Standard Error Research Articles

To determine the test-retest reliability and construct validity of the Instrumental- Timed Up and Go Test (i-TUG), TUG, and Berg Balance Scale (BBS) using EncephaLog in individuals with stroke. The study was conducted with 37 individuals diagnosed with chronic ischemic stroke. Participants were assessed using the i-TUG, TUG, BBS, and additional postural sway parameters collected via EncephaLog. Two test sessions were conducted to assess test-retest reliability. Pearson correlation coefficients were used to evaluate construct validity, and the Standard Error of Measurement and Minimal Detectable Change (MDC) were also calculated. High correlation was found between i-TUG and TUG (r = 0.92; r = 0.70), and moderate correlation between i-TUG and BBS (r= -0.54; r= -0.63). Postural sway parameters had negligible correlations with BBS and TUG. Test-retest reliability was excellent for i-TUG (ICC = 0.76), TUG (ICC = 0.83), BBS (ICC = 0.88), Time To Stand Up From The Chair (SUT) (ICC = 0.82), and Time To Sit Down On The Chair (SDT) (ICC = 0.79), but poor for Mediolateral Sway (MLsway) (ICC = 0.27) and Anteroposterior Sway (APsway) (ICC = 0.23). MDC values were as follows: i-TUG (12.36), TUG (9.21), BBS (7.48), MLsway (0.29), APsway (0.29), SUT (0.57), and SDT (0.51). EncephaLog-based i-TUG demonstrated high reliability and good validity, comparable to conventional clinical tests in chronic ischemic stroke. While sway parameters showed low correlation and reliability, i-TUG provides a promising, accessible, and objective tool for balance assessment.

Selective myectomy has gained popularity for treating facial synkinesis. Objectives & Hypotheses: We examined the combined effectiveness of depressor anguli oris (DAO), partial buccinator, and platysma myectomies. Retrospective case series. Pre- and post-operative botulinum toxin-A (BTX-A) treatments of selective myectomy patients were collected. Facial photographs were analyzed using Emotrics+. Facial Asymmetry Index (FAI) and electronic facial paralysis assessment (eFACE) scores were calculated. Twenty patients underwent myectomies. Improvements (mean ± standard error) were seen in several smile metrics, including FAI by 2.80 mm ± 0.68, nasolabial fold angle by 4.78° ± 1.83, and smile angle by 4.43° ± 1.18 (all p<0.05). Postoperative FAI was 2.79 mm. Total BTX-A decreased by 10.85 units ± 4.48 (p=0.03). eFACE revealed improved oral commissure movement and platysmal synkinesis (p<0.05 for both). Combined myectomies of the DAO, partial buccinator, and platysma clinically and statistically improve smile in facial synkinesis.

This review provides clinicians and researchers in developmental medicine and paediatric neurology with a guide to using generalized estimating equations (GEEs) for longitudinal paediatric data. We present a concise primer on core GEE concepts for non-statistical audiences, emphasizing paediatric applications. Using a randomized trial of oestrogen versus placebo for postnatal depression, we provide a reproducible workflow (in R code) for continuous and binary outcomes. We compare exchangeable and autoregressive (first-order autoregressive model) working correlations and discuss implications for efficiency and interpretation. Because the data set is maternal and contains no child outcomes, we treat it as a perinatal case study relevant to child development and use it to illustrate marginal (population-averaged) inference in longitudinal clinical data. GEEs yielded stable marginal estimates across correlation structures when the mean model was correctly specified. Oestrogen was associated with significantly lower odds of postnatal depression than placebo, with negligible differences in model fit (correlation information criterion). Statistical choices mainly affected efficiency and standard errors rather than effect sizes. GEEs provide a robust, interpretable framework for analysing correlated outcomes in paediatric research. Paired with a reproducible example, this helps clinicians and researchers select appropriate models, report working correlations transparently, and interpret marginal effects in practice.

