Negative Linear Regression Research Articles

Clonal hematopoiesis of indeterminate potential: a risk factor for future exacerbation in patients with COPD

BackgroundThere is limited data regarding the clinical significance of clonal hematopoiesis of indeterminate potential (CHIP) in patients with COPD. We aimed to evaluate whether CHIP could serve as a biomarker for the long-term prognosis of patients with COPD.MethodsNext-generation sequencing was used to detect CHIP in peripheral blood mononuclear cell samples. Participants with COPD were enrolled in a prospective observational cohort between January 2013 and December 2023. We investigated the association of CHIP status with the risk of subsequent acute exacerbation and longitudinal changes in lung function, by using negative binomial regression and linear mixed regression models, respectively.ResultsAmong 125 patients with COPD, the CHIP-positive group was 32 (25.6%). Higher smoking intensity and CAT score were significantly associated with increased risk of positive CHIP status, especially in current smokers. Positive CHIP of specific genes was significantly associated with a higher risk of subsequent mild and total acute exacerbation. Positive CHIP of ASXL transcriptional regulator 1 (ASXL1) had a lower risk of subsequent total acute exacerbation (aOR, 0.19; 95% CI, 0.04–0.95). The CHIP status did not show a statistically significant association with longitudinal changes in lung function.ConclusionsIn patients with COPD, CHIP positivity was significantly associated with an increased risk of subsequent acute exacerbations, but not with longitudinal changes in lung function.

Effects of goosegrass (Eleusine indica) competition on strawberry growth and yield

Abstract Goosegrass [Eleusine indica (L.) Gaertn.] is one of the most problematic weeds in plasticulture strawberry [Fragaria × ananassa (Weston) Duchesne ex Rozier (pro sp.) [chiloenis × virginiana]] production systems in Florida. A 2-yr trial was implemented to evaluate the effects of different E. indica densities on strawberry growth and yield. Eleusine indica densities evaluated were 0, 0.4, 0.8, 1.9, 2.7, and 3.8 plants m−2 equally distributed on the plastic-mulched bed top within the strawberry transplant holes. Eleusine indica density did not affect E. indica height or biomass. However, E. indica seed production was positively correlated with E. indica density in Season 1 and negatively correlated with E. indica density in Season 2. A negative linear regression was observed between E. indica density and strawberry yield in both seasons. For each increase in E. indica plants per square meter, strawberry yield was reduced by 316 and 2,356 kg ha−1 for Seasons 1 and 2, respectively. Our results highlight the importance of achieving adequate E. indica management to minimize yield losses.

Clinical and economic outcomes of a pharmacogenomics-enriched comprehensive medication management program in a self-insured employee population

Clinical and economic outcomes from a pharmacogenomics-enriched comprehensive medication management program were evaluated over 26 months in a self-insured U.S. employee population (n = 452 participants; n = 1500 controls) using propensity matched pre-post design with adjusted negative binomial and linear regression models. After adjusting for baseline covariates, program participation was associated with 39% fewer inpatient (p = 0.05) and 39% fewer emergency department (p = 0.002) visits, and with 21% more outpatient visits (p < 0.001) in the follow-up period compared to the control group. Results show pharmacogenomics-enriched comprehensive medication management can favorably impact healthcare utilization in a self-insured employer population by reducing emergency department and inpatient visits and can offer the potential for cost savings. Self-insured employers may consider implementing pharmacogenomics-enriched comprehensive medication management to improve the healthcare of their employees.

