Changes In Proportion Research Articles

Insights into the Pathobiology of GM1 Gangliosidosis from Single-Nucleus Transcriptomic Analysis of CNS Cells in a Mouse Model.

GM1 gangliosidosis is a lysosomal storage disorder characterized by the accumulation of GM1 ganglioside, leading to severe neurodegeneration and early mortality. The disease primarily affects the central nervous system, causing progressive neurodegeneration, including widespread neuronal loss and gliosis. To gain a deeper understanding of the neuropathology associated with GM1 gangliosidosis, we employed single-nucleus RNA sequencing to analyze brain tissues from both GM1 gangliosidosis model mice and control mice. No significant changes in cell proportions were detected between the two groups of animals. Differential expression analysis revealed cell type-specific changes in gene expression in neuronal and glial cells. Functional analysis highlighted the neurodegenerative processes, oxidative phosphorylation, and neuroactive ligand-receptor interactions as the significantly affected pathways. The contribution of the impairment of neurotransmitter system disruption and neuronal circuitry disruption was more important than neuroinflammatory responses to GM1 pathology. In 16-week-old GM1 gangliosidosis mice, no microglial or astrocyte activation or increased expression of innate immunity genes was detected. This suggested that nerve degeneration did not induce the inflammatory response but rather promoted glial cell clearance. Our findings provide a crucial foundation for understanding the cellular and molecular mechanisms of GM1 gangliosidosis, potentially guiding future therapeutic strategies.

The Psychometric Performance of the Kansas City Cardiomyopathy Questionnaire-12 in Symptomatic Obstructive Hypertrophic Cardiomyopathy

A primary goal of treating patients with obstructive hypertrophic cardiomyopathy (oHCM) is to improve their symptoms, function, and quality of life. While the psychometric properties of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ-23) have been described in oHCM, they have not been assessed for the shorter 12-item version (KCCQ-12), which is increasingly used in clinical practice. Using data from the EXPLORER-HCM trial, the psychometric properties of the KCCQ-12 were evaluated. The KCCQ-12 domain and summary scores had moderate correlations with the most relevant clinical (New York Heart Association class, exercise duration, peak oxygen consumption) and patient-reported measures (EQ-5D-5L visual analog scale, Work Productivity and Activity Impairment [WPAI] questionnaire, and Hypertrophic Cardiomyopathy Symptom Questionnaire [HCMSQ]). KCCQ-12 domain scores had strong internal consistency and test-retest reliability, demonstrated significant and proportional changes with different magnitudes of clinical change (assessed with the patient global impression of change and patient impression of severity), and demonstrated close equivalence to the KCCQ-23 scores. The KCCQ-12 demonstrated good psychometric performance for patients with oHCM, comparable to that of the KCCQ-23, supporting its use in clinical practice to care for patients with oHCM.

Clinical trial: The effectiveness of long-acting somatostatin analogue for output reduction of high-output intestinal fistula or small bowel enterostomy. A randomised controlled trial.

High-output intestinal fistulas and small bowel enterostomies are associated with morbidity and mortality. Current standard treatment for output reduction consists of fluid and dietary restrictions and medical therapy. There is conflicting evidence regarding the use of somatostatin analogues for output reduction. The aim of this study is to investigate whether lanreotide, added to current standard treatment, further reduces intestinal output in patients with high-output fistulas and enterostomies. This was an open-label, multicentre, randomised controlled trial. Adult patients with a high-output intestinal fistula (>500 mL/24 h) or small bowel enterostomy (>1500 mL/24 h) more than 4 weeks post-surgery and receiving standard medical treatment (dietary- and fluid restriction, PPI, loperamide and codeine) for at least 2 weeks were eligible for inclusion. We randomised patients 1:1 between continuing standard treatment (control), and subcutaneous lanreotide 120 mg every 4 weeks with standard treatment. The primary outcome was the number of responders, with response defined as an output reduction of ≥25%, 8 weeks after randomisation. We also investigated the proportional change in output. We randomised 40 patients; 17 had a fistula and 23 a small bowel enterostomy. There were 9/20 responders in the intervention group and 2/20 in the control group (p = 0.013). The proportional output reduction was -26% (IQR -4 to -38) in the intervention group, compared to an increase of 4% (IQR 20 to -13) in the control group (p = 0.004). In patients with a high-output fistula or small bowel enterostomy, addition of lanreotide to current standard treatment can provide a clinically relevant output reduction. EudraCT: 2013-003998-10.

