Positive Factor Research Articles

Distribution patterns, risk assessment and potential sources of heavy metals in sediment in the Qiongzhou Strait, China

Risk assessment and pollutant source analysis are crucial tools for the management and protection of coastal ecosystems. The distribution patterns, risk assessment, and potential sources of heavy metals (Cd, Cr, Fe, Ni, Cu, Zn, As, Hg, and Pb) in surface sediment were analyzed in the Qiongzhou Strait, China, in summer and autumn of 2022. Heavy metals in autumn showed higher ecological risk than that in summer. Seasonal shifts in ocean currents may result in variations in heavy metal accumulation and dispersion. Cd and Hg were the priority heavy metals found, and according to the Positive Matrix Factorization results, the study area contains five sources of pollution, with natural sources, shipping-related activities, and industrial activities being the primary contributors. This study indicated that pollutants from adjacent areas should be considered for managing the environmental quality of Qiongzhou Strait.

Risk analysis Erosive Tooth Wear (ETW): checklist for a quick assessment of the risk factors for ETW in the dental practice

Erosive Tooth Wear (ETW) is the loss of tooth structure without bacterial involvement. As the resulting loss of tooth structure is irreversible, an early evaluation of the multifactorial etiology, accurate diagnosis and regular follow-up are essential. The ETW is dynamic and its progression should be continuously monitored. A risk analysis table was developed to systematically record risk factors for ETW (Fig. 2). This allows ETW management to be integrated more efficiently into clinical practice and the progression to be documented over the years. If ETW is assumed, the risk analysis should be performed and updated at least every two years. In the assessment, risk-promoting and risk-inhibiting factors are marked, added together and compared. If the negative factors pre-dominate, measures should be taken to minimize the risk for ETW. The main purpose of the risk analysis is therefore to evaluate the individual etiology, coun-teract negative factors, promote positive factors and prevent progression.

Observation-constrained kinetic modeling of isoprene SOA formation in the atmosphere

Abstract. Isoprene has the largest global non-methane hydrocarbon emission, and the oxidation of isoprene plays a crucial role in the formation of secondary organic aerosol (SOA). Two primary processes are known to contribute to SOA formation from isoprene oxidation: (1) the reactive uptake of isoprene-derived epoxides on acidic or aqueous particle surfaces and (2) the absorptive gas–particle partitioning of low-volatility oxidation products. In this study, we developed a new multiphase condensed isoprene oxidation mechanism that includes these processes with key molecular intermediates and products. The new mechanism was applied to simulate isoprene gas-phase oxidation products and SOA formation from previously published chamber experiments under a variety of conditions and atmospheric observations during the Southern Oxidant and Aerosol Studies (SOAS) field campaign. Our results show that SOA formation from most of the chamber experiments is reasonably reproduced using our mechanism, except when the concentration ratios of initial nitric oxide to isoprene exceed ∼ 2, the formed SOA is significantly underpredicted. The SOAS simulations also reasonably agree with the measurements regarding the diurnal pattern and concentrations of different product categories, while the total isoprene SOA remains underestimated. The molecular compositions of the modeled SOA indicate that multifunctional low-volatility products contribute to isoprene SOA more significantly than previously thought, with a median mass contribution of ∼ 57 % to the total modeled isoprene SOA. However, this contribution is intricately intertwined with IEPOX-derived SOA (IEPOX: isoprene-derived epoxydiols), posing challenges for their differentiation using bulk aerosol composition analysis (e.g., the aerosol mass spectrometer with positive matrix factorization). Furthermore, the SOA from these pathways may vary greatly, mainly dependent on the volatility estimation and treatment of particle-phase processes (i.e., photolysis and hydrolysis). Our findings emphasize that the various pathways to produce these low-volatility species should be considered in models to more accurately predict isoprene SOA formation. The new condensed isoprene chemical mechanism can be further incorporated into regional-scale air quality models, such as the Community Multiscale Air Quality Modelling System (CMAQ), to assess isoprene SOA formation on a larger scale.

Insight Study of Trace Elements in PM2.5 During Nine Years in Delhi, India: Seasonal Variation, Source Apportionment, and Health Risks Assessment.