Drought reduces nitrogen supply and N2O emission in coastal bays

Severe droughts are increasingly prevalent under global climate change, disrupting watershed hydrology and coastal nitrogen cycling. However, the specific effects of drought on nitrogen transport from land to sea and subsequent nitrogen dynamics remain inadequately understood. In this study, we evaluated the consequences of the 2020–2022 drought on nitrogen supply and N2O emissions in Xiamen Bay, Southeast China. The results showed that drought significantly reduced annual NH4N, NO2N, and NO3N concentrations in Xiamen Bay by 49.4 %, 32.1 %, and 40.3 %, respectively, compared with the pre-drought year of 2019. The decline in NH4N concentration was mainly attributed to reduced surface runoff across all seasons. NO3N and NO2N concentrations declined only during spring and summer, primarily due to increased potential evapotranspiration (PET) hindering nitrogen supply via groundwater and concurrently enhancing land denitrification. Annual N2O emission from Xiamen Bay decreased by 40.0∼72.7 % during the drought, highly correlated with the decline in the concentrations of NO3N, DIN, and DTN (p < 0.001). Comparative analysis revealed that NO3N concentration exhibited consistent negative linear regressions with PET and declined as evaporative demand drought conditions worsened across Xiamen Bay, Sansha Bay, and Chesapeake Bay throughout 2010–2022. NH4N concentration showed a positive regression with river discharge in Xiamen Bay, but negative regressions in the other two bays. Our results indicates that drought reduces N2O emission primarily driven by nitrate substrate reduction in the bay. This study provides new insights for predicting coastal nitrogen dynamics and greenhouse gas emissions under global environmental change.

Longitudinal associations between beta-endorphin, nonsuicidal self-injury and comorbid psychopathology

Homeostasis models posit that nonsuicidal self-injury (NSSI) serves, in part, to upregulate the endogenous opioid system in order to compensate for an opioid deficiency. A few studies have demonstrated lower basal levels of beta-endorphin (BE), an endogenous opioid, in individuals with NSSI. However, longitudinal studies are missing. Hence, the present study aimed to investigate the longitudinal associations between NSSI, comorbid psychopathology (i.e., borderline personality disorder and depressive symptoms), pain sensitivity and basal BE levels in adolescents with NSSI. N = 53 adolescents with NSSI disorder undergoing specialized treatment participated in baseline and one-year follow-up assessments. BE was measured in plasma; pain sensitivity was assessed with a heat pain stimulation paradigm. Associations between BE and change in NSSI, borderline personality disorder and depressive symptoms as well as pain sensitivity were examined using negative binomial and linear regression analyses. We found that an increase in basal BE was significantly associated with a decrease in depressive symptoms. No associations between BE and NSSI, borderline personality disorder symptoms or pain sensitivity were observed. Our findings may confirm a role of plasma BE in the etiology of depressive symptoms but challenge current models of endogenous opioid homeostasis in NSSI.

Early microRNA and metabolite changes after anterior cruciate ligament reconstruction surgery

ObjectivesAnterior cruciate ligament (ACL) reconstruction after injury does not prevent post-traumatic osteoarthritis (PTOA). Circulating microRNA (miRNA) and metabolite changes emerging shortly after ACL injury and reconstruction remain insufficiently defined, potentially harbouring early cues contributing to PTOA evolution. Moreover, their differential expression between females and males also may influence PTOA’s natural trajectory. This study aims to determine alterations in plasma miRNA and metabolite levels in the early stages following ACL reconstruction and between females and males. MethodsA cohort of 43 ACL reconstruction patients was examined. Plasma was obtained at baseline, 2-weeks, and 6-weeks post-surgery (129 biospecimens in total). High throughput miRNA sequencing and metabolomics were conducted. Differentially expressed miRNAs and metabolites were identified using negative binomial and linear regression models, respectively. Associations between miRNAs and metabolites were explored using time and sex as co-variants, (pre- versus 2- and 6-weeks post-surgery). Using computational biology, miRNA-metabolite-gene interaction and pathway analyses were performed. ResultsLevels of 46 miRNAs were increased at 2-weeks post-surgery compared to pre-surgery (baseline) using miRNA sequencing. Levels of 13 metabolites were significantly increased while levels of 6 metabolites were significantly decreased at 2-weeks compared to baseline using metabolomics. Hsa-miR-145-5p levels were increased in female subjects at both 2-weeks (log2-fold-change 0.71, 95%CI 0.22,1.20) and 6-weeks (log2-fold-change 0.75, 95%CI 0.07,1.43) post-surgery compared to males. In addition, hsa-miR-497-5p showed increased levels in females at 2-weeks (log2-fold-change 0.77, 95%CI 0.06,1.48) and hsa-miR-143-5p at 6-weeks (log2-fold-change 0.83, 95%CI 0.07,1.59). Five metabolites were decreased at 2-weeks post-surgery in females compared to males: L-leucine (-1.44, 95%CI -1.75,-1.13), g-guanidinobutyrate (-1.27, 95%CI 1.54,-0.99), creatinine (-1.17, 95%CI -1.44,-0.90), 2-methylbutyrylcarnitine (-1.76, 95%CI -2.17,-1.35), and leu-pro (-1.13, 95%CI -1.44,-0.83). MiRNA-metabolite-gene interaction analysis revealed key signalling pathways based on post-surgical time-point and in females versus males. ConclusionMiRNA and metabolite profiles were modified by time and by sex early after ACL reconstruction surgery, which could influence surgical response and ultimately risk of developing PTOA.

