Robust Predictor Research Articles

ALBUMINURIA IS AN IMPORTANT PREDICTOR FOR ALL CAUSE MORTALITY IN GENERAL RURAL POPULATION

Objective: Albuminuria stands as a robust predictor of both cardiovascular and all-cause mortality, despite that there remains a notable gap in understanding how albuminuria's association with mortality varies across subgroups defined by sex, comorbidities and estimated glomerular filtration rate (eGFR). The aim of this study was to determine whether the association between albuminuria and mortality differs according to eGFR, sex, and comorbidities. Design and method: This prospective observational study includes 857 adult subjects from the ENAH rural study in Croatia. Albuminuria, the ratio of urinary albumin to creatinine (ACR) was subsequently categorized into two levels as >30mg/g (group A) and <30mg/g (group B). Results: Subjects from the group A were older (70.5 vs. 49.0 years), had a higher BMI (29.7 vs. 27.4 kg/m2), and lower eGFR (69.3 vs. 85.2 ml/min/1.73m2). They had higher prevalence of arterial hypertension (AH) (78.2% vs. 53.3%) and diabetes (DM) (30.8% vs. 11.9%) (p<0.001 for both). A significantly higher mortality rate (64.1% vs. 27.3%, p<0.001) was observed in Group 1 compared to the group 2. In logistic regression analysis the highest odds of mortality were observed for ACR>30mg/g (OR=2.43, 95%CI=1.40-4.19, p=0.002), followed with male gender (OR=1.79, 95%CI=1.28-2.49, p<0.001), DM (OR=1.71, 95%CI=1.10-2.67, p=0.018), eGFR < 60 (OR=1.71, 95%CI 1.00-2.94 and AH (OR=1.55, 95%CI=1.06-2.27, p=0.025). Conclusions: Our study underscores the significant impact of albuminuria on all-cause mortality in general rural population indicating that this diagnostic tool should be included in everyday clinical work.

Workplace Stress, Social Support and Coping Strategy as Predictors of Mental Well-Being among Nurses in Ibadan

This study examines workplace stress, social support and coping strategy as predictors of mental well-being among nurses in Ibadan North Local Government (LGA) Oyo State, Nigeria. Cross-sectional survey research design was adopted while purposive sampling technique was used to select the LGA. Data were collected using validated scales from 163 participants and analyzed using zero-order correlation statistics and multiple regression analysis to test four hypotheses which were accepted at p < .05 level of significance. The result revealed that significant others support and friends social support independently predicted mental well-being among nurses among study participants. Furthermore, coping strategy and workplace stress independently predicted mental well-being among nurses in the study population. Finally, workload stress, social support and coping strategy jointly predicted mental well-being among study participants. The study concluded that workplace stress, social support and coping strategy are robust predictors of mental well-being among nurses. It is recommended that management of health institutions should integrate training and education programmers that focus on coping strategy and stress reduction techniques that foster positive relationships with friends and significant others to enhance mental well-being among nurse’s workforce.

Phase angle: A robust predictor of malnutrition and poor prognosis in gastrointestinal cancer

ObjectivesThe aim of this study was to investigate the relationship among phase angle (PA), malnutrition, and prognosis in patients with gastrointestinal cancer. MethodsIn total, 870 patients with gastrointestinal cancer were enrolled. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate the association between PA and survival risk. Restricted cubic spline regression was used for flexibility analysis to explore sex-specific associations between PA and survival. Logistic regression was used to assess the relationships among PA, malnutrition, and cachexia. ResultsLow PA was closely associated with poor physical conditions, diminished quality of life, and malnutrition. Patients with low PA had a significantly worse prognosis than those with high PA (60.6% versus 72.8%; log-rank P < 0.001). PA was suitable for the prognostic assessment of patients with advanced-stage tumors. Regardless of sex, patients with lower PA showed significantly poorer survival rates. Cox proportional hazards models identified PA as an independent predictor of prognosis in patients with gastrointestinal cancer (hazard ratio (HR)=0.534; 95% confidence interval (CI)=0.409–0.696, P < 0.001). Subgroup analysis indicated that a high PA was an independent risk factor affecting the prognoses of patients with esophageal, liver, and intrahepatic bile duct cancers. Interestingly, variations in PA had a more significant prognostic effect on survival in men than in women. The logistic regression model confirmed that PA is a valuable indicator for assessing malnutrition and cachexia in patients with gastrointestinal cancer. Among all body composition indicators, PA demonstrated the highest accuracy for prognostic prediction. ConclusionsPA was identified as a robust predictor of malnutrition and poor prognosis in patients with gastrointestinal cancer.