In-hospital initiation of angiotensin receptor-neprilysin inhibition in acute heart failure: the PREMIER trial.

The efficacy and safety of early sacubitril/valsartan (Sac/Val) initiation after acute heart failure (AHF) has not been demonstrated outside North America. The present study aimed to evaluate the effect of in-hospital Sac/Val therapy initiation after an AHF episode on N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in Japanese patients. This was an investigator-initiated, multicentre, prospective, randomized, open-label, blinded-endpoint pragmatic trial. After haemodynamic stabilization within 7 days after hospitalization, eligible inpatients were allocated to switch from angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to Sac/Val (Sac/Val group) or to continue angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (control group). The primary efficacy endpoint was the 8-week proportional change in geometric means of NT-proBNP levels. A total of 400 patients were equally randomized, and 376 (median age 75 years, 31.9% women, de novo heart failure rate 55.6%, and median left ventricular ejection fraction 37%) were analysed. The per cent changes in NT-proBNP level geometric means at Weeks 4/8 were -35%/-45% (Sac/Val group) and -18%/-32% (control group), and their group ratio (Sac/Val vs. control) was 0.80 (95% confidence interval 0.68-0.94; P = .008) at Week 4 and 0.81 (95% confidence interval 0.68-0.95; P = .012) at Week 8, respectively. In the pre-specified subgroup analyses, the effects of Sac/Val were confined to patients with a left ventricular ejection fraction < 40% and were more evident in those in sinus rhythm and taking mineralocorticoid receptor antagonists. No adverse safety signal was evident. In-hospital Sac/Val therapy initiation in addition to contemporary recommended therapy triggered a greater NT-proBNP level reduction in Japanese patients hospitalized for AHF. These findings may expand the evidence on Sac/Val therapy in this clinical situation outside North America. ClinicalTrial.gov (NCT05164653) and Japan Registry of Clinical Trials (jRCTs021210046).

Impact of home visiting nurses on home death proportion in Japan: A nationwide longitudinal ecological study.

Home visiting nurses contribute to end-of-life home care in an aging society. However, few previous studies reported patient outcomes based on nursing practices. This study aimed to examine the correlation between the number of them and the change in home death proportion. We divided the number of home visiting nurses into four categories: absent, shortage, medium, and abundant. This study adopted the interaction term between the nurse categories and year as the major exposure variable, and home death proportion per municipality as the objective variable. We estimated the average marginal effects (AME) as the change in home death proportion from 2015 to 2020. The total number of home visiting nurses was 36,483 in 2015 and 65,868 in 2020. The coefficients of the interaction term were statistically significant in medium and abundant municipalities (Medium: 1.26 (95% CI: 0.49-2.04), Abundant: 2.15 (95% CI: 0.76-3.55)). Increased home death proportion were estimated as AME: 1.56% (95% CI: 0.99-2.13), 1.35% (95% CI: 0.85-1.84), 2.82% (95% CI: 2.30-3.35), and 3.71% (95% CI: 2.44-4.99) in the absent, shortage, medium, and abundant areas, respectively. To increase the proportion of home deaths, municipalities require a certain number of home visiting nurses.