Syndromic Surveillance Tracks COVID-19 Cases in University and County Settings: Retrospective Observational Study.

Syndromic surveillance represents a potentially inexpensive supplement to test-based COVID-19 surveillance. By strengthening surveillance of COVID-19-like illness (CLI), targeted and rapid interventions can be facilitated that prevent COVID-19 outbreaks without primary reliance on testing. This study aims to assess the temporal relationship between confirmed SARS-CoV-2 infections and self-reported and health care provider-reported CLI in university and county settings, respectively. We collected aggregated COVID-19 testing and symptom reporting surveillance data from Cornell University (2020-2021) and Tompkins County Health Department (2020-2022). We used negative binomial and linear regression models to correlate confirmed COVID-19 case counts and positive test rates with CLI rate time series, lagged COVID-19 cases or rates, and day of the week as independent variables. Optimal lag periods were identified using Granger causality and likelihood ratio tests. In modeling undergraduate student cases, the CLI rate (P=.003) and rate of exposure to CLI (P<.001) were significantly correlated with the COVID-19 test positivity rate with no lag in the linear models. At the county level, the health care provider-reported CLI rate was significantly correlated with SARS-CoV-2 test positivity with a 3-day lag in both the linear (P<.001) and negative binomial model (P=.005). The real-time correlation between syndromic surveillance and COVID-19 cases on a university campus suggests symptom reporting is a viable alternative or supplement to COVID-19 surveillance testing. At the county level, syndromic surveillance is also a leading indicator of COVID-19 cases, enabling quick action to reduce transmission. Further research should investigate COVID-19 risk using syndromic surveillance in other settings, such as low-resource settings like low- and middle-income countries.

Pain sensitivity as a state marker and predictor for adolescent non-suicidal self-injury.

The pain analgesia hypothesis suggests that reduced pain sensitivity (PS) is a specific risk factor for the engagement in non-suicidal self-injury (NSSI). Consistent with this, several studies found reduced PS in adults as well as adolescents with NSSI. Cross-sectional studies in adults with borderline personality disorder (BPD) suggest that PS may (partially) normalize after remission or reduction of BPD symptoms. The objective of the present study was to investigate the development of PS over 1 year in a sample of adolescents with NSSI and to investigate whether PS at baseline predicts longitudinal change in NSSI. N = 66 adolescents who underwent specialized treatment for NSSI disorder participated in baseline and 1-year follow-up assessments, including heat pain stimulation for the measurement of pain threshold and tolerance. Associations between PS and NSSI as well as BPD and depressive symptoms were examined using negative binomial, logistic, and linear regression analyses. We found that a decrease in pain threshold over time was associated with reduced NSSI (incident rate ratio = 2.04, p = 0.047) and that higher pain tolerance at baseline predicted lower probability for NSSI (odds ratio = 0.42, p = 0.016) 1 year later. However, the latter effect did not survive Holm correction (p = 0.059). No associations between PS and BPD or depressive symptoms were observed. Our findings suggest that pain threshold might normalize with a decrease in NSSI frequency and could thus serve as a state marker for NSSI.

Racial disparities in law enforcement/court-ordered psychiatric inpatient admissions after the 2008 recession: a test of the frustration-aggression-displacement hypothesis.

