Variable Trajectories Research Articles

The mechanisms of personalization

ABSTRACT This article draws on Max Weber’s account of legitimate authority to argue that there are three key mechanisms that drive the personalization of power in political regimes: the mobilization of charisma, the mobilization of legality or formal authority, and the mobilization of informal authority. The mobilization of charisma involves leaders using emotional connections with followers to undermine formal institutional constraints. The mobilization of legality refers to using legal discourses and procedures to expand formal executive powers. The mobilization of informal authority relies on leaders occupying strategic positions in patronage networks to undermine or expand formal authority. Each mechanism allows leaders to escape elite accountability through different means. The article illustrates these mechanisms through historical and contemporary examples. It argues that understanding these distinct mechanisms can help explain variation in trajectories and consequences of personalization across regimes. The framework advances theories of personalization by highlighting how personal power relies not just on disrupting elite coordination but on deploying different forms of authority.

Prediction of Lithium-Ion Battery Health Using GRU-BPP

Accurate prediction of lithium-ion batteries’ (LIBs) state-of-health (SOH) is crucial for the safety and maintenance of LIB-powered systems. This study addresses the variability in degradation trajectories by applying gated recurrent unit (GRU) networks alongside principal component analysis (PCA), Granger causality, and K-means clustering to analyze the relationships between operating conditions—such as temperature and load profiles—and battery performance degradation. This paper uses a publicly accessible dataset derived by aging three prismatic LIB cells under a realistic forklift operation profile. First, we identify the features that are relevant to driving variance, then we employ the winning algorithm of K-means clustering for the classification of operational states. Granger causality later investigates the inter-group relationships. Our GRU-BPP model achieves an RMSE value of 0.167 and an MAE of 0.129 for the reference performance testing (RPT) dataset and an RMSE of 0.032 with an MAE of 0.025 for the aging dataset, thus outperformed benchmark methods such as GRU, LME, and XGBoost. These results further enhance the predictiveness and robustness of this approach and yield a holistic solution to the conventional challenges in battery management and their remaining useful life (RUL) predictions.

Trajectory Analysis of the Four-Year Changes in Body Composition and Bone Mineral Characteristics Among Highly Competitive Male University Long-Distance Runners.

This study examined long-term changes in body composition and bone mineral characteristics among male long-distance runners from a high-profile university team, focusing on concerns about impaired musculoskeletal development due to extreme leanness and weight management practices in this population. Trajectory analyses were performed using multilevel modeling of 608 dual-energy x-ray absorptiometry datasets from 109 runners (mean age, height, and weight of 18.0 years, 171.4 cm, and 56.8 kg at baseline, respectively) collected biannually over 4 years. Linear increases in total and regional lean mass (LM) were observed on average, with the increase in leg LM being double that of arm LM (0.07 vs. 0.03 kg per occasion, respectively). Similarly, total bone mineral density (BMD) and content (BMC) exhibited linear growth on average, with BMD accrual being greater in the legs than in the arms (0.004 vs. 0.001 g/cm2 per occasion, respectively). However, rib BMD and BMC were predicted to decrease. Individually predicted growth rates in total LM were significantly associated with those in total BMD (r = 0.347, p < 0.001) and BMC (r = 0.424, p < 0.001). These results indicate site-specific musculoskeletal adaptations to intensive long-distance running training. Moreover, a random slope model accurately captured the trajectories of most dependent variables, highlighting the heterogeneity of training responses. The predictive models developed in this study offer practical strategies for identifying runners at risk of suboptimal physical development, thereby facilitating the development of personalized conditioning programs.

Regional variation of age-related blood pressure trajectories and their association with blood pressure control rates, disability-adjusted life years and death

