Post Hoc Research Articles

Convenience behavior in German university students is associated with sociodemographic, study- and health-related factors.

The transition from school to university is often accompanied by a change in students' lifestyles. So far little is known whether convenience behavior is an essential factor affecting students' health and social interaction. In a heterogeneous population regard to sociodemographic and anthropometric characteristics the Convenience Behavior Questionnaire (CBQ) showed a better relationship between convenience-related behavior with overweight and obesity than established questionnaires. Here we assessed convenience behavior in a large well characterized cohort of university students and its association with health-related (mainly sedentary behavior and physical activity), study-related and sociodemographic factors with the Convenience Behavior Questionnaire (CBQ). A total of 4,351 students participated in an online survey, of which 3,983 (23.6 ± 5.3 years old, 71.3% females) answered the questions concerning convenience behavior. A low value in the CBQ indicates more convenience behavior [Convenience Behavior Index (CBI) range: 3-15]. Differences with regard to sociodemographic (age, gender, body mass index), study-related (semester, degree, field of study) and health-related (physical activity, sedentary behavior) variables were examined with Mann-Whitney-U test or Kruskal-Wallis test and post-hoc tests (Bonferroni). The CBI of men and women differed significantly (z = -6.847, p < 0.001, r = 0.11). First-year students and students beyond their first year showed significant differences (z = -2.355, p ≤ 0.05, r = 0.04). Differences were also found in the field of study (Chi2 (6) = 147.830, p < 0.001) and the targeted degree (Chi2 (7) = 79.985, p < 0.001). Furthermore, differences were found in the body mass index (Chi2 (5) = 70.678, p < 0.001), physical activity (Chi2 (2) = 279.040, p < 0.001) and sedentary behavior (z = -4.660, p < 0.001, r = 0.07). The results showed risk groups of convenience behavior among students [men, first-year, students enrolled in "Science, Technology, Engineering and Mathematics (STEM)," bachelor]. Our results confirm for the first time in a very homogeneous population a gender difference and an association between CBI and health-related factors. Further studies are needed to analyze the health behavior of students in more detail, especially their convenience behavior.

The decomposition rate and bleaching efficacy of in-office bleaching gels with different pHs: a randomized controlled trial.

To evaluate the decomposition rate of active hydrogen peroxide (HP) and bleaching efficacy during in-office bleaching using high-concentration HP gels with different pHs. A randomized, parallel, double-blind controlled trial was conducted with 40 volunteers randomized into four groups (pH 5.4; pH 7.0; pH 7.7, and pH 8.0). During the first session in-office bleaching, approximately 0.01g of the gel was collected and titrated with potassium permanganate to obtain the concentration of active HP and pH values were measured using an electrode. Bleaching efficacy was assessed using a spectrophotometer [∆Eab, ∆E00, and WID], Vita Classical and Vita Bleachedguide scales [∆SGU]. The decomposition rate of HP concentration and pH values change were calculated using ANOVA one-way. The bleaching efficacy was assessed using two-way repeated measures ANOVA. Tukey's test was applied as a post-hoc test (p < 0.05). All gels experienced decreasing HP concentration over time. pH 5.4 gel showed greatest reduction after 50min (p < 0.001). pH 8.0 and 7.7 gels remained stable; pH 5.4 remained acidic, while pH 7.0 turned acidic (p < 0.001). No significant difference in bleaching degree was observed among gels. They all showed a similar and clinically important color change after two clinical sessions, remained stable 1-month post-treatment (p > 0.05). All bleaching gels kept at least 70% of their HP content after 50min, suggesting that there is a surplus of HP. They provided similar whitening efficacy 1-month after bleaching. It is possible that lower HP concentrations may be equally effective in achieving desired results while reducing the potential for side effects. RBR-35q7s3v.

Push-Out Bond Strength of Fiber Posts to Overflared Root Canals in Different Root Regions: Effect of Reinforcement Techniques.

