying causes for this divide, which account for the destructive resentment between the urban and the provincial along economic, cultural, and class lines.

The association between metabolomic profiles of lifestyle and the latent phase of incident chronic kidney disease in the UK Population

Chronic kidney disease (CKD) is a global health challenge associated with lifestyle factors such as diet, alcohol, BMI, smoking, sleep, and physical activity. Metabolomics, especially nuclear magnetic resonance(NMR), offers insights into metabolic profiles’ role in diseases, but more research is needed on its connection to CKD and lifestyle factors. Therefore, we utilized the latest metabolomics data from the UK Biobank to explore the relationship between plasma metabolites and lifestyle factors, as well as to investigate the associations between various factors, including lifestyle-related metabolites, and the latent phase of CKD onset. The study enrolled approximately 500,000 participants from the UK Biobank (UKB) between 2006 and 2010, excluding 447,163 individuals with missing data for any metabolite in the NMR metabolomics, any biomarker in the blood chemistry (including eGFR, albumin, or cystatin C), any factor required for constructing the lifestyle score, or a baseline diagnosis of CKD. Lifestyle scores (LS) were calculated based on several factors, including diet, alcohol consumption, smoking, BMI, physical activity, and sleep. Each healthy lifestyle component contributed to the overall score, which ranged from 0 to 6. A total of 249 biological metabolites covering multiple categories were determined by the NMR Metabolomics Platform. Random forest algorithms and LASSO regression were employed to identify lifestyle-related metabolites. Subsequently, accelerated failure time models(AFT) were used to assess the relationship between multiple factors, including traditional CKD-related biomarkers (such as eGFR, cystatin C, and albumin) and lifestyle-related metabolites, with the latent phase of incident CKD. Finally, we performed Kaplan–Meier survival curve analysis on the significant variables identified in the AFT model. Over a mean follow-up period of 13.86 years, 2,279 incident chronic kidney disease (CKD) cases were diagnosed. Among the 249 metabolites analyzed, 15 were identified as lifestyle-related, primarily lipid metabolites. Notably, among these metabolites, each 1 mmol/L increase in triglycerides in large LDL particles accelerated the onset of CKD by 24%. Diabetes, hypertension, and smoking were associated with a 56.6%, 31.5% and 22.3% faster onset of CKD, respectively. Additionally, each unit increase in age, BMI, TDI, and cystatin C was linked to a 3.2%, 1.4%, 1.6% and 32.3% faster onset of CKD. In contrast, higher levels of albumin and eGFR slowed the onset of CKD, reducing the speed of progression by 3.0% and 3.9% per unit increase, respectively. Nuclear magnetic resonance metabolomics offers new insights into renal health, though further validation studies are needed in the future.

Searching for responders to multidomain dementia prevention in late life: A pooled analysis of individual participant data from the MAPT and preDIVA trials.

It is unknown in which, if any, subgroups of older adults multidomain interventions are effective at reducing long-term dementia incidence. We pooled up to 12 years of follow-up data from 5205 participants aged > 70 from the Multidomain Alzheimer Preventive Trial (MAPT) and Prevention of Dementia by Intensive Vascular Care (preDIVA) studies. The primary outcome was incident all-cause dementia. Pre-specified subgroups were defined by dementia risk factors (age, sex, education, apolipoprotein E [APOE] genotype, cognitive status, and cardiovascular risk factors). Four hundred eighty-six participants developed dementia during 37,782 person-years of follow-up. Higher incidence was associated with baseline age, APOE ε4 genotype, physical inactivity, Mini-Mental State Examination, and blood pressure. Multidomain intervention had no effect on incident dementia overall (hazard ratio =0.98, 95% confidence interval 0.80-1.21), or in any pre-specified subgroup. A recursive partitioning algorithm also did not detect any subgroups, defined by single or multiple risk factors, showing a differential intervention effect. We did not identify any subgroups of older adults in whom multidomain interventions significantly reduced incident dementia. MAPT: NCT00672685 (clinicaltrials.gov); PreDIVA: ISRCTN29711771 (ISRCTN registry) HIGHLIGHTS: We pooled up to 12 years of follow-up data from two multidomain prevention trials. Five thousand two hundred five participants aged ≥ 70 were included. Subgroups were pre-defined by modifiable and non-modifiable dementia risk factors. A data-driven recursive partitioning algorithm was also used. Multidomain intervention did not lower incident dementia overall or in any subgroup.