Predictors of radiation-induced late rectal toxicity in prostate cancer treatment: a volumetric and dosimetric analysis.

Prostate cancer (PCa) is a prevalent malignancy in European men, often treated with radiotherapy (RT) for localized disease. While modern RT achieves high success rates, concerns about late gastrointestinal (GI) toxicities persist. This retrospective study aims to identify predictors for late GI toxicities following definitive conventionally fractionated external beam RT (EBRT) for PCa, specifically exploring the dose to the rectal wall. A cohort of 96 intermediate- to high-risk PCa patients underwent EBRT between 2008 and 2016. Rectum and rectum wall contours were delineated, and 3D dose matrices were extracted. Volumetric and dosimetric indices were computed, and statistical analyses were performed to identify predictors using the Mann-Whitney U-rank test, logistic regression, and recursive feature elimination. In our cohort, 15 out of 96 patients experienced grade II late proctitis. Our analysis reveals distinct optimal predictors for rectum and rectum wall (RW) structures varying with α/β values (3.0 and 2.3 Gy) across prescribed doses of 68 to 76 Gy. Despite variability, RW predictors demonstrate greater consistency, notably V68Gy[%] to V74Gy[%] for α/β 3.0 Gy, and V68Gy[%] to V70Gy[%] for α/β 2.3 Gy. The model with α/β 2.3 Gy, featuring RW volume receiving 70 Gy (V70Gy[%]), stands out with a BIC value of 62.92, indicating its superior predictive effectiveness. Finally, focusing solely on the rectum structure, the V74Gy[%] emerges the best predictor for α/β 3.0 Gy, with a BIC value of 66.73. This investigation highlights the critical role of V70Gy[%] in the rectum wall as a robust predictor for grade II late gastrointestinal (GI) toxicity following external beam radiation therapy (EBRT) for prostate cancer (PCa). Furthermore, our findings suggest that focusing on the rectum wall specifically, rather than the entire rectum, may offer improved accuracy in assessing proctitis development. A V70Gy (in EQD2 with α/β 2.3 Gy) of ≤5% and if possible ≤1% for the rectal wall should be achieved to minimize the risk of late grade II proctitis.

The association between monocyte-to-high-density lipoprotein ratio and hyperuricemia: Results from 2009 to 2018.

Previous research has suggested that the monocyte-to-high-density lipoprotein ratio (MHR), an emerging inflammatory biomarker, holds promise in predicting the prevalence of various cardiovascular and metabolic diseases. However, earlier investigations were constrained by the relatively modest sample sizes. This study endeavored to expand the sample size and conduct a more comprehensive exploration of the potential relationship between MHR and hyperuricemia. This cross-sectional study incorporated data from participants of the 2009 to 2018 National Health and Nutrition Examination Survey (NHANES) with complete and qualifying information. MHR was determined by calculating the ratio between monocyte count and high-density lipoprotein levels. Various statistical methodologies such as weighted multivariate logistic regression, subgroup analysis, smoothed curve fitting, and threshold analysis, have been used to explore the correlation between hyperuricemia and MHR. The study included a cohort of 17,694 participants, of whom 3512 were diagnosed with hyperuricemia. MHR levels were notably higher in the hyperuricemia group than in the normal group, aligning with an elevated body mass index (BMI). A comprehensive multivariate logistic analysis, accounting for all relevant adjustments, revealed a notable positive correlation between MHR and hyperuricemia (P < .001, OR = 1.98, 95% CI: 1.54-2.54). Subgroup analysis indicated that the MHR exhibited an enhanced predictive capacity for identifying hyperuricemia risk, particularly in females (P < .05). Curvilinear and threshold analyses revealed a nonlinear association between MHR and hyperuricemia prevalence, with a notable inflection point at 0.826. In the US population, a clear positive correlation was observed between the MHR and prevalence of hyperuricemia. Importantly, the MHR is a more robust predictor of hyperuricemia risk in females. Further investigations are required to confirm these findings.