Objectives: This study aimed to investigate the effect of different reinforcement techniques on the push-out bond strength of fiber posts to over-flared root canals. Materials and Methods: Forty-eight extracted human single-canal premolars were endodontically treated, over-flared, and randomly divided into four groups (N=12) including SARC: luting with self-adhesive resin cement, DCC: luting with dual-cure core build-up resin composite, CRR: relining root canal walls with bulk-fill resin composite, and DAP: relining fiber post with bulk-fill resin composite. After 24 hours, the roots were sectioned to obtain three cervical, middle, and apical 3mm slices. The push-out test was performed and failure pattern was examined. Kruskal-Wallis and post-hoc Dunn-Bonferroni tests were used for statistical analysis (P<0.05). Results: In all three regions, the lowest and highest bond strength was found in the SARC and DAP groups, respectively. In the middle region, there was a statistically significant difference between the bond strength of the SARC group and that of the DCC (P=0.044), CRR (P=0.021), and DAP (P<0.001) groups. There was no significant difference in the apical region. The lowest bond strength was observed in the apical region, and the highest was related to the cervical region. Adhesive failure was the most common failure pattern in all groups. Conclusion: Based on our results DCC, CRR and DAP methods increased bond strength in the middle and cervical sections of over-flared root regions. Considering that DCC is the easiest and most practical method, we propose that CRR and DAP can be replaced with this method in clinical procedures.

Visually induced vertical vergence as a motion processing biomarker associated with postural instability

The present study explored visually induced vertical vergence (VIVV) as non-specific motion processing response. Healthy participants (7 male, mean age 28.57 ± 2.30; 9 female, mean age 27.67 ± 3.65) were exposed to optokinetic stimuli in an HTC VIVE virtual reality headset while VIVV, pupil-size, and postural sway was recorded. The methodology was shown to produce VIVV in the roll plane at 30 deg/s. Subsequent trials consisted of 40 s optokinetic motion in yaw, pitch, and roll directions at 60 deg/s, and radial optic flow; optokinetic directions were inverted after 20 s of motion. Median VIVV amplitude changes were normalized to the clockwise roll rotation, analysed, and correlated with changes in pupil-size and body sway. VIVV, pupil-size, and body sway were all affected by changes in optokinetic direction. Post-hoc analyses showed significant VIVV responses during optokinetic yaw and pitch rotations, as well as during radial optic flow stimulations. VIVV magnitudes were universally correlated with pupil-size and body sway. In conclusion, VIVV was expressed in all tested dimensions and may consequently serve as a visual motion processing biomarker. Failing to support binocularity while responding to optokinetic directionality, VIVV may reflect an eye-movement response associated with increased postural instability and stress, similar to a dorsal light reflex.

Subgroup analyses from patients with pre-treated metastatic colorectal cancer receiving trifluridine/tipiracil: results of the TALLISUR trial

BackgroundIn the pivotal phase III RECOURSE trial, trifluridine/tipiracil (FTD/TPI) improved progression-free and overall survival (PFS, OS) of patients with pre-treated metastatic colorectal cancer (mCRC). Subsequently, the TALLISUR trial provided post-authorisation efficacy and safety data and patient-reported outcomes on quality of life (QoL) in a German patient cohort. The present analysis reports the final data on efficacy, safety and QoL and investigates the impact of baseline characteristics and associated prognostic subgroups on outcome.MethodsIn this prospective, multi-centre, Germany-wide, phase IV study, patients with pre-treated mCRC were given the choice to receive either FTD/TPI or best supportive care (BSC). To assess the primary endpoint, QoL, EORTC QLQ-C30 questionnaires were employed. Secondary endpoints included QoL assessed through EQ-5D-5L questionnaires, OS, PFS and safety. Additionally, 3 subgroups were defined according to a post-hoc analysis of the RECOURSE trial: best, good and poor prognostic characteristics (BPC, GPC, PPC). Patients with < 3 metastatic sites at inclusion and/or ≥ 18 months from diagnosis to inclusion were considered to have GPC. GPC patients without liver metastasis at inclusion were considered to have BPC. All remaining patients were considered to have PPC.ResultsOf 195 patients, 186 decided to receive FTD/TPI and 9 to receive BSC. The low number of patients in the BSC-arm did not allow statistically meaningful analyses. Treatment with FTD/TPI was associated with maintained QoL. For all patients, median OS was 6.9 months (95% CI 6.1 – 8.3) and for the defined subgroups (BPC n = 20 vs GPC n = 65 vs PPC n = 121) 12.2, 7.9 and 6.8 months (95% CI 6.0 – 18.2, 6.2 – 13.3, 5.4 – 8.1). The most frequent TEAEs were neutropenia (29.6%), anaemia (24.7%) and nausea (23.7%). Febrile neutropenia occurred in 1.1%.ConclusionsTreatment of patients suffering from pre-treated mCRC with FTD/TPI was associated not only with prolonged survival and delayed progression, but also with maintained QoL. Independent of other baseline characteristics such as ECOG performance status and age, low metastatic burden and indolent disease were factors associated with favourable outcome.Clinical trial registrationEudraCT-Number 2017–000292-83, first registration 19/06/2017.