The Sir Ludwig Guttmann lecture 2023: psychosocial factors and adjustment dynamics after spinal cord injury.

Narrative review OBJECTIVES: Sir Ludwig Guttmann realised spinal cord injury (SCI) rehabilitation should incorporate more than a biomedical approach if SCI patients were to adjust to their injury and achieve productive social re-integration. He introduced components into rehabilitation he believed would assist his patients build physical strength as well as psychological resilience that would help them re-engage with their communities. We pay tribute to Sir Ludwig by presenting research that has focussed on psychosocial factors that contribute to adjustment dynamics after SCI. Not applicable. Five factors with a psychosocial source will be examined, featured in my research, namely psychological distress, cognitive impairment, pain catastrophizing, sleep disorder and fatigue. A multifactorial model of adjustment will be examined. Evidence shows these factors can be significant barriers to adjustment and reciprocally related to self-efficacy and life decisions. A theoretical rehabilitation framework/model is presented called the SCI Adjustment Model (SCIAM), that explains the process of adjustment dynamics. It describes how multifactorial factors contribute to adjustment in a non-linear process over time. Key clinical messages include: (i) adjustment dynamics will be enhanced if viewed through the lens of a multifactorial model that clarifies how multiple psychosocial factors can combine and act as barriers or facilitators to adjustment; (ii) judiciously using this information, assess and then strategize to reduce the influence of barriers or strengthen facilitators during SCI rehabilitation and beyond, and (iii) integrate psychosocial guidelines and a person-centred approach into SCI rehabilitation to achieve treatment goals.

Comparing the Effect of Heat Therapy and Mitochondrial-Targeted Antioxidants in Polycystic Ovarian Syndrome Phenotype Induced by Junk Food Consumption.

Polycystic ovarian syndrome (PCOS) is a complex endocrine-metabolic disorder, and multiple factors contribute to its pathophysiology. The current study assessed a PCOS-like animal model induced by consuming a high-fat sugar (HFHS) diet and compared the treatment outcome of mitochondrial-targeted antioxidants versus heat therapy. Sixty rats were divided into the following study groups: three control groups (negative and positive for the treatments used), HFHS, hot tub therapy (HTT) treatment, and MitoQ10 treatment (500 µmol/L MitoQ10 in clean drinking water daily, from week fourteen till week twenty-two of the study). At week fourteen, PCOS was confirmed by vaginal smear examination; measurements of blood testosterone (T), anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), glucose, and insulin; and determination of the homeostatic model assessment of IR (HOMA-IR). At week 22, blood samples were collected for measurement of the serum LH, FSH, AMH, T, insulin, glucose, lipid profile, kisspeptin, ADAM metallopeptidase with thrombospondin type 1 motif 19 (ADAMTS19), S100 calcium-binding protein B (S100B), fibulin 1 (FBLN1), immunoglobulin free light chains (FLCs), kappa and lambda. Ovaries were examined for morphological changes; for the levels of glutathione (GSH), catalase, SOD, malondialdehyde (MDA), and nitric oxide (NO); and the expression of FK506 binding protein 52 (FKBP52) and the androgen receptor (AR). The consumption of HFHS diet-induced PCOS-like features, which have been ameliorated by both HTT and mitoQ10 as potential therapies, with MitoQ10 showing a superior effect over HTT.

