Sequential Regression Research Articles

Comparing US state resident IQ, socioeconomic status, and racial-ethnic composition as predictors of state violent crime rates

This study examined the extent to which state resident IQ, socioeconomic status (SES), and five racial-ethnic composition variables can independently account for differences in violent crime rates across the 48 contiguous American states using correlation and multiple regression strategies focused on 2019. Pearson correlations indicated that state violent crime rates significantly correlated − .69 with IQ, − .54 with SES, .39 with a racial-ethnic diversity composite, − .52 with White population percent, .30 with Black population percent, and .39 with Hispanic population percent. One set of five sequential multiple regression equations indicated that a state racial-ethnic diversity composite, White population percent, and Black population percent, still were significant predictors of state violent crime rates with socioeconomic status controlled. A second set of five equations showed none of the five racial-ethnic variables was a significant predictor of crime rates with IQ controlled. A third set of five equations showed that neither SES nor any of the racial-ethnic variables was a significant predictor with IQ controlled, and that IQ remained a significant predictor with SES and each of the five racial-ethnic variables in turn controlled. The findings persisted with multicollinearity and spatial autocorrelation considered. The results demonstrate the large and predominant negative relation of state resident IQ to state violent crime rates and its capacity to eliminate the relations of SES and racial-ethnic variables to those crime rates. Generally, the results underline the importance of evaluating potential crime rate predictors in a multiple regression model rather than testing their predictive capacities only as single variables.

QSAR Modeling of Substituted Benzimidazole Derivative as Angiotensin II-AT1 Receptor Antagonist: WHIM Descriptors

Selective inhibition of Angiotensin II (Ang II) is an important strategy for design of Ang II-AT1 receptor antagonist which is devoid of the common side effects of angiotensin converting enzyme inhibitors (ACEIs). QSAR study of 4, 5, 6, and 7 substituted benzimidazole analogs were performed using Dragon 2.1 (Milano Chemometrics) for antagonism of Ang II. The study was carried out on 33 compounds; mathematical models were obtained by means of the sequential multiple linear regression analysis (SMLR). QSAR analysis have produced good predictive models and give statistically significant correlations of selective Ang II antagonism with WHIM descriptors concerning size, symmetry, shape and distribution of molecules atom. The predictive ability of the resulting QSAR model was evaluated by cross validated correlation coefficient (q2 = 0.659). It was able to describe more than 68% of the variance in the experimental activity. This QSAR study helps in design and prediction of Ang II inhibitory activity of novel substituted benzimidazole Ang II-AT1 receptor antagonist.

Machine learning-driven prediction of EBNA1 inhibitors against Epstein–Barr virus in nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC), particularly prevalent in regions such as Malaysia, is a significant health concern often linked to Epstein-Barr virus (EBV) infection. The EBV nuclear antigen 1 (EBNA1), crucial for EBV survival and NPC tumorigenicity, has emerged as a potential therapeutic target for EBV-positive NPC. In this study, we utilized quantitative structure-activity relationship (QSAR) models to predict potential inhibitors of EBNA1. These models were developed based on the molecular fingerprints of known EBNA1 inhibitors, using both classification and regression approaches. Our QSAR classification models demonstrated consistently high precision, recall, F1 score, and accuracy scores across the training set. The top-performing models, constructed using logistic regression algorithms, achieved perfect precision scores of 1.000 in the test set evaluation. These models’ recall, F1 score, and accuracy scores were 0.571, 0.727, and 0.667, respectively. On the other hand, the best-performing model among the regression models was built using the sequential minimal optimization regression algorithm, achieving a correlation coefficient of 0.703. The mean absolute error and root mean square error of this QSAR regression model were 0.173 and 0.217, respectively, whereas the relative absolute error was 0.689. We screened the enamine advanced compound library using this regression model to predict compounds with potential EBNA1 inhibitory effects. This led to the identification of the top 10 compounds with the most promising predicted EBNA1 inhibitory properties.

Clinician and Practice Characteristics Associated With Support of Office-Based Methadone: Findings From a National Survey.

