Separate Analyses Research Articles

Effects of aquatic exercise program versus on-land exercise program on cancer-related fatigue, neuropathy, activity and participation, quality of life, and return to work for cancer patients: study protocol for a randomized controlled trial

BackgroundExercise has shown positive effects on fatigue, exhaustion, neuropathy, and quality of life in cancer patients. While on-land exercises have been studied, the aquatic environment offers unique advantages. Water's density and viscosity provide resistance, enhancing muscle strength, while hydrostatic pressure improves venous return. This trial aims to investigate the effect of aquatic exercises on time to return to work, work hours, work-related difficulties, daily life activity and participation, quality of life, exhaustion, fatigue, and neuropathy among cancer patients, compared to on-land exercise intervention group and a non-exercise group.MethodsThis randomized controlled trial will include 150 cancer patients aged 18–65 years with stage III colon cancer or breast cancer patients with lymph node involvement. Participants in the aquatic exercise intervention group will undergo an 8-week, twice-weekly group-based Ai-Chi program, while the on-land exercise group will perform identical exercise. The control group will not engage in any exercise.The primary outcome will be assessed using an employment barriers questionnaire, capturing return to work date and working hours and daily life participation and activity and quality of life. Secondary outcomes include exhaustion, fatigue, and neuropathy. Data will be collected at baseline, post-intervention (8 weeks), and at 3,12, and 24 months. Mixed variance analyses will explore relationships among groups and over time for independent variables, with separate analyses for each dependent variable.DiscussionThe potential benefits include an earlier return to work for patients, reducing their need for social and economic support. The study's implications on socio-economic policies are noteworthy, as a successful intervention could offer a cost-effective and non-invasive solution, improving patients' quality of life and increasing their participation in daily activities. This, in turn, could lead to a faster return to work, contributing to both personal well-being and broader societal interests by reducing reliance on social services.Trial registrationThe trial is registered at ClinicalTrials.gov NCT05427344 (22 June 2022).

Social Support and Physical Activity in College and University Students: A Meta-Analysis.

Although physical activity (PA) has a profound impact on health, many college and university students are still physically inactive. There is some evidence to suggest that social support (SS) could impact the PA levels of students, but the internal relationship and specific effects are not very clear. The purpose of this review was to determine the strength of the relationship between SS and PA and examine whether any potential associations differed in terms of age, gender, and region among college and university students. Studies were identified using the following electronic databases: PubMed, SPORTDiscus, Web of Science, and Sociological Abstracts. Moderator analyses investigating the effects of students' age, gender, and region (nation) were performed. This review included 19 articles. The results showed total SS was significantly associated with PA (r = 0.30, 95% confidence interval [CI]: [0.22, 0.37], p < .001). With respect to different types of support, friend support was more strongly associated with PA than family support. Gender factors had a significant moderating effect on the correlation between SS and PA (QM = 17.433, p < .001). Separate analyses examining the moderating effects of gender (percentage of females) found that the association between SS and PA was stronger with the increase in female percentage. In conclusion, SS is an important factor associated with PA levels and should foster SS within intervention programs according to types of SS and gender differences to increase PA levels among college and university students.

Effects of active vitamin D analogues on muscle strength and falls in elderly people: an updated meta-analysis.