With the aging population, frailty is becoming increasingly prevalent among older adults, yet its association with gout, a common form of arthritis affecting middle-aged and older adults, remains unclear. This study investigated the frailty-gout relationship through a nationwide cross-sectional analysis combined with Mendelian randomization (MR). Data from 22,324 adults aged 40 and above in the National Health and Nutrition Examination Survey (NHANES, 2007-2018) were analyzed utilizing survey-weighted logistic regression models. Genome-wide association study data from UK Biobank, TwinGen, and FinnGen were utilized to explore genetic correlations and causality. The cross-sectional study indicated a significant relationship between pre-frail (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 1.76-3.08, P < .0001) and frail (OR = 4.63, 95% CI = 3.67-5.84, P < .0001) individuals and gout. This association persisted after comprehensive covariate adjustment (pre-frail OR = 2.13, 95% CI = 1.59-2.85, P < .0001; frail OR = 4.11, 95% CI = 3.16-5.35, P < .0001). The interaction effect between frailty and gout was significantly influenced by race/ethnicity (P interaction = .0046) and gender (P interaction = 6.72 × 10-6). Linkage disequilibrium score regression analysis demonstrated a moderate yet significant genetic correlation between the frailty index and gout (rg = 0.319, standard error (SE) = 0.042, P = 2.19 × 10-14). MR analysis confirmed a causal link between frailty index and gout (OR = 2.29, 95% CI = 1.45-3.62, P < .001), while reverse MR analysis indicated no causality. These findings elucidated frailty as a risk factor for gout, underscoring the necessity for uric acid monitoring to mitigate gout risk in frail individuals, potentially informing sustained healthcare initiatives for gout in middle-aged and older adults.

Estimation of stature from hand length and hand breadth in undergraduate medical students: An anthropometric study.

Bayesian quantile regression typically uses the asymmetric Laplace distribution as working likelihood, not because it is a plausible data-generating distribution but because the corresponding maximum likelihood estimator is identical to the classical estimator by Koenker and Bassett. While point estimation is consistent, credible intervals tend to have poor frequentist coverage. We propose using infinitesimal jackknife (IJ) standard errors introduced by Giordano and Broderick, which do not require resampling and can be obtained from a single Markov chain Monte Carlo run. Simulations and applications to real data show that IJ standard errors have good frequentist properties for both independent and clustered data. We provide an R package, IJSE, that computes IJ standard errors after estimation of any model with the brms wrapper for Stan.

We present the final report from the Fabry Outcome Survey (FOS) on long-term effectiveness and safety of agalsidase alfa in adults (≥18 years old). FOS was an international, multicentre, observational registry (NCT03289065), designed to enhance the understanding of Fabry disease and improve clinical management. Primary effectiveness endpoints were annualized change in estimated glomerular filtration rate (eGFR) and left ventricular mass index (LVMI), and time to and age at composite morbidity event (comprising renal, cardiac or stroke events) and death. Safety outcomes were also assessed. FOS included data for 1864 adults (female/male, n = 907/957) who received agalsidase alfa only for a median (minimum, maximum) of 6.0 (0, 21.6) years, and 1613 untreated adults (female/male, n = 1235/378). At baseline, mean (standard deviation [SD]) eGFR was 94.01 (27.60) mL/min/1.73 m2 in treated adults; annualized changes in eGFR (slope [standard error; SE]) remained relatively stable in females and declined slightly in males (-1.07 [.12] vs. -2.17 [.12] mL/min/1.73 m2). At baseline, mean (SD) LVMI was 58.25 (25.01) g/m2.7 and LVMI (slope [SE]) remained stable (.34 [.16] vs. .38 [.15] g/m2.7/year in females and males, respectively). Time (median [95% confidence interval]) from treatment initiation to first composite event was longer for females than males (83.4 [65.7-98.0] vs. 56.3 [45.6-66.7] months); age (median [minimum, maximum]) at death was also higher for treated females than males (69.9 [32.5, 87.7] vs. 59.1 [26.2, 79.6] years). Agalsidase alfa was generally well tolerated. This report further supports the long-term effectiveness and safety of agalsidase alfa in adults with Fabry disease.

