Univariate Linear Regression Research Articles

Impact of regional differences and neighborhood socioeconomic deprivation on the outcomes of patients with lower extremity wounds evaluated by a limb-preservation service

ObjectiveManagement of lower extremity (LE) wounds has evolved with the establishment of specialized limb preservation services. Although clinical factors contribute to limb outcomes, socioeconomic status and community factors also influence the risk for limb loss. The Distressed Community Index (DCI) score is a validated index of social deprivation created to provide an objective measure of economic well-being in United States communities. Few studies have examined the influence of geographic deprivation on outcomes in patients with LE wounds. We examined relationships between socioeconomic deprivation and outcomes of inpatients evaluated by a dedicated limb preservation service (Functional Limb Extremity Service [FLEX]). MethodsInpatients referred to FLEX over a 5-year period were included. Wound, Ischemia, foot Infection (WIfI) staging was collected. DCI scores were determined using seven indices based on ZIP Code. Outcomes included any minor or major amputations, any endovascular or open LE revascularization, or wound care procedures. Disease etiology, demographic, and anthropometric data were collected. Associations between neighborhood deprivation and limb-specific outcomes were evaluated in models for the DCI and each of its components separately. ResultsA total of 677 patients were included. Thirty-eight percent were female, with a mean age of 64 years. Sixty percent had WIfI stage 3 or 4 risk of amputation, and 43% had WIfI stage 3 or 4 risk of revascularization. Mean ankle-brachial index and toe pressure were 0.96 (standard deviation [SD], 0.43) and 80 (SD, 57) mmHg. Thirty-five percent were non-White. Amputation was performed in 31% of patients, whereas 17% underwent revascularization. The mean distress score was 64 (SD, 24). Mean DCI scores did not differ across WIfI scores. Likewise, overall DCI distress score was not related to any of the outcomes in univariable or multivariable linear regression models. In univariable linear regression models for amputation, higher poverty rate (odds ratio for SD increase 1.20; 95% confidence interval, 1.02-1.42; P = .025) was significantly associated with the outcome. In multivariable models, neither DCI distress score nor any of its components remained significantly associated with the outcome. ConclusionsDespite known racial disparities in limb-specific outcomes, an aggregate measure of community level distress was not found to be related to outcomes. Although the poverty rate demonstrated a significant relationship with amputation in univariable analysis, this association was not found in multivariable models. Notably, non-White race emerged as a predictor of amputation, underscoring the importance of addressing racial disparities in LE outcomes. Further investigation of potential determinants of LE outcomes is needed, particularly the interaction of such factors with race.

The Value of Patient-Reported Outcomes to Predict Symptom Burden and Health-Related Quality of Life After Chemoradiation for Cervical Cancer: A Prospective Study

Patients with cervical cancer undergoing chemoradiation have high symptom burden. We performed an analysis of prospectively collected data on patient-reported outcomes to determine characteristics predictive of poor treatment experience. Between 2021 and 2023, we prospectively collected data on patient-reported outcomes from patients with cervical cancer undergoing definitive chemoradiation. The European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Question-Core 30 and the EORTC-Quality of Life Question-Cervical Cancer module were completed at baseline (BL) and at the end of treatment (EOT). Poor treatment experience was defined as EOT poor health-related quality of life (HRQOL), low physical function, or significant overall symptom burden. Predictive factors analyzed included demographic, clinical, and disease-specific factors and BL financial toxicity, depression, social function, and emotional function. Receiver operating characteristic analysis provided appropriate predictive cutoff values. Univariable and multivariable (MVA) linear regression analyses were performed. Forty-nine patients completed BL and EOT questionnaires. Median age was 43 years (range, 18-85 years). Most patients (59%) had stage III disease. BL financial toxicity ≥66.7, depression ≥66.7, social function ≤50, and emotional function ≤58 on the EORTC linear transformed scale of 0 to 100 were significant predictors for poor treatment experience (p ≤ .04) based on receiver operating characteristic analysis. On MVA, poor BL social function was associated with reduced EOT HRQOL (β, -9.3; 95% CI, -16.1 to -2.6; p < .008), decreased physical function (β, -24.4; 95% CI, -36.3 to -12.6; p < .001), and high symptom burden (β, 26.9; 95% CI, 17.5-36.3; p < .001). Earlier disease stage predicted decreased symptom burden (β, -6.7; 95% CI, -13.1 to -0.3; p = .039). BL financial toxicity was a significant predictor in univariable analysis (p = .001-.044) and showed a significant interaction term on MVA (p = .024-.041) for all 3 domains of poor treatment experience. Demographic and treatment-related factors were not predictive. Patients with cervical cancer with poor BL social function or high financial toxicity were at risk for increased symptom burden and poor HRQOL. Screening for these factors provides an opportunity for early intervention to improve treatment experience.

