Trajectory Model Research Articles

Research on time-energy optimal trajectory planning of articulated heavy-duty robot

Articulated heavy-duty robots are more and more widely used in the construction environment. Aiming at the problems of low working efficiency and high energy consumption of this kind of robot, a multi-objective adaptive trajectory planning method combining path optimization and trajectory optimization is proposed to improve the working efficiency of the robot and reduce energy consumption. Firstly, based on kinematics and dynamic analysis considering friction, the energy consumption model of robot trajectory is constructed. Then, according to the posture of the key points in the known workspace, the optimal path points in the joint space are obtained by a path point solution method considering the joint load characteristics. On this basis, a multi-objective model considering running time and energy consumption is established to plan the interpolation trajectory of the joint space of the quintic B-spline curve. Finally, constrained by the velocity, acceleration and torque of the joint of the manipulator, the optimal solution is obtained by using the elite non-dominated sorting genetic algorithm (NSGA-II), and the optimal weight factor is selected by a multi-objective adaptive optimization method to obtain the optimal position-time series. The experimental results show that compared with the quintic polynomial trajectory optimization method, the energy consumption of the proposed method is reduced by 10.90% under the same working efficiency. The research results of this paper provide a new optimization idea for other target trajectory planning.

Numerical-physical modelling of the long jump flight of female athletes: Impact of jump style, hairstyle and clothing

The long jump is a track and field event in which the athlete sprints down a runway and tries to leap as far as possible from a take-off line. To the best of our knowledge, there are no published studies on the aerodynamic impact of jump style, hairstyle and clothing on the long jump distance. This paper presents a numerical-physical model of the long jump flight. It allows to predict flight distance and the impact of jump style, hairstyle and clothing. It consists of five submodels: an existing model of the sprint before take-off, a computational fluid dynamics (CFD) model of different body postures in flight, a set of physical wind tunnel models for CFD validation, a full-scale wind tunnel manikin with different hairstyles and clothing and a numerical model of the flight trajectory. Jump style only impacts flight distance by 1 cm or less. Hairstyle and clothing however can cause drag to vary by more than 25% and flight distance by more than 10 cm, mostly by impacting the take-off speed. In the long term, long jump events might see the introduction of hair caps and low-drag clothing to reduce aerodynamic resistance and level the playing field.

Associations between Longitudinal Maternal and Cord Blood Vitamin D Status and Child Growth Trajectories Up to 4 Years of Age.

The current study aimed to explore the combined and individual effects of vitamin D (VitD) status in three trimesters during pregnancy and cord blood (CB) on child growth trajectories from birth to 4 years of age. Pregnant women (n = 1100) were recruited between 2013 and 2016 in the Shanghai Birth Cohort (SBC) Study. A total of 959 mother-child dyads were included. VitD status was measured by LC-MS/MS at three trimesters (T1, T2, T3) and CB. Children's weight, length/height, and head circumference were assessed at birth, 42 days, 6, 12, 24 months, and 4 years of age, and standardized into z-scores [weight-for-age z-score (WAZ), length-for-age z-score (LAZ), head circumference-for-age z-score (HCZ) and weight-for-length z-score (WLZ)]. Using the group-based trajectory model (GBTM), the trajectories of the four growth parameters were categorized into discrete groups. The generalized estimating equation (GEE) was employed to analyze the mixed effect of 25(OH)D throughout pregnancy on growth trajectories. The association between 25(OH)D status and each growth trajectory group was examined by multivariable logistic regression. Each 10 ng/mL increase in 25(OH) throughout three trimesters was not associated with four anthropometric parameters. Each 10 ng/mL increase in VitD in T3 was associated with a lower risk in the WAZ high-increasing trajectory (aOR: 0.75; 95% CI: 0.62, 0.91; p < 0.01). Each 10 ng/mL increase in VitD in CB was associated with a lower risk in the WAZ high-increasing trajectory (aOR: 0.57; 95% CI: 0.43, 0.76; p < 0.01). No significant association was found between maternal or CB VitD and LAZ or HCZ. Three trimesters' VitD throughout pregnancy had no persistent effect on the offspring's growth trajectory. However, higher VitD status in the third trimester and CB related to a lower risk of high-increasing WAZ from birth to 4 years of age. Elevated VitD levels in late pregnancy and cord blood may protect against continuous early-life weight growth at high levels.