This study investigated the concentrations, seasonal variations, sources, and human health risks associated with exposure to heavy elements (As, Al, Pb, Cr, Mn, Cu, Zn, and Ni) of PM2.5 at an urban location of Delhi (28° 38' N, 77° 10' E; 218m amsl), India, from January 2013 to December 2021. The average mass concentration of PM2.5 throughout the study period was estimated as 127 ± 77µgm-3, which is exceeding the National Ambient Air Quality Standards (NAAQS) limit (annual: 40µgm-3; 24h: 60µgm-3). The seasonal mass concentrations of PM2.5 exhibited at the order of post-monsoon (192 ± 110 µgm-3) > winter (158 ± 70 µgm-3) > summer (92 ± 44 µgm-3) and> monsoon (67 ± 32 µgm-3). The heavy elements, Al (1.19µgm-3), Zn (0.49µgm-3), Pb (0.43µgm-3), Cr (0.21µgm-3), Cu (0.21µgm-3), Mn (0.07µgm-3), and Ni (0.14µgm-3) exhibited varying concentrations in PM2.5, with the highest levels observed in the post-monsoon season, followed by winter, summer, and monsoon seasons. Six primary sources throughout the study period, contributing to PM2.5 were identified by positive matrix factorization (PMF), such as dust (paved/crustal/soil dust: 29.9%), vehicular emissions (17.2%), biomass burning (15.4%), combustion (14%), industrial emissions (14.2%), and Br-rich sources (9.2%). Health risk assessments, including hazard quotient(HQ), hazard index(HI), and carcinogenic risk(CR), were computed based on heavy elements concentrations in PM2.5. Elevated HQvalues for Cr and Mn linked with adverse health impacts in both adults and children. High carcinogenic risk values were observed for Cr in both adults and children during the winter and post-monsoon seasons, as well as in adults during the summer and monsoon seasons. The combined HIvalue exceeding one suggests appreciable non-carcinogenic risks associated with the examined elements. The findings of this study provide valuable insights into the behaviour and risk mitigation of heavy elements in PM2.5, contributing to the understanding of air quality and public health in the urban environment of Delhi.

Prevalence and Factors Associated With Willingness to Sustain Pandemic-Induced Digital Work in the General Population and Moderating Effects of Screen Hours: Cross-Sectional Study.

The pandemic has accelerated digital work transformation, yet little is known about individuals' willingness to sustain such digital modes and its associated factors. A better understanding of this willingness and its drivers is crucial for guiding the development of future digital work infrastructure, training programs, and strategies to monitor and prevent related health issues. This study aims to quantify the general population's willingness to sustain pandemic-induced digital work, identify its associated factors, and examine how screen time moderates these relationships. A cross-sectional study was conducted targeting Hong Kong residents aged ≥18 years who have increased engagement in digital work since the pandemic. Data were collected through self-reported, web-based surveys. Descriptive statistics determined prevalence rates, while structured multiphase logistic regression identified associated factors and explored the moderating effects of screen hour levels. This unfunded study enrolled 1014 participants from May 2 to June 24, 2022, and completed data analysis within 3 months after data collection. A total of 391 (38.6%; 95% CI 35.6%-41.6%) participants expressed willingness to sustain digital work. Positive factors associated with this willingness included being an employee (odds ratio [OR] 3.12, 95% CI 1.59-6.45; P=.001), being health professionals (OR 3.32, 95% CI 1.49-7.82; P=.004), longer screen hours (OR 1.09, 95% CI 1.03-1.15; P=.002), and higher depression levels (OR 1.20, 95% CI 1.01-1.44; P=.04). Conversely, negatively associated factors included older age (OR 0.87, 95% CI 0.81-0.94; P=.001), extroversion (OR 0.66, 95% CI 0.51-0.86; P=.002), higher eHealth literacy (OR 0.96, 95% CI 0.93-0.98; P<.001), perceived greater susceptibility to COVID-19 (OR 0.84, 95% CI 0.74-0.96; P=.009), residence in a high-severity COVID-19 community (OR 0.73, 95% CI 0.63-0.84; P<.001), having infected individuals in the immediate social circle (OR 0.64, 95% CI 0.46-0.88; P=.006), higher BMI (OR 0.94, 95% CI 0.90-0.99; P=.02), feelings of being out of control (OR 0.96, 95% CI 0.93-0.98; P=.002), and higher fear of COVID-19 (OR 0.96, 95% CI 0.94-0.98; P=.001). In addition, a moderating effect of screen hour level (high: >8 h/d; low: ≤8 h/d) influenced the association among 10 factors related to willingness to sustain pandemic-induced digital work, including age, education level, household size, needs for regular medical care, BMI, frequency of both vigorous and moderate physical activities, perceived COVID-19 severity, immediate social circle COVID-19 presence, and fear of COVID-19 (all P values for interaction <.05). The substantial willingness of the general population to sustain digital work after the pandemic highlights the need for robust telework infrastructure, thorough monitoring of adverse health outcomes, and the potential to expand telehealth services among this group. The identification of factors influencing this willingness and the moderating role of screen hours inform the development of personalized strategies to enhance digital work acceptance where needed.