Elderly people are at high risk of falls due to decreased muscle strength. So far, there is currently no officially approved medication for treating muscle strength loss. The active vitamin D analogues are promising but inconsistent results have been reported in previous studies. The present study was to meta-analyze the effect of active vitamin D analogues on muscle strength and falls in elderly people. The protocol was registered with PROSPERO (record number: CRD42021266978). We searched two databases including PubMed and Cochrane Library up until August 2023. Risk ratio (RR) and standardized mean difference (SMD) with 95% confidence intervals (95% CI) were used to assess the effects of active vitamin D analogues on muscle strength or falls. Regarding the effects of calcitriol (n= 1), alfacalcidol (n= 1) and eldecalcitol (n= 1) on falls, all included randomized controlled trials (RCT) recruited 771 participants. Regarding the effects of the effects of calcitriol (n= 4), alfacalcidol (n= 3) and eldecalcitol (n= 3) on muscle strength, all included RCTs recruited 2431 participants. The results showed that in the pooled analysis of three active vitamin D analogues, active vitamin D analogues reduced the risk of fall by 19%. Due to a lack of sufficient data, no separate subgroup analysis was conducted on the effect of each active vitamin D analogue on falls. In the pooled and separate analysis of active vitamin D analogues, no significant effects were found on global muscle, hand grip, and back extensor strength. However, a significant enhancement of quadriceps strength was observed in the pooled analysis and separate analysis of alfacalcidol and eldecalcitol. The separate subgroup analysis on the impact of calcitriol on the quadriceps strength was not performed due to the lack to sufficient data. The results of pooled and separate subgroup analysis of active vitamin D analogues with or without calcium supplementation showed that calcium supplementation did not affect the effect of vitamin D on muscle strength. The use of active vitamin D analogues does not improve global muscle, hand grip, and back extensor strength but improves quadriceps strength and reduces risk of falls in elderly population.

Determinants of PFOA Serum Half-Life after End of Exposure: A Longitudinal Study on Highly Exposed Subjects in the Veneto Region.

Perfluoroalkyl substances (PFAS) are widely used, ubiquitous, and highly persistent man-made chemicals. Groundwater of a vast area of the Veneto Region (northeastern Italy) was found to be contaminated by PFAS from a manufacturing plant active since the late 1960s. As a result, residents were overexposed to PFAS through drinking water until 2013, mainly to perfluorooctanoic acid (PFOA). The aim of the present study was to estimate the rates of decline in serum PFOA and their corresponding serum half-lives, while characterizing their determinants. We investigated 5,860 subjects more than 14 years of age who enrolled in the second surveillance round of the regional health surveillance program. Two blood samples were collected between 2017 and 2022 (average time between measurements: 4 years). Serum PFOA excretion rates and half-lives were estimated based on linear mixed effect models, modeling subject-specific serum PFOA concentrations over time and correcting for background concentrations. For modeling determinants of half-life [age, sex, body mass index (BMI), smoking-habit, alcohol consumption, and estimated glomerular filtration rate (eGFR)], we added interaction terms between each covariate and the elapsed time between measurements. Perfluorooctanesulfonate (PFOS) and perfluorohexanesulfonic acid (PFHxS) apparent half-lives were also estimated. A separate analysis was conducted in children (). All analyses were stratified by sex. Median initial serum concentrations of PFOA was (range: 0.5-1,090), with a median reduction of 62.45%. The mean estimated PFOA half-life was 2.36 years [95% confidence interval (CI): 2.33, 2.40], shorter in women (2.04; 95% CI: 2.00, 2.08) compared to men (2.83; 95% CI: 2.78, 2.89). Half-lives varied when stratified by some contributing factors, with faster excretion rates in nonsmokers and nonalcohol drinkers (especially in males). This study, to our knowledge the largest on PFOA half-life, provides precise estimates in young adults whose exposure via drinking water has largely ceased. For other PFAS, longer half-lives than reported in other studies can be explained by some ongoing exposure to PFAS via other routes. https://doi.org/10.1289/EHP13152.

Optimizing and designing upper-stage separation spring of lifting-body rocket

Because the upper-stage separation of a lifting-body rocket is difficult under the low-altitude and high-speed flight environments, an upper-stage separation scheme based on the separation spring is proposed. The integration of ADAMS and MATLAB realizes the multi-body dynamics simulation analysis of upper-stage separation. The experimental design method is used to carry out the target simulation and calculation of the upper-stage separation process, with the separation condition deviation and the separation spring deviation considered at the same time, thus ensuring the reliability of the separation scheme. In order to further optimize the separation scheme, an upper-stage separation optimization model is established with the Isight software, and the mass of separation spring is optimized with the multi-island genetic algorithm and significantly reduced by 48.87% under the condition that the upper-stage separation process satisfies all constraints, thereby effectively improving the performance of the lifting-body rocket.