Predictive value of the random forest model based on bioelectrical impedance analysis parameter trajectories for short-term prognosis in stroke patients

BackgroundThe short-term prognosis of stroke patients is mainly influenced by the severity of the primary disease at admission and the trend of disease development during the acute phase (1–7 days after admission).ObjectiveThe aim of this study is to explore the relationship between the bioelectrical impedance analysis (BIA) parameter trajectories during the acute phase of stroke patients and their short-term prognosis, and to investigate the predictive value of the prediction model constructed using BIA parameter trajectories and clinical indicators at admission for short-term prognosis in stroke patients.MethodsA total of 162 stroke patients were prospectively enrolled, and their clinical indicators at admission and BIA parameters during the first 1–7 days of admission were collected. A Group-Based Trajectory Model (GBTM) was employed to identify different subgroups of longitudinal trajectories of BIA parameters during the first 1–7 days of admission in stroke patients. The random forest algorithm was applied to screen BIA parameter trajectories and clinical indicators with predictive value, construct prediction models, and perform model comparisons. The outcome measure was the Modified Rankin Scale (mRS) score at discharge.ResultsPA in BIA parameters can be divided into four separate trajectory groups. The incidence of poor prognosis (mRS: 4–6) at discharge was significantly higher in the “Low PA Rapid Decline Group” (85.0%) than in the “High PA Stable Group “ (33.3%) and in the “Medium PA Slow Decline Group “(29.5%) (all P < 0.05). In-hospital mortality was the highest in the “Low PA Rapid Decline Group” (60%) compared with the remaining trajectory groups (P < 0.05). Compared with the prediction model with only clinical indicators (Model 1), the prediction model with PA trajectories (Model 2) demonstrated higher predictive accuracy and efficacy. The area under the receiver operating characteristic curve (AUC) of Model 2 was 0.909 [95% CI 0.863, 0.956], integrated discrimination improvement index (IDI), 0.035 (P < 0.001), and net reclassification improvement (NRI), 0.175 (P = 0.031).ConclusionPA trajectories during the first 1–7 days of admission are associated with the short-term prognosis of stroke patients. PA trajectories have additional value in predicting the short-term prognosis of stroke patients.

Q-learning based tracking control with novel finite-horizon performance index

A data-driven method is designed to realize the model-free finite-horizon optimal tracking control (FHOTC) of unknown linear discrete-time systems based on Q-learning in this paper. First, a novel finite-horizon performance index (FHPI) that only depends on the next-step tracking error is introduced. Then, an augmented system is formulated, which incorporates with the system model and the trajectory model. Based on the novel FHPI, a derivation of the augmented time-varying Riccati equation (ATVRE) is provided. We present a data-driven FHOTC method that uses Q-learning to optimize the defined time-varying Q-function. This allows us to estimate the solutions of the ATVRE without the system dynamics. Finally, the validity and features of the proposed Q-learning-based FHOTC method are demonstrated by means of conducting comparative simulation studies.

The Morphological Study of Colour Terms in Nigerian English

The paper investigates the nature of morphological processes of colour terms among the users of English in Nigeria and their syntactic usages using a multi-dimensional approach in data gathering. The data was drawn from one hundred subjects across ten ethnic groups, including Hausa, Igbo and Yoruba as well as fifteen textual materials written in English by Nigerian scholars. The paper adopts a cognitive linguistic multidimensional framework. The paper reveals that the colour systems and usages among Nigerians contrast with the system within the native speakers of the language. For instance "fresh leave green", "pale blue", "blood red", "yolk yellow", "black black", "dark so and so", "charcoal", "flesh", , "dirty green", "dudu" and so on are formed through several morphological processes such as coining, clipping, blending, borrowing, compounding, reduplication and affixation as well as usage in various syntactic operations as in nominals and adjectives: "The shirt is dark so and so." and "The yellows ran out of the scorching sun." which serves as adjective and nominal plural respectively. Hence the paper concludes that morphology and syntax of most colours in Nigerian context have been influenced by many indigenous languages in the country. Hence, the hierarchy of the basic colours violates the Berlin and Kay"s evolutionary sequence and Kay and Maffi"s Trajectory model of Colour terms within the circle of the native speakers of English.