Spatial variability of pollution source contributions during two (2012–2013 and 2018–2019) sampling campaigns at ten sites in Los Angeles basin

This study assessed the spatial variability of PM2.5 source contributions across ten sites located in the South Coast Air Basin, California. Eight pollution sources and their contributions were obtained using positive matrix factorization (PMF) from the PM2.5 compositional data collected during the two sampling campaigns (2012/13 and 2018/19) of the Multiple Air Toxics Exposure Study (MATES). The identified sources were “gasoline vehicles”, “aged sea salt”, “biomass burning”, “secondary nitrate”, “secondary sulfate”, “diesel vehicles”, “soil/road dust” and “OP-rich”. Among them, “gasoline vehicle” was the largest contributor to the PM2.5 mass. The spatial distributions of source contributions to PM2.5 at the sites were characterized by the Pearson correlation coefficients as well as coefficients of determination and divergence. The highest spatial variability was found for the contributions from the “OP-rich” source in both MATES campaigns suggesting varying influences of the wildfires in the Los Angeles Basin. Alternatively, the smallest spatial variabilities were observed for the contributions of the “secondary sulfate” and “aged sea salt” sources resolved for the MATES campaign in 2012/13. The “soil/road dust” contributions of the sites from the 2018/19 campaign were also highly correlated. Compared to the other sites, the source contribution patterns observed for Inland Valley and Rubidoux were the most diverse from the others likely due to their remote locations from the other sites, the major urban area, and the Pacific Ocean.

The Intellectual Class and the Rise of German Cultural Nationalism

German cultural nationalism emerged in the context of the invasion of French culture. This cultural nationalism was different from the nationalism represented by Britain and France, which focused on the expression of nationalism from the cultural level, and made use of cultural connection and unity to achieve the establishment of a nation state. In the 17th and 18th centuries, French culture invaded Germany in all aspects, and the aristocrat and the middle classes of the German states were proud of speaking French, while German was neglected as a national language. Against the background of the political and economic unification of the German region, a group of Deutsch intellectuals began to actively propagate and promote the German culture and language, hoping to establish a unified German national identity from the cultural identity to complete the unification of the country, and to make the German state regain its historical glory. The subsequent historical development proved that German cultural nationalism became the foundation stone of German unification. After the Napoleonic Wars, German cultural nationalism was further transformed into German political democracy, and Prussia finally completed the unification. How did German cultural nationalism emerge from all this, and what was the role of the German intellectual class in it? By studying this period of history, this paper is able to further understand the intricate international context and international situation in Western Europe at that time. At the same time, it draws on the positive factors of German cultural development.