Utilizing the phase-field method to investigate liquid-liquid phase separation in the ternary system of water/ethanol/butylparaben

Small-molecule compounds targeted for drug development have frequently exhibited poor solubility in water, leading to instances of liquid-liquid phase separation (LLPS) during cooling crystallization and anti-solvent crystallization processes. Addressing strategies for managing crystallization processes involving LLPS has become a significant concern. Predicting changes in the structure and concentration of each separated phase over time would contribute to setting conditions and guiding process design to prevent oiling-out and achieve particles with desired morphology. In this study, we assessed the potential of the phase-field method to predict LLPS through simulations in a typical LLPS system, especially a ternary water/ethanol/butylparaben system. Consequently, the phase states in each zone (stable, metastable, and unstable) were determined to be thermodynamically valid. Additionally, the size of the spherical dispersed phase was confirmed to change in proportion to one-third of the time according to the Ostwald ripening rule. Furthermore, the qualitative analysis of factors influencing phase structure, local composition, delay time for phase separation in spinodal decomposition, and the localized LLPS during anti-solvent addition is also feasible. These findings suggest that the phase-field method holds potential as a tool to aid in the design of crystallization processes.

Investigating the Relationship Between the Dynamics of the Structure of Intermediate Consumption and Output of Industries: Cross-Country Analysis

This paper examines one of the main prerequisites of the inter-industry balance methodology on the proportional dependence of the output of industries and their intermediate consumption. The statistical base of the study is the world input-output tables collected for the period from 2000 to 2014. According to the results of the work, it was revealed that the prerequisite of a proportional change in the vector of intermediate consumption with a change in output is not consistent. However, significant positive relationships were found between intermediate consumption and the output of industries. On the basis of the identified relationships, we conducted a clustering procedure on industries, where, in particular, clusters with strong, medium, and weak relationships between intermediate consumption and output are distinguished. Thus, the paper proposes to expand the input-output methodology by introducing proportionality coefficients for changes in the intermediate consumption of an industry with a change in its output. Proportionality coefficients are proposed to be obtained on the basis of regression equations built on statistical data from the input-output tables. It should be especially noted that in addition to obtaining point forecasts of intermediate consumption for each industry when its output changes, it is also possible to obtain probability distributions for the gross output of each industry, their value added, wages, taxes, and profits through Monte Carlo simulations based on the constructed regression equations, which will facilitate a scenario analysis of the development of the considered economic system. The results of this work can be useful to executive authorities in planning large state economic projects as well as in assessing the impact of external shocks on the countryʼs economy.

Does the Visual Field Improve After Initiation of Intraocular Pressure Lowering in the United Kingdom Glaucoma Treatment Study?

PurposeEvidence to support the hypothesis that visual field (VF) status can improve after initiation of intraocular pressure (IOP) reducing treatment is controversial. We take advantage of participant eligibility data from the United Kingdom Glaucoma Treatment Study (UKGTS) to test this hypothesis in newly diagnosed glaucomatous patients randomised to IOP lowering therapy or placebo. DesignMulticentre, randomised, triple-masked, placebo-controlled trial. ParticipantsNewly diagnosed open-angle glaucoma patients in the UKGTS with eligibility and baseline data (n = 202 and n = 205 participants from the treatment and placebo groups, respectively). MethodsUKGTS eligibility data, including two reliable VFs (Humphrey 24-2 SITA Standard) and IOP measurements were compared to UKGTS trial baseline data acquired after allocation to treatment (topical prostaglandin analog) or placebo eye drops. Mean change in VF mean deviation (MD) and proportion of eyes that improved MD by more than different thresholds were compared across this interval in the treatment and placebo groups. Secondary analyses included stratifying the groups by level of IOP, level of VF loss and age along with pointwise analyses including change in subsets of VF locations. Main outcome measureMean change in VF MD. ResultsMean (standard deviation [SD]) time between eligibility/baseline visits and reduction in IOP was 12 (3) weeks and 4.8 (4.2) and 1.0 (3.6) mmHg for the treated and placebo eyes, respectively. Mean (SD) change in MD was almost the same for the treated (-0.03 (1.45) dB) and placebo groups (+0.08 (1.72) dB) (P=0.47). Proportion of participants with an MD improvement of 1 dB or more were similar for both groups (P=0.25). No association was found between MD improvement and magnitude of IOP lowering. Stratifying data by IOP, level of VF loss and age did not reveal any differences between the treated and placebo groups and neither did any of the pointwise VF analyses. ConclusionInitial short-term VF changes in the treatment and placebo arms of UKGTS were the same. In these newly diagnosed patients (non-advanced glaucoma) we found no evidence to support the hypothesis that VF status improves after initial lowering of IOP by medical therapy.

