Significant Factors Research Articles

Radiographic Risk Factors for Adjacent Segment Disease Following Anterior Cervical Discectomy and Fusion (ACDF): A Systematic Review and Meta-Analysis.

Systematic review and meta-analysis. To assess the radiographic risk factors for adjacent segment disease (ASD) following anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathologies. PubMed, Embase and the Cochrane Library databases were searched up to December 2023. The primary inclusion criteria were degenerative spinal conditions treated with ACDF, comparing radiological parameters in patients with and without postoperative ASD. The radiographic parameters included intervertebral disc height, cervical sagittal alignment, sagittal segmental alignment, range of motion, segmental height, T1 slope, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and plate to disc distance (PPD). Risk of bias was assessed for all studies. The Cochrane Review Manager was utilized to perform the meta-analysis. From 7044 articles, 13 retrospective studies were included in the final analysis. Three studies had "not serious" bias and the other 10 studies had serious or very serious bias. The total number of patients in the included studies was 1799 patients. Five studies included single-level ACDF, 2 studies included multi-level ACDF, and 6 studies included single or multi-level ACDF. On meta-analysis, the significant risk factors associated with ASD development were reduced postoperative cervical lordosis (mean difference [MD] = 3.35°, P = .002), reduced last-follow-up cervical lordosis (MD = -3.02°, P = .0003), increased preoperative to postoperative cervical sagittal alignment change (MD = -3.68°, P = .03), and the presence of developmental cervical canal stenosis (Odds ratio [OR] = 4.17, P < .001). Decreased postoperative cervical lordosis, greater change in cervical sagittal alignment and developmental cervical canal stenosis were associated with an increased risk of ASD following ACDF.

Differentiation of acanthamoeba keratitis from other non-acanthamoeba keratitis: Risk factors and clinical features.

Infectious Keratitis is one of the most common ocular emergencies seen by ophthalmologists. Our aim is to identify the risk factors and clinical features of Acanthamoeba Keratitis (AK). This retrospective chart review study was conducted at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and included all the microbial keratitis cases, male and female patients of all ages. The main outcome is the differentiation between various microbial keratitis types. We included 134 consecutive eyes of 126 persons. We had 24 cases of acanthamoeba keratitis, 22 bacterial keratitis, 24 fungal keratitis, 32 herpetic keratitis, and 32 bacterial co-infection. Contact lens wear was found in 33 eyes (24.6%). Among acanthamoeba keratitis patients, 73% were ≤ 39 years of age, and 73% were females (P <0.001). Also, in AK cases, epithelial defect was found in all cases (100%), endothelial plaques were found in 18 eyes (69.2%), 12 cases had radial keratoneuritis (46.2%), and ring infiltrate was found in 53.8% of AK cases. We determined the factors that increase the risk of acanthamoeba infection and the clinical characteristics that help distinguish it from other types of microbial keratitis. Our findings suggest that younger females and patients who wear contact lenses are more likely to develop acanthamoeba keratitis. The occurrence of epitheliopathy, ring infiltrate, radial keratoneuritis, and endothelial plaques indicate the possibility of acanthamoeba infection. Promoting education on wearing contact lenses is essential to reduce the risk of acanthamoeba infection, as it is the most significant risk factor for this infection.

Freshmen’s Technological Expertise and Distance Learning Readiness: A Convergent Parallel Design

This convergent parallel mixed methods study primarily focused on technological expertise and distance learning readiness of freshmen students. The study had two phases: the quantitative phase and the qualitative phase. In the quantitative phase, results found that technological expertise and distance learning readiness were highly correlated with each other, with an R-value of .828 and a p-value of 0.000. In the qualitative phase, four themes were extracted: Technological Tools as a Significant Factor in Distance Education, Technological Expertise as Influenced by Minor Skills and Educational Courses, Technological Use Due to Education’s Status Quo, Challenges in Technological Availability, and Technological Background. The results showed a merging and converging characteristic of both data. The lived experiences of the freshmen students showed that technological tools, which are an indicator of technological expertise, are also a factor to be considered in distance learning readiness.