Interictal discharge traveling waves recorded from stereoelectroencephalography electrodes.

Interictal epileptiform discharges (IEDs) are intermittent high-amplitude electrical signals that occur between seizures. They have been shown to propagate through the brain as traveling waves when recorded with epicortical grid-type electrodes and small penetrating microelectrode arrays. However, little work has been done to translate experimental IED analyses to more clinically relevant platforms such as stereoelectroencephalography (SEEG). In this pilot study, the authors aimed to define a computational method to identify and characterize IEDs recorded from clinical SEEG electrodes and leverage the directionality of IED traveling waves to localize the seizure onset zone (SOZ). Continuous SEEG recordings from 15 patients with medically refractory epilepsy were collected, and IEDs were detected by identifying overlapping peaks of a minimum prominence. IED pathways of propagation were defined and compared to the SOZ location determined by a clinical neurologist based on the ictal recordings. For further analysis of the IED pathways of propagation, IED detections were divided into triplets, defined as a set of 3 consecutive contacts within the same IED detection. Univariate and multivariate linear regression models were employed to associate IED characteristics with colocalization to the SOZ. A median (range) of 22.6 (4.4-183.9) IEDs were detected per hour from 15 patients over a mean of 23.2 hours of recording. Depending on the definition of the SOZ, a median (range) of 20.8% (0.0%-54.5%) to 62.1% (19.2%-99.4%) of IEDs per patient traversed the SOZ. IEDs passing through the SOZ followed discrete pathways that had little overlap with those of the IEDs passing outside the SOZ. Contact triplets that occurred more than once were significantly more likely to be detected in an IED passing through the SOZ (p < 0.001). Per our multivariate model, patients with a greater proportion of IED traveling waves had a significantly greater proportion of IEDs that localized to the SOZ (β = 0.64, 95% CI 0.01-1.27, p = 0.045). By using computational methods, IEDs can be meaningfully detected from clinical-grade SEEG recordings of patients with epilepsy. In some patients, a high proportion of IEDs are traveling waves according to multiple metrics that colocalize to the SOZ, offering hope that IED detection, with further refinement, could serve as an alternative method for SOZ localization.

Stigma and its influencing factors for seeking professional psychological help among pregnant women: A cross-sectional study

Although the stigma associated with seeking professional psychological help has received significant attention, few studies have focused on the status and factors influencing this stigma among pregnant women, especially those with a Chinese cultural background. This study aimed to assess the status of stigma associated with seeking professional psychological help and its influencing factors. A total of 1325 pregnant women were recruited from Hunan Province, China. The Stigma for Seeking Professional Psychological Help questionnaire, Patient Health Questionnaire-9, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and questionnaires on sociodemographic characteristics and pregnancy-related information were used. Descriptive, univariate, correlation, and multivariate linear regression analyses were used to investigate the status of stigma and identify its influencing factors. Pregnant Chinese women experienced a mild to moderate level of stigma associated with seeking professional psychological help, and self-stigma was more common than social stigma associated with seeking psychological help. The results of the multivariate analysis suggested that perceived social support, positive coping styles, negative coping styles, and depressive symptoms were the factors influencing self-stigma and social stigma associated with seeking professional psychological help. Advanced age and a low educational level were the only predictors associated with self-stigma, while a history of multiple pregnancies had an effect only on social stigma associated with seeking professional psychological help. Chinese pregnant women experienced a mild to moderate level of stigma associated with seeking professional psychological help. Destigmatizing interventions focusing on self-stigma and social stigma should be designed according to maternal characteristics, social support, coping style, and depressive symptoms.

The Application of a Synthetic Biodegradable Temporizing Matrix in Extensive Burn Injury: A Unicenter Experience of 175 Cases.