Comparison of remimazolam and midazolam for sedation during colonoscopy in Japanese patients: A propensity score matching analysis.

To compare the efficacy and safety of sedation with midazolam and remimazolam for colorectal endoscopy. This single-center, two-arm, post-hoc analysis of the REM-IICTJP01 study investigated the efficacy and safety of remimazolam for gastrointestinal endoscopic sedation. We enrolled 40 and 208 patients who underwent colonoscopy under remimazolam and midazolam sedation, respectively, during the same period. The primary outcome was the time from the end of the colonoscopy until discharge. The secondary outcomes included the time from the end of the colonoscopy until awakening, dosage, and adverse events. Propensity score matching was employed to eliminate the effect of confounding factors. Thirty-seven patients in each group were matched. After propensity matching, the time to awakening after colonoscopy was 28.0 (13.0-37.0) min in the midazolam group and 0 (0-0) min in the remimazolam group; moreover, the time till discharge was 40.0 (35.0-46.5) min in the midazolam group and 0 (0-5.0) min in the remimazolam group, both of which were significantly shorter in the remimazolam group (p < 0.01). The number of additional doses was 0 (0-0) and 2 (1-3) in the midazolam and remimazolam groups, respectively. The total dose was 2.0 (2.0-3.5) and 6.0 (5.0-7.0) mg in the midazolam and remimazolam groups, respectively. Remimazolam yielded significantly faster times to awakening and discharge safely compared to midazolam.

Promoting walking as a self-care strategy in women with fibromyalgia: a cross‑sectional study using accelerometers.

Walking is a beneficial healthy lifestyle for fibromyalgia patients as it reduces the intensity of pain and fatigue experienced and improves quality of life. In this context, self-efficacy and commitment are potential predictors of walking for women with fibromyalgia. Present study aims at examining the moderation role of exercise commitment in the association between self-efficacy for walking and walking behavior in this population. It is a cross‑sectional study. A total of 132 women with fibromyalgia participated (mean age = 57.63, SD = 10.44) between January and December 2018. Self-efficacy about walking was assessed through Spanish version of self-efficacy scale for physical activity scale (SEPAS) and exercise commitment through ad-hoc questionnaire (two Likert-type items about the committed action of physical activity). Walking behavior was measured using accelerometers for seven consecutive days. Pain and fatigue prior to placement of the accelerometer were evaluated as possible covariates. Regarding medical history, time since onset of symptoms (i.e. pain, fatigue) and since diagnosis, and medication were also assessed as possible covariates. A moderation effect of exercise commitment was found in the relationship between self-efficacy on walking behavior (B = 10.48, p = .021, 95%, CI = 0.61 to 6.79). Post-hoc analyses showed a significant and positive relationship between self-efficacy and walking only with high commitment to physical activity (t = 10.08, p = .027, 95%, CI = 3.77 to 5.64). Self-efficacy for walking and commitment should be assessed and potentially targeted when focusing on increasing walking in women with fibromyalgia. Key Points • Associations between walking self-efficacy and exercise engagement provide indications of modifiable targets for promoting an active lifestyle in fibromyalgia. • When patients feel engaged in their physical exercise pattern (walking), patients feel more able to perform the behavior. • Rehabilitation interventions, focused on chronic pain, should contemplate the promotion of self-efficacy and engagement.