Adaptive control for circulating cooling water system using deep reinforcement learning.

Due to the complex internal working process of circulating cooling water systems, most traditional control methods struggle to achieve stable and precise control. Therefore, this paper presents a novel adaptive control structure for the Twin Delayed Deep Deterministic Policy Gradient algorithm, which is based on a reference trajectory model (TD3-RTM). The structure is based on the Markov decision process of the recirculating cooling water system. Initially, the TD3 algorithm is employed to construct a deep reinforcement learning agent. Subsequently, a state space is selected, and a dense reward function is designed, considering the multivariable characteristics of the recirculating cooling water system. The agent updates its network based on different reward values obtained through interactions with the system, thereby gradually aligning the action values with the optimal policy. The TD3-RTM method introduces a reference trajectory model to accelerate the convergence speed of the agent and reduce oscillations and instability in the control system. Subsequently, simulation experiments were conducted in MATLAB/Simulink. The results show that compared to PID, fuzzy PID, DDPG and TD3, the TD3-RTM method improved the transient time in the flow loop by 6.09s, 5.29s, 0.57s, and 0.77s, respectively, and the Integral of Absolute Error(IAE) indexes decreased by 710.54, 335.1, 135.97, and 89.96, respectively, and the transient time in the temperature loop improved by 25.84s, 13.65s, 15.05s, and 0.81s, and the IAE metrics were reduced by 143.9, 59.13, 31.79, and 1.77, respectively. In addition, the overshooting of the TD3-RTM method in the flow loop was reduced by 17.64, 7.79, and 1.29 per cent, respectively, in comparison with the PID, the fuzzy PID, and the TD3.

Association between blood pressure multi-trajectory and cardiovascular disease among a Chinese elderly medical examination population.

This study aimed to characterize multivariate trajectories of blood pressure [systolic blood pressure (SBP) and diastolic blood pressure (DBP)] jointly and examine their impact on incident cardiovascular disease (CVD) among a Chinese elderly medical examination population. A total of 13,504 individuals without CVD during 2018-2020 were included from the Chinese geriatric physical examination cohort study. The group-based trajectory model was used to construct multi-trajectories of systolic blood pressure and diastolic blood pressure. The primary outcome was the incidence of the first CVD events, consisting of stroke and coronary heart diseases, in 2021. The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between BP multi-trajectories and incident CVD events. We identified four blood pressure (BP) subclasses, summarized by their SBP and DBP levels from low to high as class 1 (7.16%), class 2 (55.17%), class 3 (32.26%), and class 4 (5.41%). In 2021, we documented 890 incident CVD events. Compared with participants in class 1, adjusted HRs were 1.56 (95% CI: 1.12-2.19) for class 2, 1.75 (95% CI: 1.24-2.47) for class 3, and 1.88 (95% CI: 1.24-2.85) for class 4 after adjustment for demographics, health behaviors, and metabolic index. Individuals aged 65 years and above with higher levels of BP trajectories had higher risks of CVD events in China. Individuals with higher levels of both SBP and DBP trajectories over time were associated with an increased risk of incident CVD in the Chinese elderly population.

Prenatal exposure to PM2.5 and childhood body mass index growth trajectories from birth to 6 years old

This study aimed to determine the relationships between prenatal PM2.5 exposure and childhood growth trajectories during the first 6 years of life. A total of 47,625 pairs of mothers and children were recruited from a prospective birth cohort conducted between 2011 and 2013 in Wuhan, China, and followed for 6 years. We used the group-based trajectory models to classify the population into three trajectory groups: slow growth (n = 13,671, 28.7%), normal growth (n = 29,736, 62.4%), and rapid growth (n = 4218, 8.9%). Multinomial logistic regression models were used to determine the associations of prenatal PM2.5 exposure and childhood growth trajectories. Compared to normal growth trajectory, increased PM2.5 exposure in trimester 1, trimester 2 and the entire pregnancy showed significant associations with an increased risk of the slow growth trajectory but reduced the risk for the rapid growth trajectory, significant association of prenatal PM2.5 exposure with rapid growth trajectory was only observed in the trimester 3. Stratified analyses displayed relatively stronger associations among those mothers with maternal age over 35 years, pre-pregnancy BMI ≥ 25 kg/m2, and previous delivery experience. Prenatal exposure to PM2.5, particularly during the midpoint period of pregnancy, was more likely to have a slow growth trajectory and a lower risk of rapid growth trajectory. Maternal age, pre-pregnancy BMI, and previous delivery experience might modify these associations.