The ambiguous clinical presentation of leptospirosis poses challenges for accurately assessing the global burden of this emerging disease. As a result, leptospirosis has not been recognized for inclusion in the WHO's neglected tropical diseases list. This underscores the urgent need for a diagnostic biomarker for early detection of illness and well-defined estimation of disease burden in urban and low-income settings. The recently discovered PF07598 gene family encoding virulence-modifying proteins (VMPs), including full-length LA3490, its truncated N-terminal ricin-binding lectin (RBL) domain, and a natural variant encoding only the C-terminal domain (LA0591), was evaluated for its potential to detect anti-VMP-specific IgG antibodies in early infection. The study was conducted on a well-characterized sample of febrile patients from Sri Lanka, with leptospirosis confirmation by microscopic agglutination test (MAT) and Quantitative PCR. The sample included 113 confirmed cases, 45 probable cases, 75 febrile patients, and 41 healthy subjects. Among confirmed cases, mean ELISA optical density (OD) values for LA0591, LA3490, and RBLs were 1.045 (standard error [SE]: 0.063), 0.835 (SE: 0.032), and 0.536 (SE: 0.019), respectively, compared with 0.261 (SE: 0.043), 0.697 (SE: 0.026), and 0.303 (SE: 0.019) in healthy subjects. Anti-VMP antibodies were detectable as early as day 2. In seroconversion cases, ELISA OD for LA0591 in acute MAT-negative samples was 1.347, comparable with high MAT titers. ROC analysis showed AUCs of 0.947 for LA0591 and 0.930 for LA3490, confirming their reliability as diagnostic markers. LA0591 demonstrated superior sensitivity, specificity, and early diagnostic capability, establishing it as a valuable tool for leptospirosis detection.

In the extremely preterm period (ePTB; less than 28weeks), non-Hispanic (NH) Black infants in the US show relatively lower risk of neonatal death than do NH white infants. Explanations for this survival advantage include higher levels of stillbirth among NH Black persons, which could leave behind hardier members of the conception cohort that survive to birth. We test this "high stillbirth" explanation in the US and focus on NH Black singleton ePTB males given their large survival advantage. We applied time-series methods to 288 monthly conception cohorts (1995-2018 US fetal, birth, and neonatal death records) for NH Black and NH white singletons in the ePTB range (N = 473,472). We specified positive monthly outliers in male relative to female NH Black stillbirths in the ePTB range to gauge high NH Black male stillbirths. NH Black male ePTB singleton infants show a stronger neonatal survival advantage (relative to NH whites) for cohorts with high NH Black male stillbirth (4.4 fewer deaths per 100 live births, standard error = 1.3, p < .001). Cohort variation in fetal loss, as measured by high NH Black male stillbirth, may explain a portion of the counterintuitive racial/ethnic patterns in live birth mortality among extremely preterm births.

While Seasonal Malaria Chemoprevention (SMC) has been adopted as a malaria control strategy in regions with seasonal transmission, continued monitoring and evaluation of its effectiveness across diverse ecological, epidemiological, and healthcare settings remain critical for optimizing the intervention. This study aims to assess the ongoing population-level impact of SMC under routine programme conditions by evaluating rates of uncomplicated and severe malaria following four rounds of administration. A pre-post analysis was conducted using real-world surveillance data from clinic visits in 285 villages in Nouna District, Burkina Faso, along with National Malaria Control Programme data on SMC administration. Estimates of the population used for person-time calculations were derived from a census conducted as part of a randomized controlled trial. Malaria rates for children under 5 were analyzed for each epidemiological week in 2021, for each health post in the study area. Negative binomial regression models were used, with person-time at risk used as an offset and standard errors clustered by health post, to obtain incidence rate ratios (IRRs) and rate differences. Changes in diagnoses were estimated from the administration weeks to each of the three weeks post- administration within the same population. Injury rates were used as a negative control outcome to assess potential unmeasured confounding. Although SMC was administered during peak malaria transmission weeks within each cycle, both uncomplicated and severe malaria rates remained high through December, following the fourth and final round of SMC. There was a substantial reduction in infection rates in the 3weeks post SMC, with gradual increases in rates across the three weeks. The rates of uncomplicated and severe malaria per 1000 person-weeks in the administration weeks were 8.5 (95% CI 7.0 to 10.1) and 0.31 (95% CI 0.22 to 0.40), respectively. Uncomplicated malaria rates were lower by 41%, 95%CI (31-50%), 34% (23-43%) and 22% (12-31%) in the first, second and third weeks after administration, respectively. Severe malaria rates declined by 47% (21-64%), 47% (31-59%) and 34% (17-47%) in the three weeks post-administration. Injury rates, the negative control outcome, did not change significantly across the three weeks. In programme settings, at the population level, SMC administration was associated with a substantial reduction in uncomplicated and severe malaria, though this effect was limited to the immediate weeks following administration. The gradual increase in malaria rates by the third week suggests a shorter duration of protection than previously observed. Extending the areas where 5 rounds of distribution occur may be necessary to effectively prevent malaria infections in regions with a longer transmission season. Regular evaluation of local malaria trends and impact of SMC can help further tailor and optimize SMC programmes for specific regional contexts.