Influence of the activation time of magnesium surfaces on the concentration of active hydroxyl groups and corrosion resistance

Magnesium alloys have been extensively studied as degradable biomaterials for clinical applications due to their biocompatibility and mechanical properties. However, their poor corrosion resistance can lead to issues such as osteolysis and the release of gaseous hydrogen. This study investigated the influence of the activation time of magnesium surfaces in a sodium hydroxide (NaOH) solution on the concentration of active hydroxyl groups and corrosion resistance. The results indicated that immersion time significantly influences the formation of a corrosion-resistant film and the distribution of surface hydroxyl groups. Specifically, specimens treated for 7.5 h exhibited the highest concentration of hydroxyl groups and the most uniform oxide film distribution. Electrochemical tests demonstrated capacitive behavior and passive surface formation for all evaluated times, with the 7.5-h immersion in NaOH yielding superior corrosion resistance, lower current density, and a more efficient and thicker protective film. SEM and EDS analyses confirmed increased formation of Mg(OH)₂ for samples treated for 5 and 7.5 h, while a 10-h treatment resulted in a brittle, porous layer prone to degradation. Statistical analysis using ANOVA and Fisher's LSD test corroborated these findings. The optimal 7.5-h alkali treatment enhanced magnesium's corrosion resistance and surface properties, making it a promising candidate for orthopedic implants. However, further studies are necessary to assess biocompatibility and physiological responses before clinical implementation.

Prognostic impact of quantitative flow ratio (QFR)-consistent complete revascularization in patients with myocardial infarction and multivessel coronary artery disease

Complete revascularization is associated with improved outcomes in patients with myocardial infarction and multivessel coronary artery disease. Quantitative flow ratio (QFR) represents an emerging angiography-based tool for functional lesion assessment. The present study investigated the prognostic impact of QFR-consistent complete revascularization in patients with myocardial infarction and multivessel disease. A total of 792 patients with myocardial infarction and multivessel disease were enrolled in the analysis. Post-hoc QFR analyses of 1320 non-culprit vessels were performed by investigators blinded to clinical outcomes. The primary endpoint was a composite of all-cause death, non-culprit vessel related non-fatal myocardial infarction, and ischemia-driven revascularization at two years after index myocardial infarction. Patients were stratified into a QFR-consistent PCI group (n=646) and a QFR-inconsistent PCI group (n=146), based on whether the intervention was congruent with the QFR-determined functional significance of the non-culprit lesions. The primary endpoint occurred in a total of 22 patients (3.4%) in the QFR-consistent PCI group and in 27 patients (18.5%) in the QFR-inconsistent group (HR 0.17, 95%CI 0.10-0.30, p<0.001).The difference in the primary endpoint was driven by reduced rates of non-fatal myocardial infarction (2.0% vs. 15.1%; HR 0.13, 95%CI 0.06-0.25; p<0.001) and ischemia-driven revascularization (1.2% vs. 5.5%; HR 0.21, 95%CI 0.08-0.57; p=0.001) in the QFR-consistent PCI group. Among patients with myocardial infarction and multivessel disease, a QFR-consistent complete revascularization was associated with a reduced risk of all-cause mortality, non-fatal myocardial infarction, and ischemia-driven revascularization. These findings underline the value of angiography-based functional lesion assessment for personalized revascularization strategies.

Re-evaluating Methods for Assessing Differences in Response in Ileal vs. Colonic Crohn's Disease: A Post-hoc Analysis of the FITZROY Trial.

The ileum is the most commonly affected segment of the gastrointestinal tract in Crohn's disease (CD). We aimed to determine whether disease location affects response to filgotinib, a Janus kinase (JAK) inhibitor, in patients with moderate-to-severely active Crohn's disease (CD) and applying appropriate methods to account for differences in measuring disease activity in the ileum compared to the colon. This post-hoc analysis of data from the FITZROY phase 2 trial (NCT02048618) compared changes in the Crohn's Disease Activity Index (CDAI) and Simple Endoscopic Score for Crohn's Disease (SES-CD) amongst patients with ileal-dominant and isolated colonic CD treated with 10 weeks of filgotinib 200mg daily or placebo. A mixed effects model for repeated measures was used to test whether ileal disease responded differently than colonic disease, by evaluating for effect modification using the interaction term of treatment assignment-by-disease location. Numerically greater proportions of patients with isolated colonic disease compared to ileal-dominant CD achieved clinical remission (CDAI <150, 75.9% vs. 41.6%) and endoscopic response (SES-CD reduction by 50%, 52.5% vs. 15.5%) at Week 10. However, after adjusting for baseline disease activity by disease location and within-patient clustering effects, there was no significant difference in treatment response by disease location (mean difference in ΔCDAI between ileal-dominant vs. isolated colonic disease +9.24 [95% CI: -87.19, +105.67], p=0.85; mean difference in ΔSES-CD -1.93 [95% CI: -7.03, +3.44], p=0.48). Filgotinib demonstrated similar efficacy in ileal-dominant and isolated colonic CD when controlling for baseline disease activity and clustering effects.