Asymptotic analysis of conversion-limited phase separation

Liquid–liquid phase separation plays a major role in the formation and maintenance of various membrane-less subcellular structures in the cytoplasm and nucleus of cells. Biological condensates contain enhanced concentrations of proteins and RNA, many of which can be continually exchanged with the surrounding medium. Coarsening is an important step in the kinetics of phase separation, whereby an emulsion of polydisperse condensates transitions to a single condensate in thermodynamic equilibrium with a surrounding dilute phase. A key feature of biological phase separation is the co-existence of multiple condensates over significant time scales, which is consistent with experimental observations showing a slowing of coarsening rates. It has recently been proposed that one rate limiting step could be the slow interfacial conversion of a molecular constituent between the dilute and dense phases. In this paper, we analyse conversion-limited phase separation within the framework of diffusion in singularly perturbed domains, which exploits the fact that biological condensates tend to be much smaller than the size of a cell. Using matched asymptotic analysis, we solve the quasi-static diffusion equation for the concentration in the dilute phase, and then derive kinetic equations for the slow growth/shrinkage of the condensates. This provides a systematic way of obtaining corrections to mean-field theory that take into account the geometry of the cell and the locations of all the condensates.

Abstract WP158: Cortical Superficial Siderosis is Associated With Ischemia After Intracerebral Hemorrhage

Background: Ischemia on diffusion weighted imaging (DWI) after intracerebral hemorrhage (ICH) increases the risk of future ischemic stroke. Radiographic markers of small vessel disease, including cerebral microbleeds (CMB), are associated with DWI lesions. Though cortical superficial siderosis (cSS) is also a hemorrhagic small vessel disease subtype, it is unclear if cSS similarly relates to DWI lesions. We hypothesized that cSS would represent a more severe phenotype of small vessel disease and would associate with DWI lesions after ICH independent to other small vessel disease markers. Methods: Using the Intracerebral Hemorrhage Outcomes Project (ICHOP), we included all cases of spontaneous ICH who underwent DWI and susceptibility imaging/gradient echo. DWI hyperintensities were identified if &gt;10mm from the hematoma with decreased ADC signal. cSS were identified as subarachnoid hemosiderin deposition without acute subarachnoid hemorrhage. The relationship of cSS with DWI lesion presence as the outcome was assessed with logistic regression adjusted for ICH score, blood pressure change within 24 hours, and small vessel disease markers (CMB and white matter hyperintensity). Sensitivity analyses were performed to adjust for demographics and ICH location. A secondary analysis using linear regression assessed the association with the number of DWI lesions adjusted for similar covariates. Results: Of 198 patients analyzed, DWI lesions were observed in 31.3% and cSS in 10.6%. The presence of cSS was associated with DWI lesions (adjusted OR 3.72, CI: 1.29-10.72), independent of other small vessel disease markers. Separate sensitivity analyses adjusting for sex, race, and ICH location did not change the association of cSS with DWI lesions. In secondary analyses, cSS was not associated with greater number of DWI lesions counts (b 0.213, CI -0.53-0.63). Discussion: cSS is associated with the presence of DWI lesions, independent to other small vessel disease markers. cSS may represent a severe phenotype of small vessel disease with a risk of ICH recurrence and ischemia. Further work is required to investigate underlying mechanisms and optimal strategies to mitigate competing risks of future hemorrhage and ischemic events in these patients.