Societies under duress may selectively increase the reporting of disordered persons from vulnerable communities to law enforcement. Mentally ill African American males reportedly are perceived as more threatening relative to females and other race/ethnicities. We examine whether law enforcement/court order-requested involuntary psychiatric hospitalizations increased among African American males shortly after ambient economic decline-a widely characterized population stressor. We identified psychiatric inpatient admissions requested by law enforcement/court orders from 2006 to 2011 across four US states (Arizona, California, New York, North Carolina). Our analytic sample comprises 13.1 million psychiatric inpatient admissions across 95 counties over 72months. We operationalized exposure to economic downturns as percent change in monthly employment in a metropolitan statistical area (MSA). We used zero inflated negative binomial and linear fixed effects regression analyses to examine psychiatric inpatient admissions requested by law enforcement/court orders following regional employment decline over a time period that includes the Great Recession of 2008. Declines in monthly employment precede by one month a 6% increase in psychiatric hospitalizations requested by law enforcement/court order among African American males (p < 0.05), but not among other race/sex groups. Estimates amount to an excess of 2554 involuntary admissions among African American males statistically attributable to aggregate-level employment decline. Economic downturns may increase involuntary psychiatric commitments among African American males. Our findings underscore the unique vulnerability of racial/ethnic minorities during economic contractions.

Continuous low-level dietary exposure to glyphosate elicits dose and sex-dependent synaptic and microglial adaptations in the rodent brain.

Prolonged exposure to low levels of dietary contaminants is a context in modern life that could alter organ physiology gradually. Here, we aimed to investigate the impact of continuous exposure to acceptable daily intake (ADI) and non-observable adverse effect level (NOAEL) of glyphosate from gestation to adulthood using C57BL/6J mice and incorporating these levels into their food pellets. From adulthood, we analyzed neurophysiological and neuro-glia cellular adaptations in male and female animals.Using ex-vivo hippocampal slice electrophysiology, we found a reduced efficacy of Schaffer collateral-to-CA1 excitatory synapses in glyphosate-exposed dietary conditions, with ADI and NOAEL dose-dependent effects. Short-term facilitation of excitatory synaptic transmission was specifically increased in NOAEL conditions, with a predominant influence in males, suggesting a reduced probability of neurotransmitter release. Long-term synaptic potentiation (LTP) was decreased in NOAEL-exposed mice. Next, we explore whether these neurophysiological modifications are associated with neuro-glia changes in the somatosensory cortex and hippocampus. High-resolution confocal microscopy analyses unveil a dose-dependent increased density of excitatory Vglut1+ Homer1+ synapses. Microglial Iba1+ cells displayed a shortening of their ramifications, a sign of cellular reactivity that was more pronounced in males at NOAEL levels. The morphology of GFAP+ astrocytes was generally not modified. Finally, we asked whether mouse-specific cross-correlations exist among all data sets generated. This examination included the novel object recognition (NOR) test performed before ex vivo functional and immunohistochemical examinations. We report a negative linear regression between the number of synapses and NOR or LTP maintenance when plotting ADI and NOAEL datasets.These results outline synaptic and microglial cell adaptations resulting from prenatal and continuous dietary low levels of glyphosate, discernible in, but not limited to, adult males exposed to the NOAEL. We discuss the potential significance of these findings to real-world consumer situations and long-term brain resilience.

Risk Terrain and Multilevel Modeling of Street Robbery Distribution in Baltimore City

The structure and functions of neighborhoods determine the impact of measures used to estimate the distribution of street robbery across space and time. The risk of street robbery could vary between different sections of the area. Prior research has typically relied on one-dimensional analysis, which sparsely accounts for the hierarchical configuration of a neighborhood’s influence on spatial crime distribution. Much less is known about how the predictor variables moderate each other at different neighborhood levels. Data was collected from 13,789 US Census blocks ( N = 13,788) aggregated to administrative neighborhoods ( N = 278) to examine how neighborhood structure affects street robbery distribution at two spatial levels. A Risk Terrain Model was adopted to develop a physical environment risk measure—Aggregate Neighborhood Risk of Crime (ANROC), which, alongside sociodemographic risk factors, predicted the outcomes of the Negative Binomial General Linear Regression models. Study findings suggest that individual-level (block) and group (neighborhood) level predictors influenced street robbery. Both group-level physical environment and total population moderated the impact of the individual-level physical environment on street robbery incidents.