Trajectories of Sugar-Sweetened Beverage Intake in Early Life: Evidence from a Birth Cohort Study.

Infancy and early childhood are periods of dietary transition. Early exposure to specific foods and the establishment of dietary habits during this period can shape long-term food preferences and have lasting effects on health. This study aimed to examine the longitudinal trajectories of sugar-sweetened beverage (SSB) intake in Australian children from birth to age 3 years and identify early-life and socioeconomic factors influencing those trajectories. Mother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids birth cohort study were interviewed on their weekly frequency of SSB intake at 4-month, 8-month, 1-year, 2-year, and 3-year age points. Group-based trajectory modelling analysis was performed to identify trajectories for SSB intake among Australian children. A multivariable logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories. The intake of SSBs showed two distinct quadratic trajectories (high and low) with age. While the two trajectories remained distinctive throughout, the SSB consumption for both groups consistently increased between 4 months and 2 years of age and subsequently stabilised. Compared to low SSB consumers (75%), the high SSB consumers (25%) were significantly more likely to be living in households with three or more children (relative risk (RR): 1.59, 95%CI: 1.02-2.48), had low maternal education (left school < year 12-RR: 1.75, 95%CI: 1.09-2.81; completed year 12-RR: 1.57, 95%CI: 1.02-2.81), and resided in highly/the most socioeconomically disadvantaged areas (highly disadvantaged-RR: 1.89, 95%CI: 1.13-3.18; most disadvantaged-RR: 2.06, 95%CI: 1.25-3.38). Children's SSB intake patterns are established early in life as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socioeconomic factors. Hence, interventions targeted to limit SSB intake and improve nutrition amongst children should occur in early life.

Enhancing payload capacity to low earth orbit via a relay solution trajectory with laser-powered vehicles

ABSTRACT Low Earth Orbit (LEO) stands as the primary access point for deep space exploration endeavors, encompassing a variety of space missions such as communication satellites, Earth observation platforms, and scientific research missions. In light of the expanding scope of human activities in space, the cost associated with accessing LEO has emerged as a critical focal point for spacecraft designers. Within the spectrum of proposed solutions, laser-powered vehicle has emerged as a viable avenue toward achieving cost-effective launch options. In order to significantly augment the payload capacity of laser-powered launch vehicles destined for LEO, this study introduced a novel Relay Solution Trajectory Flight Scheme. Central to this scheme was the implementation of a relay mirror system affixed to a satellite, which served to stabilize the incident angle of the laser beam directed toward the laser-powered vehicle, thereby ensuring continuous alignment between the laser beam and the vehicle’s axis throughout the duration of the flight. Following the development of comprehensive structural, propulsive, aerodynamic, and trajectory models tailored for the laser-powered vehicle, an optimization of its flight trajectory was conducted, comparing this innovative strategy with two conventional flight strategies. The outcomes of this analysis showcased a notable enhancement of 269.29% in payload capacity compared to conventional strategies that lacked a relay satellite system, within a designated 400 km LEO flight scenario. This endeavor underscored the transformative potential of advanced relay systems in reshaping payload delivery mechanisms and elevating mission feasibility levels, notwithstanding the intricate coordination challenges posed by intricate satellite systems.