Do rural migrant parents intend to settle in cities? Impacts of childcare strategies, split households, migration duration, and distance

IntroductionThe current transnational and internal migration involve more and more circular and temporary residences in the host communities. However, few studies have examined the settlement intention of circular and temporary migrant parents with children under 18 years old, which has made inclusive planning for these migrants' needs difficult. This paper aimed to examine whether rural migrant parents intended to settle in cities, with specific discussion about the impacts of childcare strategies, split households, and migration duration and distance.MethodsThis was a cross-sectional study design. The data was sourced from the China Migrants Dynamic Survey.ResultsThrough analysis of a sample of 4,247 rural migrant parents in the Pearl River Delta, this study found that 56% of rural migrant parents intended to become urban settlers. Higher levels of education and income and longer migration durations yielded the parents' increased intention to become urban settlers. The birthplaces and primary caregivers of migrants' children were also significant factors. Moreover, split households, especially households in which the youngest child did not live with the parents in cities, decreased parents' intention to settle permanently. Instead of geographic distance, administrative provincial boundaries were found to be a critical factor in inter-provincial migrant parents' decreased intention to settle in cities.DiscussionThis study provides insights into understanding urbanization in China and contributes to future policy studies regarding internal migration, social integration and population growth, especially in a low fertility and rapid aging contest.

Elements of Minority Stress and Resilience in LGBTQ+ Students’ Experience of Education

ABSTRACT This study investigates the experiences of minority stress and resilience among LGBTQ+ students in educational settings and identifies critical contributors to their well-being. To highlight the unique educational experiences of LGBTQ+ participants a qualitative research strategy was employed. We conducted narrative interviews with 27 LGBTQ+ people aged 17 to 41 who are or have been enrolled in primary, secondary or tertiary education in Slovenia. The results indicate that minority stress is a significant in their educational experiences, with various deleterious effects. The testimonies of our respondents indicate, albeit to a lesser extent, that the education system can enhance the resilience of LGBTQ+ youth and mitigate the negative impacts of minority stress. This study confirms prior research on minority stress effects on LGBTQ+ individuals. It asserts that LGBTQ+ youth experience minority stress within the education system, while emphasizing that certain aspects of resilience can significantly mitigate these negative effects. As social support emerged as a significant factor in our study, it would be reasonable to investigate how school personnel can enhance LGBT youths’ resilience in the future. Additionally, it would be beneficial to investigate how the support of peers and (chosen) families influences the school experiences of LGBTQ+ students.

Emergency Tracheostomy: Complications, Anesthetic Techniques, and Outcomes.

Objectives: Acute upper airway obstruction is a critical medical condition that presents considerable challenges to anesthesiologists. This study aims to provide a formal report on the incidence and outcomes of perioperative complications, as well as the factors that influence unstable intraoperative hemodynamics. Methods: This retrospective study reviewed patients aged 18 years and older who underwent emergency tracheostomy between January 2013 and October 2021. Data on perioperative complications and outcomes within the first 24 hours and 7 days after surgery were subjected to analysis. Descriptive and multivariate analyses were used to examine the results. Results: A total of 253 patients were included in the study. The mean age was 61.5 ± 12.9 years. Malignancy was detected in 78.3% of the patients. General anesthesia was administered to 43.9% of the patients. The incidence of intraoperative complications was 51.8%, with hypotension and hypertension occurring in 30.4% and 22.5% of the cases, respectively. Desaturation and cardiac arrest were observed in 4.7% and 0.8% of the patients, respectively. The mortality rate at 7 days after surgery was 1.6%. Multivariate analysis revealed that monitored anesthesia care [adjusted odds ratio (OR) = 1.80; 95% confidence interval (CI): 1.08-3.00] and hypertensive patients (adjusted OR = 1.70, 95% CI: 1.01-2.86) were associated with unstable intraoperative hemodynamics. Conclusions: Cardiovascular instability represented the majority of the complications observed. Monitoring anesthesia care and hypertension were significant prognostic factors for unstable intraoperative hemodynamics. We recommend extensive communication between ear, nose, and throat surgeons and anesthesiologists to determine the appropriate choice of anesthesia.