The effect of sustained-release CARvedilol in patients with hypErtension and heart failure with preserved ejection fraction: a study protocol for a pilot randomized controlled trial (CARE-preserved HF).

Although beta-blockers improve clinical outcomes in heart failure with reduced ejection fraction, the benefit of beta-blockers in heart failure with preserved ejection fraction (HFpEF) is uncertain. Global longitudinal strain (GLS) is a robust predictor of heart failure outcomes, and recent studies have shown that beta-blockers are associated with improved survival in those with low GLS (GLS <14%) but not in those with GLS ≥14% among patients with LVEF ≥40%. Therefore, the objective of this trial is to evaluate the effect of sustained-release carvedilol (carvedilol-SR) on the outcome [N-terminal pro-B-natriuretic peptide (NT-proBNP) concentration] in patients with hypertension and HFpEF and will assess the differential effects of these drugs on the outcome, according to the GLS categories. This prospective randomized double-blind multicenter trial (CARE-preserved HF) will include 100 patients with HFpEF from three tertiary hospitals in South Korea. Patients with HFpEF and hypertension aged ≥20 years who have evidence of functional and structural heart disease on echocardiography and elevated natriuretic peptide will be enrolled. Eligible participants will be randomized 1:1 to either the carvedilol-SR group (n = 50) or the placebo group (n = 50). Patients in the carvedilol-SR group will receive 8, 16, 32, or 64 mg carvedilol-SR once daily for 6 months, and the dose of carvedilol will be up-titrated at the discretion of the treating physicians. The primary efficacy outcome was the time-averaged proportional change in N-terminal pro-B-natriuretic peptide concentration from baseline to months 3 and 6. We will also evaluate the differential effects of carvedilol-SR on primary outcomes according to GLS, using a cut-off of 14% or the median value. This randomized controlled trial will investigate the efficacy and safety of carvedilol-SR in patients with HFpEF and hypertension. ClinicalTrial.gov, identifier NCT05553314.

Objective Assessment of Physical Activity at Home Using a Novel Floor-Vibration Monitoring System: Validation and Comparison With Wearable Activity Trackers and Indirect Calorimetry Measurements.

The self-monitoring of physical activity is an effective strategy for promoting active lifestyles. However, accurately assessing physical activity remains challenging in certain situations. This study evaluates a novel floor-vibration monitoring system to quantify housework-related physical activity. This study aims to assess the validity of step-count and physical behavior intensity predictions of a novel floor-vibration monitoring system in comparison with the actual number of steps and indirect calorimetry measurements. The accuracy of the predictions is also compared with that of research-grade devices (ActiGraph GT9X). The Ocha-House, located in Tokyo, serves as an independent experimental facility equipped with high-sensitivity accelerometers installed on the floor to monitor vibrations. Dedicated data processing software was developed to analyze floor-vibration signals and calculate 3 quantitative indices: floor-vibration quantity, step count, and moving distance. In total, 10 participants performed 4 different housework-related activities, wearing ActiGraph GT9X monitors on both the waist and wrist for 6 minutes each. Concurrently, floor-vibration data were collected, and the energy expenditure was measured using the Douglas bag method to determine the actual intensity of activities. Significant correlations (P<.001) were found between the quantity of floor vibrations, the estimated step count, the estimated moving distance, and the actual activity intensities. The step-count parameter extracted from the floor-vibration signal emerged as the most robust predictor (r2=0.82; P<.001). Multiple regression models incorporating several floor-vibration-extracted parameters showed a strong association with actual activity intensities (r2=0.88; P<.001). Both the step-count and intensity predictions made by the floor-vibration monitoring system exhibited greater accuracy than those of the ActiGraph monitor. Floor-vibration monitoring systems seem able to produce valid quantitative assessments of physical activity for selected housework-related activities. In the future, connected smart home systems that integrate this type of technology could be used to perform continuous and accurate evaluations of physical behaviors throughout the day.