Alternative models for methadone delivery outside of federal and state-regulated opioid treatment programs may improve access. We determined factors associated with clinician support for continuing office-based methadone. We used data from the electronic Opioid Use Disorder Provider COVID-19 Survey conducted among X-waivered clinicians who were providing outpatient, longitudinal treatment of opioid use disorder (OUD) from July 2020 to August 2020. The outcome variable was selecting "The opportunity for patients to receive office-based methadone" when asked "Which pandemic-related policy changes or new policy changes would you like to be continued or started after the pandemic?" Using sequential multivariable logistic regression modeling, we estimated the association between clinician and practice characteristics and support for office-based methadone. Of 1900 respondents, 728 met the inclusion criteria. Twenty-eight percent indicated support for office-based methadone. Clinician characteristics associated with support for office-based methadone were being Black or African American versus White (adjusted odds ratio [AOR] [95% confidence interval (CI)], 2.88 [1.19-6.98]), having provided medications for OUD (MOUD) for >15 years versus ≤15 years (AOR [95% CI], 1.66 [1.02-2.68]), treating 51 to 100 patients with MOUD monthly versus <25 patients (AOR [95% CI], 1.79 [1.04-3.09]), providing methadone (AOR [95% CI], 1.71 [1.03-2.85]) versus not providing MOUD previously, and working in an academic medical center versus other settings (AOR [95% CI], 1.88 [1.11-3.16]). A minority of surveyed X-waivered clinicians supported office-based methadone. Efforts to expand access to methadone via office-based settings should address implementation barriers.

Long COVID prevalence differences across 27 European countries that participated in the 2021 Survey of Health, Ageing and Retirement in Europe

Abstract The COVID-19 pandemic caused a significant burden in Europe, with over 60% of infected individuals developing Long COVID symptoms. Variations in Long COVID prevalence across countries are linked to individual-level factors, but the influence of population-based country-level characteristics remains unclear. Thus, our objective was to assess how country-level characteristics related to: (i) the way European countries responded to the COVID-19 pandemic, (ii) their population-level health status, (iii) provision and access to healthcare services, (iv) human development, governance, and environmental risk factors, are associated with Long COVID. We used a sample of 4,004 middle-aged and older adults from 27 European countries who, in summer 2021, participated in Corona Survey 2 (from Survey of Health, Ageing and Retirement in Europe) and who reported COVID-19 infection one year prior to the survey. To assess the potential role of country-level characteristics, while controlling for key individual-level factors, we estimated three sequential multilevel random intercept logistic regression models. Approximately 70% of respondents who had COVID-19 also experienced Long COVID symptoms and there were significant cross-country differences in Long COVID rates, ranging from 32% to 89%. About 13% of the total variance in the risk of having Long COVID can be attributed to cross-country differences and the remaining 87% to individual-level factors. The individual-level characteristics also accounted for 6% of the observed cross-country differences in Long COVID rates (compositional effects) while the country-level characteristics further reduced this variance by over 50%. Both individual and country-level factors influence Long COVID occurrence, emphasizing the need for tailored recovery plans, healthcare planning and resource allocation at the national level to address this condition.

Does the attractiveness of K‐culture shape the enjoyment of foreign language learners of Korean?

AbstractAttraction to the target culture can be a reason to study the language, especially in the case of languages other than English (LOTEs). Recently, the number of Korean language learners has surged alongside the growing popularity of Korean pop culture (K‐pop). However, it is unknown whether the initial attraction to the culture and the first steps in that direction shape foreign language (FL) emotions in the longer term. To fill this gap, this mixed‐methods study examined to what extent the attractiveness of the Korean Culture (K‐culture) predicts foreign language enjoyment (FLE) after controlling for other established learner variables (i.e., the length of FL study, FL proficiency, frequency of FL use outside of class, and attitudes toward the teacher and FL) through sequential regression analysis. The quantitative findings are complemented by the open‐ended responses to the sources of FLE using the American Council on Teaching of Foreign Languages 3Ps framework (products, practices, and perspectives) through NVivo. A total of 782 university students studying Korean as FL completed an online survey on the attractiveness of K‐culture and FLE. The results showed that the attitude toward the teacher and attractiveness of K‐culture are the strongest predictors of FLE.