Abstract TP21: Consequences of Atrial Fibrillation Burden on Deep Cerebral Hemodynamic Related Structural Brain Damage

Background: Recent data using ultrahigh-resolution brain MRI suggests that atrial fibrillation (AF) has adverse effects on wall shear stress and blood flow in lenticulostriate arteries (LSA). The structural consequences of such pathophysiological alterations and whether they contribute to cognitive impairment in AF are not known. We hypothesized that the AF burden is associated with the severity of MRI markers of ischemic and hemorrhagic injury related to LSA disease. Methods: We analyzed data from 560 patients with AF and no clinical history of stroke or neurodegenerative disease, who received brain MRIs at a tertiary referral center. Neuroimaging data were collected by a stroke neurologist who was blinded to the clinical data. The presence of paroxysmal/persistent vs permanent AF was the main measure of AF burden. The imaging outcome variables were counts of deep lacunes, deep cerebral microbleeds (dCMB), and presence of a peri-basal ganglia white matter hyperintensity pattern (peri-BG WMH). Results: The mean age of the 560 AF patients was 73 + 11 and 212 (38%) patients were female. Mean CHA 2 DS 2 -VASc was 3.4 + 1.5 and 86 (15.4%) had permanent atrial fibrillation. Deep lacunes were found in 26.6%, dCMBs in 6.3% and a peri-BG WMH pattern in 2.7% of patients. In univariate analyses, the presence of permanent AF was associated with higher mean deep lacune counts (0.84 vs 0.51, p=0.026), higher mean dCMB counts (0.25 vs 0.1, p=0.018), and peri-BG WMH pattern (7.1% vs 1.9%, p=0.016) when compared to paroxysmal/persistent AF. In separate multivariable analyses, permanent AF type remained an independent predictor of dCMBs (p=0.019) and peri-BG WMH pattern (p=0.028) after controlling for age, sex, and vascular risk factors. Permanent AF also showed a tendency for independent association with deep lacunes (p=0.06) in a similar model. Discussion: Our results show that AF burden independently correlates with parenchymal MRI markers of LSA disease in patients without history of stroke. Such deep brain damage might contribute to AF-induced cognitive changes. The effects of better rhythm control on visible brain damage and cognitive changes should be studied in randomized trials.

Towards a better understanding of real-world home-visiting programs: a large-scale effectiveness study of parenting mechanisms in Brazil

BackgroundThe scale-up of parenting programmes to support early childhood development (ECD) is poorly understood. Little is known about how and when early interventions are most effective. Sustainability of ECD programming...

Abstract TP154: Association of Left Ventricular Hypertrophy With Ischemic Lesions After Intracerebral Hemorrhage

Background: Ischemic lesions on diffusion weighted imaging (DWI) occur in one-third of intracerebral hemorrhage (ICH). Due to conflicting prior studies, it is uncertain if the degree of systolic blood pressure reduction increases the risk. Patients with severe, chronic hypertension may be more vulnerable to the development of ischemia after ICH due to altered cerebral autoregulatory limits. Using cardiac remodeling as a biomarker for severe chronic hypertension, we hypothesized that the presence of left ventricular hypertrophy (LVH) is associated with DWI lesions. Methods: Patients with spontaneous ICH enrolled in the Intracerebral Hemorrhage Outcomes Project who underwent DWI imaging and transthoracic echocardiography (TTE) during hospitalization were included. Lesions were identified as hyperintensities &gt;10mm remote from the hematoma with corresponding low ADC signal. LVH presence was identified using clinically obtained TTE reports with imaging evidence of moderate-severe left ventricular wall thickness. The relationship between LVH and DWI ischemic lesions was assessed with logistic regression modeling after adjusting for age, ICH volume, intraventricular hemorrhage, hypertension history, and blood pressure change within 24 hours. A secondary analysis using linear regression assessed the association with the number of DWI lesions adjusting for similar covariates. Results: Of 187 patients analyzed, DWI lesions were observed in 30.5% and LVH was seen in 23.5%. In our logistic regression analyses, we identified that LVH was associated with DWI lesions (adjusted OR 2.77, CI: 1.19-6.40). Separate sensitivity analyses adjusting for sex (OR 2.47, CI 1.05-5.83) and race (OR 2.52, CI 1.08-5.91) did not change these relationships. In secondary analysis, we identified that LVH was associated with increased DWI lesion number (B 1.018, CI 0.40-1.63 ). Discussion: LVH is associated with the presence and burden of DWI lesions. Further work is required to assess aggregate relationships of chronic hypertension/LVH, acute blood pressure change, ischemic lesions, and ICH outcomes to determine whether patients with LVH necessitate different acute blood pressure treatment goals.