In-stent restenosis estimation following carotid artery stenting: The robust predictive value of atherogenic index of plasma and other non-traditional lipid profiles.

Atherosclerotic carotid artery stenosis is a significant contributor to ischemic strokes, and carotid artery stenting (CAS) has emerged as a pivotal treatment option. However, in-stent restenosis (ISR) remains a concern, impacting the long-term patency of CAS. This study aimed to investigate the predictive value of non-traditional lipid profiles, including the atherogenic index of plasma (AIP), in ISR development. This retrospective single-center study involved patients presenting at a tertiary healthcare facility with severe carotid artery disease between 2016 and 2020 who subsequently underwent CAS. A total of 719 patients were included in the study. The study cohort was divided into ISR and non-ISR groups based on restenosis presence, confirmed by angiography following ultrasonographic follow-up assessments. Non-traditional lipid indices, such as AIP, atherogenic index (AI), and lipoprotein combined index (LCI), were evaluated along with traditional risk factors. During a 24-month follow-up, ISR occurred in 4.03% of patients. To determine the predictors of restenosis, three different models were constructed in multivariate analysis for non-traditional lipid indices. Multivariate analysis revealed AIP as a robust independent predictor of ISR (OR: 4.83 (CI 95 % 3.05-6.63, p < .001). Notably, AIP demonstrated superior predictive accuracy compared to AI and LCI, with a higher Area Under the Curve (AUC) of 0.971. Non-traditional lipid profiles, especially AIP, were found to be associated with an increased risk of ISR and may serve as predictors of ISR in patients undergoing CAS.

Determinants Factor of Passengers’ Propensity to Utilise E-Hailing Services in Kota Kinabalu, Sabah

In the realm of public transportation, e-hailing services have emerged as a prominent mode of transportation in recent years. This study aims to elucidate the complex relationships between four key constructs, namely safety features, fare, ease of usage, and accessibility, in shaping user inclination towards the adoption of e-hailing services. Using the Stated Preference Survey (SPS) method, a meticulously designed online questionnaire was administered to three hundred respondents in Kota Kinabalu. Employing partial least squares-structural equation modelling for analysis, the results highlight the significance of ease of usage and accessibility as robust predictors influencing Kota Kinabalu residents' preference for using e-hailing services. The safety aspect displays notable disparities based on gender, as male and female consumers possess contrasting perspectives regarding the degree of protection provided by e-hailing services. In contrast, the concept of price value has a restricted ability to forecast user propensity, as surge pricing was universally enforced during peak hours in all e-hailing services. The study's findings provide useful insights for e-hailing businesses, indicating strategic enhancements in service delivery to guarantee customer comfort and safety, thereby increasing their service coverage, and attracting a wider user demographic.

Predictive Value of Neutrophil-to-Monocyte Ratio, Lymphocyte-to-Monocyte Ratio, C-Reactive Protein, Procalcitonin, and Tumor Necrosis Factor Alpha for Neurological Complications in Mechanically Ventilated Neonates Born after 35 Weeks of Gestation.

This prospective study investigated the association between elevated neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein (CRP), procalcitonin, and tumor necrosis factor-alpha (TNF-alpha) and the risk of developing neurological complications in mechanically ventilated neonates. The aim was to evaluate these biomarkers' predictive value for neurological complications. Within a one-year period from January to December 2022, this research encompassed neonates born at ≥35 weeks of gestational age who required mechanical ventilation in the neonatal intensive care unit (NICU) from the first day of life. Biomarkers were measured within the first 24 h and at 72 h. Sensitivity, specificity, and area under the curve (AUC) values were calculated for each biomarker to establish the best cutoff values for predicting neurological complications. The final analysis included a total of 85 newborns, of which 26 developed neurological complications and 59 without such complications. Among the studied biomarkers, TNF-alpha at >12.8 pg/mL in the first 24 h demonstrated the highest predictive value for neurological complications, with a sensitivity of 82%, specificity of 69%, and the highest AUC (0.574, p = 0.005). At 72 h, TNF-alpha levels greater than 14.3 pg/mL showed further increased predictive accuracy (sensitivity of 87%, specificity of 72%, AUC of 0.593, p < 0.001). The NMR also emerged as a significant predictor, with a cutoff value of >5.3 yielding a sensitivity of 78% and specificity of 67% (AUC of 0.562, p = 0.029) at 24 h, and a cutoff of >6.1 showing a sensitivity of 76% and specificity of 68% (AUC of 0.567, p = 0.025) at 72 h. Conversely, CRP and procalcitonin showed limited predictive value at both time points. This study identifies TNF-alpha and NMR as robust early predictors of neurological complications in mechanically ventilated neonates, underscoring their potential utility in guiding early intervention strategies. These findings highlight the importance of incorporating specific biomarker monitoring in the clinical management of at-risk neonates to mitigate the incidence of neurological complications.