Feasibility of big data analytics in disaster psychiatry: Impact of Seoul Itaewon tragedy on sentiment distribution on Twitter

Numerous studies have highlighted the significant impact of disasters on mental health, often leading to psychiatric disorders among affected individuals. Timely identification of disaster-related mental health problems is crucial to prevent long-term negative consequences and improve individual and community resilience. To address the limitations of prior research that has focused solely on isolated incidents, we analyzed the impact of a recurring Halloween event in Itaewon, South Korea, which culminated tragically in a crowd crush incident in 2022. We conducted sentiment analysis on big data from Korean Twitter to gauge the impact of this disaster on public sentiment. We collected tweets 2 weeks before and after the annual festival from 2020 to 2022, allowing for the consideration of variability across years and days before the disaster. Using a pre-trained RoBERTa neural network model fine-tuned with public sentiment datasets, we categorized tweets into seven pre-defined emotional categories: Anger, sadness, happiness, disgust, fear, surprise, and neutrality. These sentiments were then analyzed as daily time-series data. The overall tweet volume across all sentiment categories increased, particularly showing an increase in the number of tweets indicating “Sadness” in 2022 compared with that in previous years. Post-disaster, a substantial increase was noted in the proportion of tweets expressing “Sadness” and “Fear.” This trend was confirmed by Seasonal Autoregressive Integrated Moving Average with Exogenous Regressor models. Notably, there was an increase in the number of tweets expressing all sentiments, including “Happy.” However, significant changes in proportions were observed only in tweets categorized as expressing “Sadness” [0.046 (95% CI: 0.024–0.068, P < 0.0001)] and “Fear” [0.033 (95% CI: 0.014–0.051, P < 0.0001)]. Our study demonstrates the feasibility of using sentiment data from social media, combined with sentiment classification, to assess distinct public mental health features following disasters. This approach provides valuable insights into the emotional impact of each event.

Prenatal vitamin D deficiency exposure leads to long-term changes in immune cell proportions

Vitamin D deficiency is a common deficiency worldwide, particularly among women of reproductive age. During pregnancy, it increases the risk of immune-related diseases in offspring later in life. However, how the body remembers exposure to an adverse environment during development is poorly understood. Herein, we explore the effects of prenatal vitamin D deficiency on immune cell proportions in offspring using vitamin D deficient mice established by dietary manipulation. We found that prenatal vitamin D deficiency alters immune cell proportions in offspring by changing the transcriptional properties of genes downstream of vitamin D receptor signaling in hematopoietic stem and progenitor cells of both the fetus and adults. Moreover, further investigations of the associations between maternal vitamin D levels and cord blood immune cell profiles from 75 healthy pregnant women and their term offspring also confirm that maternal vitamin D levels in the second trimester significantly affect immune cell proportions in the offspring. These findings imply that the differentiation properties of hematopoiesis act as long-term memories of prenatal vitamin D deficiency exposure in later life.

Does vertical integration increase the costs for primary care inpatients? Evidence from a national pilot programme in China