Expert Opinion, Real-World Classification, and Decision-Making in Thoracolumbar Burst Fractures Without Neurologic Deficits?

Retrospective analysis of prospectively collected data. To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making. This study is a sub-analysis of a prospective observational study in TL fractures. Twenty two experts were asked to review 183 CT scans and recommend treatment for each fracture. The expert recommendation was based on radiographic review. Overall agreement between the expert panel and real-world surgeons regarding surgery was 63.2%. In 36.8% of cases, the expert panel recommended surgery that was not performed in real-world scenarios. Conversely, in cases where the expert panel recommended non-surgical treatment, only 38.6% received non-surgical treatment, while 61.4% underwent surgery. A separate analysis of A3 and A4 fractures revealed that expert panel recommended surgery for 30% of A3 injuries and 68% of A4 injuries. However, 61% of patients with both A3 and A4 fractures received surgery in the real world. Multivariate analysis demonstrated that a 1% increase in certainty of PLC injury led to a 4% increase in surgery recommendation among the expert panel, while a .2% increase in the likelihood of receiving surgery in the real world. Surgical decision-making varied between the expert panel and real-world treating surgeons. Differences appear to be less evident in A3/A4 burst fractures making this specific group of fractures a real challenge independent of the level of expertise.

Understanding hydrological processes of glacierized catchments in the western Himalayas by a multi‐year tracer‐based hydrograph separation analysis

AbstractSnow and glacier melt are significant contributors to streamflow in Himalayan catchments, and their increasing contributions serve as key indicators of climate change. Consequently, the quantification of these streamflow components holds significant importance for effective water resource management. In this study, we utilized the spatio‐temporal variability of isotopic signatures in stream water, rainfall, winter fresh snow, snowpack, glaciers, springs, and wells, in conjunction with hydrometeorological observations and Snow Cover Area (SCA) data, to identify water sources and develop a conceptual understanding of streamflow dynamics in three catchments (Lidder, Sindh, and Vishow) within the western Himalayas. The following results were obtained: (a) endmember contributions to the streamflow exhibit significant spatial and seasonal variability across the three catchments during 2018–2020; (b) snowmelt dominates streamflow, with average contributions across the entire catchment varying: 59% ± 9%, 55% ± 4%, 56% ± 6%, and 55% ± 9% in Lidder, 43% ± 6%, 38% ± 6%, 32% ± 4%, and 33% ± 5% in Sindh and 45% ± 8%, 40% ± 6%, 39% ± 6%, and 32% ± 5% in Vishow during spring, summer, autumn, and winter seasons, respectively; (c) glacier melt contributions can reach ~30% to streamflow near the source regions during peak summer; (d) The primary uncertainties in streamflow components are attributed to the spatiotemporal variability of tracer signatures of winter fresh snow/snowpack (±1.9% to ±20%); (e)regarding future streamflow components, if the glacier contribution were to disappear completely, the annual average streamflow in Lidder and Sindh could decrease up to ~20%. The depletion of the cryosphere in the region has led to a rapid increase in runoff (1980–1900), but it has also resulted in a significant streamflow reduction due to glacier mass loss and changes in peak streamflow over the past three decades (1990–2020). The findings highlight the significance of environmental isotope analysis, which provides insights into water resources and offers a critical indication of the streamflow response to glacier loss under a changing climate.

Prognostic Value and Relative Cutoffs of Triglycerides Predicting Cardiovascular Outcome in a Large Regional-Based Italian Database.