Stories that engage the audience: An investigation of popular breast cancer narratives on social media

Narratives play a critical role in health communication and promotion on social media. This study aimed to identify the features of popular social media narratives that generate emotional support and engage users in cancer communication. We conducted a content analysis of popular breast cancer narratives (N = 410) by five influential breast cancer non-profit organizations on Facebook. Based on a theoretical framework grounded in narrative communication research, we analyzed these narratives in the following dimensions: narrative content (e.g., character attributes, events, and mood), narrative form (e.g., perspective and length), literary techniques (e.g., imperatives, metaphors, and celebrity appeals), and visual elements (e.g., the color pink, events, and vividness). Negative binomial and linear regressions were conducted to examine the relationships between narrative characteristics and three types of social media engagement: affective, cognitive, and behavioral engagement. Results showed that cancer stories that were longer, less emotionally intensive, told from the cancer survivor’s perspective, with gender identity–related information, describing the act of providing social support, explicitly requesting engagement and/or donation, and using more vivid forms of visuals such as linked images tended to be more engaging. However, different narrative features were associated with the three engagement outcomes differently. This study provides a framework for understanding how health communicators can leverage social media to share cancer narratives to reach and engage the intended audience.

Halogenated bisphenol A derivatives potently inhibit human, rat, and mouse gonadal 3β-hydroxysteroid dehydrogenases: Structure-activity relationship and in silico molecular docking analysis

Bisphenol A (BPA) is a widely used plastic material, and halogenated BPA derivatives are formed either by synthesis or environmental processes. However, the effect of halogenated bisphenols on steroidogenesis remains unclear. The aim of this study was to compare inhibition of 6 BPA derivatives on gonadal 3β-hydroxysteroid dehydrogenases (3β-HSDs) in three species (human, rat, and mouse). The inhibition on human 3β-HSD2 was tetrabromo BPA (TBBPA, IC50, 1.01 μM)>trichloro BPA (TrCBPA, 3.95 μM)>tetrachloro BPA (TCBPA, 4.14 μM)>monochloro BPA (MCBPA, 4.74 μM)>others with TrCBPA of competitive, TBBPA of noncompetitive and MCBPA/TCBPA of mixed inhibition. The inhibition on rat 3β-HSD1 was TCBPA (1.68 μM)>TrCBPA (1.72 μM)>MCBPA (2.80 μM)>BPA>others with mixed inhibition. The inhibition on mouse 3β-HSD6 was TrCBPA (1.59 μM) >MCBPA (3.36 μM)>TCBPA (3.72 μM)>others with mixed inhibition. Molecular docking analysis showed that TBBPA, TrCBPA, and TCBPA bind to steroid active sites, contacting with catalytic residue Tyr154 of human 3β-HSD2. MCBPA, TrCBPA, and TCBPA bind to steroid active site of rat 3β-HSD1. MCBPA and TrCBPA bind to active site of mouse 3β-HSD6. Regression of lowest binding energy values with Ki values revealed a significant negative linear regression (P < 0.05). In conclusion, halogenated BPA derivatives are more potent inhibitors of three 3β-HSDs than BPA and there is structure-dependent inhibition. SynopsisChlorinated bisphenol derivatives after water chlorination process and other halogenated bisphenols effectively inhibit human and rat 3β-HSD activity, thereby leading to steroid hormone deficiency.