Objectives: Addressing extensive and deep burn wounds poses considerable challenges for both patients and surgeons. The NovoSorb® Biodegradable Temporizing Matrix (BTM) emerged as a novel dermal substitute and has been subjected to evaluation in large burn wound cases, with a specific focus on identifying risk factors associated with suboptimal take rates. Methods: All patients with burn wounds greater than 10% body surface that underwent BTM treatment between March 2020 and November 2023 were eligible for inclusion. Univariate analyses and linear regression models were employed to discern risk factors and predictors influencing the take rates of both the BTM and split-thickness skin grafts (STSGs). Results: A total of 175 patients (mean age 56.2 ± 19.8 years, 70.3% male) were evaluated. The mean take rates of the BTM and STSGs were 82.0 ± 24.7% and 87.3 ± 19.0%, respectively. There were significant negative correlations between BTM take and the number of surgeries before BTM application (r = -0.19, p = 0.01), %TBSA and STSG take (r = -0.36, p = <0.001) and significant positive correlations between BTM and STSG take (r = 0.41, p ≤ 0.001) in addition to NPWT and STSG take (r = 0.21, p = 0.01). Multivariate regression analyses showed that a larger number of surgeries prior to BTM application (OR -3.41, 95% CI -6.82, -0.03, p = 0.04) was associated with poorer BTM take. Allograft treatment before BTM application (OR -14.7, 95% CI -23.0, -6.43,p = 0.01) and failed treatment with STSG before BTM application (OR -20.8, 95% CI -36.3, -5.23, p ≤ 0.01) were associated with poorer STSG take, whereas higher BTM take rates were associated with overall higher STSG take (OR -0.15, 95% 0.05, 0.26, p = 0.01). The Meek technique was used in 24 patients and showed similar take rates (BTM: 76.3 ± 28.0%, p = 0.22; STSG: 80.7 ± 21.1, p = 0.07). Conclusions: This study summarizes our findings on the application of a BTM in the context of large burn wounds. The results demonstrate that successful treatment can be achieved even in patients with extensive burns, resulting in satisfying take rates for both the BTM and STSG. The data underscore the importance of promptly applying a BTM to debrided wounds and indicate good results when using Meek.

CORRELATION ANALYSIS BETWEEN VASCULAR OVERLOAD INDEX AND LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSION

Objective: The vascular overload index (VOI) is commonly used to assess the’overload’phenomenon induced by hypertension,and vascular overload is one of the pathogenic mechanisms for left ventricular hypertrophy(LVH)associated with hypertension. The left ventricular mass index (LVMI) is the most frequently used diagnostic indicator for LVH. Research has found that VOI derived from office blood pressure readings is correlated with LVH,but it doesn’t evaluate the relationship between vascular load during different periods of the day and LVH. This study aims to investigate the correlation between VOI obtained from 24-hour ambulatory blood pressure and LVH. Design and method: A total of 591 hypertensive patients hospitalized from July 2020 to July 2022 were included. Echocardiography was performed in each patient,and the LVMI was calculated; The 24-hour VOI(VOI24h=1.33×SBP24h-0.33×DBP24h-133.3mmHg),daytime VOI(VOId),and nighttime VOI(VOIn)were calculated based on the 24-hour ambulatory blood pressure results. A multivariate logistic regression was utilized to explore the correlation between VOI at different times and LVH,adjusting for covariates such as gender,age,BMI,triglycerides,cholesterol,HDLand LDL. Results: The age of the 591 hypertensive patients was 63.8±13.3years and BMI was 25.7±3.6Kg/m2.Univariate linear regression analysis showed that VOI24h,VOId,and VOIn were positively correlated with LVMI(P&lt;0.001). After adjusting,all of VOI remained correlated with LVMI. Compared with the lowest tertile of VOI24h, the highest tertile had β (95%CI) of 9.25(6.09∼12.4). For VOId,the highest tertile compared to the lowest had β (95%CI) of 8.70(5.55∼11.86),and for VOIn,it was 9.48(6.32∼12.64).Univariate logistic regression analysis indicated that all of VOI were significantly associated with LVH(P&lt;0.001),and after adjusting for confounders,all of VOI still correlated with LVH,with OR(95%CI)respectively being 1.04(1.02∼1.07),1.04(1.02∼1.07),and 1.03(1.01∼1.05). Subgroup analysis revealed that regardless of the comorbidity of the hypertensive patients,all of VOI were all related to LVH.However, when analyzed by season,VOI24h and VOId were significantly associated with LVH in summer and winter, but not in spring and autumn; VOIn was only associated with LVH in winter. Conclusions: In the hypertensive patients,VOI derived from 24-hour ambulatory blood pressure is significantly correlated with LVH. Compared to spring and autumn,vascular load during summer and winter is significantly associated with LVH. Therefore,not only should steady blood pressure control over 24 hours be emphasized,but also pay attention to the impact of vascular load on LVH during summer and winter.

Quantitative assessment of background parenchymal enhancement is associated with lifetime breast cancer risk in screening MRI