HPV Vaccination Stages and Associated Factors Among Children of Immigrant Women.

This study aimed to identify key determinants by stage of implementation of human papillomavirus (HPV) vaccination among children of immigrant women in South Korea. Cross-sectional descriptive study. The sample comprised 262 Chinese, Vietnamese, and Korean-Chinese women with children living in South Korea. The survey was conducted using self-report questionnaires. The HPV vaccination levels in children were classified into four transition stages. Sequential logistic regression analysis was conducted to identify the factors affecting the transition of HPV vaccination status. Social norms had the greatest influence on the intention to vaccinate. Perceived barriers were a significant factor associated with intention or initiation of vaccination, whereas perceived severity and susceptibility were associated with the intention and initiation stages, respectively. Upon the initiation of HPV vaccination, low perception of discrimination in healthcare was associated with continued vaccination. Given the importance of completing multiple doses of the HPV vaccine within a given timeframe, it is important to provide culturally appropriate interventions in stages to prevent dropouts.

A Study of the Influence of Ion-Ozonized Water on the Properties of Pasta Dough Made from Wheat Flour and Pumpkin Powder.

Water treated with ion ozone improves the technological qualities of food products. Therefore, ion-ozonated water was used in the work, and whole-grain flour from soft wheat of the Almaly variety and pumpkin powder were used as raw materials to improve the quality and nutritional value of the pasta. This study investigated the effects of ion-ozone concentration in ion-ozonated water Cio, water temperature tw, pumpkin powder content Cpp and drying temperature td on various characteristics affecting the quality of pasta, including its organoleptic physical, chemical, and rheological properties. These characteristics were assessed by conducting multiple experiments, a total of 25 indicators were determined, such as humidity, acidity, cooking properties, deformation, and other basic quality indicators. To reduce the number of experiments and obtain a reliable assessment of the influence of individual factors on the quality indicators of pasta, methods involving the multifactorial design of experiments were applied. Data processing and all necessary calculations were carried out using the PLAN sequential regression analysis program. Consequently, our findings indicate that minimizing dry water (DM) loss in cooking water requires a dual approach: increasing ion-ozone concentration and optimizing pasta composition and drying conditions, specifically by reducing pumpkin powder content and drying temperature. As a result, it was established that to obtain high-quality pasta from whole-grain flour with high quality and rheological properties, it is necessary to use the following optimal production modes: ion-ozone concentration in ion-ozonated water Cio = 2.5 × 10-6 mg/cm3, water temperature tw = 50 °C, pumpkin powder content Cpp = 3.0%, and pasta drying temperature td = 50 °C. The resulting pasta is an environmentally friendly product with a high content of biologically active substances.

Residential water choices: Assessing the willingness to adopt alternative water sources by examining risk perceptions and personal norms in Belgium

With escalating freshwater scarcity, transformative shifts in infrastructure, technology, and societal attitudes are essential. This study applies Protection Motivation Theory to explore how perceived water scarcity impacts individuals' willingness to reduce tap water consumption and increase the use of alternative sources in households. An online survey (n = 2623) in Belgium assessed acceptance of tap water, rainwater, and recycled greywater for various household activities. Sequential regression analysis examined the influence of threat appraisal, coping appraisal, personal norms, and socio-demographics on this willingness. The results indicate that willingness to conserve tap water is strongly driven by self-efficacy rather than risk appraisal. Conversely, willingness to use rainwater and recycled greywater depends on perceived future water scarcity, perceived self-efficacy, and personal norms. Perceptions of present water scarcity negatively influenced the willingness to use rainwater and recycled greywater, suggesting a boomerang effect. However, future water scarcity perceptions encourage the use of alternative water sources, providing a nuanced perspective. These findings provide valuable insights into the acceptance of alternative water sources and underline the importance of context-specific approaches, enhancing self-efficacy and personal norms to encourage the adoption of alternative water sources for household activities, ensuring effective freshwater conservation.