Black Americans have worse stroke outcome compared with non-Hispanic whites

IntroductionWe studied racial differences in post-stroke outcomes using a prospective, population-based cohort of stroke survivors as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project. MethodsNeurologic (NIHSS, range of 0–42, higher scores are worse), functional (ADLs/IADLs, range 1–4, higher scores are worse), and cognitive (3MSE, range 0–100, higher scores are better) outcomes were measured 90 days after stroke. Cox proportional hazards and negative binomial linear regression models were used to examine the associations between race and 90-day all-cause mortality and NIHSS, respectively, whereas linear regression was used for ADLs/IADLs and 3MSE scores. Covariates included demographics, initial NIHSS, comorbidities, prior stroke history, tPA treatment status, pre-stroke disability, and pre-stroke cognition. The mortality model was also adjusted for DNR status. ResultsAt 90 days post-stroke, Black American individuals (BAs) (n = 122) had a median (IQR) NIHSS of 2 (1,6) compared to NIHSS of 1 (0,3) in non-Hispanic White American individuals (NHWs) (n = 795). BAs had a median (IQR) ADL/IADL score of 2.41 (1.50, 3.39) compared to 2.00 (1.27, 2.95) in NHWs. BAs scored a median of 84 (75, 92) on the 3MSE compared to NHWs’ score of 91.5 (83, 96). Death occurred in 23 (8%) of BAs and 268 (15%) of NHWs within 90 days among those who participated in baseline. After adjustment for covariates, functional outcomes at 90 days were worse in BAs compared to NHWs, with 15.8% (95% CI=5.2, 26.4) greater limitations in ADLs/IADLs and 43.9% (95% CI=12.0, 84.9) greater severity of stroke symptoms. Cognition at 90 days was 6.5% (95% CI=2.4, 10.6) lower in BAs compared to NHWs. BAs had a 35.4% lower (95% CI=-9.8, 61.9) hazard rate of mortality than NHWs. ConclusionsIn this prospective, population-based community sample, BAs had worse neurologic, functional and cognitive outcomes at 90 days compared to NHWs. Future research should investigate how social determinants of health including structural racism, neighborhood factors and access to preventive and recovery services influences these racial disparities.

Hospitalization patterns for adolescents with eating disorders during COVID-19

PurposeThe purpose of this study was to examine differences in clinical characteristics and hospital length of stay (LOS) for adolescents with eating disorders (EDs) requiring medical stabilization during the pre-COVID-19 and COVID-19 time periods.MethodsMedical record data were abstracted for patients with EDs hospitalized for medical stabilization between 1/1/2019–2/29/2020 (pre-COVID-19) and 3/1/2020–12/31/2021 (during COVID-19). Patient demographics, clinical characteristics and LOS were compared between COVID-19 eras. Patients were categorized as boarding if they remained hospitalized ≥ 1 day after medical stabilization. Multivariate negative binomial linear regression models were performed to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for factors related to increased LOS.ResultsOf the 467 admissions during this study, 120 were pre-COVID-19 and 347 were during COVID-19. Monthly admissions for EDs were higher during COVID-19 versus pre-COVID-19 (15.8 vs. 8.6, p = 0.001). On multivariate analysis, factors associated with increased LOS included admission during COVID-19 (IRR 1.27, 95% CI 1.15–1.40), p = 0.001), boarding (IRR 1.77, 95% CI 1.63–1.93, p = 0.001), public insurance (IRR 1.12, 95% CI 1.01–1.23, p = 0.032), nasogastric tube usage (IRR 1.62, 95% CI 1.48–1.76, p = 0.001), heart rate < 40 beats per minute (IRR 1.21, 95% CI 1.11–1.33, p = 0.001) and abnormal electrocardiogram (IRR 1.25, 95% CI 1.14–1.37, p = 0.001).ConclusionIn addition to clinical factors, we found that admission during COVID-19, boarding, and public insurance were associated with increased LOS among patients with EDs. There is a need for greater availability of ED treatment centers to care for patients with EDs after medical stabilization.

Effects of chiropractic use on medical healthcare utilization and costs in adults with back pain in Ontario, Canada from 2003 to 2018: a population-based cohort study