Despite longstanding epidemiologic data on the association between increased serum triglycerides and cardiovascular events, the exact level at which risk begins to rise is unclear. The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension has conceived a protocol aimed at searching for the prognostic cutoff value of triglycerides in predicting cardiovascular events in a large regional-based Italian cohort. Among 14 189 subjects aged 18 to 95 years followed-up for 11.2 (5.3-13.2) years, the prognostic cutoff value of triglycerides, able to discriminate combined cardiovascular events, was identified by means of receiver operating characteristic curve. The conventional (150 mg/dL) and the prognostic cutoff values of triglycerides were used as independent predictors in separate multivariable Cox regression models adjusted for age, sex, body mass index, total and high-density lipoprotein cholesterol, serum uric acid, arterial hypertension, diabetes, chronic renal disease, smoking habit, and use of antihypertensive and lipid-lowering drugs. During 139 375 person-years of follow-up, 1601 participants experienced cardiovascular events. Receiver operating characteristic curve showed that 89 mg/dL (95% CI, 75.8-103.3, sensitivity 76.6, specificity 34.1, P<0.0001) was the prognostic cutoff value for cardiovascular events. Both cutoff values of triglycerides, the conventional and the newly identified, were accepted as multivariate predictors in separate Cox analyses, the hazard ratios being 1.211 (95% CI, 1.063-1.378, P=0.004) and 1.150 (95% CI, 1.021-1.295, P=0.02), respectively. Lower (89 mg/dL) than conventional (150 mg/dL) prognostic cutoff value of triglycerides for cardiovascular events does exist and is associated with increased cardiovascular risk in an Italian cohort.

Determination of Nitric Oxide and Its Metabolites in Biological Tissues Using Ozone-Based Chemiluminescence Detection: A State-of-the-Art Review.

Ozone-based chemiluminescence detection (CLD) has been widely applied for determining nitric oxide (•NO) and its derived species in many different fields, such as environmental monitoring and biomedical research. In humans and animals, CLD has been applied to determine exhaled •NO and •NO metabolites in plasma and tissues. The main advantages of CLD are high sensitivity and selectivity for quantitative analysis in a wide dynamic range. Combining CLD with analytical separation techniques like chromatography allows for the analytes to be quantified with less disturbance from matrix components or impurities. Sampling techniques like microdialysis and flow injection analysis may be coupled to CLD with the possibility of real-time monitoring of •NO. However, details and precautions in experimental practice need to be addressed and clarified to avoid wrong estimations. Therefore, using CLD as a detection tool requires a deep understanding of the sample preparation procedure and chemical reactions used for liberating •NO from its derived species. In this review, we discuss the advantages and pitfalls of CLD for determining •NO species, list the different applications and combinations with other analytical techniques, and provide general practical notes for sample preparation. These guidelines are designed to assist researchers in comprehending CLD data and in selecting the most appropriate method for measuring •NO species.

Impact of PNPLA3 and TM6SF2 polymorphisms on the prognosis of patients with MASLD and type 2 diabetes mellitus.

Longitudinal studies assessing the impact of genetic polymorphisms on outcomes in patients with Type 2 Diabetes Mellitus (T2DM) and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) are scarce. This study aimed to evaluate the effect of PNPLA3 and TM6SF2 risk alleles on hepatic and extrahepatic outcomes in T2DM-MASLD individuals. Patients' polymorphisms were analysed as follows: PNPLA3 CC, CG and GG; TM6SF2 CC and CT + TT; combined comparing no mutant allele, one allele G or T or ≥2 alleles G or T. Hierarchical models were built to assess associations between polymorphisms and outcomes, independently of confounding factors. Multivariate logistic regression was used for cirrhosis and its complications and extrahepatic cancer, and Cox regression for cardiovascular events (CVEs) and all-cause mortality. In total, 407 T2DM-MASLD patients (62.1 ± 10.5 years, 67.6% women) were followed for 11 (6-13) years. Having at least one G or T allele independently increased the risk of cirrhosis in the separate analysis of PNPLA3 and TM6SF2. Combined polymorphism analysis demonstrated an even higher risk of cirrhosis if two or more risk alleles were present (OR 18.48; 95% CI 6.15-55.58; p < .001). Regarding cirrhosis complications, the risk was higher in PNPLA3 GG and TM6SF2 CT + TT, also with an even higher risk when two or more risk alleles were present in the combined evaluation (OR 27.20; 95% CI 5.26-140.62; p < .001). There were no associations with CVEs or mortality outcomes. In T2DM, PNPLA3 and TM6SF2 polymorphisms, individually and additively, impact MASLD severity, with an increased risk of cirrhosis and its complications.