The restorative threshold of dentists varies considerably. This retrospective study examined the association between the depth of radiolucency in proximal surfaces on bitewing radiographs and the probability of restorative treatment among Finnish dentists. The study population comprised 160 patients aged 18-40 years who underwent routine dental examinations by 16 randomly selected dentists within the Public Dental Services of Kuopio, Finland, in 2022. Data on patient characteristics, caries lesions, radiographic findings, and treatment decisions were manually extracted from the local electronic health record system. The depth of radiolucency was measured for all proximal caries lesions that had been registered by the dentists and were visible on the radiographs. The association between radiolucency depth and treatment decisions was estimated using linear regression analyses with cluster-robust standard errors. Bitewing radiography had been used for 128 patients (80%). Most of the 394 caries lesions that had been registered were radiographically confined to the enamel (57%) or outermost third of dentin (27%), whereas 12% were in the middle third of dentin, and 4% extended to the inner third of dentin. Regression analyses revealed that the predicted probability of restorative treatment was 8% for lesions reaching the dentinoenamel junction and 75% for those extending to the border between the outer and middle thirds of dentin. The probability of restorative treatment increased sharply with the depth of radiolucency and was unexpectedly high for lesions confined to enamel or the outer third of dentin.

Background and Objectives: Non-pharmaceutical interventions such as cognitive training, transcranial electrical stimulation (tES), and repetitive transcranial magnetic stimulation (rTMS) have shown promise in improving cognitive outcomes in Alzheimer’s disease (AD) and dementia. However, the long-term effects of repeated non-invasive interventions remain unknown. This study investigated whether repeated non-invasive interventions administered over a span of 1 to 3 years were associated with slower cognitive decline compared to typical AD progression, and whether longer no-treatment intervals between treatments predicted greater post-treatment decline. Materials and Methods: Seventy-three participants living with dementia or AD received 2 to 9 blocks of non-invasive treatments (including tES, rTMS, cognitive training). Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog) scores were collected longitudinally up to 3 years (36 months), across multiple intervention and assessment sessions. A mixed-effects model was used to estimate the rate of cognitive decline, adjusting for baseline age, sex, and baseline cognition (MoCA) with participants being the random effect. The observed rate of change was compared to a meta-analysis estimate of AD progression. Additionally, a linear mixed-effects model using robust sandwich estimation of standard errors was employed to assess whether the no-treatment interval was associated with changes in ADAS-Cog scores. Results: Participants showed a significantly slower rate of cognitive decline than expected from the AD reference rate (p &lt; 0.001), with many demonstrating stabilized ADAS-Cog scores during their respective treatment periods, ranging from 1 to 3 years. Medication analyses revealed no significant effect of AD medications, antidepressants, antihypertensives, or cholesterol-lowering agents on cognitive outcomes. Furthermore, longer no-treatment intervals were significantly associated with greater post-treatment decline (p &lt; 0.001). Conclusions: Repeated non-invasive treatments seem to slow the rate of cognitive decline in individuals living with dementia when administered over a prolonged period. This study provides evidence supporting the feasibility and effects of personalized long-term non-invasive treatment strategies for dementia.