On building machine learning models for medical dataset with correlated features

Abstract This work builds machine learning models for the dataset generated using a numerical model developed on an idealized human artery. The model has been constructed accounting for varying blood characteristics as it flows through arteries with variable vascular properties, and it is applied to simulate blood flow in the femoral and its continued artery. For this purpose, we designed a pipeline model consisting of three components to include the major segments of the femoral artery: CFA, the common femoral artery and SFA, the superficial artery, and its continued one, the popliteal artery (PA). A notable point of this study is that the features and target variables of the former component pipe form the set of features of the latter, thus resulting in multicollinearity among the features in the third component pipe. Thus, we worked on understanding the effect of these correlated features on the target variables using regularized linear regression models, ensemble, and boosting algorithms. This study highlighted the blood velocity in CFA as the primary influential factor for wall shear stress in both CFA and SFA. Additionally, it established the blood rheology in PA as a significant factor for the same in it. Nevertheless, because the study relies on idealized conditions, these discoveries necessitate thorough clinical validation.

PERFORMANCE INVESTIGATION OF A 5 MW PHOTOVOLTAIC SYSTEM: ALFASHIR SUDAN

This study comprehensively analyzes the operational performance and economic feasibility of a 5MW grid-connected photovoltaic in Sudan over a two-year monitoring period. Leveraging the capabilities of PVSyst software, the actual plant performance was rigorously compared to simulation predictions. Results revealed a significant disparity between observed and simulated energy generation, prompting the exploration of potential areas for enhancement. Seasonal fluctuations in the performance ratio were evident, with peak values during some seasons, albeit not consistently aligning with simulation projections. Despite these challenges, the Plant made a notable impact by reducing CO2 emissions, highlighting the environmental benefits of solar energy. Financial analysis unveiled discrepancies between actual and simulated savings, underscoring the need for optimization and efficiency improvements. The equity payback period, influenced by electricity pricing policies, was estimated at 15 years, emphasizing its role in assessing project economics. The region's high radiation intensity and humidity levels emerged as significant factors affecting plant performance. Addressing these challenges is crucial for maximizing the PV plant's operational efficiency and viability. Our Recommendations include thoroughly examining control system functions during commissioning and improving operational accuracy.

Drinking behavior patterns may be associated with persistent depressive symptoms after alcohol abstinence in alcohol use disorder.

This study examined the association between drinking behavior patterns and depressive symptoms after alcohol abstinence in patients with alcohol use disorder (AUD). We recruited 102 AUD inpatients with baseline depressive symptoms, indicated by scores ≥6 on the Quick Inventory of Depressive Symptomatology Self-Report Japanese Version (QIDS-SR-J) pre-detoxification. Post-4-week abstinence, remission was defined as QIDS-SR-J scores <6. Patients were classified into remitted (n = 51) and persistent (n = 51) groups. Comparative analyses were conducted using patient profiles and the Drinking Behavior Pattern 20-item Questionnaire (DBP-20). Logistic regression identified factors related to post-abstinence persistent depression. Receiver operating characteristic curve analysis determined DBP-20 cutoff scores differentiating between persistent and remitted depression. The persistent group exhibited higher scores in the DBP-20 "coping with negative affect" subscale. Logistic regression showed low education, unemployment, and using alcohol for coping as significant factors for persistent depression. Conversely, an automatic drinking pattern indicated natural remission post-abstinence. A subscale score of ≥8 in alcohol use for coping, especially among unemployed patients, predicted persistent depression (sensitivity 86.8%, positive predictive value 73.3%). Unemployed patients with AUD using alcohol to cope with negative affect may experience residual depression even after detoxification. In contrast, patients with AUD with predominantly automatic drinking behavior may exhibit natural remission post-abstinence.

Human milk microbiome: associations with maternal diet and infant growth.