Rural-Urban Differences in Mortality among Mechanically Ventilated Patients in Intensive and Intermediate Care.

Rationale: Intermediate care (also termed "step-down" or "moderate care") has been proposed as a lower cost alternative to care for patients who may not clearly benefit from intensive care unit admission. Intermediate care units may be appealing to hospitals in financial crisis, including those in rural areas. Outcomes of patients receiving intermediate care are not widely described. Objectives: To examine relationships among rurality, location of care, and mortality for mechanically ventilated patients. Methods: Medicare beneficiaries aged 65 years and older who received invasive mechanical ventilation between 2010 and 2019 were included. Multivariable logistic regression was used to estimate the association between admission to a rural or an urban hospital and 30-day mortality, with separate analyses for patients in general, intermediate, and intensive care. Models were adjusted for age, sex, area deprivation index, primary diagnosis, severity of illness, year, comorbidities, and hospital volume. Results: There were 2,752,492 hospitalizations for patients receiving mechanical ventilation from 2010 to 2019, and 193,745 patients (7.0%) were in rural hospitals. The proportion of patients in rural intermediate care increased from 4.1% in 2010 to 6.3% in 2019. Patient admissions to urban hospitals remained relatively stable. Patients in rural and urban intensive care units had similar adjusted 30-day mortality, at 46.7% (adjusted absolute risk difference -0.1% [95% confidence interval, -0.7% to 0.6%]; P = 0.88). However, adjusted 30-day mortality for patients in rural intermediate care was significantly higher (36.9%) than for patients in urban intermediate care (31.3%) (adjusted absolute risk difference 5.6% [95% confidence interval, 3.7% to 7.6%]; P < 0.001). Conclusions: Hospitalization in rural intermediate care was associated with increased mortality. There is a need to better understand how intermediate care is used across hospitals and to carefully evaluate the types of patients admitted to intermediate care units.

The Association of Vaccination for Common Adult Infectious Diseases and Uptake of COVID-19 Vaccines among 5,006,851 Veterans, 20 December 2020-31 October 2021.

Disparities in vaccination coverage for coronavirus disease 2019 (COVID-19) in the United States (U.S.) are consistent barriers limiting our ability to control the spread of disease, particularly those by age and race/ethnicity. This study examines the association between previous vaccination for common adult infectious diseases and vaccination for SARS-CoV-2 among a cohort of veterans in the U.S. Sociodemographic and clinical data were utilized from three databases within the Veterans Health Administration included in the electronic health record. We examined the association of previous vaccination for common adult vaccinations through six separate multivariable logistic regression analyses, one for each previous vaccine exposure, adjusting for demographic and clinical variables. We also examined the association of receiving any one of the six common adult vaccinations and vaccination against SARS-CoV-2. Adjusted models indicate higher odds of vaccination for SARS-CoV-2 among those who received each of the previous vaccinations. Significant differences were also noted by race/ethnicity and age. Veterans who recorded receiving any one of the previous vaccinations for common adult infections had significantly greater odds of receiving any vaccination against SARS-CoV-2. Understanding veterans' previous vaccination status can assist researchers and clinicians in impacting the uptake of novel vaccines, such as vaccination against SARS-CoV-2.

Multiple augmented reduced rank regression for pan-cancer analysis.