Designing User Experience Improvement and User Behavior Pattern Recognition Algorithms in Design Operation

Enhancing user experience (UX) is a key component in customer retention and sales promotion in e-commerce platforms. To build an effective UX model it is necessary to predict the user behavior more accurately and develop UX model that is tailored based on those behavior patterns. Existing models lack the ability to integrate advanced Machine Learning (ML) models to address the challenges. This study is an attempt to tackle these limitations that employs advanced AI tools to predict user behavior so that to construct an more effective UX model. The study involved 80 users from China who were aged 26 to 52, with diverse backgrounds in education, occupation, and tech proficiency. The work have employed Google Analytics, Hotjar, and FullStory to collect the user interactions and by using Generalized Sequential Pattern (GSP) algorithm, Decision Trees (DT), and Logistic Regression (LR) the work attempts to accurately predict the user behavior patterns. The results show that the model achieved better accuracy of 0.8795 and an F1 Score of 0.8610 on the test dataset. It also excelled in conversion rate (12.34%) and bounce rate (28.65%) which show effectiveness in retaining users and converting visits into actions.

The indirect effect of parents’ work-family conflict on students’ psychosocial well-being

ABSTRACT This study aims to investigate the cascading impact of parents’ work-family conflict (WFC) on students’ psychosocial well-being. This study examines the sequential mediation effect of parents’ well-being and positive discipline using the conservation of resources (COR) theory and emotional contagion theory. Data were collected using an online survey platform where every participant received a concern form and unique code. The analysis used data from 351 parent–child dyads after removing 76 participants who failed the attention check items or did not complete the three phases of data collection. Data were analysed using a sequential mediation regression model six proposed by Hayes. The results confirmed a sequential mediation model where the parent's WFC indirectly impacted the student's psychosocial well-being through the mediating role of the parent's well-being and positive discipline. This study also discovered that WFC directly impacted parents’ well-being, positive discipline, and students’ psychosocial well-being. Organisations must provide parents with psychological services to reduce WFC and maintain their well-being. On the other hand, schools should communicate with parents and encourage positive discipline for students. This current study has advanced the literature by examining the link between parents’ WFC and students’ psychosocial well-being.

Accelerating the convergence of coupled cluster calculations of the homogeneous electron gas using Bayesian ridge regression.

The homogeneous electron gas is a system that has many applications in chemistry and physics. However, its infinite nature makes studies at the many-body level complicated due to long computational run times. Because it is size extensive, coupled cluster theory is capable of studying the homogeneous electron gas, but it still poses a large computational challenge as the time needed for precise calculations increases in a polynomial manner with the number of particles and single-particle states. Consequently, achieving convergence in energy calculations becomes challenging, if not prohibited, due to long computational run times and high computational resource requirements. This paper develops the sequential regression extrapolation (SRE) to predict the coupled cluster energies of the homogeneous electron gas in the complete basis limit using Bayesian ridge regression and many-body perturbation theory correlation energies to the second order to make predictions from calculations at truncated basis sizes. Using the SRE method, we were able to predict the coupled cluster double energies for the electron gas across a variety of values of N and rs, for a total of 70 predictions, with an average error of 5.20 × 10-4 hartree while saving 88.9h of computational time. The SRE method can accurately extrapolate electron gas energies to the complete basis limit, saving both computational time and resources. Additionally, the SRE is a general method that can be applied to a variety of systems, many-body methods, and extrapolations.