The Serological Evidence of Positive Rheumatoid Factor in Morphea Patients and Its Relation to Disease Severity

The Serological Evidence of Positive Rheumatoid Factor in Morphea Patients and Its Relation to Disease Severity

Characteristics and Effectiveness of Individual Psychotherapy for Palliative and End-of-Life Care: A Literature Review for Randomized Controlled Trials

Objective The introduction of psychotherapy in palliative and end-of-life care settings has become increasingly common and is effective in decreasing many psychological problems. This review reports the characteristics and effectiveness of individual psychotherapeutic interventions for patients receiving palliative and end-of-life care. In addition, the review reports the effectiveness of psychotherapies considering the expected life expectancy.Methods The PubMed, Google Scholar, and Cochrane Library databases were searched for English-language articles published between January 2000 to May 2023.Results Twenty-six studies were included and classified into a total of nine types of psychotherapies, namely, dignity therapy (DT), life review therapy, narrative therapy, managing cancer and living meaningfully (CALM), individual meaning-centered psychotherapy, meaning and purpose therapy, meaning-making therapy, meaning-of-life therapy, and cognitive therapy.Conclusion Most of the psychotherapies provided to patients receiving palliative and end-of-life care showed effectiveness in the reduction of negative emotions and positive factors related to end-of-life issues. Most studies targeted patients with advanced cancer; however, studies on DT did not limit the target group to patients with cancer. Considering the expected life expectancy, CALM was found to be suitable for patients receiving early palliative care.

Restricting the content of alcohol advertising and including text health warnings: A between-group online experiment with a non-probability adult sample in the United Kingdom.

Statutory options for restricting alcohol advertising include limiting it to product-orientated information and requiring health warnings. We assess the impact of removing positive contextual factors from alcohol advertising and including a health warning among adults in the United Kingdom (UK). We conducted a 2 × 2 online between-group experiment with adults (18+) (n = 2421) recruited from a non-probability research panel in the United Kingdom. Participants were randomized to see an alcohol (vodka) advertisement (advert) which varied by context (no context vs. imagery depicting positive social interactions around alcohol) and message (multiple text health warning vs. "drink responsibly"). The multiple text health warning, based on recent legislation in Ireland, comprised three separate warnings (liver disease, cancers, drinking during pregnancy) and a web address for alcohol-related information and support. The "drink responsibly" control reflected the self-regulatory messages commonly used by alcohol companies. Participants rated the advert on 7-point scales for advert attractiveness, product appeal, trial intentions, perceived harm, and whether it made drinking alcohol seem enjoyable. Removing the positive social context reduced positive advert and product reactions (difference in estimated marginal means [EMM]: -1.57 [makes drinking alcohol seem enjoyable] to -0.23 [intention to try]). Including the multiple text health warning also reduced positive advert and product reactions (difference in EMM: -0.55 [advert attractiveness] to -0.25 [intention to try]) and increased perceived product harm (difference in EMM: +0.25). There were no interactions between advert context and message for any outcome. Restricting content and including a multiple text health warning (compared to a "drink responsibly" message) may attenuate the persuasive impact of alcohol advertising and increase perceived product harm. Further research is needed to examine different degrees of content restrictions, alternative warning content and design, generalizability to different alcohol products and advert formats, and whether the impact of content controls varies among population subgroups.

#1098 Utilizing a novel individual patient performance score for mortality prediction in hemodialysis patients

Abstract Background and Aims Chronic kidney disease (CKD) management has advanced significantly over recent years, yet mortality rates among hemodialysis (HD) patients remain high. This study aims to assess the impact of changes in an individualized patient performance score (IPPS) on survival in a large cohort of HD patients. Method This multicentre, observational, prospective cohort study included HD patients across 19 countries, starting from January 1st, 2022. We followed these patients for one year, categorizing them based on their survival status at year's end. We calculated the mean IPPS monthly, from June to December 2021, and divided the patients into tertiles based on their December 2021 scores. Subsequently, we formed five groups based on their IPPS dynamics over six months. We used Kaplan-Meier and Cox regression analyses to evaluate survival, presenting the results as hazard ratios (HR) and 95% confidence intervals (95% CI). A p-value below 0.05 was considered statistically significant. The IPPS, ranging from 0 to 100, was calculated based on eight key performance areas, with higher scores indicating better medical performance: Vascular Access (20 points): type of vascular access, episodes of thrombosis and infection); HD adequacy (20 points): eKt/V, blood flow and treatment time; Anemia (20 points): hemoglobin concentration, transferrin saturation, ferritin; Arterial hypertension (10 points): mean arterial pressure; Mineral Bone disease (15 points): iPTH, plasmatic phosphorus and calcium; Fluid status (5 points): percentage of interdialytic fluid gain; Nutrition (5 points): plasmatic albumin and phosphorus and Others (5 points): influenzae vaccination, transplantation status and hospitalization events. The final score is obtained by the weighted sum of positive clinical factors, subtracted from the weighted sum of negative clinical factors and is reported as a number ranging from 0 to 100, with a higher score representing a better medical performance. Results The study included 10 458 HD patients. In the survival analysis, a significant increase in mortality odds was observed in patients with a stable IPPS of 72 or lower, compared to those with a score consistently above 86. Patients transitioning from the lowest to the highest tertile in six months had a mortality HR similar to those consistently in the highest tertile. On the other hand, patients showing a decrease in IPPS score from the highest to the lowest tertile in the same period had a mortality HR similar to the intermediate group (Table 1). Conclusion A lower total IPPS score (&amp;lt;72) was associated with a threefold increase in mortality risk compared to scores above 86. An increase in IPPS from the lowest to the highest tertile correlated with a significant reduction in mortality, equating to the survival rates of patients consistently scoring high. These findings underscore the potential of IPPS as a valuable tool for guiding clinical interventions in the HD population to enhance patient survival.