Risk Factors of Asymptomatic Kidney Stone Passage in Adults with Recurrent Kidney Stones.

Kidney stones are a common health problem and are characterized by a high risk of recurrence. A certain number of kidney stones passed asymptomatically. Data regarding the frequency of asymptomatic spontaneous stone passages are limited. To assess the frequency of asymptomatic spontaneous stone passage and its covariates, we conducted a post-hoc analysis of the prospective randomized NOSTONE trial. All asymptomatic spontaneous stone passages were identified by comparing the total number of kidney stones on low-dose non-contrast CT imaging at the beginning and end of the study, considering symptomatic stone passages and surgical stone removal. The statistical analysis focused on the association of independent variables and the number of asymptomatic spontaneous stone passages using linear regression analyses. Of the 416 randomized patients, 383 with both baseline and end-of-study CT were included in this analysis. The median follow-up period was 35 months, the median patient age was 49 years (IQR:40 - 55), and 20% of the patients were female. A total of 442 stone events occurred in 209 out of 383 (55%) patients: 217 out of 442 (49%) were symptomatic spontaneous stone passages, 67 out of 442 (15%) were surgically removed stones, and 158 out of 442 (36%) were asymptomatic spontaneous stone passages. The median size of asymptomatic stones (2.4 mm; IQR:1.95-3.4) and the size of symptomatic stones (2.15 mm; IQR:1.68-2.79) that passed spontaneously were not significantly different (p=0.37). The number of asymptomatic spontaneous stone passages was significantly associated with a higher number of stones on CT at randomization (P=0.001). Limitations include the lack of data on stone size at the time of passage and overrepresentation of White men. Asymptomatic stone passage was common in patients with recurrent calcium-containing kidney stones. The higher the number of stones at presentation, the more likely it was that a kidney stone would spontaneously pass over time without causing any symptoms.

Relevance of Age and Hypertension for Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest - A BOX-trial sub study.

To assess whether the optimal mean arterial blood pressure (MAP) target after out-of-hospital cardiac arrest (OHCA) is influenced by age and a history of arterial hypertension. Post-hoc analysis of data from the Blood Pressure and Oxygenation Targets in Post Resuscitation Care (BOX) trial. The trial included 789 comatose patients randomized to a MAP target of 63mmHg or 77mmHg. The primary outcome of this sub-study was one-year all-cause mortality. Cox proportional-hazards regression and restricted cubic splines were used to examine whether prevalent hypertension and age modified the effect of low versus high MAP target on all-cause mortality. Of the 789 patients randomized, 393 were assigned to a high MAP target, and 396 to a low MAP target. Groups were well balanced for mean age (high MAP target 63±13 years versus low 62±14 years) and hypertension (45% versus 47% respectively). At one year, the primary outcome occurred in 143 patients (36%) with high MAP target and 138 (35%) with low MAP target. The risk of the primary outcome increased linearly with increasing age (P<0.001). The effect of a high versus low MAP target on the primary outcome was modified by age when tested continuously, potentially favoring low MAP target in younger patients (P for interaction=0.03). Prevalent hypertension did not modify the effect of a high versus low MAP target on the primary outcome (P for interaction=0.67). Among patients resuscitated after OHCA, older patients and those with a history of hypertension did not benefit from a higher MAP target.

Prognostic value of weight loss in hospitalized patients with heart failure.

Weight loss is a poor prognostic factor in patients with chronic heart failure (HF). However, whether the same is true for hospitalized patients with HF is unknown, even though hospitalization is the first opportunity for many patients to be diagnosed with HF. This study aimed to investigate the prognostic value of weight loss in patients hospitalized for HF. This was a post-hoc analysis of the FRAGILE-HF study, a prospective multi-center, observational study including 1,332 hospitalized older (≥65 years) patients with HF. The primary outcome was all-cause death within two years of discharge. Self-reported body weight data one year prior to hospital admission were available for 1,106 patients (83.0%) and were compared with their weight after decongestion therapy. The median weight change was -6.9% [-2.4 - -11.9] and 86.8% of the overall cohort experienced some weight loss. Whereas patients with weight loss ≥ 5%, which is a well-validated cut-off in chronic HF, had comparable mortality to those with less weight loss (p = 0.96 by log-rank test), patients with weight loss > 12%, the lowest quartile value, had higher mortality than those with less weight loss (p = 0.024 for all-cause mortality, p = 0.028 for non-cardiovascular mortality, and p = 0.28 for cardiovascular mortality, respectively). In a Cox proportional hazard model, > 12% weight loss was associated with high mortality after adjusting for known prognostic factors and history of malignancy (adjusted hazard ratio: 1.485 [1.070-2.062], p=0.018). Weight loss derived from patient-reported body weight one year before hospitalization was significantly associated with increased mortality after discharge, mainly due to non-cardiovascular etiology, in elderly patients hospitalized for HF.