Abstract Background/Introduction While the relationship between blood pressure (BP) changes and increasing age is well described, age-related BP trajectories may vary substantially across different populations and associated with differential CV risk and outcomes. Purpose The dataset of the May Measurement Month (MMM) international campaigns enables a unique investigation of regional, socio-economic and sex differences in age-BP trajectories and their association with major public-health outcomes. Method Global BP data from more than 4,5 million adult (≥18 years) screenees obtained during the cross-sectional MMM campaigns in 2017, 2018, 2019, and 2021 were used for analysis. Average BP and slopes of BP changes across age groups were calculated within regional, socio-economic and sex strata. BP slopes of individuals between 30 and 70 years of age were derived from adjusted linear regression models, along with baseline BP estimates at young age. These BP slopes were correlated in regression models adjusted for baseline BP at young age with country-specific all-cause rates of DALYs (Disability-Adjusted Life Years), death (both from Global Burden of Disease Study 2019), life expectancy (World Bank data SP.DYN.LE00.IN 2019) and BP control rates (NCD Risk Factor Collaboration). Results Age-related BP changes differed distinctly across global geographic regions, income levels, and between sexes. The steepest increase in BP with age was observed in populations from Africa and Europe, whereas a more gradual rise in BP with increasing age was seen in South-East Asian populations. Women had lower BP levels than men at younger ages (twenties and thirties), but subsequently experienced a more pronounced age-related BP increase resulting in diminishing sex differences across older age groups. Geographically divergent age-related BP trajectories were significantly associated with major national public health indicators. Globally, the steeper the age-related BP slope, the stronger the association with poor BP control (β = -0.46 [95% CI: -0.74; -0.19], p=0.001), increased DALY’s (β = 66155.68 [95% CI: 44847.0; 87464.36], p&amp;lt;0.001) and death rates. (β = 1017.3 [95% CI: 351.72; 1682.89], p=0.003). Conclusion Age-related BP trajectories vary considerably across global populations and contribute considerably to the variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of lifestyle and other factors contributing to adverse BP trajectories to improve health outcomes.Average blood pressure by ageAssiciations with public health metrics

Palliative neurology

Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create aneed for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include ateam-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.

Subjective well-being across the life course among non-industrialized populations.

Subjective well-being (SWB) is often described as being U-shaped over adulthood, declining to a midlife slump and then improving thereafter. Improved SWB in later adulthood has been considered a paradox given age-related declines in health and social losses. While SWB has mostly been studied in high-income countries, it remains largely unexplored in rural subsistence populations lacking formal institutions that reliably promote social welfare. Here, we evaluate the age profile of SWB among three small-scale subsistence societies (n = 468; study 1), forest users from 23 low-income countries (n = 6987; study 2), and Tsimane' horticulturalists (n = 1872; study 3). Across multiple specifications, we find variability in SWB age profiles. In some cases, we find no age-related differences in SWB or even inverted U-shapes. Adjusting for confounders reduces observed age effects. Our findings highlight variability in average well-being trajectories over the life course. Ensuring successful aging will require a greater focus on cultural and socioecological determinants of individual trajectories.

Benchmarking Stroke Outcome Prediction through Comprehensive Data Analysis - NeuralCup 2023.

Stroke is a significant cause of mortality and long-term disability worldwide, with variable recovery trajectories posing substantial challenges in anticipating post-event care and rehabilitation planning. The NeuralCup 2023 consortium was established to address these challenges by comparing the predictability of stroke outcome models through a collaborative, data-driven approach. This study presents the consortium's findings, which involved 15 participating teams worldwide. Using a comprehensive dataset, which included clinical and imaging data, we conducted an open competition to identify and compare predictors of motor, cognitive, and neuropsychological (emotional) outcomes one-year post-stroke. Analyses incorporated both traditional and novel methods, including machine learning algorithms. These efforts culminated in the search for 'optimal recipes' for predicting each domain through an exhaustive exploration of the features of all the approaches. Key predictors included lesion characteristics, T1-weighted MRI sequences, and demographic factors. Notably, integrating FLAIR imaging and white matter tract analysis emerged as crucial to improving the accuracy of cognitive and motor outcome predictions, respectively. These findings advocate for a tailored, multifaceted approach to stroke outcome prediction, underscoring the potential of collaborative data science in addressing complex neurological prognostication challenges. This study also sets a new benchmark methodology in stroke research, offering a foundational step toward personalized care strategies that could significantly impact recovery planning and quality of life for stroke survivors.