MicroRNA Expression Profile in Acute Ischemic Stroke

Acute ischemic stroke with large vessel occlusion (LVO) continues to present a considerable challenge to global health, marked by substantial morbidity and mortality rates. Although definitive diagnostic markers exist in the form of neuroimaging, their expense, limited availability, and potential for diagnostic delay can often result in missed opportunities for life-saving interventions. Despite several past attempts, research efforts to date have been fraught with challenges likely due to multiple factors, such as the inclusion of diverse stroke types, variable onset intervals, differing pathobiologies, and a range of infarct sizes, all contributing to inconsistent circulating biomarker levels. In this context, microRNAs (miRNAs) have emerged as a promising biomarker, demonstrating potential as biomarkers across various diseases, including cancer, cardiovascular conditions, and neurological disorders. These circulating miRNAs embody a wide spectrum of pathophysiological processes, encompassing cell death, inflammation, angiogenesis, neuroprotection, brain plasticity, and blood–brain barrier integrity. This pilot study explores the utility of circulating exosome-enriched extracellular vesicle (EV) miRNAs as potential biomarkers for anterior circulation LVO (acLVO) stroke. In our longitudinal prospective cohort study, we collected data from acLVO stroke patients at four critical time intervals post-symptom onset: 0–6 h, 6–12 h, 12–24 h, and 5–7 days. For comparative analysis, healthy individuals were included as control subjects. In this study, extracellular vesicles (EVs) were isolated from the plasma of participants, and the miRNAs within these EVs were profiled utilizing the NanoString nCounter system. Complementing this, a scoping review was conducted to examine the roles of specific miRNAs such as miR-140-5p, miR-210-3p, and miR-7-5p in acute ischemic stroke (AIS). This review involved a targeted PubMed search to assess their influence on crucial pathophysiological pathways in AIS, and their potential applications in diagnosis, treatment, and prognosis. The review also included an assessment of additional miRNAs linked to stroke. Within the first 6 h of symptom onset, three specific miRNAs (miR-7-5p, miR-140-5p, and miR-210-3p) exhibited significant differential expression compared to other time points and healthy controls. These miRNAs have previously been associated with neuroprotection, cellular stress responses, and tissue damage, suggesting their potential as early markers of acute ischemic stroke. This study highlights the potential of circulating miRNAs as blood-based biomarkers for hyperacute acLVO ischemic stroke. However, further validation in a larger, risk-matched cohort is required. Additionally, investigations are needed to assess the prognostic relevance of these miRNAs by linking their expression profiles with radiological and functional outcomes.

The factors influencing self-management in patients with depression: a qualitative research from China

BackgroundAs depressed patients often fail to seek help and obtain treatment on time for reasons such as stigma and lack of treatment resources, research on self-management for depressed patients is crucial. This study aimed to explore the factors influencing self-management in depression patients from the perspectives of both patients and psychiatric nurses.MethodsSix depression patients and twelve psychiatric nurses were chosen for semi-structured interviews through a purposive sampling method from a tertiary Grade A psychiatric hospital in Shandong Province, China. The group of depressed patients included in the study had a male to female sex ratio of 1:1 with a mean age of 46years. The psychiatric nurse group had a male to female ratio of 1:2 with a mean age of 42.42 years. We used descriptive qualitative research techniques. Nvivo 12.0 software was used for the data management and analysis using thematic analysis.ResultsThe factors influencing the self-management of depression patients were summarized into three themes and eight sub-themes: disease impact (symptoms, stigma), the degree of symptom control (medication adherence, depression’s cognitive status, its treatment and rehabilitation as well as additional factors), and support (self-efficacy, external support).ConclusionsThis study found that multiple factors influence the self-management of depression patients, including disease impact, the degree of symptom control, and support. In addition to helping patients integrate social resources and seek social support, medical staff should also pay attention to changes in the patient’s condition and disease control. Moreover, they should help patients increase their self-efficacy and enhance their self-management abilities through health education and other means.Clinical trial numberNot applicable.