The effect of different parameters of low-level laser used in the treatment of oral mucositis, on the viability and apoptosis of oral squamous cell carcinoma cells: Invitro study.

Oral mucositis is a complication of chemo/radiotherapy. To assess the impact of various power levels of diode-laser on the survival and expression of apoptosis-related genes in oral cancer cells, it is crucial to consider the potential existence of malignant cells within the treatment region and the reliance of laser effectiveness on its specific characteristics. Cal-27 cells were cultivated and exposed to a 660 nm-diode-laser at power levels of 20, 40, and 80 mW, alongside non-irradiated control cells. Viability and expression of Bax and Bcl-2 mRNA were assessed with Methyl Thiazolyl Tetrazolium (MTT) and Real-time Polymerase Chain Reaction (RT-PCR), respectively. The results were analyzed using one-way ANOVA and Tukey post-hoc test (p < 0.05). A significant reduction in viability was found only in the 20 mW group compared to controls (p = 0.001). Cell survival was significantly lower in cells receiving 20 mW laser than those treated with 40 and 80 mW (p < 0.05). None of the laser groups showed significant changes in BcL-2, but Bax was significantly lower in cells receiving 40 and 80 mW (p < 0.05), compared to controls. Laser irradiation at 660 nm (2 J/cm2, 30 s) significantly reduced the viability of oral cancer cells when using 20 mW power. These specifications align with the recommendation that the lowest possible laser dose should be applied for treating cancer patients. The exact mechanism of cell death following laser therapy with these specifications requires further investigation.

Joint attention and maternal attention across varying dyadic interactions for autistic children

BackgroundJoint attention (JA) is an area of delay associated with autism. Individual differences in JA are shown to relate to language development. The present study examined JA initiations (IJA) and responses to JA (RJA) of autistic children in structured and unstructured contexts with their mothers to examine the relation between mother attention and JA. MethodForty-two autistic children (ages 2.5 to 5.5 years) and their mothers engaged in 15 m interactions in three social contexts (competing demands, teaching, free play). Children were categorized by language level into limited language (N = 20) and verbal (N = 21) groups based on ADOS-2 module to assess group and contextual differences. Contingency analyses assessed bi-directional temporal relations between observed child JA and mother attention in lagged intervals. ResultsRate of children’s IJA and maternal attention differed depending on the context of their interaction. Child IJA and mother attention showed a bi-directional temporally contingent association such that child IJA predicted subsequent maternal attention, and maternal attention predicted subsequent child IJA. RJA was unrelated to maternal attention in contingency analyses. Post-hoc analyses indicated a language level group by receptive communication, and group by expressive communication interaction on the contingency between child IJA and subsequent mother attention such that a stronger contingency emerged for dyads wherein children had limited language. ConclusionsThe present study illustrates the important role that children’s social communication behaviors may have within mother-child social interactions, and how children’s verbal ability, as well as the context of the social interaction may influence bi-directional social attention.

Morphological changes in eggs and embryos of Aedes aegypti (Diptera: Culicidae) exposed to predicted climatic scenarios for the year 2100 in the Central Amazon