Measuring teacher-student relationships among children with emotional and behavioral problems

A rapidly growing body of research indicates that the quality of children's relationships with teachers can affect students’ emotional, behavioral, and school related adjustment. The vast majority of this research has relied on measures that assess teacher—rather than student—perceptions of these relationships. In this study, we administered a student self-report measure of teacher-student relationships (TSR) to 185 children, all of whom had emotional and behavioral problems. Children's special education teachers (N = 76) also completed a validated measure of TSR. Results of a confirmatory factor analysis of child ratings confirmed a model that included three TSR factors: Communication, Trust, and Alienation. Analyses of similarities between student and teacher views of their relationship with one another suggested limited concordance, however, student perceptions of TSR were robust predictors of their emotional, behavioral, and school adjustment even after controlling for teacher perceptions of TSR. These findings provide preliminary support for the importance assessing student perceptions of TSR and initial evidence for the construct validity, reliability and criterion-related validity of a child report measure of teacher-student relationships among students with emotional and behavioral problems.

Predictive Model for Estimating the Risk of Epilepsy After Aneurysmal Subarachnoid Hemorrhage: The RISE Score.

The occurrence of seizures after aneurysmal subarachnoid hemorrhage (aSAH) is associated with a poorer functional and cognitive prognosis and less favorable quality of life. It would be of value to promptly identify patients at risk of epilepsy to optimize follow-up protocols and design preventive strategies. Our aim was to develop a predictive score to help stratify epilepsy risk in patients with aSAH. This is a retrospective, longitudinal study of all adults with aSAH admitted to our center (2012-2021). We collected demographic data, clinical and radiologic variables, data on early-onset seizures (EOSs), and data on development of epilepsy. Exclusion criteria were previous structural brain lesion, epilepsy, and ≤7 days' follow-up. Multiple Cox regression was used to evaluate factors independently associated with unprovoked remote seizures (i.e., epilepsy). The best fitting regression model was used to develop a predictive score. Performance was evaluated in an external validation cohort of 308 patients using receiver-operating characteristic curve analysis. From an initial database of 743 patients, 419 met the inclusion criteria and were included in the analysis. The mean age was 60 ± 14 years, 269 patients (64%) were women, and 50 (11.9%) developed epilepsy within a median follow-up of 4.2 years. Premorbid modified Rankin Score (mRS) (hazard ratio [HR] 4.74 [1.8-12.4], p = 0.001), VASOGRADE score (HR 2.45 [1.4-4.2], p = 0.001), surgical treatment (HR 2.77 [1.6-4.9], p = 0.001), and presence of EOSs (HR 1.84 [1.0-3.4], p = 0.05) were independently associated with epilepsy. The proposed scale, designated RISE, scores 1 point for premorbid mRS ≥ 2 (R), VASOGRADE-Yellow (I, Ischemia), surgical intervention (S), and history of EOSs (E) and 2 points for VASOGRADE-Red. RISE stratifies patients into 3 groups: low (0-1), moderate (2-3), and high (4-5) risk (2.9%, 20.8%, and 75.7% developed epilepsy, respectively). On validation in a cohort from a different tertiary care center (N = 308), the new scale yielded a similar risk distribution and good predictive power for epilepsy within 5 years after aSAH (area under the curve [AUC] 0.82; 95% CI 0.74-0.90). The RISE scale is a robust predictor of post-SAH epilepsy with immediate clinical applicability. In addition to facilitating personalized diagnosis and treatment, RISE may be of value for exploring future antiepileptogenesis strategies.