The trajectory of anxiety symptoms during the transition from childhood to young adulthood is predicted by IQ and sex, but not polygenic risk scores

AbstractBackgroundUnderstanding the factors that determine distinct courses of anxiety symptoms throughout development will better guide interventions. There are scarce data‐driven longitudinal studies, using multi‐modal predictors, investigating the chronicity of anxiety symptoms from childhood to young adulthood, particularly in a middle‐income country.Methods2033 youths (ages 6–14 years [Mean age = 10.4 ± 1.94) at Baseline] were enrolled in the Brazilian High‐Risk Cohort for Mental Conditions longitudinal study, and assessed at three timepoints, between 2010 and 2019, using the Screen for Child Anxiety Related Disorders. Confirmatory Factor Analysis provided input to Growth Mixture Models to identify the best fitting trajectory model. Multinomial logistic regression analyses tested the effects of intelligence quotient (IQ), environmental factors and polygenic risk scores on internalizing symptomatology within trajectory class membership.ResultsThe best model solution identified three classes: high‐decreasing, moderate/low‐stable and low‐increasing symptoms over time. The high‐decreasing class showed a higher incidence of anxiety symptoms at the second time point (Mean age = 13.8 ± 1.93); while anxiety symptoms were highest in the low‐increasing class at the third timepoint (Mean age = 18.35 ± 2.03). Further, lower IQ predicted membership in the high‐decreasing trajectory class (OR = 0.68, 95% CI [0.55, 0.85]), while higher IQ predicted membership in the low‐increasing trajectory class (OR = 1.95, 95% CI [1.42, 2.67]). Finally, females were more likely than males to be in the low‐increasing trajectory class. Polygenic risk scores were not associated with anxiety trajectory class membership.ConclusionRecognizing that anxiety symptoms follow diverse paths over time will allow for more effective intervention strategies. Specifically, interventions could accommodate children for greater anxiety risk in early childhood (i.e., lower IQ) versus late adolescence (i.e., higher IQ). That said, the emotional needs of girls in late adolescence should be monitored, regardless of their cognitive abilities or high achievements.

Uncovering patterns of white-matter degeneration in normal aging: links between morphometry and microstructure

Abstract While tract-wise differences in volume and microstructure are common targets of investigation in age-related changes in the white matter (WM), there has been relatively little exploration into other attributes of tract morphometry or its relation to microstructure in vivo, and limited understanding on how they jointly inform the understanding of the WM aging trajectory. This study examines ten WM tracts for tract-wise differences in morphometry (i.e. volume, length, and volume-to-length ratio) and microstructural integrity (i.e. fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity) using diffusion MRI data from the Human Connectome Project in Aging (HCP-A) with the goal of laying the foundation for a more comprehensive model of age-related WM microstructure-morphometry trajectories with a special focus on age-shifted correlations and sex differences. Results indicated that degeneration in microstructure was detectable at younger ages than changes in morphometry, with widely heterogeneous patterns of interrelation and morphometry-microstructural associations in aging both across tracts and between sexes. Multi-parametric signatures of decline suggest differing stages or mechanisms of degeneration across tracts, with female subjects exhibiting a higher proportion of tracts in later stages of decline than males. This work highlights the value of integrating microstructural and morphometric measures of WM health, and encourages the integration of yet more modalities in improving our mechanistic understanding of WM aging.

Frailty trajectories and determinants in Chinese older adults: A longitudinal study

ObjectivesThis study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese. Methods2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors. ResultsFour FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed. ConclusionsFrailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.

Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing

ObjectivesTo classify older adults into clusters based on accumulating long-term conditions (LTC) as trajectories, characterise clusters and quantify their associations with all-cause mortality.DesignWe conducted a longitudinal study using the English...

Trajectories of craving in the course of pharmacotherapy trials for methamphetamine use disorder.

The aim of this study was to measure trajectories of craving for methamphetamine during the course of pharmacotherapy trials for methamphetamine use disorder. Craving trajectories were identified using Group-Based Trajectory Modeling. The association of craving trajectories with drug use trajectories was examined using a dual trajectory model. Association of craving trajectories with other health and social outcomes was also examined. The study used pooled data from five randomized controlled pharmacotherapy trials for methamphetamine use disorder. A total of 866 adults with methamphetamine use disorder participated in randomized controlled pharmacotherapy trials. Craving was assessed weekly using the Brief Substance Craving Scale. Drug use was assessed using urine toxicology. Alcohol- and drug-related problems, as well as psychiatric, medical, legal, employment and relationship problems, were measured using the Addiction Severity Index. A three-trajectory model with high, medium and low craving trajectories was selected as the most parsimonious model. Craving trajectories were associated with methamphetamine use trajectories in the course of trial; 88.4% of those in the high craving trajectory group had a consistently high frequency of methamphetamine use compared with 18.7% of those in the low craving group. High craving was also associated with less improvement in most other outcomes and higher rate of dropout from treatment. In turn, low craving was associated with a rapidly decreasing frequency of methamphetamine use, greater improvement in most other outcomes and a lower rate of dropout. Participants on modafinil daily and ondansetron 1 mg twice daily were less likely to be in the high craving group compared with those on placebo. Trajectories of methamphetamine craving in the course of clinical trials for methamphetamine use disorder appear to be both highly variable and strongly associated with greater frequency of drug use, other drug-related outcomes and dropout from trials. Two medications, modafinil daily and ondansetron at a dose of 1 mg two times daily, appear to be associated with greater reduction in craving in the course of treatment compared with placebo. A decrease in methamphetamine craving shows promise as an early indicator of recovery from methamphetamine use disorder.