Optimizing Lightweight Material Selection in Automotive Engineering: A Hybrid Methodology Incorporating Ashby’s Method and VIKOR Analysis

The automotive industry is responsible for about 20% of greenhouse gas emissions in Europe, and it is under notable pressure to meet the reduction targets set by the European Union for the next decades. In this context, lightweighting is a very effective design strategy for which materials selection plays a key role. One of the main challenges of lightweighting is selecting materials with enhanced structural properties but a reduced weight in comparison with traditional solutions. The spectrum of available materials is very large, and the choice needs to be carefully evaluated based on multiple factors, such as mechanical behavior, raw materials cost, the availability of manufacturing processes, and environmental impact. This article presents an innovative methodology for materials selection in the lightweight automotive field based on the Ashby approach for mechanical performance coefficients as an initial filtering criterion. Following this preliminary screening, this study adopts the VIKOR (Vise Kriterijumska Optimizacija I Kompromisno Resenje) MCDA (Multi-Criteria Decision Analysis) technique to rank feasible design solutions based on case study boundary conditions. The evaluation criterion of different design options encompasses crucial factors, such as mechanical properties, cost considerations, and environmental impact measures. The method is finally validated by the application of a redesign case study, a motor bracket of an electric commercial car.

Parents favor daughters: A meta-analysis of gender and other predictors of parental differential treatment.

Decades of research highlight that differential treatment can have negative developmental consequences, particularly for less favored siblings. Despite this robust body of research, less is known about which children in the family tend to be favored or less favored by parents. The present study examined favored treatment as predicted by birth order, gender, temperament, and personality. We also examined whether links were moderated by multiple factors (i.e., parent gender, age, reporter, domain of parenting/favoritism). Multilevel meta-analysis data were collected from 30 peer-reviewed journal articles and dissertations/theses and 14 other databases. In all, the data reflected 19,469 unique participants (Mage = 19.57, SD = 13.92). Results showed that when favoritism was based on autonomy and control, parents tended to favor older siblings. Further, parents reported favoring daughters. Conscientious and agreeable children also received more favored treatment. For conscientious children, favoritism was strongest when based on differences in conflict (i.e., more conscientious children had relatively less conflict with their parents). Parents and clinicians should be aware of which children in a family tend to be favored as a way of recognizing potentially damaging family patterns. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Dietary flaxseed: Cardiometabolic benefits and its role in promoting healthy aging.

Flaxseed, a rich source of omega-3 polyunsaturated fatty acid alpha-linolenic acid (ALA), lignans, and soluble fiber, has attracted attention for its potential to improve multiple cardiometabolic risk factors. While its benefits are well-recognized, comprehensive evaluations of its direct impact on clinical outcomes, such as the prevention or progression of cardiometabolic diseases, remain limited. Additionally, its potential to support healthy aging and longevity through fundamental biological mechanisms has not been fully elucidated. This review synthesizes existing research on flaxseed supplementation, highlighting its effects on cardiometabolic risk factors and outcomes, the underlying biological mechanisms, and its broader implications for health promotion and aging. Findings demonstrate that flaxseed supplementation significantly improves several cardiometabolic risk factors, including body weight, body mass index, lipid levels, blood pressure, glycemic measures, markers of inflammation (e.g., C-reactive protein and interleukin-6), oxidative stress, and liver enzymes. Blood pressure reductions range from approximately 2 to 15mmHg for systolic blood pressure and 1 to 7mmHg for diastolic blood pressure, with the magnitude influenced by dose, duration, and baseline risk profiles. While direct evidence linking flaxseed to the prevention of hypertension, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, type 2 diabetes, chronic kidney disease, and cardiovascular disease is limited, its bioactive components-ALA, lignans, and fiber-are strongly associated with reduced risks of these conditions. The benefits of flaxseed are mediated through multiple pathways, including anti-inflammatory and antioxidant effects, improved lipidlevels, improved glucose metabolism and insulin sensitivity, modulation of gut microbiota, and enhanced vascular health. Beyond cardiometabolic outcomes, flaxseed may influence key biological processes relevant to aging, underscoring its potential to promote healthy aging and longevity. Optimal cardiometabolic benefits appear to be achieved with ground whole flaxseed at doses of ≥ 30g/day for at least 12weeks, particularly among individuals at high cardiometabolic risk. Future research should focus on elucidating flaxseed's mechanisms of action, clarifying its role in disease prevention, and refining dietary recommendations to harness its potential for cardiometabolic health and aging interventions.