Notes from the Underground: Seeking the top personality correlates of self-referencing.

Self-focused language use has been frequently assumed to reflect narcissism; however, research indicates that the association between first-person singular pronouns (i.e., "I-talk") and grandiose narcissism is negligible. To extend this literature, we progressively identify vulnerable narcissism and rumination as positive correlates of I-talk in five studies (valid Ns = 211, 475, 1253, 289, 1113). The first study revealed positive correlates of I-talk suggestive of vulnerable narcissism. The second study showed more directly that vulnerable narcissism was a positive correlate but that this association was attributable to shared variance with neuroticism. The third study, a preregistered effort, replicated and extended the results of the second study. The fourth and fifth studies focused on rumination in a preregistered manner. All the studies point to a clear distinction: While grandiose narcissism is negligibly related to I-talk, vulnerable narcissism is positively related to I-talk; moreover, rumination is a robust predictor of I-talk. A research synthesis revealed the following constructs significantly capture I-talk: depression (r = 0.10), neuroticism (r = 0.15), rumination (r = 0.14), and vulnerable narcissism (r = 0.12). The association between I-talk and neuroticism was partially mediated by rumination, providing a testable candidate mechanism for neuroticism interventions.

A robust genetic algorithm-based optimal feature predictor model for brain tumour classification from MRI data

ABSTRACT Brain tumour can be cured if it is initially screened and given timely treatment to the patients. This proposed idea suggests a transform- and windowing-based optimization strategy for exposing and segmenting the tumour region in brain pictures. The processes of image processing that are included in the proposed idea include preprocessing, transformation, feature extraction, feature optimization, classification, and segmentation. In order to convert the pixels connected to the spatial domain into a multi-resolution domain, the Gabor transform is first applied to the brain test image. The Gabor converted brain image is then used to extract the parameters of the multi-level features. After that, the Genetic Algorithm (GA) is used to optimize the extracted features, and Neuro Fuzzy System (NFS) is used to classify the optimistic prominent section. Finally, the tumour region in brain images is found and segmented using the normalized segmentation algorithm. The effective detection and classification of brain tumours by the characteristics of sensitivity, specificity, and accuracy are described by the suggested GA-based NFS classification approach. The trial findings are displayed with an average of 99.37% sensitivity, 98.9% specificity, 99.21% accuracy, 97.8% PPV, 91.8% NPV, 96.8% FPR, and 90.4% FNR.

Metabolic phenotyping with computed tomography deep learning for metabolic syndrome, osteoporosis and sarcopenia predicts mortality in adults.

Computed tomography (CT) body compositions reflect age-related metabolic derangements. We aimed to develop a multi-outcome deep learning model using CT multi-level body composition parameters to detect metabolic syndrome (MS), osteoporosis and sarcopenia by identifying metabolic clusters simultaneously. We also investigated the prognostic value of metabolic phenotyping by CT model for long-term mortality. The derivation set (n=516; 75% train set, 25% internal test set) was constructed using age- and sex-stratified random sampling from two community-based cohorts. Data from participants in the individual health assessment programme (n=380) were used as the external test set 1. Semi-automatic quantification of body compositions at multiple levels of abdominal CT scans was performed to train a multi-layer perceptron (MLP)-based multi-label classification model. External test set 2 to test the prognostic value of the model output for mortality was built using data from individuals who underwent abdominal CT in a tertiary-level institution (n=10141). The mean ages of the derivation and external sets were 62.8 and 59.7years, respectively, without difference in sex distribution (women 50%) or body mass index (BMI; 23.9kg/m2). Skeletal muscle density (SMD) and bone density (BD) showed a more linear decrement across age than skeletal muscle area. Alternatively, an increase in visceral fat area (VFA) was observed in both men and women. Hierarchical clustering based on multi-level CT body composition parameters revealed three distinctive phenotype clusters: normal, MS and osteosarcopenia clusters. The L3 CT-parameter-based model, with or without clinical variables (age, sex and BMI), outperformed clinical model predictions of all outcomes (area under the receiver operating characteristic curve: MS, 0.76 vs. 0.55; osteoporosis, 0.90 vs. 0.79; sarcopenia, 0.85 vs. 0.81 in external test set 1; P<0.05 for all). VFA contributed the most to the MS predictions, whereas SMD, BD and subcutaneous fat area were features of high importance for detecting osteoporosis and sarcopenia. In external test set 2 (mean age 63.5years, women 79%; median follow-up 4.9years), a total of 907 individuals (8.9%) died during follow-up. Among model-predicted metabolic phenotypes, sarcopenia alone (adjusted hazard ratio [aHR] 1.55), MS+sarcopenia (aHR 1.65), osteoporosis+sarcopenia (aHR 1.83) and all three combined (aHR 1.87) remained robust predictors of mortality after adjustment for age, sex and comorbidities. A CT body composition-based MLP model detected MS, osteoporosis and sarcopenia simultaneously in community-dwelling and hospitalized adults. Metabolic phenotypes predicted by the CT MLP model were associated with long-term mortality, independent of covariates.