A growth-coupling strategy for improving the stability of terpenoid bioproduction in Escherichia coli

BackgroundAchieving cost-competitiveness remains challenging for industrial biomanufacturing. With whole-cell biocatalysis, inefficiency presents when individual cells vary in their production levels. The problem exacerbates when the basis for such production heterogeneity is heritable. Here, evolution selects for the low- and non-producers, as they have lowered/abolished the cost of bioproduction to fitness. With the scale of population expansion required for industrial bioproduction, the asymmetrical enrichment can be severe enough to compromise the performance, and hence commercial viability of the bioprocess. Clearly, addressing production heterogeneity is crucial, especially in improving the stability of bioproduction across the cell generations. In this respect, we designed a growth-coupling strategy for terpenoid bioproduction in Escherichia coli. By knocking out the native 1-deoxy-D-xylulose 5-phosphate reductoisomerase (dxr) gene and introducing the heterologous mevalonate pathway, we created a chassis that relies solely on the latter for synthesis of all terpenoids. We hypothesise that the need to sustain the biosynthesis of endogenous life-sustaining terpenoids will impose a minimum level of productivity, which concomitantly improves the bioproduction of our target terpenoid.ResultsFollowing the confirmation of lethality of a dxr knockout, we challenged the strains with a continuous plasmid-based bioproduction of linalool. The Δdxr strain achieved an improved productivity profile in the first three days post-inoculation when compared to the parental strain. Productivity of the Δdxr strain remained observable near the end of 12 days, and after a disruption in nutrient and oxygen supply in a separate run. Unlike the parental strain, the Δdxr strain did not evolve the same deleterious mutations in the mevalonate pathway, nor a viable subgroup that had lost its resistance to the antibiotic selection pressure (a plausible plasmid loss event). We believe that this divergence in the evolution trajectories is indicative of a successful growth-coupling.ConclusionWe have demonstrated a proof of concept of a growth-coupling strategy that improves the performance, and stability of terpenoid bioproduction across cell generations. The strategy is relatively broad in scope, and easy to implement in the background as a ‘fail-safe’ against a fall in productivity below the imposed minimum. We thus believe this work will find widespread utility in our collective effort towards industrial bioproduction.

Polymorph sampling with coupling to extended variables: enhanced sampling of polymorph energy landscapes and free energy perturbation of polymorph ensembles.

A novel approach to computationally enhance the sampling of molecular crystal structures is proposed and tested. This method is based on the use of extended variables coupled to a Monte Carlo based crystal polymorph generator. Inspired by the established technique of quasi-random sampling of polymorphs using the rigid molecule constraint, this approach represents molecular clusters as extended variables within a thermal reservoir. Polymorph unit-cell variables are generated using pseudo-random sampling. Within this framework, a harmonic coupling between the extended variables and polymorph configurations is established. The extended variables remain fixed during the inner loop dedicated to polymorph sampling, enforcing a stepwise propagation of the extended variables to maintain system exploration. The final processing step results in a polymorph energy landscape, where the raw structures sampled to create the extended variable trajectory are re-optimized without the thermal coupling term. The foundational principles of this approach are described and its effectiveness using both a Metropolis Monte Carlo type algorithm and modifications that incorporate replica exchange is demonstrated. A comparison is provided with pseudo-random sampling of polymorphs for the molecule coumarin. The choice to test a design of this algorithm as relevant for enhanced sampling of crystal structures was due to the obvious relation between molecular structure variables and corresponding crystal polymorphs as representative of the inherent vapor to crystal transitions that exist in nature. Additionally, it is shown that the trajectories of extended variables can be harnessed to extract fluctuation properties that can lead to valuable insights. A novel thermodynamic variable is introduced: the free energy difference between ensembles of Z' = 1 and Z' = 2 crystal polymorphs.

Quantifying perceived risk in driving: A Monte Carlo approach for obstacle avoidance