Ingestion of human milk (HM) is identified as a significant factor associated with early infant gut microbial colonization, which has been associated with infant health and development. Maternal diet has been associated with the HM microbiome (HMM). However, a few studies have explored the associations among maternal diet, HMM, and infant growth during the first 6 months of lactation. For this cross-sectional study, Mam-Mayan mother-infant dyads (n = 64) were recruited from 8 rural communities in the Western Highlands of Guatemala at two stages of lactation: early (6-46 days postpartum, n = 29) or late (109-184 days postpartum, n = 35). Recruited mothers had vaginally delivered singleton births, had no subclinical mastitis or antibiotic treatments, and breastfed their infants. Data collected at both stages of lactation included two 24-h recalls, milk samples, and infant growth status indicators: head-circumference-for-age-z-score (HCAZ), length-for-age-z-score (LAZ), and weight-for-age-z-score (WAZ). Infants were divided into subgroups: normal weight (WAZ ≥ -1SD) and mildly underweight (WAZ < -1SD), non-stunted (LAZ ≥ -1.5SD) and mildly stunted (LAZ < -1.5SD), and normal head-circumference (HCAZ ≥ -1SD) and smaller head-circumference (HCAZ < -1SD). HMM was identified using 16S rRNA gene sequencing; amplicon analysis was performed with the high-resolution ANCHOR pipeline, and DESeq2 identified the differentially abundant (DA) HMM at the species-level between infant growth groups (FDR < 0.05) in both early and late lactation. Using both cluster and univariate analyses, we identified (a) positive correlations between infant growth clusters and maternal dietary clusters, (b) both positive and negative associations among maternal macronutrient and micronutrient intakes with the HMM at the species level and (c) distinct correlations between HMM DA taxa with maternal nutrient intakes and infant z-scores that differed between breast-fed infants experiencing growth faltering and normal growth in early and late lactation. Collectively, these findings provide important evidence of the potential influence of maternal diet on the early-life growth of breastfed infants via modulation of the HMM.

Virtual influencer marketing: Evaluating the influence of virtual influencers’ form realism and behavioral realism on consumer ambivalence and marketing performance

The existing literature examines VIs’ utilitarian, personal, and relational traits, but a gap exists in interface design understanding. This study employs avatar marketing and ambivalence theories to explore how VIs’ design elements (VI’s varying form realism and behavioral realism design) induce ambivalent emotions (eeriness and coolness) and impact VI marketing performance (follow and purchase intentions). Two experimental studies were conducted, using ANCOVA, multiple regression, and PROCESS macro analyses. In Study 1, utilizing contemporary VIs from the market, it was revealed that a VI exhibiting mid (vs. low) form realism triggered heightened perceptions of both eeriness and coolness, with these effects being magnified under the condition of high (vs. low) behavioral realism. In Study 2, using VIs generated through the StyleGAN AI technique, it was validated that those with high (vs. low) form realism were associated with decreased perceptions of eeriness and increased coolness, particularly when combined with high (vs. low) behavioral realism. Additionally, our findings emphasized the negative impact of eeriness and the positive influence of coolness on VI performance outcomes. In summary, our study reveals the significant role of VI interface designs in VI marketing performance, highlighting consumers' mixed emotions as crucial mediators in this context. Additionally, our findings highlight the negative impact of eeriness and the positive influence of coolness on VI performance. Its primary contribution is uncovering VIs’ interface designs as significant factors in VI marketing performance, while recognizing consumers’ ambivalent emotions as vital mediators in this relationship.

Clinical and Prognostic Significance of Glutathione Peroxidase 2 in Lung Adenocarcinoma.

Glutathione peroxidase 2 (GPX2) is an antioxidant enzyme with an important role in tumor progression in various cancers. However, the clinical significance of GPX2 in lung adenocarcinoma has not been clarified. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to analyze GPX2 mRNA expression. Then, we conducted immunohistochemistry (IHC) to assess GPX2 expression in specimens acquired from 351 patients with lung adenocarcinoma who underwent surgery at Kyushu University from 2003 to 2012. We investigated the association between GPX2 expression and clinicopathological characteristics and further analyzed the prognostic relevance. qRT-PCR revealed that GPX2 mRNA expression was notably higher in tumor cells than in normal tissues. IHC revealed that high GPX2 expression (n = 175, 49.9%) was significantly correlated with male sex, smoking, advanced pathological stage, and the presence of pleural, lymphatic, and vascular invasion. Patients with high GPX2 expression exhibited significantly shorter recurrence-free survival (RFS) and overall survival. Multivariate analysis identified high GPX2 expression as an independent prognostic factor of RFS. GPX2 expression was significantly associated with pathological malignancy. It is conceivable that high GPX2 expression reflects tumor malignancy. Therefore, high GPX2 expression is a significant prognostic factor of poor prognosis for completely resected lung adenocarcinoma.

Screening of variables affecting the selective leaching of valuable metals from waste motherboards' PCBs.