Low surgical weight associated with ETV failure in pediatric hydrocephalus patients.

The use of endoscopic third ventriculostomy (ETV) for treatment of pediatric hydrocephalus has higher failure rates in younger patients. Here we investigate the impact of select perioperative variables, specifically gestational age, chronological age, birth weight, and surgical weight, on ETV failure rates. A retrospective review was performed on patients treated with ETV - with or without choroid plexus cauterization (CPC) - from 2010 to 2021 at a large academic center. Analyses included Cox regression for independent predictors and Kaplan-Meier survival curves for time to-event outcomes. In total, 47 patients were treated with ETV; of these, 31 received adjunctive CPC. Overall, 66% of the cohort experienced ETV failure with a median failure of 36 days postoperatively. Patients aged < 6 months at time of surgery experienced 80% failure rate, and those > 6 months at time of surgery experienced a 41% failure rate. Univariate Cox regression analysis showed weight at the time of ETV surgery was significantly inversely associated with ETV failure with a hazard ratio of 0.92 (95% CI 0.82, 0.99). Multivariate analysis redemonstrated the inverse association of weight at time of surgery with ETV failure with hazard ratio of 0.76 (95% CI 0.60, 0.92), and sensitivity analysis showed < 4.9kg as the optimal cutoff predicting ETV/CPC failure. Neither chronologic age nor gestational age were found to be significantly associated with ETV failure.In this study, younger patients experienced higher ETV failure rates, but multivariate regression found that weight was a more robust predictor of ETV failure than chronologic age or gestational age, with an optimal cutoff of 4.9kg in our small cohort. Given the limited sample size, further study is needed to elucidate the independent role of weight as a peri-operative variable in determining ETV candidacy in young infants. Previous presentations: Poster Presentation, Congress of Neurological Surgeons.

Assessing the predictive value of insulin resistance indices for metabolic syndrome risk in type 2 diabetes mellitus patients

Limited research has explored the effectiveness of insulin resistance (IR) in forecasting metabolic syndrome (MetS) risk, especially within the Iranian population afflicted with type 2 diabetes mellitus (T2DM). The present investigation aimed to assess the efficacy of IR indices in predicting the risk of MetS among T2DM patients. Convenient sampling was utilized to select four hundred subjects with T2DM. Metabolic factors and IR indices, including the Waist Circumference-Triglyceride Index (WTI), Triglyceride and Glucose Index (TyG index), the product of TyG index and abdominal obesity indices, and the Metabolic Score for Insulin Resistance (METS-IR), were evaluated. Logistic regression, coupled with modeling, was employed to explore the risk of MetS. The predictive performance of the indices for MetS stratified by sex was evaluated via receiver operating characteristic (ROC) curve analysis and estimation of the area under the curve (AUC) values. The TyG-Waist Circumference (TyG-WC) index exhibited the largest AUCs in both males (0.91) and females (0.93), while the TyG-Body Mass Index (TyG-BMI) demonstrated the smallest AUCs (0.77 in males and 0.74 in females). All indices significantly predicted the risk of MetS in all subjects before and after adjustment (p < 0.001 for all). The TyG-WC index demonstrated the highest odds ratios for MetS (8.06, 95% CI 5.41–12.00). In conclusion, all IR indices assessed in this study effectively predicted the risk of MetS among Iranian patients with T2DM, with the TyG-WC index emerging as the most robust predictor across both genders.