Abstract In this study, we analyze an important property of the very local interstellar medium, i.e., turbulence that affects the intensity and shape of the Interstellar Boundary Explorer (IBEX) ribbon. Specifically, we simulate the propagation of the ribbon’s parent ions before they become secondary energetic neutral atoms that can be observed at 1 au by IBEX. We then test how different slab/2D turbulence fractions affect the intensity and shape of the modeled ribbon and compare to the latest IBEX ribbon-separated data. We compare 1D cuts across the modeled and observed ribbon as a function of angle away from the ribbon center. We find that the intensities of the modeled ribbon are larger than most of the data, except near the ecliptic plane. However, the model intensities are sensitive to how we model the neutral solar wind, which forms the source ion population for the ribbon. We then compare the model and data by normalizing the fluxes to their respective peak intensities and find the peaks’ angular distances from the ribbon center. We find that most of the model peaks lie within 3° of the data peaks, which we consider our 1σ uncertainty (half the size of an IBEX pixel). By averaging the instances where the model peaks match the data peaks (within 3°), we find that the mean is slab-50%, with a standard deviation of ±28% and standard error of ±5%.

The U.S. Emergency Medical Service (EMS) system faces persistent workforce shortages. Thousands of military personnel transition out of service each year with EMS-related training, yet little is known about their roles or willingness to pursue civilian EMS careers. Despite low national unemployment rates among veterans, many remain underutilized in healthcare occupations. We aim to describe the current roles of nationally certified military EMS clinicians and assess their interest in transitioning to civilian EMS employment. We conducted a cross-sectional survey of National Registry-certified EMS clinicians actively serving in the U.S. military. Respondents recertifying between October 2021 and April 2022 were invited to complete a voluntary, one-time survey. The analytic sample included military-affiliated clinicians aged 18-85 who reported an EMS job role and responded to a question about interest in civilian EMS transition. Descriptive statistics multivariable Poisson regression with robust standard errors were used to characterize EMS roles and identify factors associated with transition interest. Referent groups for categorical variables were selected based on the subgroup with the largest number of respondents. Among 1,937 included respondents, the median age was 32 years (interquartile range: 27-40), and most were male (66.6%) and White, non-Hispanic (58.3%). Respondents represented all major military branches, with the largest proportion from the Air Force (60.3%). Most held emergency medical technician certification (82.5%). Overall, 60.5% expressed interest in civilian EMS employment after separation. Transition interest was highest among clinicians in the Army (prevalence ratio: 1.23; 95% confidence interval: 1.11-1.36), Navy (1.31; 1.17-1.45), and Coast Guard (1.13; 1.01-1.27) compared to the Air Force. Those in educational or non-traditional roles had higher prevalence of interest than those in hospital-based roles, while older clinicians had significantly lower prevalence of interest. Findings from this convenience sample suggest that a substantial portion of military EMS clinicians, particularly younger personnel and those affiliated with the Army, Navy, and Coast Guard, may be interested in transitioning to civilian EMS roles. While not representative of all military EMS personnel, these patterns highlight the potential utility of structured veteran-to-civilian EMS pathways. Future research using more representative sampling strategies is needed to confirm these trends and inform workforce development efforts.

Precise leveling is the basic method for estimating sea level changes, geoid/quasi - geoid determination, and recent vertical movements of the Earth’s crust for more than 150 years. Despite the long - term usage of the method, there are some issues about the a ccuracy of leveling networks. It is supposed that the propagation of leveling errors is proportional to the square root of the leveled d istance. However, there is a lack of correspondence between the leveling accuracy given by the least squares mean error per 1 km leveling distance and the final standard deviations of the adjusted benchmark heights as regards their remoteness from the datum point . To investigate the sources of this accuracy disagreement, we adjusted the precise leveling network of the Bulgaria – III leveling cycle 33 times. A different nodal benchmark was chosen as a datum point in each adjustment. All adjustments produced the same adjusted benchmark elevations and mean adjustment error per 1 km leveling distance, equal to 1.21 mm .km - 0.5 . Ho wever, the sums of the standard errors of the adjusted heights of the nodal benchmarks, and as a result, the average of these standard errors varied between adjustments. The minimum sum of the benchmark standard errors was obtained when the datum point was set in the Knezha benchmark, located almost in the center of the network. The average standard error of the benchmark in this adjustment was es timated to be 10. 89 mm. The official datum point in the Third Leveling of Bulgaria is the fundamental benchmark in Varna, located in the network periphery. The average standard error of the benchmark in an adjustment with a datum point in Varna was estimated to be 13. 68 mm. Comparison between the means of the benchmark standard error samples based on the datum point in Knezha and Varna, performed by t - test under the assumption of equal sample variances, shows that the mean of the standard error sample based on the datum point in Knezha is significantly less than in Varna. The conclusion is valid at a 99% confidence level. In addition, a better correspondence between the leveling accuracy given by the least squares mean error per 1 km leveling distance and the final s tandard de viations of benchmarks was found in the case of the Knezha datum point adjustment.