Objective This study aims to develop a model for quantifying perceived risk in obstacle avoidance, emphasizing how drivers’ perceived risk characteristics influence their driving decisions. The research addresses the lack of attention given to modeling risk from the perspective of drivers’ risk perceptions. Methods Monte Carlo methods are employed to account for the uncertainties and complexities of driving behavior, restoring the probabilistic nature of risk. The proposed method quantifies perceived risk by incorporating drivers’ fuzzy perceptions, enabling a quantitative evaluation during obstacle avoidance. A logit model is used to link perceived risk with driving decisions, identifying key factors influencing driver behavior in obstacle avoidance scenarios. Results Experimental data revealed significant variations in vehicle trajectories and speed distributions due to differences in drivers’ experience and proficiency. The perceived risk indicator (PRI) values for leftward bypasses were higher compared to rightward bypasses, and the receiver operating characteristic (ROC) curve confirmed the PRI’s strong predictive ability with an area under the curve (AUC) of 0.820. The logit model showed that both PRI and speed significantly influenced the probability of choosing a rightward bypass, achieving 90% accuracy. Building on the model, the study predicted and visualized the probability of vehicles turning right to avoid obstacles at different positions and speeds within 200 m of the obstacle. Conclusions The research offers a framework for traffic professionals to understand driver-perceived risk and decision-making mechanisms. This understanding is beneficial for improving traffic safety and highlights the importance of considering drivers’ risk perceptions in modeling driving behavior.

An algorithm for multi-target tracking in low-signal-to-clutter-ratio underwater acoustic scenes

To simplify the computational complexity of the Joint Probabilistic Data Association (JPDA) algorithm for multi-target tracking in low-signal-to-clutter-ratio underwater acoustic scenes, and to solve the problem of unstable tracking caused by poor measurement accuracy of active sonar, a trajectory information-based JPDA optimization algorithm (TJPDA) is designed to meet the real-time and stability requirements of practical engineering. The false alarm rate is reduced by accumulating correlated target trajectories in multiple frames, and the influence factor is introduced to modify the correlation probability and simplify the confirmation matrix splitting process. This effectively solves the problem of information combination explosion and trajectory divergence caused by adjacent target interference in low signal-to-clutter-ratio underwater acoustic scenes. The simulation results show that compared with the JPDA algorithm, the TJPDA algorithm not only improves target-tracking accuracy but also reduces computation time, making it more suitable for practical engineering applications.

Trajectories of disease severity and their clinical outcome in real-world patients with systemic lupus erythematosus

ObjectiveSystemic lupus erythematosus (SLE) is characterised by variability of disease activity patterns over time. This study aimed to investigate the trajectories of SLE disease severity patterns, identify clinical and demographic variables, and assess the association between trajectories of SLE disease severity and all-cause mortality. MethodsA retrospective cohort of newly diagnosed patients with SLE was established using the Korean nationwide healthcare claims information database between 1st January 2008 and 31st December 2016. Using group-based trajectory modelling (GBTM), they were clustered based on the trajectory of SLE disease severity patterns during a two-year follow-up from the cohort entry date. We performed Cox proportional hazards models to compare the mortality between trajectories of SLE disease severity patterns. ResultsA total of 8901 patients with SLE were included in the analysis from 2008 to 2016. Five distinct SLE disease severity trajectories were identified as optimal: consistently severe (4.6 %), mild-then-moderate (11.6 %), moderate-then-mild (15.1 %), consistently moderate (30.4 %), and consistently mild (38.3 %). Patients with consistently mild disease severity were more likely to be older; those with consistently severe disease severity were more likely to be male with more comorbidities than other groups. Compared to the consistently mild disease severity, the other trajectory groups showed a higher risk of all-cause mortality. ConclusionThrough GBTM, dynamic two-year severity trajectories of newly diagnosed SLE were identified. Patients’ demographics and comorbidities attributed to changes in SLE severity trajectories, which may inform evidence for clinical decision-making.

A longitudinal study of within-person trajectories in quality of life in patients receiving early palliative care.

To reveal the within-person trajectories in quality of life (QOL) in patients receiving early palliative care. Previous studies have mostly focused aggregated trajectories, based on all research participants combined, whereas this study focused on within-person trajectories in QOL and on whether the variability in QOL trajectories across patients is substantial enough to raise doubts about aggregated trajectories. Twenty-five older persons in early palliative care completed the McGill Quality of Life Questionnaire multiple times. Reliable change analyses provided estimates of the occurrence of statistically significant within-person change. There was reliable, within-person variation in QOL scores across time, more so for physical than for psychological aspects of well-being. Changes in QOL scores occurred for most patients but the trajectories were not linear and there was no common trend in the nonlinear patterns. Reliable change across time can be identified in persons receiving early palliative care. However, the trajectories are notably variable and patient-specific. The high degrees of within-person variability across time suggests the importance of repeated QOL assessments and of dynamic tailoring of clinical treatments.