BackgroundAdults with back pain commonly consult chiropractors, but the impact of chiropractic use on medical utilization and costs within the Canadian health system is unclear. We assessed the association between chiropractic utilization and subsequent medical healthcare utilization and costs in a population-based cohort of Ontario adults with back pain.MethodsWe conducted a population-based cohort study that included Ontario adult respondents of the Canadian Community Health Survey (CCHS) with back pain from 2003 to 2010 (n = 29,475), followed up to 2018. The CCHS data were individually-linked to individual-level health administrative data up to 2018. Chiropractic utilization was self-reported consultation with a chiropractor in the past 12 months. We propensity score-matched adults with and without chiropractic utilization, accounting for confounders. We evaluated back pain-specific and all-cause medical utilization and costs at 1- and 5-year follow-up using negative binomial and linear (log-transformed) regression, respectively. We assessed whether sex and prior specialist consultation in the past 12 months were effect modifiers of the association.ResultsThere were 6972 matched pairs of CCHS respondents with and without chiropractic utilization. Women with chiropractic utilization had 0.8 times lower rate of cause-specific medical visits at follow-up than those without chiropractic utilization (RR5years = 0.82, 95% CI 0.68-1.00); this association was not found in men (RR5years = 0.96, 95% CI 0.73–1.24). There were no associations between chiropractic utilization and all-cause physician visits, all-cause emergency department visits, all-cause hospitalizations, or costs. Effect modification of the association between chiropractic utilization and cause-specific utilization by prior specialist consultation was found at 1-year but not 5-year follow-up; cause-specific utilization at 1 year was lower in adults without prior specialist consultation only (RR1year = 0.74, 95% CI 0.57–0.97).ConclusionsAmong adults with back pain, chiropractic use is associated with lower rates of back pain-specific utilization in women but not men over a 5-year follow-up period. Findings have implications for guiding allied healthcare delivery in the Ontario health system.

Several serum lipid metabolites are associated with relapse risk in pediatric-onset multiple sclerosis

Background: The circulating metabolome is altered in multiple sclerosis (MS), but its prognostic capabilities have not been extensively explored. Lipid metabolites might be of particular interest due to their multiple roles in the brain, as they can serve as structural components, energy sources, and bioactive molecules. Gaining a deeper understanding of the disease may be possible by examining the lipid metabolism in the periphery, which serves as the primary source of lipids for the brain. Objective: To determine if altered serum lipid metabolites are associated with the risk of relapse and disability in children with MS. Methods: We collected serum samples from 61 participants with pediatric-onset MS within 4 years of disease onset. Prospective longitudinal relapse data and cross-sectional disability measures (Expanded Disability Status Scale [EDSS]) were collected. Serum metabolomics was performed using untargeted liquid chromatography and mass spectrometry. Individual lipid metabolites were clustered into pre-defined pathways. The associations between clusters of metabolites and relapse rate and EDSS score were estimated utilizing negative binomial and linear regression models, respectively. Results: We found that serum acylcarnitines (relapse rate: normalized enrichment score [NES] = 2.1, q = 1.03E–04; EDSS: NES = 1.7, q = 0.02) and poly-unsaturated fatty acids (relapse rate: NES = 1.6, q = 0.047; EDSS: NES = 1.9, q = 0.005) were associated with higher relapse rates and EDSS, while serum phosphatidylethanolamines (relapse rate: NES = −2.3, q = 0.002; EDSS: NES = −2.1, q = 0.004), plasmalogens (relapse rate: NES = −2.5, q = 5.81E–04; EDSS: NES = −2.1, q = 0.004), and primary bile acid metabolites (relapse rate: NES = −2.0, q = 0.02; EDSS: NES = −1.9, q = 0.02) were associated with lower relapse rates and lower EDSS. Conclusion: This study supports the role of some lipid metabolites in pediatric MS relapses and disability.

Associations of Enlarged Perivascular Spaces With Brain Lesions, Brain Age, and Clinical Outcomes in Chronic Traumatic Brain Injury.