To explore the relationship between migraine attack onset in children and adolescents and Chinooks, which are dry and warm westerly winds that generally occur in the winter and bring about abrupt weather changes to the east of the Rocky Mountains in Southern Alberta, Canada. This was a prospective longitudinal clinical cohort study with recruitment from November 2020 to May 2024. Participants were: 8-18 years old, had migraine as per International Classification of Headache Disorders 3rd edition criteria, had 1-15 headache days/month, lived in the geographical location where Chinook winds occur, and had exposure to at least one pre-Chinook or Chinook day during the study period. Chinook days were defined using Nkemdirim's criteria and Environment Canada data were used to categorize day type as either Chinook, pre-Chinook, or non-Chinook. Weather data were merged with data from daily headache diaries, completed for periods of 8-30 days. The primary outcome was attack onset, defined as a day with a new migraine attack of moderate or severe severity, as per the 4-point scale (0 = none, 1 = mild, 2 = moderate, and 3 = severe). Both univariate and adjusted models were used to determine if there was an association between migraine attack onset and day type (i.e., pre-Chinook, Chinook, or non-Chinook) at the aggregate study sample level. The adjusted models controlled for age and sex, and both models included a random intercept. Subsequently, individual n = 1 models were fitted to explore each individual participant's personal odds of migraine attack onset on both pre-Chinook and Chinook days versus non-Chinook days. Pre-Chinook/Chinook sensitivity values were calculated for each individual by dividing the model's regression coefficient by its standard error. Sensitivity values >1.96 suggest a significant association between pre-Chinook/Chinook days and attack onset. Sixty youth with 1253 days of complete data, of which 144 (12%) were attack onset days, participated in the study. There were 158 Chinook (13%), 124 pre-Chinook (10%), and 971 non-Chinook days (77%). There were 39 female participants (39 of 60; 65%), with a median age of 14 years (quartile [Q] 1 = 12, Q3 = 16), and a median headache frequency of 6.2 days/month (Q1 = 4, Q3 = 11). Neither the univariate nor the adjusted models found any significant association between day type and attack onset at an aggregate level (pre-Chinook adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.54-1.78, p = 0.947; Chinook adjusted OR, 1.15; 95% CI, 0.69-1.91, p = 0.596). No individual participants met the threshold for statistically significant pre-Chinook or Chinook sensitivity. We did not find a relationship between pre-Chinook and Chinook conditions and migraine attack onset. This may be due to the lack of an association between Chinooks and attack onset in youth with migraine, or due to a lack of statistical power in our study. Future studies with greater statistical power should aim to assess for a potential relationship between Chinooks and attack onset, as it could have important treatment implications.

Generating parasite genomes is challenging when little of the DNA in infected host tissue is from the parasite. We used selective whole genome amplification (SWGA) to generate genomic data from wildlife samples of the avian haemosporidian Haemoproteus majoris (lineage PARUS1) and its host, the blue tit (Cyanistes caeruleus). We used SWGA to amplify the parasite DNA in nine avian blood samples collected between 1996 and 2021, and subsequently performed short-read sequencing and bioinformatically separated the host and parasite reads in each sample. SWGA increased the percentage of parasite reads significantly. Sequencing to a depth of about 56 million reads (forward and reverse) per sample resulted on average (± standard error [SE]) in 11.3X ± 1.85 for the host genome and 1.17X ± 0.446 mean depth of coverage for the host and parasite, respectively, after SWGA. Furthermore, about 74% of the host genome (genome size approx. 1.2Gb) and 33% of the parasite genome (approx. 23.9Mb) had at least 1X coverage on average; two samples had 1X coverage of approximately 60% of the parasite genome. Parasite sequencing success was positively correlated with parasitemia. When comparing the parasite sequences in the four best samples, we identified 9895 sites (minimum 5X coverage) that varied among the infections. When filtering the full dataset to at least six samples per variant, we identified 14,512,339 and 7068 sites that varied among samples in the host and parasite populations, respectively, revealing variation among samples and years. SWGA facilitates dual host-parasite population genomics in this system and will greatly expand our understanding of host-parasite interactions over space and time.