Remnant cholesterol and new-onset atrial fibrillation: The Atherosclerosis Risk in Communities study

BackgroundThe relationship between remnant cholesterol (RC) and atrial fibrillation (AF) remains unclear. ObjectiveThe purpose of this study was to comprehensively explore the association between RC characteristics and new-onset AF. MethodsData from 5 follow-up visits of the ARIC (Atherosclerosis Risk in Communities) study were analyzed. RC were multidimensionally evaluated in 4 characteristics: baseline level, variability, cumulative exposure, and trajectory. Baseline RC was obtained from the initial visit (V1), and new-onset AF was monitored in V2 to V5 (cohort 1, n = 14,450). RC variability, cumulative RC, and RC trajectory were calculated by RC values gathered from V1 to V3, and new-onset AF was monitored in V4 and V5 (cohort 2, n = 11,012). Participants were divided into 4 groups based on quartiles or trajectories. Cox proportional hazards analyses were used to investigate the relationship between RC characteristics and AF. ResultsFollowing median follow-up of 22.39 years in cohort 1 and 16.71 years in cohort 2, a total of 1993 AF events in cohort 1 and 1571 in cohort 2 were identified. Participants with the highest quartile exhibited an elevated risk of new-onset AF, with the multivariable-adjusted hazard ratios of 1.35 (P = .009) for baseline RC and 1.26 (P = .09) for RC variability. Although the highest quartile of cumulative RC (P = .130) and the high-increasing trajectory (P = .322) did not demonstrate a statistically significant association with AF occurrence, they indicate a trend toward heightened risk. ConclusionOur findings reveal that higher levels of RC, particularly at baseline and in variability, are associated with an increased risk of AF.

The multiscale response of global cropland cropping intensity to urban expansion

CONTEXTUrban expansion(UE) and multiple cropping(MC) are key factors in anthropogenic impacts on global environmental change. However, the multi-scale response patterns of UE and MC have not yet been revealed, and how urbanization affects cropland intensification is still not deeply explored. OBJECTIVEThis study examines the spatial and temporal trends in global UE and MC and analyses the multi-scale response patterns of both. METHODSThe GEE (Google Earth Engine) platform was used to count global cropland cropping intensity (CCI) and impervious surface rasters on an image-by-image basis, while GIS was employed for spatial analyses, and the generalized additive model (GAM) was applied to inscribe variable response trajectories. RESULTS AND CONCLUSIONThe global multiple cropping index(MCI) increased significantly (by 4.1 %) over the period 2001–2019, with growth in double- and triple-cropped cropland dominating this change. Double cropping, as a widespread global farming strategy, has led to a shift towards the intensification of agriculture, with countries in the northern hemisphere contributing more. Global UE significantly expands to twice the baseline level at an average annual growth rate of 2. 42 × 104 km2 over the period 2001–2019, with the expansion of world-class urban agglomerations in China, the United States and Europe dominates this trend. The spatial clustering of MC and UE has continued to intensify, with high-intensity cropping strategies progressively clustering towards areas of significant UE, and this tendency has a clear decreasing urban-rural gradient effect. The global CCI grows significantly and non-linearly with UE, but an important inflection point in the growth trajectory has occurred under the influence of threshold effects. Developed countries tend to be more flexible in their cropping intensity strategies as they move forward with urbanization. There is a clear increasing effect of the urban-rural gradient in the degree of non-linearity in the response of urbanization and cropping intensity. SIGNIFICANCEThe results of the study contribute to the understanding of the complex spatial and temporal coupling mechanisms between UE and MC, and provide useful insights for the development of trade-offs between urbanization and maturity strategies.

An Integrated Dynamic and Quality Modeling Framework for Batch Processes

This manuscript considers batch process operations and addresses the challenge of identifying a model that synergistically captures the dynamic input–output behavior of continuously measured variables along with the quality variables measured only at batch termination. To this end, an optimization-based framework is developed to identify one model that captures both the dynamics between the inputs and the continuously measured output variables, measurements of which are available at every time step, and the relation between the dynamic “state” information and the terminal quality measurements. Existing approaches either do not identify the dynamic and the quality model simultaneously, or they simply connect the whole trajectory of the process variables with the qualities and do not address the dynamic relationship between the inputs and the process variables. The improved modelling performance of the model obtained from this approach is demonstrated using data from a Uni-axial Rotational Molding process, and compared with existing modelling approaches.