Emotion regulation among adults with asthma: Links with short-acting inhaler medication overuse and utilization of acute medical care

Objective Existing research suggests that emotion plays an important role in airway inflammation and asthma symptom control. The objective of this study was to determine whether difficulties regulating emotion were associated with overuse of short-acting inhaled medications and acute medical care usage in adults with asthma. Methods The sample included 401 adults with asthma recruited from an online panel of adults with chronic respiratory disease. Sequential binary logistic regression models were used to examine the associations of emotion regulation with short-acting inhaled medication use and acute medical care use, controlling for patient characteristics and comorbid mental health conditions. Results Greater difficulties with emotion regulation were significantly associated with greater odds of short-acting inhaler medication overuse (p < 0.001), emergency department visits (p < 0.001), and hospitalizations (p = 0.001). Conclusions Emotion dysregulation may play an important role in asthma management. Evidence-based interventions to reduce difficulties in emotion regulation may help improve problematic patterns of short-acting medication overuse and acute service use. The current findings should be interpreted in the context of several limitations, including the use of self-report measures. Future research should use electronic medical records or metered dose inhalers to objectively assess short-acting inhaler overuse and acute medical care use.

ENHANCING TEACHER PRACTICES IN ASSESSING FUNCTIONAL PERFORMANCE OF STUDENTS WITH AUTISM SPECTRUM DISORDER (ASD): AN EMPIRICAL PERSPECTIVE

Youth students with Autism Spectrum Disorder (ASD) are at higher risk of functional skills deficiency, which presents a barrier to the acquisition of academic skills. This study examines teachers’ practices in determining the functional performance of students with ASD in stage-based education pathways in Kenya. A quantitative research design was employed, involving 47 teachers and 76 students with ASD from various primary schools. Data were collected using a self-administered rating scale for teachers and a modified version of the Vineland Adaptive Behaviour Scales for students. Descriptive and sequential regression analyses were conducted to evaluate teacher practices and their impact on students’ functional skills. Findings show that the identification and use of instructional resources were the most frequently performed practices among teachers, while the assessment of functional skills was the least. The study found significant correlations between teacher practices and students’ functional skill acquisition, particularly communication skills. However, the relationships among teacher practices were generally weak, indicating a lack of integration in their approaches. The study concludes that a comprehensive approach, incorporating multiple assessment practices, is essential for improving student outcomes. Recommendations include targeted professional development for teachers, standardized assessment practices, and increased collaboration with parents to support functional skill development in students with ASD. These findings underscore the need for enhanced training and resource access to optimize educational outcomes within the Competency-Based Curriculum framework.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0717/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Molecular, Socioeconomic, and Clinical Factors Affecting Racial and Ethnic Disparities in Colorectal Cancer Survival

Disparity in overall survival (OS) and differences in the frequency of driver gene variants by race and ethnicity have been separately observed in patients with colorectal cancer; however, how these differences contribute to survival disparity is unknown. To quantify the association of molecular, socioeconomic, and clinical covariates with racial and ethnic disparities in overall survival among patients with colorectal cancer. This single-center cohort study was conducted at a tertiary-level cancer center using relevant data on all patients diagnosed with colorectal cancer from January 1, 1973, to March 1, 2023. The relative contribution of variables to the disparity was determined using mediation analysis with sequential multivariate Cox regression models. OS, from diagnosis date and from start of first-line chemotherapy. The study population of 47 178 patients (median [IQR] age, 57.0 [49-66] years; 20 465 [43.4%] females and 26 713 [56.6%] males; 3.0% Asian, 8.7% Black, 8.8% Hispanic, and 79.4% White individuals) had a median (IQR) follow-up from initial diagnosis of 124 (174) months and OS of 55 (145) months. Compared with White patients, Black patients had worse OS (hazard ratio [HR], 1.16; 95% CI, 1.09-1.24; P <.001), whereas Asian and Hispanic patients had better OS (HR, 0.66; 95% CI, 0.59-0.74; P <.001; and 0.86; 95% CI, 0.81-0.92; P <.001, respectively). When restricted to patients with metastatic disease, the greatest disparity was between Black patients compared with White patients (HR, 1.2; 95% CI, 1.06-1.37; P <.001). Evaluating changes in OS disparity over 20 years showed disparity decreasing among Asian, Hispanic, and White patients, but increasing between Black patients and White patients (HRs, 1.18; 95% CI, 1.07-1.31 for 2008-2012; 1.24, 95% CI, 1.08-1.42 for 2013-2017; and 1.50; 95% CI, 1.20-1.87 for 2018-2023). Survival outcomes for first-line chemotherapy were worse for Black patients compared with White patients (median OS, 18 vs 26 months; HR, 1.30; 95% CI, 1.01-1.70). Among 7628 patients who had clinical molecular testing, APC, KRAS, and PIK3CA showed higher variant frequency in Black patients (false discovery rate [FDR], 0.01; < 0.001; and 0.01, respectively), whereas BRAF and KIT were higher among White patients (FDR, 0.001 and 0.01). Mediation analysis identified neighborhood socioeconomic status as the greatest contributor to OS disparity (29%), followed by molecular characteristics (microsatellite instability status, KRAS variation and BRAF variation, 10%), and tumor sidedness (9%). This single-center cohort study identified substantial OS disparity and differing frequencies of driver gene variations by race and ethnicity. Socioeconomic status had the largest contribution but accounted for less than one-third of the disparity, with substantial contribution from tumor molecular features. Further study of the associations of genetic ancestry and the molecular pathogenesis of colorectal cancer with chemotherapy response is needed.