ObjectivesTo compare the quantitative background parenchymal enhancement (BPE) in women with different lifetime risks and BRCA mutation status of breast cancer using screening MRI.Materials and methodsThis study included screening MRI of 535 women divided into three groups based on lifetime risk: nonhigh-risk women, high-risk women without BRCA mutation, and BRCA1/2 mutation carriers. Six quantitative BPE measurements, including percent enhancement (PE) and signal enhancement ratio (SER), were calculated on DCE-MRI after segmentation of the whole breast and fibroglandular tissue (FGT). The associations between lifetime risk factors and BPE were analyzed via linear regression analysis. We adjusted for risk factors influencing BPE using propensity score matching (PSM) and compared the BPE between different groups. A two-sided Mann–Whitney U-test was used to compare the BPE with a threshold of 0.1 for multiple testing issue-adjusted p values.ResultsAge, BMI, menopausal status, and FGT level were significantly correlated with quantitative BPE based on the univariate and multivariable linear regression analyses. After adjusting for age, BMI, menopausal status, hormonal treatment history, and FGT level using PSM, significant differences were observed between high-risk non-BRCA and BRCA groups in PEFGT (11.5 vs. 8.0%, adjusted p = 0.018) and SERFGT (7.2 vs. 9.3%, adjusted p = 0.066).ConclusionQuantitative BPE varies in women with different lifetime breast cancer risks and BRCA mutation status. These differences may be due to the influence of multiple lifetime risk factors. Quantitative BPE differences remained between groups with and without BRCA mutations after adjusting for known risk factors associated with BPE.Clinical relevance statementBRCA germline mutations may be associated with quantitative background parenchymal enhancement, excluding the effects of known confounding factors. This finding can provide potential insights into the cancer pathophysiological mechanisms behind lifetime risk models.Key PointsExpanding understanding of breast cancer pathophysiology allows for improved risk stratification and optimized screening protocols.Quantitative BPE is significantly associated with lifetime risk factors and differs between BRCA mutation carriers and noncarriers.This research offers a possible understanding of the physiological mechanisms underlying quantitative BPE and BRCA germline mutations.

Otolaryngology-head and neck surgery resident and medical school characteristics: Current paradigm amidst changing application criteria

PurposeTo determine the characteristics of current US Otolaryngology-Head and Neck Surgery (Oto-HNS) residents and their medical school. MethodsData were manually collected between Dec 2022 and Jan 2023 for 1649 residents attending 163 US-based ACGME accredited Oto-HNS residency programs, reflecting the 2018–2022 cohort. All data were collected from publicly available sources including residency and medical school program websites, web of science, and professional networking sites (ex: LinkedIn, Doximity). Data were analyzed to determine the “feeder” schools which contributed the greatest number and percent of residents. Using univariable linear regression models, we characterized factors which were associated with feeder school status. ResultsOf 1649 residents analyzed, 364 (22 %) matched to their home program and 918 (56 %) stayed in the region of their medical school. The median [IQR] number of published papers and abstracts was 5 [3, 9] with an h-index of 2 [1,4]. Factors associated with producing a greater percent of Oto-HNS residents include presence of an interest group, presence of a home program, USNWR research rank of the medical school, Doximity reputation rank of the home residency program, average pre-residency h-index of the school's graduates, and total NIH research funding (each p < 0.001). ConclusionsIn the changing landscape of residency applications after the USMLE Step 1 exam's transition in January 2022 to pass/fail scoring, it is important to objectively characterize current Oto-HNS residents. Findings from this study will inform prospective residents and residency programs seeking to improve access to Oto-HNS. Future small-scale studies may help further identify driving factors within medical school curricula.

Unveiling buyers’ preferences for privately developed affordable housing: a study in Kolkata, India

Purpose The purpose of this study is to examine the buyers’ preferences influencing the purchase of privately developed affordable housing in Kolkata and to determine whether unsold houses result from misalignment with these preferences. Design/methodology/approach The literature review and user-opinion survey identified 119 independent variables that indicate buyers’ preferences. A questionnaire survey of 383 households in affordable housing units from 32 housing complexes in Kolkata recorded buyers’ preferences and satisfaction against the independent variables grouped under five levels of characteristics. The product weights of variables derived from the rank sum method and percentage satisfaction give the Utility Score. Multivariate regression and univariate linear regressions were conducted to determine the significance of each Level of characteristics and each variable, identifying the significant variables that would affect the sale of affordable houses. Findings The multivariate regression analysis has indicated that 68.56% of the variation in the percentage of unsold houses was explained by the five utility scores, which affirms that misalignment with buyers’ preferences significantly affects the sale of privately developed affordable houses. Furthermore, building and neighbourhood-level utility show the highest significance as predictors, while city-level and miscellaneous utility have moderate significance, but housing complex-level utility lacks statistical significance. Originality/value This study addresses a research gap in privately developed affordable housing in Kolkata, enhancing understanding of buyer preferences in this segment.

Non-linear relationship of serum albumin-to-globulin ratio and cognitive function in American older people: a cross-sectional national health and nutrition examination survey 2011-2014 (NHANES) study.