According to the IPCC, by the year 2100, rises in global temperature could reach up to 5 °C above current averages. On a planet-wide scale, this is one of the effects of climate changes that could have repercussions on the biological cycle of Aedes aegypti, the main arbovirus vector in urban environments and a transmitter of the arboviruses that cause dengue, Zika, chikungunya and urban yellow fever. The objective of this study was to evaluate morphological changes in Ae. aegypti eggs and embryos maintained in a climate change simulator. For this, specimens obtained from an insectarium were kept in four chambers that simulated the range of environmental scenarios predicted by the IPCC for the year 2100. The eggs obtained from each room were collected and transported to the laboratory for morphometric and morphological analysis, using confocal and scanning microscopy. Aedes aegypti eggs (n=20) were used to obtain the following variables: total width, total length, length-width ratio and diameter of the micropylar disc. Additionally, 20 embryos were used to obtain the data on head capsule length, width and length-width ratio. The data were subjected to a normality test and the means of each variable were compared using ANOVA and Tukey's post-hoc test, considering (p ≤ 0.05). A significant reduction (p < 0.05) was observed mainly in the mean lengths under the current-extreme scenario (587.5 and 553.6 μm, respectively), as well as in the widths under the current-mild scenario (171 and 158.4 μm, respectively). The length of the cephalic capsule was also affected, showing significant differences in the means under the current-intermediate scenario (189.5 and 208.5 μm, respectively), as well as in the widths between the current-intermediate scenarios (173.7 and 194.9 μm, respectively). The results suggest significant changes in the morphometry of Ae. aegypti eggs and embryos as a result of the climatic influences to which the adults were subjected, which may have an impact on vector population density and, consequently, on arbovirus dynamics in urban environments.

Trueness of the apical and middle root portion segments of 3D-printed removable die and alveolar cast designs manufactured using stereolithographic 3D printing.

The present study evaluated the effects of the root portion design, segment (middle vs. apical), and part (die vs. cast) on the trueness of three-dimensional (3D)-printed removable die-cast complex. The trueness of apical and middle segments of the root portion of 45 3D-printed removable dies and casts with three different root portion designs (n = 15) was assessed using a metrology-grade computer program. The three removable dies and cast designs (root form [RF], conical [CON], and cylindric [CYL]) were created using professional computer-aided manufacturing computer programs (DentalCAD 3.1 Rijeka, and InLab CAD 22.0), and manufactured using stereolithographic 3D printer (Form3; FormLabs, Somerville, MA). Subsequently, the 3D-printed removable dies and casts were scanned by a single operator with an intraoral scanner (PrimeScan; Dentsply Sirona, Charlotte, NC), and their respective standard tessellation language files were aligned and compared to master reference files in a metrology-grade computer program (Geomagic Control X; 3D systems, Rock Hill, NC). The root mean square (RMS) values of the middle and apical segments for each removable die and cast were calculated and analyzed using a mixed model including a repeated measure 3-way analysis of variance (ANOVA) and post-hoc stepdown Bonferroni-corrected pairwise comparisons (α = 0.05). A statistically significant 3-way interaction between factors was detected, suggesting that the part (removable die or alveolar cast) and their design affected the RMS values of their apical and middle root portion segment. (p = 0.045). The post-hoc analysis identified significant differences between RMS values of the apical segments of the CON and CYL removable dies (p = 0.005). Significant differences were observed between the middle and apical segments of the CON (p < 0.001) and RF removable die designs (p = 0.004). No statistically significant differences were noticed between the RMS of the different alveolar cast designs (p > 0.05). Significant differences were detected between the apical and middle segments of the same alveolar cast design (p < 0.05). For the manufacturing trinomial and 3D printing strategy used in the present study, the interaction of the part, design, and segment affected the trueness of removable dies and alveolar casts. The trueness was higher on the middle segment on removable dies and alveolar casts in all designs used, except for CYL removable dies, where the trueness difference between segments was small. Higher trueness values may be achieved with designs with simple apical segment geometries.

The robust SmartEnsembleNet: A game changer in finger knuckle biometrics

SmartEnsembleNet represents a major leap forward in the domain of biometric identification, focusing on the relatively underexplored area of finger knuckle biometrics. This research enhances the effectiveness and uniqueness of biometric systems by leveraging the distinct and secure features of finger knuckle patterns. As a complement to existing biometric techniques like fingerprints and facial recognition, it adds an additional layer of security and reliability. Addressing the challenges faced by finger knuckle identification, such as image acquisition, environmental effects, and aging, SmartEnsembleNet introduces a pioneering multi-layered ensemble learning strategy that combines eight diverse machine learning models. These models, trained via a 5-fold cross-validation on datasets from IIT Delhi and PolyU, demonstrate significant improvements in accuracy, precision, recall, and F1-score. A distinctive feature of SmartEnsembleNet is its innovative meta-model, streamlining the creation of a meta-dataset. This dataset is created by applying bilinear interpolation to the predicted probabilities from the top-performing model, and it is further refined by subtracting these interpolated probabilities from the validation data. This iterative process generates ‘smart data’, which serves as the basis for training the ultimate ‘smart model’. Logistic regression is chosen for its outstanding performance. This method, applied uniformly to both training and testing phases, considerably enhances classification accuracy in finger knuckle biometrics, establishing new benchmarks. SmartEnsembleNet’s performance undergoes a detailed evaluation using the Friedman test and Nemenyi post-hoc analysis, guaranteeing a selection process grounded in statistical rigor. With its resilience to noise and adaptability under various conditions, SmartEnsembleNet not only addresses existing gaps in finger knuckle biometric research but also pioneers future advancements, providing a versatile and secure solution impactful for both academia and high-security scenarios.