Natural background levels, source apportionment and health risks of potentially toxic elements in groundwater of highly urbanized area

Identifying the natural background levels (NBLs), threshold values (TVs), sources and health risks of potentially toxic elements in groundwater is crucial for ensuring the water security of residents in highly urbanized areas. In this study, 96 groundwater samples were collected in urban area of Sichuan Basin, SW China. The concentrations of potentially toxic elements (Li, Fe, Cu, Zn, Al, Pb, B, Ba and Ni) were analyzed for investigating the NBLs, TVs, sources and health risks. The potentially toxic elements followed the concentration order of Fe > Ba > B > Al > Zn > Li > Cu > Ni > Pb. The NBLs and TVs indicated the contamination of potentially toxic elements mainly occurred in the northern and central parts of the study area. The Positive Matrix Factorization (PMF) model identified elevated concentrations of Fe, Al, Li, and B were found to determine groundwater quality. The primary sources of Fe, Al, Pb, and Ni were attributed to the dissolution of oxidation products, with Fe additionally affected by anthropogenic reduction environments. Li and B were determined to be originated from the weathering of tourmaline. High levels of Ni and Cu concentrations were derived from electronic waste leakage, while excessive Ba and Zn were linked to factory emissions and tire wear. The reasonable maximum exposure (RME) of hazard index (HI) was higher than safety standard and reveal the potential health risks in the southwestern study area. Sensitivity analysis demonstrated the Li concentrations possessed the highest weight contributing to health risk. This study provides a valuable information for source-specific risk assessments of potentially toxic elements in groundwater associated with urban areas.

Prognostic and Predictive Significance of HER2-low Expression in Metastatic Hormone Receptor Positive Breast Cancer Patients Receiving CDK4-6 Inhibitor Therapy

Objective: This study aimed to analyze the predictive and prognostic value of HER2-low expression in hormone receptor (HR) positive human epidermal growth factor receptor-2 (HER2) negative metastatic breast cancer patients receiving cyclin-dependent kinase-4/6 inhibitor (CDK4/6i) therapy. Methods: This retrospective study included patients who received CDK4/6i plus endocrine therapy (ET). The pathological and clinical characteristics and survival times of the patients were compared and analyzed. Results: Our study included 122 patients. There were HER2-zero 88(72%) and HER2-low 34 (28%) patients. The median progression free survival (mPFS) of all patients who received CDK4/6i+ET was 21 (95% confidence interval (CI),18.5–23.5) months, while mPFS was not reached in the HER2-zero group, and mPFS in the HER2-low group was 12 (95%CI, 6.8–17.1) months (p=0.001). The mPFS was shorter in patients with primary endocrine resistance (6 vs. 21 months, p=0.001). There was a change in the HER2-low status of 26(45%) patients with recurrence compared to the first biopsy. In the HER2-zero and HER2-low groups, 22(25%) and 24(71%) patients, respectively, progressed with CDK4/6i+ET (p=0.001). Estrogen receptor (ER) levels less than and greater than 50% resulted different mPFS (6 and 21 months, respectively) (p=0.025). Median PFS differed based on CDK4/6i+ET combination, treatment line, and best treatment response (all p=0.001). In multivariate analysis, HER2 status(p=0.018), chemotherapy status(p=0.006), best response status with CDK4/6i (p=0.001) for PFS, and best response status with CDK4/6i therapy (p=0.007) for OS were significant. Conclusions: In patients with HR+HER- metastatic breast cancer receiving CDK4/6i therapy, the duration of mPFS was lower in the HER2-low group than that in the HER2-zero group. HER2-low expression is a predictive biomarker of response to CDK4/6 inhibitor therapy.