Abstract P185: Patient Portal Access, Health Literacy, Patient Trust in Health System, and Shared Decision Making Among US Adults with Hypertension: A National Cross-Sectional Study

Background: Shared decision-making (SDM) is increasingly recognized as central to delivering patient-centered care and improving hypertension control. However, there is limited understanding of the association between patients' access to patient portals, health literacy, trust in the health system, and involvement in SDM. Objectives: This study investigated the associations between patients' access to patient portals, health literacy, trust in the health system, and patients’ involvement in SDM among adults with hypertension in the United States (US). Methods: This cross-sectional study utilized data from the 2022 Health Information National Trends Survey (HINTS 6) conducted among US adults. The exposure variables were patient portal use, health literacy, patients' trust in health systems, and whether the participant was offered access to patient portals by healthcare providers. The outcome of interest was whether patients were always involved in SDM (Yes/No) during the past 12 months. Analyses were weighted according to HINTS 6 methodology. We performed three weighted sequential multivariable logistic regression models (Fig. 1, Models 1-3). The fully adjusted model included demographics, clinical characteristics, and social determinants of health and resources for implementing SDM and was stratified by age (&lt;65 and ≥65 years). Results: We included 1703 adults with hypertension (mean age of 61.6, SD 13.9 years; 52.5% male; and 64.9% White adults). About 86.4% of participants were offered online access to patient portals by their healthcare providers. In the fully adjusted model (Fig. 1, Model 3), adults who were offered access to patient portals (adjusted odds ratio [aOR] 1.90, 95% CI 1.03-3.49), with higher health literacy levels (aOR 2.18, 95% CI 1.42-3.34), and with higher trust in health systems (aOR 3.08, 95% CI 2.26-4.21) were more likely to engage in SDM than their counterparts. These associations were similar among adults &lt;65 years (Fig. 2). However, among adults ≥65 years, offering online access to patient portals was not associated with involvement in SDM; while those who used the patient portal 6-9 times during the past 12 months were more likely to engage in SDM than those who never used it (aOR 2.26, 95% CI 1.06-4.83). Conclusion: Offering access to patient portals may enhance SDM among US adults with hypertension, especially for adults with higher health literacy levels and greater trust in health systems. These associations differed by age.

What's Up, Mister! An Investigation of the Team-Fan Conversational Approach

This paper proposes a research model for investigating the effect on fan satisfaction and fan loyalty of the three dimensions of the customer engagement construct on Mobile Instant Messaging Apps when they are used as Engagement Platforms in a conversational marketing approach. To test the hypotheses, a sequential regression model was implemented. A survey was conducted on fans of a famous football team in Italy that has recently decided to use WhatsApp (Mobile Instant Messaging App - MIM) to allow fans to communicate directly with football players. The results highlight the importance of emotional engagement on fan satisfaction and the role of behavioural engagement through the use of WhatsApp for enhancing fan commitment. Fans who are engaged and more satisfied thanks to the use of MIM apps can be ambassadors for the sport brand thus affecting the fan behaviour-based relationship performance and the support to the team. For this reason, sports team managers need to consider the MIM app as a tool that can increase fan engagement.