ObjectiveTo assess the impact of vertical integration (VI) within County-Level Integrated Health Organisations (CIHOs) on the costs of primary care inpatients.MethodsThis study assessed Xishui, a national pilot county for CIHOs, using inpatient claims data. The treatment group comprised 10,118 inpatients from 5 vertically integrated township health centres (THCs), while the control group consisted of 21,165 inpatients from 19 non-vertically integrated THCs. The periods from July 2020 to December 2021 and January 2022 to December 2022 were defined as pre- and post-policy intervention, respectively. The primary outcome variables were total health expenditures (THS), out-of-pocket (OOP) expenditures, and the proportion of OOP expenditures. Propensity score matching was employed to align inpatient demographics and disease characteristics between the groups, followed by a difference-in-differences analysis to evaluate the outcomes.FindingsVI significantly increased THS (β = 0.1337, p < 0.01) and OOP expenditures per case (β = 0.1661, p < 0.001), but the increase in the proportion of OOP expenditures per case was not significant (β = 0.0029, p > 0.05). For the basic medical insurance for urban and rural residents, THS per case (β = 0.1343, p < 0.01) and OOP expenditures (β = 0.1714, p < 0.001) significantly increased. For the basic medical insurance system for employees, THS per case also increased significantly (β = 0.1238, p < 0.01), but the change in OOP expenditure proportion per case was not significant (β = 0.1020, p > 0.05). The THS per case led by Xishui County People’s Hospital, the leading county medical sub-centre (CMSC), significantly increased (β = 0.1753, p < 0.01), whereas the increase led by Xishui County Traditional Chinese Medicine Hospital was not significant (β = 0.0742, p > 0.05). Increases in OOP expenditures per case were significant in CMSCs led by the People’s Hospital and the Traditional Chinese Medicine Hospital (β = 0.1782, p < 0.01 and β = 0.0757, p < 0.05, respectively).ConclusionVI significantly increased THS and OOP expenditures for primary care inpatients. However, VI could exacerbate economic disparities in disease burden across different insurance categories.

Maternal Work and Infant Feeding Practices in the First 6 Months.

The purpose of this study was to examine the relationship between maternal work and infant feeding practices and explore the moderating impact of parental stress. Prospective data on categorical hours worked and infant feeding practices were collected at 3 and 6 months postpartum in a prospective prenatal cohort of 95 women. Chi-square tests were used to compare change in proportion of exclusive breastfeeding from birth to 6 months and maternal work status. Rates of exclusive breastfeeding significantly decreased from birth to 6 months, while the percent of mothers working outside of the home significantly increased from 3 to 6 months. At 6 months, mothers who worked full time pumped significantly more than their non-working counterparts. Multivariate logistic regression models were used to test the prediction of exclusive breastfeeding by maternal work, including sociodemographic covariates, and the moderating impact of parental stress. Results indicated that maternal education, paternal education, and maternal work significantly predicted exclusive breastfeeding at 6 months. Full time work (OR = 0.09, 95% CI = 0.01, 0.62) was associated with a decreased odds of exclusive breastfeeding. Additionally, higher maternal (OR = 1.44, 95% CI = 1.05, 1.97) and paternal (OR = 1.28, 95% CI = 1.00, 1.66) education was associated with an increased odds of exclusive breastfeeding. Maternal stress did not predict exclusive breastfeeding, nor did it have a moderating effect on the relationship between maternal work and breastfeeding. Future studies should investigate maternal work in more diverse birthing populations to better understand how families can incorporate breastfeeding as a primary infant feeding practice.

Sustainability of the Preferences for Everyday Living Inventory Use in Ohio Nursing Homes Over Time

ObjectivesIn 2015, the Ohio Department of Medicaid incentivized use of the Preferences for Everyday Living Inventory (PELI) as a quality initiative. The pay-for-performance (P4P) program, however, was then deimplemented in 2019. This study investigated the sustainability of use of the PELI in Ohio nursing homes (NHs) from 2017 to 2021 and examined barriers to PELI implementation. DesignThis study analyzed 2 waves of Ohio Biennial Survey of Long-Term Care Facilities data. Setting and ParticipantsData were drawn from 433 NHs in Ohio that reported on PELI implementation efforts between 2017 and 2021. MethodsThis study examined the change in proportion of NHs implementing the PELI (ie, conducted for all residents, used in care planning) and change in proportion of NHs using different PELI assessment formats (ie, the full 72-item PELI, MDS 3.0 Section F items only). Frequencies of reported barriers to PELI implementation by NH administrators were tabulated. ResultsResults indicate that although use of the full 72-item PELI decreased over time, only a small percentage discontinued its use despite possible impacts of P4P changes in 2019 and challenges posed by the COVID-19 pandemic. NHs adapted their PELI assessment formats likely in response to perceived barriers of PELI use (ie, length of the full PELI, time constraints, and residents’ level of cognitive impairment). Conclusions and ImplicationsFindings suggest that Ohio NHs sustained PELI implementation over time in the context of large systemic changes in P4P financial incentives and COVID-19 safeguards. Barriers were reported at the organizational level, yet NHs continued to prioritize PCC with the PELI. Policy/P4P mandates may serve as effective implementation incentives that encourage sustainability of quality care practices. Future research should explore long-term sustainability and stakeholder perspectives on PELI utilization.