Source-oriented health risk assessment of soil potentially toxic elements based on Monte Carlo simulation in the upper reaches of Wei River Basin, China.

The natural environment and public health are gravely threatened by the enrichment of soil potentially toxic elements (PTEs). To explore the contamination level, sources and human health risks posed by PTEs, high-density soil sampling was carried out in the upper Wei River region (UWRR). The results demonstrated that the pollution risk and ecological risk in UWRR as a whole were at a low level, but there were moderate or higher ecological risks of Hg and Cd in some areas. Source analysis of soil PTEs was conducted via absolute principal component score multiple linear regression (APCS-MLR) and positive matrix factorization (PMF) receptor models. APCS-MLR identified three potential sources, while the source division of PMF model was more detailed, which identified four potential sources: mining, coal combustion, machinery manufacturing and agricultural sources, with contribution percentages of 31%, 3%, 37% and 29% respectively. According to the probabilistic human health risk assessment (HHRA), the non-carcinogenic risk for adults was negligible, while that for children cannot be negligible. There were total carcinogenic risks for all populations, but the risk level was acceptable. The total cancer risk for children surpassed 1E-04 by 31.29%, implying a significant carcinogenic risk. Machinery manufacturing was found to be the most significant anthropogenic source of health concerns. This study offers an illustration of probabilistic risk assessment based on sources. The results of the study are favorable to provide new perspectives and scientific reference for soil PTE risk assessment and pollution control.

Increased Plasma Pyruvate Kinase M2 (PK-M2) in Heart Failure: A Novel Biomarker Related to Cardiac Function and its Clinical Implications.

The purpose of this study was to investigate whether circulating pyruvate kinase M2 (PK-M2) levels are elevated in the peripheral blood and to assess their association with diagnosis and prognosis in patients with heart failure (HF). We conducted a prospective investigation involving 222 patients with HF and 103 control subjects, measuring PK-M2 concentrations using ELISA. The primary outcome, assessed over a median follow-up of 2 years (interquartile range: 776 to 926 days), was the time to the first occurrence of either rehospitalization for worsening HF or cardiovascular death. Patients with HF had higher PK-M2 levels than controls (17.4±4.1 versus 7.8±2.3 U/mL, P <0.001), and these levels correlated with HF severity (New York Heart Association cardiac function class). Patients with reduced left ventricular ejection fraction had higher PK-M2 concentrations than those with preserved ejection fraction (18.3±4.5 versus 16.7±3.6 U/mL, P <0.01). In a subset of patients with HF (n=52), PK-M2 levels significantly decreased following standardized HF treatment (mean difference, -4.3±0.5 U/mL, P <0.001). A high PK-M2 level had a 1.913-fold higher risk of the primary outcome (P=0.033) after adjusting for multiple cardiovascular risk factors, but not with cardiovascular death. Additionally, PK-M2 added incremental prognostic value beyond clinical predictors and N-terminal pro-brain natriuretic peptide (P <0.05). Elevated PK-M2 levels are associated with primary outcomes and rehospitalization for worsening heart failure in patients with HF. These findings suggest that PK-M2 is a potential biomarker for HF diagnosis and prognosis, warranting consideration for serial patient assessment.

Associations of modifiable dementia risk factors with dementia and cognitive decline: evidence from three prospective cohorts