Psychological health status of Chinese university students: based on Psychological Resilience Dynamic System Model

IntroductionThe mental health of unverisity students is influenced by diverse factorsis multifaceted, requiring further investigation to evaluate its current status and determinants. The present study aims to address this gap by targeting Chinese university students and employing the Psychological Resilience Dynamic System model. Through a questionnaire survey, this research endeavors to explore the mental health status and influencing factors. Ultimately, the findings of this study aim to provide a theoretical basis and tailored practical guidance for the development of mental health intervention strategies for university students.MethodsBased on the Psychological Resilience Dynamic System Model, the mental health status of 3,390 Chinese university students from 15 universities was empirically investigated with the principle of stratified sampling and the geographical distribution and disciplinary diversity of universities. The questionnaires used included Kessler psychological distress scale, psychological resilience scale,positive psychological capital scale, family hardiness index and social support scale. Among the participants, 47.85% were male and 52.15% were female. Regarding the origin, 42.89% of the students were from rural areas, while 57.11% were from urban areas.ResultsKey findings unveil: (1) A prevalence of 24.54% in students has suboptimal mental health, with 18.70 and 5.84%, respectively, representing those with poor and relatively poor mental health conditions; (2) A noteworthy negative correlation (p &amp;lt; 0.01) between mental health scores of university students and nine pivotal factors, including psychological resilience, self-efficacy, optimism, hope, resilience, family resilience, objective support, subjective support, and support utilization; (3) Eight factors, including grade, family economic status, psychological resilience, self-efficacy, optimism, family resilience, objective support, and support utilization, emerge as significant predictors of university students’ mental health (p &amp;lt;0.001), collectively elucidating 57.9% of the total variance in mental health.DiscussionThe aforementioned research results, indicate that the influencing factors on the mental health of university students encompass four main aspects. These include individual demographic factors such as grade and family economic status, positive psychological capital factors such as psychological resilience, self-efficacy, optimism, hope, and resilience, family resilience factors including responsibility, control, and challenge, and societal support factors including objective support, subjective support, and support utilization. Based on this, this paper focuses on four recommendations: giving full play to the leading role of universities in mental health education and stress intervention, strengthening the educational power of positive family ideals and role modeling, building a support system for positive social atmosphere and psychological counseling, and improving the self-shaping ability of university students’ psychological resilience and positive psychological capital. These recommendations aspire to better promote the mental health of university students and provide a strength reserve for psychological problem intervention.

#2622 Very late renal recovery in patient with light chain cast nephropathy: the prognostic value of renal biopsy

Abstract Background and Aims Renal biopsy is not necessary to assess LCCN (Light Chain Cast Nephropathy) in patients with laboratory features suggestive of the disease. However, it has been shown that the histological picture often correlates with renal outcome. We present the case of a 55-year-old man with no significant previous medical history that was evaluated in the emergency department for a stage 3 AKI (sCr 17.3 mg/dl, eGFR 3 ml/min/1.73 m2). Laboratory tests showed a Lambda Micromolecular Myeloma (K chains 44.6 mg/l, λ 4160 mg/l and K/ λ 0.01); Bence Jones not evaluable due to anuria. Bone marrow plasmacytosis was 70%. Method The patient started chemotherapy with Bortezomib and Dexamethasone and hemodialysis thrice a week with a PMMA hemofilter in order to improve the FLC (Free Light Chain) removal rate. After three months of treatment the patient achieved a complete hematologic response but he didn't reach any renal response. In order to assess a more precise renal prognosis a kidney biopsy was performed. The histopathological exam showed a Cast Nephropathy (&amp;lt; 5 casts/mm2) associated with low grade interstitial fibrosis and tubular atrophy (IFTA +1). After 5 cycles with Bortezomib and Dexamethasone, one year after onset, the patient underwent ASCT (Autologous Stem Cell Transplantation). Results In the following months, a progressive increase in renal function allowed us to perform a gradual reduction of dialysis rate, until discontinuation occurred 16 months after disease onset. To date, three years after onset, complete hematologic and renal remission persists with an eGFR of 20 ml/min/1.73 m2. Conclusion Renal biopsy, performed even several months after disease onset, could play a pivotal role in cases of LCCN with a discordance between hematologic and renal response. A low cast number and low IFTA grade are known to be positive prognostic factors for renal outcome and they can predict a renal recovery that sometimes could be exceptionally late.