The presence of valuable and hazardous metals in waste printed circuit boards, especially, motherboards, makes their recovery necessary as implies great economic and environmental advantages and develops urban mining processes. Hence, this research is focused on the selective leaching of Cu, Pb, and Sn as base metals using nitric acid and hydrochloric acid and Au, Ag, and Pd as precious metals using thiourea and sodium thiosulfate from waste motherboards' PCBs in a sequential eco-friendly two-stage process. Previously, thiourea and sodium thiosulfate were used as leaching agents to investigate their applicability for the leaching of metals from PCBs in a single-stage process. Screening experimental design was applied to screen the variables affecting the leaching process in order to evaluate their impact on the recovery of metals and select the significant factors. The results demonstrated that base and precious metals can be leached appropriately in two consecutive stages compared to a single-stage process. Nitric acid was found to be a much more efficient agent to leach Cu and Pb in comparison with hydrochloric acid which was more suitable for the leaching of Sn. In the case of precious metals, higher amounts of Au were leached using thiourea, whereas sodium thiosulfate was able to leach more Pd. Roughly similar results were obtained for the leaching of Ag using these leaching agents. Nitric acid concentration, average particle size, temperature, and leaching time were found to be significant to maximize the leaching of Cu and Pb and minimize that for Au, Ag, and Pd in the first stage. Initial pH was the only variable influencing the second stage, in particular, Au leaching by thiourea.

Evaluating Drivers and Barriers of Integrated Waste Management System Implementation in Indonesian Construction Industry: A DEMATEL-Based Analytical Network Process

The growth of construction industries in Indonesia creates an increasing level of generated construction waste. The limited implementation of ISO 14001 in the Indonesian construction industry might indicate the limited implementation of waste management based on sustainability principles. Therefore, this study aims to explore the drivers and barriers to implementing integrated waste management in construction industries. The Content Validity Index (CVI) and Modified Kappa methods were utilized to validate the indicators from the literature review. A total of 18 driver factors and 21 barrier factors in six dimensions were assessed by seven experts. This study then employs the decision-making evaluation and laboratory-based analytical network process (DEMATEL-based ANP) to find the weight and relation between each indicator and dimension. The results show that environmental awareness is the most important factor that drives construction industries to implement waste management in their company. In contrast, a lack of education about waste management is the most significant factor that inhibits construction industries from implementing sound waste management systems.

Persistence comparison of two Shiga-toxin producing Escherichia coli (STEC) serovars during long-term storage and thermal inactivation in various wheat flours.

Foodborne outbreaks associated with Shiga toxin-producing Escherichia coli (STEC) contaminated wheat flour have been an increasing food safety concern in recent decades. However, there is little literature aimed at investigating the impact of different flour types on the persistence of STEC during storage and thermal inactivation. Therefore, two serovars of STEC, O121 and O157, were selected to inoculate each of five different types of common wheat flours: whole wheat, bleached, unbleached, bread, and self-rising. Inoculated flours were examined for the stability of STEC during storage for up to 42 days at room temperature (RT) and aw ~0.56. Additionally, the thermal resistance of O121 and O157 under isothermal conditions at 60, 70, 80, and 90°C was analyzed for the inoculated flours. STEC storage persistence at RT was generally not affected by flour type, however, decreases of 1.2 and 2.4 log CFU/day within whole wheat flour for O121 and O157, respectively, were significantly lower than other flours. Though few differences were identified in relation to flour type, O121 exhibited significantly better survival rates than O157 during both equilibrium and storage periods. Compared to an approximate 6 log reduction in the population of O157, O121 population levels were reduced by a significantly lower amount (~3 log) during the entire storage period at RT. At each isothermal temperature, the impact of flour type on the thermal resistance capabilities of O121 or O157 was not a significant factor and resulted in similar survival curves regardless of serovar. Instead of exhibiting linear survival curves, both O121 and O157 displayed nonlinear curves with some shoulder/tail effect. Similar for both O121 and O157, the predicted decimal reduction time (D-value) decreased from approximately 25 min to around 8 min as the isothermal temperature increased from 60°C to 90°C. Results reported here can contribute to risk assessment models concerning contamination of STEC in wheat flour and add to our understanding of the impacts of flour type and STEC serovar on desiccation stability during storage and isothermal inactivation during thermal treatment.