Determining critical monitoring periods for accurate wearable step counts in patients with degenerative spine disorders

Longitudinal physical activity monitoring is a novel and promising objective outcome measure for patients with degenerative spine disorder (DSD) that currently lacks established standards for data collection and interpretation. Here, we monitored 100 patients with DSD with the Apple Watch to establish the optimal duration and pattern of step count monitoring needed to estimate their weekly physical activity before their elective surgery. Participants were predominantly female (65.3%), had an average age of 61.5 years, and showed consistent step counts between preoperative days, as well as across weekends and weekdays. Intraclass correlations (ICC) analysis showed that a step count average over 2 days achieved an ICC of 0.92 when compared to a 7-day average before surgery, while 4 days were required for a similar agreement of 0.93 with a 14-day average. Sequential linear regression demonstrated that incorporating additional preoperative days improved the model’s ability to predict 7- and 14-days step count averages. We conclude that, while daily preoperative step counts remain relatively stable, longer activity monitoring is necessary to account for the variance in step count over an increasing time frame, and the full extent of data fluctuation may only become apparent with long-term trend analysis.

Heart failure related fatigue: An exploratory analysis of serum osmolality from the national health and nutrition examination survey

BackgroundFatigue is a prominent symptom of heart failure (HF). However, underlying mechanisms remain poorly understood. Fluid volume status has been suggested as a physiologic mechanism of HF-related fatigue. Serum osmolality may fluctuate with changes in volume status associated with neurohormonal dysregulation. The relationship of fatigue to serum osmolality has not been assessed in adults with HF. ObjectivesDescribe the relationship between serum osmolality and fatigue in adults with HF. MethodsWe analyzed two waves of cross-sectional data from the National Health and Nutrition Examination Survey (2015–2016 and 2017–2018). Adults who self-reported having HF without select co-morbid conditions known to contribute to fatigue were included. Data were weighted to provide US national estimates, and complex sample design used for analyses. Sequential logistic regression was used to isolate the effect of serum osmolality on the odds of having fatigue. ResultsData from the sample represented 1.4 million Americans with HF (58.5 % male; median age 68 years), of whom 1,001,589 (67.9 %) reported fatigue. Participants with fatigue had lower serum osmolality compared to those without fatigue (t = -3.04, p = .009). Higher serum osmolality was associated with 8.8 % lower odds of experiencing fatigue when controlling for sex and body mass index (OR = 0.912, p = .007, CI 0.857 - 0.972). ConclusionsHF-related fatigue is associated with lower serum osmolality. Low serum osmolality may indicate excess volume and the presence of a heightened neurohormonal response, both of which may influence fatigue. Alternatively, serum osmolality may directly affect other physiologic changes that may contribute to fatigue.

Octogenarians unable to return home by postoperative-day 30

BackgroundFor older adults undergoing surgery, returning home is instrumental for functional independence. We quantified octogenarians unable to return home by POD-30, assessed geriatric factors in a predictive model, and identified risk factors to inform decision-making and quality improvement. MethodsThis retrospective cohort study examined patients ≥80 years old from the ACS NSQIP Geriatric Surgery Pilot, using sequential logistic regression modelling. The primary outcome was non-home living location at POD-30. ResultsOf 4946 patients, 19.8 ​% lived in non-home facilities at POD-30. Increased odds of non-home living location were seen in patients with preoperative fall history (OR 2.92, 95%CI 2.06–4.14) and new postoperative pressure ulcer (OR 2.66, 95%CI 1.50–4.71) Other significant geriatric-specific risk factors included mobility aid use, surrogate-signed consent, and postoperative delirium, with odds ratios ranging from 1.42 (1.19–1.68) to 1.97 (1.53–2.53). ConclusionsThese geriatric-specific risk factors highlight the importance of preoperative vulnerability screening and intervention to inform surgical decision-making.