The Impact of Physical, Financial, and Psychological Factors on Elderly Life Satisfaction

This study aims to enhance the life satisfaction of the elderly population in South Korea by exploring their satisfaction levels and identifying influencing factors. Utilizing data from the 17th Korean Welfare Panel, which includes 6,260 individuals aged 65 and older, this study employs independent sample t-tests, one-way ANOVA, and hierarchical regression analysis. The results showed that, in general, the life satisfaction of the elderly population was somewhat lower than that of the general adult population in all areas, except for job satisfaction and satisfaction with housing. Key factors influencing life satisfaction among the elderly population include demographic characteristics (gender, age, economic activity, residence, education level), subjective health status factors, financial factors (disposable income, monthly living expenses), and psychological factors (depression, self-esteem). Notably, psychological factors, particularly self-esteem and depression, profoundly affect all life satisfaction domains. Enhancing life satisfaction necessitates fostering positive self-perception and capabilities in the elderly population, suggesting the need for programs focused on positive emotional experiences. Moreover, depression significantly reduces life satisfaction, underscoring the importance of policy interventions to address negative emotions in this demographic. This study is expected to provide basic data for establishing concrete and effective policies for improving the quality of life for the elderly population. Additionally, by highlighting the importance of positive psychological factors, it is anticipated that the study will offer a new direction for improving the life satisfaction of the elderly population.

#1030 Addressing the unmet need of patient reported outcomes in ANCA associated vasculitis, in routine clinical practice

Abstract Background and Aims ANCA associated vasculitis (AAV) is associated with increased morbidity. Recent years has seen improvement in clinical outcomes yet little work has been done to better understand the patient's role within this condition. Patient reported outcome measures (PROMs) are increasingly standard in clinical research outcomes, as well as an overall indicator for good quality patient care. With the exception of Robson et al AAV-PRO [1], little research has been done to develop validated disease specific tools for patients living with AAV. We aim to develop a disease specific tool that can be used in clinical practice to aid patients and clinicians in understanding and track changes in health-related quality of life (HRQoL) over time. Method AAV patients from a single centre were invited to take part in focus groups conducted using a semi-structured topic guide. Participants were asked to discuss topics relating to four broad areas; 1) the effects of AAV on everyday life and living, 2) the effects of treatment on everyday life and living, 3) the role of patients in health management and the patient experience 4) a review of existing generic and disease specific PROM tools (SF-36 and AAV-PRO). Audio transcript of each focus group was transcribed verbatim and data was analysed using a combination of inductive and deductive framework analysis [2]. Results Twenty-eight patients with AAV were invited to participate, 19 attended one of three, 2.5 hour focus groups, 2 patients failed to attend, 4 declined and 3 were unavailable. The mean age of participants was 66.6 +9.4 years and there was a near equal male to female split (10:9). The median time from diagnosis as 7.4 years. Three participants had active or newly diagnosed AAV with BVAS scores of &amp;gt;10. Five participants had previously required dialysis with 1 receiving a renal transplant. All participants received glucocorticoid and immunosuppressive therapy (cyclophosphamide and or Rituximab), 15 (78.9%) were still receiving immunotherapy. Full analysis of the qualitative data is being undertaken. Preliminary findings outlined what was most important to participants when considering HRQoL. Areas acknowledged included; self-identity, social roles e.g. fulfilling caring responsibilities, fears of relapse and disease and treatment burden. Fifty-six deductive and inductive codes were identified which have been further categorised. Participants felt existing tools lacked consideration of some key issues. Scoring systems were considered to be negativity worded e.g. mild, moderate, severe, with the term ‘none’ being the only positive option. Participants reported that existing tools overlooked positive factors which impact HRQoL, such as symptom validation, close clinician monitoring and improvement with treatment. Limitations were noted when trying to address transient or inconsistent symptoms and difficulty separating vasculitis from other health conditions when answering questions. Participants expressed a preference for using a PROM as part of their clinical care and felt that completing it prior to clinic would be most helpful and facilitate discussions with healthcare professionals. The use of an electronic-PROM was widely supported and would support clinicians and patients to monitor changes over time. Conclusion The AAV-PRO represents a significant advancement over generic tools such as the SF-36, however, existing PROMs are not without limitations and are primarily used in research practices. Our study revealed that patients desire active participation in HRQoL discussions and further work to incorporate this into the clinic setting is needed. We are continuing to develop a PROM tool that can be used to assess patients HRQoL in relation to their AAV in the outpatient setting. We believe this will allow a deeper understanding of the disease burden and could support a comprehensive, patient-centred approach to decision-making, offering new insights and identifying the need for supportive care. On a broader scale, these insights can be utilized to compare treatments, shed light on inequalities and facilitate enhancements in services.