Urbanicity and psychotic experiences: Social adversities, isolation and exposure to natural environments predict psychosis

BackgroundResearch has shown that incidence rates of psychotic experiences are higher in urban areas, defined by their population density, and that an increasing number of people move to cities. Thus, it is critical to understand which characteristics of cities drive this association. To date, efforts to explore urban risk have predominantly focused on a few or single preselected candidate factors and clinical populations. MethodsWe aimed to identify the best predictors of psychotic experiences (PE) in a subclinical population, considering 26 factors describing the physical and social environment. Two feature selection models were employed, i.e., a Boruta algorithm, a random forests approach, and an elastic net penalised logistic regression model. ResultsIndividual-specific social environment features emerged as the most robust predictors of PE, including childhood adversity, stressful life events, social isolation and low household income. Exposure to natural environments was found to be negatively associated with PE. ConclusionsSpending more time in residential natural environments could be an actionable target for preventing and treating psychosis.

Association of Elevated C-Reactive Protein with Worsened Outcomes in Different Histologies of Renal Cortical Tumors: Analysis of the INMARC Registry

BackgroundTo evaluate relationship between histological subtypes of renal cell carcinoma (RCC) and preoperative c-reactive protein (CRP). Patients and MethodsWe queried the International Marker Consortium for Renal Cancer database for patients affected by RCC. Patients were classified according to their histology: benign tumors, clear cell (cc) RCC, chromophobe (ch) RCC, papillary (p) RCC, and variant histology (vh) RCC; and according to CRP (mg/L): low CRP ≤5 and high CRP >5. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM), recurrence and association between CRP and histology. Multivariable analysis (MVA) via Cox regression and multivariable logistic regression were fitted to elucidate predictors of outcomes. ResultsTotal 3902 patients (high CRP n = 1266) were analyzed; median follow up 51 (IQR 20-91) months. On MVA elevated CRP was an independent risk factor associated with increased risk of ACM in benign tumors (HR 5.98, P < .001), ccRCC (HR 2.69, P < .001), chRCC (HR 3.99, P < .001), pRCC (HR 1.76, P = .009) and vhRCC (HR 2.97, P =.007). MVA for CSM showed CRP as risk factor in ccRCC (HR 2.77, P < .001), chRCC (HR 6.16, P = .003) and pRCC (HR 2.29, P = .011), while in vhRCC was not (P = .27). MVA for recurrence reported CRP as risk factor for ccRCC (HR 1.30, P = .013), while in chRCC (P = .33), pRCC (P = .34) and vhRCC (P = .52) was not. On multivariable logistic regression CRP was a predictor of pRCC (OR 1.003, P = .002), while decreasing CRP was associated with benign tumors (OR 0.994, P = .048). ConclusionElevated CRP was a robust predictor of worsened ACM in all renal cortical neoplasms. While most frequently observed in pRCC patients, elevated CRP was independently associated with worsened CSM in non-vhRCC. Conversely, elevated CRP was least likely to be noted in benign tumors, and elevation in this subgroup of patients should prompt further consideration for surveillance given increased risk of ACM. Further investigation is requisite.

Geosocietal Support for Democracy: Survey Evidence from Ukraine

We examine why public support for democracy in Ukraine increased after Russia’s 2014 intervention and surged after Russia’s 2022 invasion—despite concerns that the wartime quest for security would diminish support for political freedoms. We statistically analyze original data generated as part of annual opinion surveys by the Institute of Sociology at Ukraine’s National Academy of Sciences in 2017 (N = 2,199), 2018 (N = 1,800), and a 2021–22 panel survey with the same respondents (N = 475) interviewed before and after Russia’s invasion. Our findings indicate that wartime support for democracy is in significant respects geosocietal—arising from the mobilization of civic national identity conditioned by salient geopolitical threats. Civic pride, attribution of threat to an external authoritarian aggressor, and war onset were the strongest and most robust predictors of multiple democracy support indicators, overriding personal loss and stress. The findings call for more attention to the interaction of geopolitical and social contexts shaping political attitudes, with implications for democratic futures globally.