The effect of irrigation solution temperature and novel heat-treated rotary files on apical debris extrusion and canal preparation time.

This study aimed to compare apical debris extrusion and canal preparation time with ProTaper Gold (PTG) and ProTaper Ultimate (PTU) files at different temperatures. Mesio-buccal roots of 60 mandibular first molars were distributed into six groups depending on the file type (PTG, PTU) and irrigation solution temperature (20, 37, 45°C). During instrumentation, extruded debris were collected and weighed to measure the mass in milligrams. The canal preparation time was recorded in seconds. ANOVA followed by Bonferroni post-hoc tests were used for analysis. The amount of debris extrusion was significantly higher in PTU, which was affected by the irrigation solution temperature (p < 0.05). The difference in canal preparation time was not significant between the two file systems, however, it was significant between the different temperatures (p = 0.001). Both file systems had shorter canal preparation times at 20°C. The irrigation solution temperature could influence the debris extrusion and time of canal preparation.

Inequality in continuity of care after hospitalization due to cardiac conditions

Abstract Background Cardiac conditions are a common cause of hospitalization worldwide. The need for follow-up within primary care and/or specialized care continues after discharge. Continuity of care is crucial to enable a seamless chain of care after hospitalization. Research regarding inequality in continuity of care after discharge is lacking. Purpose The aim was to investigate how patients’ perceptions of continuity of care vary between age, gender, and diagnosis groups. Methods Patients were consecutively included within six weeks after hospitalization due to a cardiac condition. Data were collected with the short version of the Patient Continuity of Care Questionnaire (PCCQ-12). The independent t-test was used to compare differences between sexes and age groups (&amp;lt; 65 years or ≥ 65 years). Differences between diagnosis groups were evaluated with the one-way analysis of variance (ANOVA) and post-hoc analysis with the least significant difference (LSD) correction. The significance level was set at p &amp;lt;0.05 for all analyses. Results A total of 1,000 patients were included (mean age 72 years (SD 10) 66% male). The patients were hospitalized due to myocardial infarction (36%), atrial fibrillation (26%), angina pectoris (21%) or heart failure (17%). Significant differences between age, gender and diagnosis were found: Patients &amp;lt; 65 years perceived significantly higher levels of continuity of care than patients ≥ 65 years. Men had significantly higher scores than women. Patients hospitalized due to acute myocardial infarction perceived significantly higher levels of continuity of care compared to patients who had been hospitalized due to angina pectoris, atrial fibrillation, or heart failure (Table 1). Significant differences were also found between men and women. Men &amp;lt;65 years perceived significantly higher levels of continuity of care (mean 48.08) compared to men ≥ 65 years (mean 45.51, p= 0.008 ). Men who had been hospitalized due to myocardial infarction had significantly higher scores on the PCCQ-12 (mean 48.82) compared to men who had been hospitalized due to angina (mean 44.48), atrial fibrillation (mean 44.09) and heart failure (mean 45.24) (Figure 1). Women &amp;lt;65 years had significantly higher scores on the PCCQ-12 (mean 45.00) compared to women ≥ 65 years (mean 40.71, p 0.018). Women who had been hospitalized due to myocardial infarction or atrial fibrillation had significantly higher scores on the PCCQ-12 (mean 42.48 and 43.02, respectively) compared to women hospitalized due to heart failure (mean 38.00) (Figure 1). Conclusion Overall, patients hospitalized due to cardiac conditions perceive a rather high level of continuity of care. However, statistically significant differences were found between men and women, between younger and older patients, and between diagnosis groups, indicating that care inequality exists in continuity of care.