Inflammation and liver function are associated with cognitive decline and dementia. Little is known about the serum albumin-to-globulin ratio on cognitive function. The objective of this study was to investigate the association between albumin-to-globulin ratio and cognitive function among the American older people. The public data available on the US National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014 was used for this cross-sectional study. Participants aged ≥60 years completed the cognitive function assessments, including word learning and recall modules from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the animal fluency (AF) test, and the digit symbol substitution test (DSST). A composite cognition score was calculated to evaluate global cognition. The univariate and multivariate linear regression analysis, curve fitting, a threshold effect, along with a subgroup analysis and interaction tests were conducted. Serum albumin-to-globulin ratio (per 0.1 unit) was positively associated DSST score (β = 0.36, 95% CI: 0.21, 0.51), AF score (β = 0.1, 95% CI: 0.04, 0.16) and global cognition score (β = 0.05, 95% CI: 0.02, 0.07), after being fully adjusted, while albumin-to-globulin ratio was not related to CERAD score (β = 0.05, 95% CI: -0.02, 0.12). A non-linear was observed in the dose-response relationship between albumin-to-globulin ratio and global cognition (P for non-linearity < 0.001). The subgroup analysis was overall stable, yet the interaction test was significant for age on global cognition (P for interaction = 0.036). The findings of this cross-sectional study suggested a positive and non-linear association between albumin-to-globulin ratio and cognitive function in the American older people. Maintaining albumin-to-globulin ratio with an appropriate range may be one of the therapeutic strategies to limit the progression of cognitive decline for the older people.

Determinants of circulating calcitriol in cardiovascular disease

Circulating calcitriol may contribute to the risk of cardiovascular disease (CVD), but its regulation in patients with CVD is poorly characterized. We therefore aimed to assess determinants of circulating calcitriol in these patients. We analyzed 2183 independent samples from a large cohort of patients scheduled for coronary angiography and 1727 independent samples from different other cohorts from patients with a wide range of CVDs, including heart transplant candidates, to quantify the association of different parameters with circulating calcitriol. We performed univariable and multivariable linear regression analyses using the mathematical function that fitted best with circulating calcitriol. In the multivariable analysis of the large single cohort, nine parameters remained significant, explaining 30.0 % (32.4 % after exclusion of 22 potential outliers) of the variation in circulating calcitriol (r=0.548). Log-transformed 25-hydroxyvitamin D [25(OH)D] and log-transformed glomerular filtration rate were the strongest predictors, explaining 17.6 % and 6.6 %, respectively, of the variation in calcitriol. In the analysis of the combined other cohorts, including heart transplant candidates, the multivariable model explained a total of 42.6 % (46.1 % after exclusion of 21 potential outliers) of the variation in calcitriol (r=0.653) with log-transformed fibroblast growth factor-23 and log-transformed 25(OH)D explaining 29.0 % and 6.2 %, respectively. Circulating 25(OH)D was positively and FGF-23 inversely associated with circulating calcitriol. Although significant, PTH was only a weak predictor of calcitriol in both analyses (<2.5 %). In patients with CVD, FGF-23 and 25(OH)D are important independent determinants of circulating calcitriol. The relative importance of these two parameters may vary according to CVD severity. Future studies should focus on the clinical importance of regulating circulating calcitriol by different parameters.

Enhancing adherence to recommended food practices in Norwegian kindergartens: The role of knowledge and application of national guidelines for food and meals

Aim: This study sought to investigate the relationship between knowledge and the practical application (including grocery lists, meal plans and food-related pedagogical plans) of Norwegian national guidelines for food and meals in kindergartens, together with the quality of food served in adherence to these guidelines. The study also examined the frequency of daily meals provided and the quality of food served. Moreover, it explored whether pedagogical staff’s knowledge of these guidelines was linked to their practical application. Method: Data were collected from 324 kindergarten staff members by means of a web-based questionnaire distributed to both public and private kindergartens in Norway between 2018 and 2020. Univariate and multivariate linear regression analyses were employed to explore associations between pedagogical staff knowledge of the content of national guidelines and food quality in line with national guidelines. Results: Of the 324 participating kindergartens, two-thirds were private providers and one-third were public. A total of 155 kindergartens were in eastern Norway, 41 in mid-Norway, 50 in the west, 48 in the south and 26 in northern Norway. The study found that pedagogical staff’s knowledge and the use of national guidelines were positively associated with better food quality and adherence to guidelines for food and meals in kindergartens. In addition, the frequency of daily meals provided by kindergartens was associated with food quality. Conclusions: An association was found between pedagogical staff’s knowledge and application of national guidelines for food and meals, and the quality of food served in adherence to these guidelines. In addition, a correlation was observed between the frequency of meals provided by a kindergarten and food quality. These findings suggest that stressing the development of a better understanding of the content of national guidelines for food and meals could potentially enhance food and meal practices in kindergartens, but further research to explore this possibility is warranted.

The Role of Psychosomatic Traits in Tailored Workup for Anterior Cervical Discectomy and Fusion-A Case Series.