The Utility of International Negotiation: Four Hundred Years of Attempts to Negotiate Political and Diplomatic Stability

Abstract This article examines the challenges to international negotiation processes in a world where attempts have been made to create order, but, at present, disorder is on the rise again. Several historical cases are analyzed and compared to detect both positive and negative factors influencing the utility of negotiation processes as an instrument of conflict management and international governance. How has mankind managed to use negotiation as an alternative to warfare? What are the conditions for negotiation effectiveness? What is the utility of negotiation if the context is not ripe for solving problems in a peaceful way? What does history tell us about the ways to deal with interstate wars in the 21st century?

Deciphering Mean Flow-Eddy Interaction in Pacific-North American Teleconnection Linked to Storm Tracks at Subseasonal Timescale

Abstract The features of large-scale atmospheric circulations, storm tracks, and the mean flow-eddy interaction during winter Pacific-North American (PNA) events are investigated using National Centers for Environmental Prediction-National Center for Atmospheric Research (NCEP-NCAR) reanalysis data at subseasonal timescale from 1979 to 2022. The day-to-day variations of storm-track activity and stream function reveal that storm-track activity varies along the evolution of mean flow. To better understand storm track variability with the mean flow-eddy interaction, further exploration is made by analyzing local energy energetics. The changes in horizontal and vertical baroclinic energy conversions from background flow correspond to the storm track anomalies over the North Pacific, indicating that the anomalies in storm tracks are due to the anomalous mean flow associated with PNA patterns impacting energy conversion through mean flow-eddy interaction. Eddy feedback driven by vorticity and heat fluxes is analyzed. This provides a concrete illustration of how eddy feedback serves as a positive factor for the upper-tropospheric circulation anomalies associated with the PNA pattern.

An attainable site suitability index for utility-scale solar facilities

Large, utility-scale solar energy facilities are increasingly being deployed throughout the United States, with nearly 10 000 projects over 1 megawatt completed by the end of 2023. One understudied aspect of the decision making process for these solar projects concerns site suitability. The current body of literature on this topic has identified core infrastructure, such as substations or transmission lines, as important in this process, yet other variables serve as potentially important drivers. This research aims to provide policymakers, planners, and regulators with a practically applicable method to better identify areas that are suitable candidates for such solar facilities. In particular, this paper develops a replicable method that produces a site suitability index that accounts for a suite of variables that are considered key, positive factors in where solar facilities ought to locate, including: (1) economic factors; (2) critical infrastructure and high energy users; and (3) workforce. Ultimately, our work is valuable to government and local officials such as policymakers and planners with limited resources and in-house capacity to understand the suitability for energy infrastructure. In fact, providing an attainable index for the site suitability of utility-scale solar facilities reduces the burden on policy and planning related stakeholders to understand the competitive advantage of their regions and to convey it to interested developers.