ObjectiveThis study aims to assess the relationship between modifiable dementia risk factors and both dementia and cognitive decline.MethodsData were obtained from the Health and Retirement Study (HRS) [2008–2020], the China Health and Retirement Longitudinal Study (CHARLS) [2011–2020], and the English Longitudinal Study of Ageing (ELSA) [2010–2020]. After adjusting for confounding factors, multivariable logistic regression was utilized to analyze the relationship between modifiable dementia risk factors and dementia, while multivariable linear regression was employed to examine the relationship between these risk factors and cognitive decline. Additionally, the Cox proportional hazards model was used to assess the relationship between the number of risk factor events, clusters, and dementia risk.ResultsA total of 30,113 participants from HRS, CHARLS, and ELSA were included (44.6% male, mean age 66.04 years), with an average follow-up period of 7.29 years. A low education level was significantly associated with an increased risk of dementia and accelerated cognitive decline (Overall, OR = 2.93, 95% CI: 2.70–3.18; Overall, β = −0.25, 95% CI: −0.60 to-0.55). The presence of multiple dementia risk factors correlated with a higher dementia risk; Specifically, compared with more than 5 risk factor events, both having no dementia risk factors and having only one dementia risk factor were associated with a significantly lower risk of dementia (Overall, HR = 0.15, 95% CI: 0.11–0.22, HR = 0.22, 95% CI: 0.18–0.25). Compared to the group with no coexistence of risk factors, the clusters of excessive alcohol, diabetes, vision loss, and hearing loss (HR = 4.11; 95% CI = 3.42–4.95; p &amp;lt; 0.001); excessive alcohol, vision loss, smoking, and hearing loss (HR = 5.18; 95% CI = 4.30–6.23; p &amp;lt; 0.001); and excessive alcohol, obesity, diabetes, and smoking (HR = 5.96; 95% CI = 5.11–6.95; p &amp;lt; 0.001) were most strongly associated with dementia risk.ConclusionAmong the 11 risk factors, educational attainment has the greatest impact on dementia risk and cognitive decline. A dose–response relationship exists between the number of modifiable risk factor events and dementia risk. The coexistence of multiple risk factors is associated with dementia risk, and these associations vary by risk factor cluster.

Advantages and Challenges of Graphene Transistors for High-Frequency Applications

Graphene is regarded as an ideal material for next-generation high-frequency (HF) electronic devices, attributed to its unique two-dimensional structure, high carrier mobility, and exceptional electrical properties. In recent years, the limitations of conventional silicon-based technologies for high-frequency applications have become increasingly apparent, resulting in heightened interest in graphene transistors, which exhibit significant potential for applications in wireless communications, radar systems, and terahertz technology. These transistors exhibit high cutoff frequency and low noise characteristics, along with favorable bipolar properties, which provide them with significant advantages in radio frequency (RF) applications. However, despite the significant theoretical advantages of graphene materials, their practical application is still restricted by multiple factors. Specifically, insufficient voltage gain from weak current saturation, material uniformity issues, and large-scale production challenges have restricted the widespread adoption of graphene transistors in high-frequency electronic devices. This paper reviews the relevant literature, examines the disparity between the electrical performance and practical applications of graphene transistors, and identifies the key factors influencing their implementation. The results demonstrate that targeted bandgap engineering, innovative device architectures, and the exploration of new materials can help graphene transistors can mitigate existing challenges and position themselves as key components in future HF electronic devices, driving significant advancements and broader integration of related technologies.

Design of a high transmission illumination optics for anamorphic EUV lithography optics using deep reinforcement learning

The design of the illumination optics for high numerical aperture (NA) anamorphic extreme ultraviolet (EUV) projection optics is a critical challenge to EUV lithography in advanced technology node. However, the EUV illumination optics design using conventional methods have flaws in illumination efficiency and illumination uniformity due to the limitations of relay configuration and matching method that can only consider one factor affecting illumination uniformity. One-mirror configuration can improve illumination efficiency by reducing the number of mirrors. Deep reinforcement learning (RL) can solve the limitations by considering multiple factors simultaneously. In this paper, a design method for a high transmission relay system and a matching method for double facets using deep RL are proposed to design NA 0.55 anamorphic EUV illumination optics. The one-mirror relay system is designed by first calculating its coaxial spherical initial configuration using matrix optics; then the one off-axis relay mirror, which is tilted and decentered to eliminate ray obscuration, is fitted into a conic surface. To satisfy the requirements of multiple factors that affect illumination uniformity, the assignment relationships between the field facets and the pupil facets are determined using deep RL under a certain illumination mode. Simulation results show that the illumination efficiency is 26.24%, and the illumination uniformity can reach 99% on the mask under different illumination modes.