Ten-year trajectory of coronary artery calcification and risk of cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis.

Whether and how coronary artery calcium (CAC) progress contributes to cardiovascular outcomes has not been fully elucidated. The aim of this study was to identify different patterns of CAC change and evaluate the associations with different cardiovascular outcomes. Data from the Multi-Ethnic Study of Atherosclerosis study were analyzed. Participants with at least three CT measurements were included. The main study outcome is hard cardiovascular disease (CVD). CAC scores were determined as phantom-adjusted Agatston scores. A group-based trajectory model was used to identify latent groups and estimated the hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional regression models. A total of 3,616 participants were finally enrolled [mean age 60.55 (SD 9.54) years, 47.76% men and 39.30% Caucasian]. Four distinct trajectories in CAC were identified: class 1, low-stable (24.17%); class 2, low-increasing (27.60%); class 3, moderate-increasing (30.56%); and class 4, elevated-increasing (17.67%). During 13.58 (SD 2.25) years of follow-up, 291 cases of hard CVD occurred. The event rates of hard CVD per 1,000 person-years were 2.23 (95% CI 1.53-3.25), 4.60 (95% CI 3.60-5.89), 7.67 (95% CI 6.38-9.21) and 10.37 (95% CI 8.41-12.80) for classes 1-4, respectively. Compared to participants assigned to class 1, the full-adjusted HRs of hard CVD for classes 2-4 were 2.10 (95% CI 1.33-3.01), 3.17 (95% CI 2.07-4.87), and 4.30 (95% CI 2.73-6.78), respectively. The graded positive associations with hard CVD were consistently observed in subgroups of age, sex, and race, with the presence or absence of hypertension or diabetes. By analyzing potential risk factors for distinctive CAC trajectories, risk factors for the onset and progression of CAC could possibly differ: age, male sex, history of hypertension, and diabetes are consistently associated with the low-, moderate-, and elevated-increasing trajectories. However, Caucasian race, cigarette smoking, and a higher body mass index was related only to risk of progression but not to incident CAC. In this multi-ethnic population-based cohort, four unique trajectories in CAC change over a 10-year span were identified. These findings signal an underlying high-risk population and may inspire future studies on risk management.

Prevalence, pain trajectories, and presurgical predictors for chronic postsurgical pain in a pediatric sample in Spain with a 24-month follow-up.

Pediatric chronic pain, particularly chronic postsurgical pain (CPSP), poses a significant public health challenge, impacting 20% of pediatric populations. While several presurgical predictors have been identified, there is a scarcity of data on long-term outcomes, especially beyond 1 to 2 years postsurgery. Previous research primarily focuses on North American children, creating gaps in understanding CPSP outcomes in diverse health systems, such as in Spain. This study, registered as NCT04735211, investigates CPSP in 159 children and adolescents (mean age = 12.4 years, 37.1% girls, retention rate = 65%) undergoing various surgeries in Spain. The objectives include examining CPSP prevalence (Numerical Rating Scale ≥ 4) at 3, 6, 12, and 24 months, exploring postsurgical pain trajectories through group-based trajectory modeling, and identifying potential presurgical predictors for CPSP (pain intensity, pain catastrophizing, pain anxiety, fear of pain, kinesiophobia, health-related quality of life, pain interference, and physical activity), using multiple logistic regressions. Results show a CPSP prevalence of 41% at 3 months, decreasing to 14% at 24 months. Presurgical factors including pain intensity (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.02-1.53), pain catastrophizing (aOR = 1.06, 95% CI = 1.00-1.13), and pain anxiety (aOR = 1.06, 95% CI = 1.02-1.11) were associated with CPSP at 3 months. Group-based trajectory modeling revealed 3 postsurgical pain trajectories: Low Pain with Rapid Recovery Group (30.2%), Moderate Pain with Recovery Group (53.5%), and High Pain with Slow Recovery Group (16.3%), with group differences in presurgical predictors, excluding physical activity. This study contributes valuable insights into CPSP, emphasizing the need for long-term follow-up. The findings could inform the implementation of preventive programs for CPSP into diverse health systems.