Assessing residential sustainable energy autonomous buildings for hot climate applications

This paper introduces an innovative solution for clean energy autonomous building (AB) sustainability, offering a 5Z concept—zero-carbon, zero-energy, zero grid connections, zero energy bills, and zero emission mobility. This paper focuses on fundamental research to design sustainable, energy-ABs striving for self-sufficiency in arid climates, using Kuwait as a case study. The study highlights the importance of stringent engineering AB modeling, renewable technology integration, and clean energy storage. The technical approaches include characterizing non-thermal and thermal demands, achieving net-zero energy generation, and custom sizing renewable energy and energy storage systems (ESS) for electric vehicle (EV) charging points. The research methodology involves local construction with yearly weather and energy profile data to simulate the actual system using ESP-r building model. The study's findings reveal the need for a large-scale energy system, energy demand reduction (EDR) inclusive of heating, cooling, appliances, and EV, with the corresponding changes in local energy production system size, battery capacity, and the number of photovoltaics (PVs). The results show varying EDR levels ranging from base case to 10% and to 50% leading to proportional changes in energy system size, size of battery from 3415 kWh to 1710 kWh and the number of PVs from 362 to 181, which means EDR not only optimizes space but also proves cost-effective. The significant implication of this study, not only bridging the knowledge gap and the lack of how-know, but also making a significant advancement and forward thinking in sustainable green electric home modernization and environmentally friendly transportation. This approach transforms energy management practices for more sustainable cities and societies, reducing emissions in both urban infrastructure and transportation.

What are the associated factors of low husbands/partners independent decision-maker in women’s contraceptive use decision-making process in Ethiopia? Multilevel analysis

BackgroundMany married women of reproductive age with husbands or partners are less cooperative in using contraceptives, often resulting in unintended pregnancies or secret contraceptive use. This private use of contraceptives causes women to suffer from side effects without proper support, and many women in Ethiopia die due to unintended pregnancies. However, the involvement of husbands or partners in the contraceptive decision-making process in Ethiopia is often neglected. There is also a lack of evidence regarding the determinants of husbands’ or partners’ decision-making power on contraceptive use in Ethiopia.ObjectiveThis study aimed to assess the determinants of low involvement of husbands/partners in women’s contraceptive use decision-making processes in Ethiopia.MethodsThis study was based on Ethiopian Demographic and Health Survey data, collected from January 18 to June 27, 2016. Weighted samples of 3,669 reproductive-age women were included. Husbands’/partners’ independent decision-making was measured by whether the husband/partner decided independently or alone about contraceptive use, categorized as “Yes” or “No”. A multilevel logistic regression model was fitted, and ICC (Intra-class Correlation Coefficient), MOR (Median Odds Ratio), PCV (Proportion Change in Variance), and deviance were used to assess model fitness and comparison. Variables with a p-value of ≤ 0.2 in the bivariate analysis were considered candidates for multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval was used to determine both the direction and strength of the association, and a p-value of < 0.05 was used to declare statistical significance.ResultsHusbands’/partners’ independent decision-making in women’s contraceptive use was found to be 5.41% [4.72-6.19%]. Significant factors associated with this included: Husbands/partners aged 31–59 years (Adjusted Odds Ratio (AOR) = 1.3; Confidence Interval (CI) 2.3–5.4) and over 59 years (AOR = 2.3; CI 1.2–4.3), Educational level of husbands/partners: primary education (AOR = 3.2; CI 2.9–4.3), secondary education (AOR = 3.9; CI 2.7–4.4), and higher education (AOR = 4.3; CI 2.8-5.0), Media exposure (AOR = 4.5; CI 2.2–5.4), History of pregnancy termination (AOR = 3.3; CI 2.6–4.1), Perception that distance to health facilities is not a significant problem (AOR = 3.0; CI 1.7–4.7) and Urban residency (AOR = 3.5; CI 1.6–4.2).ConclusionsIn Ethiopia, the involvement of husbands/partners in the contraceptive use decision-making process is low. To increase their decision-making power, attention should be given to factors such as age, educational level, media exposure, history of pregnancy termination, distance to health facilities, and urban residency.