Multifaceted impacts of double-aging neighborhood’s built environments on SAIP: a deep dive into Chinese rapidly aging urban society

IntroductionThe healthy aging of older adults in dual-older adult communities is influenced by multiple factors, and understanding its underlying mechanisms can promote healthy aging among the older adults in a wide range of developing countries. This comprehensive study delves into the intricate interplay between multifaceted built environmental factors, and their direct and indirect effects on the successful AIP residing in double-aging neighborhoods.MethodsApplying a series of HLM, the research meticulously explores the intricate links between SAIP and multi-scale aging spaces, including home space, community social participation, and built environments.ResultsThe results show that: (1) Older adults people’s need for spiritual comfort derived from home space exceed the need for financial support and family care, becoming a major positive factor for SAIP; (2) The neighborhood based on acquaintance society, partly replace the role of home-based care in influencing SAIP. Especially, community participation has a positive impact, serving as an extension of the home space, such as college for senior citizens and outdoor activity space; (3) The built environment of double-aging neighborhoods has a significant positive effect, with a sense of place identity replacing the reliance on family members and acquaintances to facilitate SAIP; (4) In high-density old district, the distribution of public facilities is saturated, and the proper utilizes of these facilities becomes an important factor affecting SAIP.DiscussionWe provide a multi-factorial perspective of SAIP, demonstrating the compensatory and substitutional roles of community-based older adults care services and friendly neighborhood relationships in fulfilling home-based older adults care functions. This approach better promotes the construction of age-friendly communities and supports SAIP.

Climate change aggravated wildfire behaviour in the Iberian Peninsula in recent years

Climate change is considered to affect wildfire spread both by increasing fuel dryness and by altering vegetation mass and structure. However, the direct effect of global warming on wildfires is hard to quantify due to the multiple non-climatic factors involved in their ignition and spread. By combining wildfire observations with the latest generation of climate models, here we show that more than half of the large wildfires (area>500 ha) occurring in the Iberian Peninsula between 2001 and 2021 present a significant increase in the rate of spread with respect to what it would have been in the pre-industrial period, attributable to global warming. The average acceleration of the rate of spread due to increased fuel dryness is between 2.0% and 8.3%, whereas the influence of enhanced vegetation growth since the pre-industrial period could potentially be even higher than the direct impact of temperature increase in fuel conditions.

Effect of prophylactic doses of enoxaparin on antifactor Xa activity confirmed by rotational thromboelastometry in critically ill patients: a preliminary prospective cohort study

IntroductionCritically ill patients present multiple risk factors for venous thromboembolism (VTE). Underdosing of antithrombotic medications can result in VTE even as bleeding remains a significant concern for critically ill patients. On the other hand bleeding, remaining a significant concern for the critically ill, can be worsend by overdosing of antithrombotic medications. The present study aimed to assess the effects of prophylactic doses of enoxaparin on antifactor Xa activity (anti-Xa) and rotational thromboelastometry (ROTEM) parameters in critically ill patients.Materials and methodsIn this prospective single-center cohort study, the effects of enoxaparin were assessed via anti-Xa monitoring. Standard laboratory coagulation and ROTEM parameters were also determined using the same blood samples.ResultsA total of 61 patients (42.6% women) were enrolled in this study, whose median age was 59.0 (interquartile range: 43.0–70.0) years. Based on anti-Xa, the effects of enoxaparin were normal in 35 subjects (57.4%); in 17 patients (27.9%), the anti-Xa troughs and/or peaks were higher than the prophylactic range; in 9 patients (14.7%), the anti-Xa peak was lower than the prophylactic range. There were differences among the anti-Xa groups with respect to some ROTEM parameters. No VTE was detected among the study subjects. In 3 subjects (4.9%), there were signs of bleeding, and these patients presented with longer thrombin times.ConclusionAnti-Xa values may be within the prophylactic range in slightly more than half of the critically ill patients receiving enoxaparin at prophylactic doses. The dosing of low-molecular-weight heparin (LMWH) in critically ill patients may require individualization based on anti-Xa. Further studies are therefore required to establish a universal anti-Xa prophylactic range for LMWH, the timing of anti-Xa determination, and management of LMWH dosing.