Prospective study. To evaluate the influence of preoperatively assessed psychosomatic traits on postoperative pain, disability, and quality of life outcomes. Anterior cervical discectomy and fusion (ACDF) is a widely employed surgical procedure for treating cervical spondylosis. Despite its effectiveness, various studies have reported non-success rates in terms of alleviating disability and pain. Psychological factors have become increasingly recognized as critical determinants of surgical outcomes in various medical disciplines. The full extent of their impact within the context of ACDF remains insufficiently explored. This case series aims to assess the influence of preoperative psychological profiling on long-term pain, disability and quality of life outcomes. We conducted a prospective cohort study of prospectively collected data from 76 consecutive patients who underwent ACDF with PEEK inter-fixed cages from July 2019 to November 2021. The preoperative psychological traits were assessed using the Symptom Checklist 90 (SCL-90) questionnaire. The Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Neck Disability index (NDI), EuroQol-5D (EQ-5D), and Short Form-36 (SF-36) were collected preoperatively, one month postoperatively, and at least one year after the surgical procedure. The correlation analyses revealed associations between psychosomatic traits and multiple preoperative and postoperative outcome measures. The univariate analyses and linear regression analyses demonstrated the influence of the Global Severity Index (GSI) over the final follow-up scores for the ODI, VAS, NDI, EQ-5D, and SF-36. The GSI consistently exhibited a stronger correlation with the final follow-up pain, disability, and quality of life outcomes with respect to the correspondent preoperative values. This study highlights the importance of psychosomatic traits as predictive factors for ACDF outcomes and emphasizes their relevance in preoperative assessment for informing patients about realistic expectations. The findings underscore the need to consider psychological profiles in the preoperative workup, opening avenues for research into medications and psychological therapies. Recognizing the influence of psychosocial elements informs treatment strategies, fostering tailored surgical approaches and patient care.

An analysis of the factors involved in IOL decentration after phacoemulsification using CASIA 2 anteriorsegmentoptical coherence tomography.

To evaluate the magnitude of IOL transversal shift (ITS) after phacoemulsification and to analyse the factors contributing to IOL decentration and ITS. 94 consecutive patients who underwent cataract surgery and IOL implantation was enrolled. Each patient underwent anterior segment optical coherence tomography with CASIA 2 (Tomey, Nagoya, Japan) to assess crystalline lens decentration, thickness and diameter seven days preoperatively and at one and sixty days postoperatively. Univariate and multivariate linear regression analysis were performed to evaluate the determinants of ITS and final decentration. The preoperative crystalline lens diameter was associated with the ITS and with the IOL final decentration. A positive association between the final IOL decentration and the first post-surgical day decentration was found (p < 0.0001). Greater crystalline lens diameter was associated with greater decentration and with greater ITS. Day-one IOL decentration seems to be the main determinant of final IOL decentration.

Insight into the imbalance of forest cover change at county level in mainland China during 2000–2020: From the perspective of subdividing forest cover change into forest gain and loss

The significant growth of China's forest resources presents a remarkable case in global vegetation dynamics. However, there is spatial imbalance in forest cover changes, which is not only reflected in regional imbalances, but also between total and net changes. There is still a lack of knowledge in this imbalance. In our comprehensive study, we subdivided forest cover change into forest gain and loss, and calculated the total and net forest change across 2850 county-level administrative units in mainland China, utilizing the Global Forest Change Dataset. The univariate linear regression and the Sen + Mann-Kendall test is utilized to explore the temporal trends in forest loss. Additionally, spatial autocorrelation models were employed to examine the spatial differentiation of forest cover change. Our findings unveiled a wide spectrum of forest loss rates ranging from 0% to 27%, and gain rates ranging from 0% to 10%, with the highest rates observed in the southern counties. We observed that the forest loss trends in southeastern counties showed significant and slight increases, while the northwestern counties experienced significant and slight decreases, with the Huhuanyong Line serving as the demarcation. In terms of spatial patterning, quite a number of the southern counties displayed a “large net change, large total change” state, which contrasted with diverse patterns observed in certain western regions. Spatial autocorrelation analysis showed that the High-high clusters of both forest gain and loss were primarily observed in southern counties, with the Low-low clusters in the northwest. This detailed analysis provides valuable insights into the dynamics of forest cover changes, offering a robust scientific foundation for developing informed and region-specific conservation policies.