Abstract Pathological gaming has been linked to poor mental health, but few studies differentiate between gaming categories. This study examined associations between gaming behavior and internalizing disorders among Norwegian university students ( N = 5578). Participants completed the Gaming Addiction Scale for Adolescents (GASA) and a self-report version of the Composite International Diagnostic Interview (CIDI). Gaming was categorized as non-gaming, recreational, engaged, problematic, and pathological. Internalizing disorders (past 30 days) were assessed using the CIDI. Poisson regression models with a log-link and robust standard errors were used to compute pairwise risk ratios between gaming categories and any internalizing disorder. Regression analyses showed that compared to non-gamers, all other categories—including recreational gamers—showed increased risk of internalizing disorders. Notably, our results indicated that engaged gamers and problematic/pathological gamers did not differ significantly in their risk for internalizing disorders. The findings suggest that even non-problematic gaming may be linked to internalizing symptoms. Future research should explore whether pre-existing vulnerabilities contribute to both increased gaming and mental health challenges.

With the globalization of Green Trade Barriers (GTBs) and the continuous tightening of green technical standards, exploring the impact of GTBs on the financialization of Chinas export-oriented manufacturing enterprises and its underlying mechanism has become a critical research focus.This research selects Chinese A-share listed export-oriented manufacturing enterprises covering the period from 2009 to 2024 as its research samples. It incorporates multi-source datasetsspecifically the WTO Environmental Database, CSMAR Database, and annual reports of listed companiesand adopts a two-way fixed effects model along with a mediation effect model to carry out empirical analysis. The results show that: (1) GTBs significantly increase the level of corporate financialization, which supports Hypothesis H1; (2) GTBs elevate firms short-term financialization by reducing the current asset ratio, thereby verifying Hypothesis H2. A set of robustness testsfor instance, sensitivity analysis of fixed effect specifications, replacement of industry fixed effects, adjustment of clustered standard errors, and modification of variable functional formsfurther confirm the reliability of the baseline conclusions. Theoretically, this study enriches the research framework linking international trade policy, environmental regulation, and corporate financialization, addressing the gap in existing studies that mostly focus on macroeconomic fluctuations or general trade policy uncertainty. Practically, it provides insights for export-oriented manufacturing enterprises to balance short-term financialization and core business development, and suggests policymakers introduce measures to alleviate enterprises compliance pressures and prevent the "hollowing-out" of the real economy. Limitations include a sample restricted to A-share listed enterprises; future research may expand the sample scope and explore firm heterogeneity.

This study assesses the connection between environmental degradation, agro-climate financing, and economic growth in Sub-Saharan Africa (SSA) using yearly time series data from 2000 to 2022. The system generalized method of moments (GMM) was employed to tackle endogeneity issues, with robustness checks performed using DOLS and FMOLS to address cross-sectional dependence through robust standard errors. This method revealed important insights into the dynamics of economic growth. The findings show a significant positive connection between the economy’s past success and its current growth. CO2 emissions negatively impact economic growth, demonstrating the detrimental effects of environmental degradation. Agricultural finance has a positive influence on economic growth by boosting productivity and fostering economic growth. However, climate financing has a short-term negative impact on growth owing to high initial costs and inefficiencies, but it promotes long-term growth when combined with agricultural finance. The interaction between CO2 emissions and agricultural finance shows that increasing emissions reduces the benefits of agricultural investments, underscoring the vulnerability of agriculture-dependent economies. Conversely, the interaction of agricultural finance with climate finance enhances economic growth, demonstrating the relevance of combining climate and agricultural investments. Additionally, the study finds that exchange rate stability positively affects growth, while inflation has a negative impact. Robustness checks validate these findings and underscore the need for varied analytical methods to capture economic interactions comprehensively. The study recommends comprehensive policy measures to tackle environmental, agricultural, and climate challenges, promote sustainable growth, and leverage integrated financial solutions for long-term development in Sub-Saharan Africa.