Hypothetical Interventions on Cardiovascular Health Metrics for Abnormal Cognitive Aging: An Application of the Parametric g-formula in the CLHLS Cohort Study with 12 Years Follow-Up

BackgroundAbnormal cognitive aging is closely related to dementia.ObjectivesThis study aimed to estimate the effect of cardiovascular health (CVH) metrics on abnormal cognitive aging.DesignA longitudinal cohort study.SettingParticipants were recruited from the Chinese Longitudinal Health Longevity Survey.ParticipantsA total of 3298 participants aged ≥65 years with normal cognitive performance at baseline were included.MeasurementsCognitive performance was measured by the Chinese version of the Mini-Mental State Examination (MMSE). CVH was assessed with six metrics, including hypertension, diabetes, exercise, body mass index (BMI), diet, and smoking. Group-based trajectory model was used to identify the trajectory groups of cognitive aging over 12 years (2002–2014 and 2005–2018). The parametric g-formula was applied to estimate the effect of each single six CVH metrics and their combinations on the 12-year cognitive aging trajectory.ResultsFour trajectory groups of cognitive aging were identified: Stable-high (77.4%), Unstable (4.9%), Slow decline (11.1%), and Rapid decline (6.6%). Unstable, Slow decline, and Rapid decline trajectory groups were considered as abnormal cognitive aging (22.6%). Single interventions on hypertension, exercise, BMI, and diet could reduce the risk of abnormal cognitive aging. Moreover, the risk ratios of joint intervention on exercise, BMI, and diet for Unstable, Slow decline, and Rapid decline trajectory groups were 0.38 (95% CI: 0.30–0.48), 0.45 (95% CI: 0.37–0.54), and 0.3 (95% CI: 0.23–0.41), respectively.ConclusionA considerable proportion of the participants experienced abnormal cognitive aging during their aging process. Interventions on these CVH metrics (i.e., exercise, BMI, and diet), which are fairly practical and feasible for older adults, may be effective strategies for preventing abnormal cognitive aging.

New Disease Trajectories of Heart Failure: Challenges in Determining the Ideal Timing of Palliative Care Implementation.

Background: The disease trajectory of heart failure (HF), along with other organ failures, is still being elucidated. The trajectory is represented as a descending saw-tooth curve, indicating the frequent exacerbations and hospitalizations and slow progression to death. However, the clinical pattern of HF is no longer unique because of the definition of three distinct phenotypes, according to different values of ejection fraction (EF): HF with reduced EF (HFrEF), mildly reduced EF (HFmEF), and preserved EF (HFpEF). Patients with HFrEF have access to pharmacological and nonpharmacological treatments that have been shown to reduce mortality, unlike the other two classes for which no effective therapies are present. Therefore, their disease trajectories are markedly different. Methods: In this study, multiple new disease trajectories of HFrEF are being proposed, ranging from a complete and persistent recovery to rapid clinical deterioration and premature death. These new trajectories pose challenges to early implementation of palliative care (PC), as indicated in the guidelines. Results: From these considerations, we discuss how the improved prognosis of HFrEF because of effective treatment could paradoxically delay the initiation of early PC, especially with the insufficient palliative knowledge and training of cardiologists, who usually believe that PC is required only at the end of life. Conclusions: The novel therapeutic approaches for HF discussed in this study highlight the clinical specificity and peculiar needs of patients with HF. The changing model of disease trajectories of patients with HF will provide new opportunities for the early implementation of PC.