Statistical approaches that successfully combine multiple datasets are more powerful, efficient, and scientifically informative than separate analyses. To address variation architectures correctly and comprehensively for high-dimensional data across multiple sample sets (ie, cohorts), we propose multiple augmented reduced rank regression (maRRR), a flexible matrix regression and factorization method to concurrently learn both covariate-driven and auxiliary structured variations. We consider a structured nuclear norm objective that is motivated by random matrix theory, in which the regression or factorization terms may be shared or specific to any number of cohorts. Our framework subsumes several existing methods, such as reduced rank regression and unsupervised multimatrix factorization approaches, and includes a promising novel approach to regression and factorization of a single dataset (aRRR) as a special case. Simulations demonstrate substantial gains in power from combining multiple datasets, and from parsimoniously accounting for all structured variations. We apply maRRR to gene expression data from multiple cancer types (ie, pan-cancer) from The Cancer Genome Atlas, with somatic mutations as covariates. The method performs well with respect to prediction and imputation of held-out data, and provides new insights into mutation-driven and auxiliary variations that are shared or specific to certain cancer types.

Investment Uncertainties and Economic Growth in Sub-Saharan Africa

Abstract This study investigated the effect of uncertainties, segmented into macroeconomic and political components, on investment in sub-Saharan Africa, with thirty-one countries represented. The analyses were further nuanced to trace the investment-growth link within this set of countries. Two investment types—private and foreign direct—were covered in separate analyses. The sample of countries was chosen through stratified sampling to include oil-exporting, other resource-intensive, and nonresource-endowed countries. The Jorgenson investment model, which explicitly incorporates uncertainty into the investment decision-making process using adaptive and extrapolative approaches, was adopted for the study, and augmented with the partial adjustment model to address the assumption that the user cost of capital adjusts instantaneously. For the two investment types considered, the impartial contract and foreign investment model and the country risk and private investment model were adopted, respectively. The two-way system generalized method of moments technique was employed for estimation. The results showed that foreign direct investment (FDI) in oil-exporting and other resource-intensive countries was only sensitive to macroeconomic uncertainty, while FDI in nonresource-intensive countries was vulnerable to both macroeconomic and political uncertainties. This finding strengthens the belief that, regardless of political instability, natural resources are a major attraction for foreign investors in sub-Saharan Africa. Finally, the study revealed that private investment in the resource-intensive region was primarily affected by macroeconomic uncertainty, whereas its political vulnerability was mainly observed in the oil-exporting and nonresource-intensive regions. To mitigate investment uncertainties in sub-Saharan Africa, it is crucial to focus on minimizing the volatility of interconnected price variables, requiring collaborative efforts.

The role of environment and AGN feedback in quenching local galaxies: comparing cosmological hydrodynamical simulations to the SDSS

ABSTRACT We present an analysis of the quenching of local observed and simulated galaxies, including an investigation of the dependence of quiescence on both intrinsic and environmental parameters. We apply an advanced machine learning technique utilizing random forest classification to predict when galaxies are star forming or quenched. We perform separate classification analyses for three groups of galaxies: (a) central galaxies, (b) high-mass satellites ($M_{*} \gt 10^{10.5}\,{\rm {\rm M}_{\odot }}$), and (c) low-mass satellites ($M_{*} \lt 10^{10}\,{\rm {\rm M}_{\odot }}$) for three cosmological hydrodynamical simulations (Evolution and Assembly of GaLaxies and their Environments, Illustris, and IllustrisTNG), and observational data from the Sloan Digital Sky Survey. The simulation results are unanimous and unambiguous: quiescence in centrals and high-mass satellites is best predicted by intrinsic parameters (specifically central black hole mass), while it is best predicted by environmental parameters (specifically halo mass) for low-mass satellites. In observations, we find black hole mass to best predict quiescence for centrals and high-mass satellites, exactly as predicted by the simulations. However, local galaxy overdensity is found to be most predictive parameter for low-mass satellites. None the less, both simulations and observations do agree that it is environment which quenches low-mass satellites. We provide evidence which suggests that the dominance of local overdensity in classifying low-mass systems may be due to the high uncertainty in halo mass estimation from abundance matching, rather than it being fundamentally a more predictive parameter. Finally, we establish that the qualitative trends with environment predicted in simulations are recoverable in the observation space. This has important implications for future wide-field galaxy surveys.