Gut microbiota-based discriminative model for patients with ulcerative colitis: A meta-analysis and real-world study.

Gut microbiota directly interacts with intestinal epithelium and is a significant factor in the pathogenesis of ulcerative colitis (UC). A meta-analysis was performed to investigate gut microbiota composition of patients with UC in the United States. We also collected fecal samples from Chinese patients with UC and healthy individuals. Gut microbiota was tested using 16S ribosomal RNA gene sequencing. Meta-analysis and 16S ribosomal RNA sequencing revealed significant differences in gut bacterial composition between UC patients and healthy subjects. The Chinese UC group had the highest scores for Firmicutes, Clostridia, Clostridiales, Streptococcaceae, and Blautia, while healthy cohort had the highest scores for P-Bacteroidetes, Bacteroidia, Bacteroidales, Prevotellaceae, and Prevotella_9. A gut microbiota-based discriminative model trained on an American cohort achieved a discrimination efficiency of 0.928 when applied to identify the Chinese UC cohort, resulting in a discrimination efficiency of 0.759. Additionally, a differentiation model was created based on gut microbiota of a Chinese cohort, resulting in an area under the receiver operating characteristic curve of 0.998. Next, we applied the model established for the Chinese UC cohort to analyze the American cohort. Our findings suggest that the diagnostic efficiency ranged from 0.8794 to 0.9497. Furthermore, a combined analysis using data from both the Chinese and US cohorts resulted in a model with a diagnostic efficacy of 0.896. In summary, we found significant differences in gut bacteria between UC individuals and healthy subjects. Notably, the model from the Chinese cohort performed better at diagnosing UC patients compared to healthy subjects. These results highlight the promise of personalized and region-specific approaches using gut microbiota data for UC diagnosis.

The Safety, Operation, and Energy Efficiency of Rail Vehicles—A Case Study for Poland

The objective of the article was to describe the importance of a good technically and economically planned process for purchasing a rail vehicle. Compliance with this process with safety standards and energy efficiency is crucial regarding effectiveness in the long-life cycle cost of a rail vehicle. Methods that were used focused on audit and document analysis. In the result based on a specific audit of a railway company, some non-compliances were found, and it was methodically proven that they are significant risk factors in terms of performing such processes in the future. Major conclusions regarded the importance of fulfilling legal requirements of SMS for purchase purposes, involvement of a safety engineer post in this process, and usage of technical feedback regarding previous operation of railway vehicles and operational findings from the past. The transport policy of the EU and other developed countries sets ambitious goals for reducing energy consumption in transportation activities, which is linked to the aim of reducing environmental burdens.

Acute cholecystitis, obesity, and steatohepatitis constitute the lethal triad for bile duct injury (BDI) during laparoscopic cholecystectomy.

The most feared complication during laparoscopic cholecystectomy remains a bile duct injury (BDI). Accurately risk-stratifying patients for a BDI remains difficult and imprecise. This study evaluated if the lethal triad of acute cholecystitis, obesity, and steatohepatitis is a prognostic measure for BDI. A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) registry was performed. All laparoscopic cholecystectomy cases within the main NSQIP database for 2012-2019 were queried. Two study cohorts were constructed. One with the lethal triad of acute cholecystitis, BMI ≥ 30, and steatohepatitis. The other cohort did not have the full triad present. Multivariate analysis was performed via logistic regression modeling with calculation of odds ratios (OR) to identify independent factors for BDI. An uncontrolled and controlled propensity score match analysis was performed. A total of 387,501 cases were analyzed. 36,887 cases contained the lethal triad, the remaining 350,614 cases did not have the full triad. 860 BDIs were identified resulting in an overall incidence rate 0.22%. There were 541 BDIs within the lethal triad group with 319 BDIs in the other cohort and an incidence rate of 1.49% vs 0.09% (P < 0.001). Multivariate analysis identified the lethal triad as an independent risk factor for a BDI by over 15-fold (OR 16.35, 95%CI 14.28-18.78, P < 0.0001) on the uncontrolled analysis. For the controlled propensity score match there were 29,803 equivalent pairs identified between the cohorts. The BDI incidence rate remained significantly higher with lethal triad cases at 1.65% vs 0.04% (P < 0.001). The lethal triad was an even more significant independent risk factor for BDI on the controlled analysis (OR 40.13, 95%CI 7.05-356.59, P < 0.0001). The lethal triad of acute cholecystitis, obesity, and steatohepatitis significantly increases the risk of a BDI. This prognostic measure can help better counsel patients and potentially alter management.