Analysis of Vegetation Environmental Stress and the Lag Effect in Countries along the “Six Economic Corridors”

Climate conditions have a significant impact on the growth of vegetation in terrestrial ecosystems, and the response of vegetation to climate shows different lag effects with the change in spatial pattern and category of the ecosystem. Exploring the interaction mechanism between climate and vegetation growth is helpful to promote the sustainable development of the regional ecological environment. Using normalized vegetation index (NDVI) and meteorological data, based on univariate linear regression and partial correlation analysis, this study explores the temporal and spatial pattern and change trend of vegetation cover in regions and node cities along the “six economic corridors”, and analyzes the environmental stress of vegetation growth and the lag effect of climate response. This study shows that there are great differences in the overall vegetation coverage along the “six economic corridors”. The vegetation coverage in Southeast Asia is the best and that in central and West Asia is the worst. The vegetation coverage in the study area shows an improvement trend, accounting for 39.6% of the total area. There are significant differences in the lag effect of vegetation response and the main climate factors affecting vegetation growth, which is related to the diversity of vegetation and climate characteristics. In this study, we selected regions along the “six economic corridors” that exhibit large latitude and altitude gradients, diverse climate types, and significant seasonal changes and spatial differences in climate conditions as our research areas. Additionally, we considered the impact of different regions and various types of vegetation on their response to climate change. This is of great significance for gaining a deeper understanding of the response mechanism of global climate change and vegetation ecology. Furthermore, our research can provide valuable information to support the ecological environment protection of different typical vegetation against extreme climates, ultimately contributing to the sustainable development of “the Belt and Road”.

Prevalence and Correlates of Exposure (Direct and Indirect) to Perceived Racism-Based Police Violence among Black Emerging Adult College Students

ABSTRACT A growing body of evidence makes plain that exposure to perceived racism-based events, particularly for Black emerging adults aged 18–29, represents a major public health concern in the United States given its widespread prevalence and documented association with adverse health outcomes. However, research on the prevalence and correlates of exposure to perceived racism-based police violence (RPV) for Black emerging adults is scant. The current study examines the prevalence and correlates of RPV exposure among a sample of 300 Black emerging adult college students, utilizing computer-assisted surveys. Univariate, bivariate, and multiple linear regression analyzes were conducted. We found moderately low rates for direct RPV exposure (M ean = 5.85) and moderately high rates (M ean = 10.4) for indirect exposure. Being younger and having incomes greater than $10,000 were significant predictors of direct RPV exposure, whereas being female and older were significant predictors of indirect RPV exposure. Our findings provide implications for future research and underscore the need for social work clinicians to include the RPV scales during their assessments for traumatic experiences.

Mediating Effect of the NLR on the Relationship Between HbA1c and Left Atrial Stiffness in Overweight Patients With Hypertension.

We aimed to investigate the association between hemoglobin A1c (HbA1c) and left atrial (LA) stiffness in patients with hypertension and to explore the mediating effect of the neutrophil/lymphocyte ratio (NLR) on this association. Essential hypertensive patients (n = 292) aged 18-83 years were enrolled and divided into two groups based on the LA stiffness index (LASI): Group I (LASI ≤ 0.32, n = 146) and Group II (LASI > 0.32, n = 146). The LASI was defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') to LA reservoir strain. Multivariate linear regression analysis was performed to determine the independent predictors of the LASI. Age, BMI, SBP, HbA1c, CRP, and NLR were significantly greater in Group II than in Group I (P < 0.05). Additionally, Group II had a greater LA volume index (LAVI), left ventricular mass index (LVMI), and early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') and lower LA reservoir, conduit, and booster pump strains than Group I (P < 0.001). Univariate and multivariate linear regression models revealed that age, SBP, HbA1c, and the NLR were independently associated with the LASI. Further mediation analysis was performed to determine the mediating effect of the NLR on the association between HbA1c and the LASI and revealed that the NLR had a mediating role only in overweight hypertensive patients, and the proportion of the mediating effect was 21.9%. The NLR was independently correlated with the LASI and played a mediating role in the relationship between HbA1c and the LASI in overweight hypertensive patients.

Periorbital Rejuvenation: Artificial Intelligence Highlights the Importance of Brow Lift