From hatching to juvenile: Larval development of Vieja fenestrata (Teleostei: Cichlidae).

This study delves into the early development of Vieja fenestrata (Cichlidae), with a specific focus on the description of external morphological and morphometric changes, and growth patterns from hatching to the loss of larval characters under controlled laboratory conditions at a temperature of 28°C. Asynchronous hatching was observed between 58 and 60 h postfertilization, with the posterior body emerging first. Over 14 days, significant morphological, physiological, and behavioral changes were observed, revealing a complex developmental trajectory. The initial developmental phases were characterized by rapid vascularization, fin differentiation, and heightened activity, and the subsequent days witnessed the flexion of the notochord, emergence of swim bladder functionality, and transition to exogenous feeding. Maturation progressed with the absorption of the yolk sac, regression of cement glands, and fin ray development, culminating in metamorphosis by 14 days post-hatching. Throughout this period, evolving pigmentation patterns and structural adaptations highlight the species' adaptive strategies. During the larval period of V. fenestrata, substantial changes in morphological proportions were observed. Before the inflection, tail length, trunk length, and body depth had negative allometric growth, and head length, eye diameter, and snout length had positive allometric growth. After the inflection, body depth and snout length showed positive allometric growth; head length and trunk length exhibited isometric growth, whereas tail length and eye diameter demonstrated negative allometric growth. These findings contribute insights into the intricate developmental dynamics of V. fenestrata. Moreover, further research may explore these developmental dynamics' ecological and evolutionary implications.

Changes in Eyelid Height Based on Intra-Operative Quantification of Levator Aponeurosis Advancement in Patients with Unilateral Ptosis

ABSTRACT Objective To present marginal reflex distance (MRD-1) outcomes based on intra-operative quantification of levator aponeurosis advancement. Methods Forty-eight patients with unilateral aponeurotic ptosis underwent anterior levator aponeurosis advancement. Distance of advancement intra-operatively was compared with MRD-1 outcomes at the immediate postoperative sitting, approximately 1 week, and 1 month period. Surgical success was defined as a symmetric MRD-1 or an MRD-1 within 1 millimeter of the contralateral eyelid. Results Most MRD-1 exhibited the following trends: 1) initial decrease at about 1 week and increase at 1 month (n = 11), 2) initial increase at about 1 week with levelling at 1 month (n = 8), and 3) increasing through time (n = 7). Success rate significantly decreased through time (p = .0464). The change in proportion of successful and failed surgeries was insignificant. Surgical revision rate was 10.4%. Conclusion Levator aponeurosis advancement distances do not correlate with MRD-1 outcomes linearly. MRD-1 exhibited stability over time with a satisfactory success rate at 1 month.

Genetic determinants and phenotypic consequences of blood T-cell proportions in 207,000 diverse individuals

T-cells play a critical role in multiple aspects of human health and disease. However, to date the genetic determinants of human T-cell abundance have not been studied at scale because assays quantifying T-cell abundance are not widely used in clinical or research settings. The complete blood count clinical assay quantifies lymphocyte abundance which includes T-cells, B-cells, and NK-cells. To address this gap, we directly estimate T-cell fractions from whole genome sequencing data in over 200,000 individuals from the multi-ethnic TOPMed and All of Us studies. We identified 27 loci associated with T-cell fraction. Interrogating electronic health records identified clinical phenotypes associated with T-cell fraction, including notable changes in T-cell proportions that were highly dynamic over the course of pregnancy. In summary, by estimating T-cell fraction, we obtained new insights into the genetic regulation of T-cells and identified disease consequences of T-cell fractions across the human phenome.