Enlarged perivascular spaces (ePVS) have been identified as a key signature of glymphatic system dysfunction in neurologic conditions. The incidence and clinical implications of ePVS after traumatic brain injury (TBI) are not yet understood. We investigated whether individuals with chronic moderate-to-severe TBI had an increased burden of ePVS and whether ePVS burden is modulated by the presence of focal lesions, older brain age, and poorer sleep quality. We examined whether an increased burden of ePVS was associated with poorer cognitive and emotional outcomes. Using a cross-sectional design, participants with a single moderate-to-severe chronic TBI (sustained ≥10 years ago) were recruited from an inpatient rehabilitation program. Control participants were recruited from the community. Participants underwent 3T brain MRI, neuropsychological assessment, and clinical evaluations. ePVS burden in white matter was quantified using automated segmentation. The relationship between the number of ePVS, group membership, focal lesions, brain age, current sleep quality, and outcome was modeled using negative binomial and linear regressions. This study included 100 participants with TBI (70% male; mean age = 56.8 years) and 75 control participants (54.3% male; mean age = 59.8 years). The TBI group had a significantly greater burden of ePVS (prevalence ratio rate [PRR] = 1.29, p = 0.013, 95% CI 1.05-1.57). The presence of bilateral lesions was associated with greater ePVS burden (PRR = 1.41, p = 0.021, 95% CI 1.05-1.90). There was no association between ePVS burden, sleep quality (PRR = 1.01, p = 0.491, 95% CI 0.98-1.048), and sleep duration (PRR = 1.03, p = 0.556, 95% CI 0.92-1.16). ePVS was associated with verbal memory (β = -0.42, p = 0.006, 95% CI -0.72 to -0.12), but not with other cognitive domains. The burden of ePVS was not associated with emotional distress (β = -0.70, p = 0.461, 95% CI -2.57 to 1.17) or brain age (PRR = 1.00, p = 0.665, 95% CI 0.99-1.02). TBI is associated with a greater burden of ePVS, especially when there have been bilateral brain lesions. ePVS was associated with reduced verbal memory performance. ePVS may indicate ongoing impairments in glymphatic system function in the chronic postinjury period.

Examining the Stand Level CO2 Fluxes of Spring Forest Geophytes

Spring forest ephemerals often create homogeneous patches in the understory; however, our knowledge about their stand level characteristics is deficient. Our aims were to examine, parallel to their phenology, the stand level Net Ecosystem CO2 Exchange (NEE) and evapotranspiration (ET) fluxes as well as the dependence of NEE on leaf area (LA), air temperature (Tair) and light (PPFD) in three spring forest geophytes that are widespread in Europe. Furthermore, we compared the leaf and stand level net photosynthesis. The methods used included open chamber measurements with an infrared gas analyser in permanent plots on a weekly basis. The results showed that the stand levels of all three species proved to be carbon sinks from the beginning of the vegetation period until the end of it or until the last phase of fruit formation. The largest amount of carbon sink was observed at the peak of blooming. A positive linear correlation was measured between NEE and PPFD as well as between NEE and LA, while a negative linear regression was measured between NEE and Tair. The remarkable carbon uptake capacity indicates the non-negligible role of geophyte vegetation in the carbon flux of temperate forests. In addition, the research provided new proof about the role of stand level operation, stability and regulation.

Determining Tipping Points and Responses of Macroinvertebrate Traits to Abiotic Factors in Support of River Management.

Although the trait concept is increasingly used in research, quantitative relations that can support in determining ecological tipping points and serve as a basis for environmental standards are lacking. This study determines changes in trait abundance along a gradient of flow velocity, turbidity and elevation, and develops trait-response curves, which facilitate the identification of ecological tipping points. Aquatic macroinvertebrates and abiotic conditions were determined at 88 different locations in the streams of the Guayas basin. After trait information collection, a set of trait diversity metrics were calculated. Negative binomial regression and linear regression were applied to relate the abundance of each trait and trait diversity metrics, respectively, to flow velocity, turbidity and elevation. Tipping points for each environmental variable in relation to traits were identified using the segmented regression method. The abundance of most traits increased with increasing velocity, while they decreased with increasing turbidity. The negative binomial regression models revealed that from a flow velocity higher than 0.5 m/s, a substantial increase in abundance occurs for several traits, and this is even more substantially noticed at values higher than 1 m/s. Furthermore, significant tipping points were also identified for elevation, wherein an abrupt decline in trait richness was observed below 22 m a.s.l., implying the need to focus water management in these altitudinal regions. Turbidity is potentially caused by erosion; thus, measures that can reduce or limit erosion within the basin should be implemented. Our findings suggest that measures mitigating the issues related to turbidity and flow velocity may lead to better aquatic ecosystem functioning. This quantitative information related to flow velocity might serve as a good basis to determine ecological flow requirements and illustrates the major impacts that hydropower dams can have in fast-running river systems. These quantitative relations between invertebrate traits and environmental conditions, as well as related tipping points, provide a basis to determine critical targets for aquatic ecosystem management, achieve improved ecosystem functioning and warrant trait diversity.