Buying a Wealthy Dream: Determinants of Rural Residents' Lottery Purchase Behavior in China.

The expansion of illicit lottery activities has caused significant harm to both agricultural production and the livelihood of rural residents. An analysis of the factors that influence rural residents' participation in underground lotteries can provide crucial insight for regulating the lottery industry's development. This study examines the present state of rural residents' participation in underground lotteries, investigates the factors that impact their participation using the Double-Hurdle model, and further employs the ISM model to evaluate the correlations and hierarchical structure among the factors, using field survey data collected from 603 rural residents in S Province, China. The findings reveal that 53.07% of the respondents have participated in underground lotteries. Risk preference, information acquisition, social networks, age, education, family burden, percentage of agricultural labor, agricultural business scale, and household income significantly affect whether residents purchase lotteries (WPL). All factors, except the percentage of agricultural labor and agricultural business scale, also significantly impact underground lottery spending (LS). Among the significant influencing factors, rural residents' risk preference is the direct surface factor, whereas agricultural business scale, household income, information acquisition, and social networks are the middle indirect factors, and residents' age, education, family burden, and percentage of agricultural labor are the deep-rooted factors. It is recommended to regulate the lottery industry's development can be achieved by enhancing entertainment and cultural activities, expanding economic opportunities, enhancing rural education, increasing law awareness, and improving the public welfare lottery business model. The conclusions offer a valuable reference point for the standardized development of the lottery industry and the promotion of social stability in rural areas.

Implementation of sonopartogram: multicenter feasibility study.

Well-established clinical practice for assessing progress in labor involves routine abdominal palpation and vaginal examination (VE). However, VE is subjective, poorly reproducible and painful for most women. In this study, our aim was to evaluate the feasibility of systematically integrating transabdominal and transperineal ultrasound assessment of fetal position, parasagittal angle of progression (psAOP), head-perineum distance (HPD) and sonographic cervical dilatation (SCD) to monitor the progress of labor in women undergoing induction of labor (IOL). We also aimed to determine if ultrasound can reduce women's pain during such examinations. Women were recruited as they presented for IOL in three maternity units. Ultrasound assessments were performed in 100 women between 37 + 0 and 41 + 6 weeks' gestation. A baseline combined transabdominal and transperineal scan was performed, including assessment of fetal biometry, umbilical artery and fetal middle cerebral artery Doppler, amniotic fluid index, fetal spine and occiput positions, psAOP, HPD, SCD and cervical length. Intrapartum scans were performed instead of VE, unless there was a clinical indication to perform a VE, according to protocol. Participants were asked to indicate their level of pain by verbally giving a pain score between 0 and 10 (with 0 representing no pain) during assessment. Repeated measures data were analyzed using mixed-effect models to identify significant factors that affected the relationship between psAOP, HPD, SCD and mode of delivery. A total of 100 women were included in the study. Of these, 20% delivered by Cesarean section, 65% vaginally and 15% by instrumental delivery. There were no adverse fetal or maternal outcomes. A total of 223 intrapartum ultrasound scans were performed in 87 participants (13 women delivered before intrapartum ultrasound was performed), with a median of two scans per participant (interquartile range (IQR), 1-3). Of these, 76 women underwent a total of 151 VEs with a median of one VE per participant (IQR, 0-2), with no significant difference between vaginal- or Cesarean-delivery groups. After excluding those with epidural anesthesia during examination, the median pain score for intrapartum scans was 0 (IQR, 0-1) and for VE it was 3 (IQR, 0-6). Cesarean delivery was significantly associated with a slower rate of change in psAOP, HPD and SCD. Comprehensive transabdominal and transperineal ultrasound assessment can be used to assess progress in labor and can reduce the level of pain experienced during examination. Ultrasound assessment may be able to replace some transabdominal and vaginal examinations during labor. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.