The impact of ageing-in-place reforms on the provision of home care packages for older Australians, 2008-21: a repeated cross-sectional study.

To assess changes following the 2013-21 Home Care Package (HCP) reforms in the rate of HCPs provided to Australians aged 65 years or older, the characteristics of people who have received HCPs, and the capacity of the program to meet demand for its services during 2018-21. Repeated cross-sectional population-based study; analysis of Australian Institute of Health and Welfare GEN Aged Care and Australian Department of Health Home Care Packages program data. HCPs provided to non-Indigenous Australians aged 65 years or older, 2008-09 to 2020-21. Changes in age- and sex-standardised HCP rates (number per 1000 older people) and changes in proportions of recipients for selected characteristics, 2013-14 to 2020-21, overall and by care level; correspondence of proportional HCP supply and demand, 2018-19 to 2020-21, by care level. A total of 490 276 HCPs were provided during 2008-21. The age- and sex-standardised HCP rate rose from 9.23 per 1000 people aged 65 years or more in 2013-14 to 16.4 per 1000 older people in 2020-21. The increases in age- and sex-standardised HCP rate between 2013-14 and 2020-21 were greatest for level 1 (from 0.19 to 5.05 per 1000 older people) and level 3 HCPs (from 0.35 to 3.62 per 1000 older people); the rate for level 2 HCPs declined from 6.75 to 5.82 per 1000 older people, and that for level 4 HCPs did not change. The proportion of culturally and linguistically diverse recipients rose from 10.8% to 16.2%; the overall proportion of recipients living outside major cities rose slightly, from 28.1% to 28.7%, but declined for higher care level HCPs (level 3: from 30.8% to 27.8%; level 4: from 29.6% to 25.2%). During 2018-19 to 2020-21, the proportions of lower level (1 and 2) HCPs generally exceeded demand, while the supply of higher level (3 and 4) HCPs generally fell short of demand. Despite the increased overall availability of HCPs, the supply of higher care level HCPs is still lower than the demand, probably contributing to suboptimal support for the ageing-in-place preferences of older Australians, especially in regional and remote areas.

Stroke Incidence in Patients With Hypertension According to Cardiorespiratory Fitness.

Hypertension and physical inactivity are risk factors for stroke. The effect of cardiorespiratory fitness (CRF) on stroke risk in patients with hypertension has not been assessed. We evaluated stroke incidence in patients with hypertension according to CRF and changes in CRF. We included 483 379 patients with hypertension (mean age±SD; 59.4±9.0 years) and no evidence of unstable cardiovascular disease as indicated by a standardized exercise treadmill test. Patients were assigned to 5 age- and sex-specific CRF categories based on peak metabolic equivalents achieved at the initial exercise treadmill test and in 4 categories based on metabolic equivalent changes over time (n=110 576). Multivariable Cox models, adjusted for age, and comorbidities were used to estimate hazard ratios and 95% CIs for stroke risk. During a median follow-up of 10.6 (interquartile range, 6.6-14.6) years, 15 925 patients developed stroke with an average yearly rate of 3.1 events/1000 person-years. Stroke risk declined progressively with higher CRF and was 55% lower for the High-fit individuals (hazard ratio, 0.45 [95% CI, 0.42-0.48]) compared with the Least-fit. Similar associations were observed across the race, sex, and age spectra. Poor CRF was the strongest predictor of stroke risk of all comorbidities studied (hazard ratio, 2.24 [95% CI, 2.10-2.40]). Changes in CRF reflected inverse and proportional changes in stroke risk. Poor CRF carried a greater risk than any of the cardiac risk factors in patients with hypertension, regardless of age, race, or sex. The lower stroke risk associated with improved CRF suggests that increasing physical activity, even later in life, may reduce stroke risk.