Abstract Goals/Purpose Well described facial changes occur over time, which collectively result in an increased perceived age of an individual. These changes affect everything including the bony framework, facial fat pads, soft tissue, skin quality, and facial muscles. Aesthetic surgery provides an opportunity to reverse the appearance of facial aging. With the recent increase in mask utilization following the COVID-19 pandemic, an increased focus on the upper face and the impact of age-related changes in the periorbital region has been observed. Blepharoplasty and brow lifts aim to restore a youthful, rested, and attractive appearance by addressing the periorbital region. Blepharoplasty is a commonly performed procedure and has consistently ranked the third most common aesthetic procedure performed by plastic surgeons since 2018. However, following the pandemic we saw a 28% increase in blepharoplasties performed, now totaling 1.4 million in 2022. Over the same time period, the number of brow lifts performed has increased by 60%, now accounting for 352,324 surgeries performed in 2022. Despite this increase, recent surveys demonstrate that nearly 30% of plastic surgeons feel that neuromodulators have completely replaced operative brow lifting procedures. Additionally, a recently published study demonstrated that 62% of patients presenting for blepharoplasty have unfavorable preoperative brow aesthetics. However, only 36% of patients underwent brow lifts.Those with preoperative unfavorable brows who underwent a brow lift procedure were found to have significantly higher postoperative aesthetic scores than those who did not. Despite the increase in popularity of periorbital procedures, the literature continues to lack objective evaluation and outcome measurements related to perceived facial aging and the impact of individual procedures. The goal of this study is to quantify the impact of different periorbital rejuvenation surgeries on perceived age through the utilization of artificial intelligence (AI) in the form of convolutional neural network algorithms. Methods/Technique A retrospective review of patients who underwent periorbital rejuvenation surgery (upper blepharoplasty, lower blepharoplasty, and brow lift) at a single cosmetic practice between 2018-2023 was performed. Charts were reviewed for demographic information, periocular history, prior surgeries, surgical technique utilized, and complications/revisions. Exclusion criteria included: simultaneous procedures, incomplete patient records, poor quality or missing photographs, periocular medical conditions with cosmetic impact, and facial aesthetic procedures performed in the postoperative period. Pre and post operative frontal photographs of each patient were analyzed using four facial analysis AI platforms (Face++, Betaface, Facelytics, and Everypixel). Each platform generated an age estimate. A collective pre-op and post-op age estimation was then calculated for each patient by averaging the 4 platforms responses. To evaluate accuracy of the AI age estimation, a percent error was calculated by dividing the difference between the true age and estimated preoperative age by the true preoperative age. To account for natural aging between surgery and post-op photographs due to follow-up time, a corrective difference was calculated and subtracted from the mean postoperative estimated age. Statistical analysis included student’s t-test for univariate analysis and linear regression for multivariate analysis. All statistical analyses were performed on Stata version 14.0 (Stata Corporation, College Station, Texas, USA). Results/Complications A total of 153 patients were included for analysis, of which 120 underwent upper blepharoplasty, 66 underwent lower blepharoplasty, and 35 underwent a brow lift procedure. The study population consisted of 130 females and 23 males, 95% were Caucasian, and the average preoperative age was 58.1 (± 9.2 years). Post-operative photographs were taken at 3.8 months (± 5.4 months). Across all AI platforms, the mean age estimation percent error was 10%, with the tendency for AI to underestimate compared to true age. Univariate analysis revealed an overall age reduction following periorbital rejuvenation surgery of 1.03 years (p&amp;lt;0.001), with a standard error of 0.257. When controlling for all other procedures via linear regression, patients who underwent brow lifts demonstrated a statistically significant age reduction, with the mean AI perceived age reduction of 1.72 years (p=0.007). No significant age reduction was identified for patients undergoing lower blepharoplasty (regardless of technique), ptosis repair, or fat pad resection. Conclusion The results of this study highlight the rejuvenation power of a brow lift, with an average age reduction of nearly 2 years. In our patient population, brow lifting procedures conveyed the most age reduction of periorbital surgery. Recently published literature indicates that brow lifts are under performed and can serve as a potential avenue for further facial rejuvenation. Therefore, when planning periorbital rejuvenation, a thorough preoperative evaluation of brow position and shape should be performed and additional consideration should be given to operative brow lifting procedures.

Study of association between corneal shape parameters and axial length elongation during orthokeratology using image-pro plus software

BackgroundThe aim was to validate the correlation between corneal shape parameters and axial length growth (ALG) during orthokeratology using Image-Pro Plus (IPP) 6.0 software.MethodsThis retrospective study used medical records of myopic children aged 8–13 years (n = 104) undergoing orthokeratology. Their corneal topography and axial length were measured at baseline and subsequent follow-ups after lens wear. Corneal shape parameters, including the treatment zone (TZ) area, TZ diameter, TZ fractal dimension, TZ radius ratio, eccentric distance, pupil area, and pupillary peripheral steepened zone(PSZ) area, were measured using IPP software. The impact of corneal shape parameters at 3 months post-orthokeratology visit on 1.5-year ALG was evaluated using multivariate linear regression analysis.ResultsALG exhibited significant associations with age, TZ area, TZ diameter, TZ fractal dimension, and eccentric distance on univariate linear regression analysis. Multivariate regression analysis identified age, TZ area, and eccentric distance as significantly correlated with ALG (all P < 0.01), with eccentric distance showing the strongest correlation (β = −0.370). The regressive equation was y = 1.870 − 0.235a + 0.276b − 0.370c, where y represents ALG, a represents age, b represents TZ area, and c represents eccentric distance; R2 = 0.27). No significant relationships were observed between the TZ radius ratio, pupillary PSZ area, and ALG.ConclusionsIPP software proves effective in capturing precise corneal shape parameters after orthokeratology. Eccentric distance, rather than age or the TZ area, significantly influences ALG retardation.