Person-specific emotional dynamics: a story of a traumatic loss

The impact of traumatic loss on an individuals’ mental health is a critical area of study. While most research has focused on general grief patterns, the unique trajectories of trauma survivors have been understudied. This research utilizes a high-resolution dataset from a single individual over several years, including a period of unexpected tragedy. Using person-specific dynamic modeling and network analysis, the study examines the psychological processes related to traumatic loss. The results reveal a complex distress trajectory and emotional variability with increasing resilience over time. Findings suggest that traumatic loss can induce strongly interconnected emotional networks, typically linked to vulnerability to psychological disorders. Yet, a heightened correlation within a network representing both positive and negative aspects could indicate the emergence of adaptive coping strategies. The study emphasizes that analyzing emotional inertia and variability separately provides a holistic clinical perspective and deepens the understanding of diverse psychological states and affective dynamics. This research underlines the benefits of investigating individual experiences and stresses the need for idiographic approaches in trauma and grief studies. Future research utilizing high-resolution data from multiple individuals may provide a more comprehensive understanding of the diverse trajectories of grief and inform the future of personalized intervention and care.

A clinical protocol for a German birth cohort study of the Maturation of Immunity Against respiratory viral Infections (MIAI).

Respiratory viral infections (RVIs) are a major global contributor to morbidity and mortality. The susceptibility and outcome of RVIs are strongly age-dependent and show considerable inter-population differences, pointing to genetically and/or environmentally driven developmental variability. The factors determining the age-dependency and shaping the age-related changes of human anti-RVI immunity after birth are still elusive. We are conducting a prospective birth cohort study aiming at identifying endogenous and environmental factors associated with the susceptibility to RVIs and their impact on cellular and humoral immune responses against the influenza A virus (IAV), respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The MIAI birth cohort enrolls healthy, full-term neonates born at the University Hospital Würzburg, Germany, with follow-up at four defined time-points during the first year of life. At each study visit, clinical metadata including diet, lifestyle, sociodemographic information, and physical examinations, are collected along with extensive biomaterial sampling. Biomaterials are used to generate comprehensive, integrated multi-omics datasets including transcriptomic, epigenomic, proteomic, metabolomic and microbiomic methods. The results are expected to capture a holistic picture of the variability of immune trajectories with a focus on cellular and humoral key players involved in the defense of RVIs and the impact of host and environmental factors thereon. Thereby, MIAI aims at providing insights that allow unraveling molecular mechanisms that can be targeted to promote the development of competent anti-RVI immunity in early life and prevent severe RVIs. https://drks.de/search/de/trial/, identifier DRKS00034278.

Exercise as part of survivorship care in metastatic breast cancer: protocol for the randomized EMBody trial

BackgroundExercise is associated with improved survival, physical functioning, treatment tolerability, and quality of life in early-stage breast cancer. These same endpoints matter in metastatic breast cancer (MBC). Prior trials in MBC have found exercise to be not feasible or of limited benefit, possibly due to inclusion of patients with heterogeneous disease trajectories. Patients with MBC have variable disease trajectories and supportive care needs; those with indolent MBC have longer life expectancy, lower symptom burden and distinct priorities, and are well-positioned to participate in and benefit from an exercise program. The EMBody trial aims to determine the impact of a multimodal exercise intervention on cardiorespiratory fitness, physical function, body composition, and patient-reported outcomes, specifically in patients with stable, indolent MBC.MethodsEligible patients have MBC with no evidence of disease progression on current therapy in the prior 12 months and cannot be receiving cytotoxic chemotherapy. The trial aims to enroll 100 patients, randomized 1:1 to the exercise intervention versus usual care, stratified by baseline function. The virtually-delivered exercise intervention arm achieves moderate intensity exercise with exercise physiologists 3 days/week for 16 weeks. The 60-minute sessions include aerobic, resistance, balance and stretching exercises. The exercise arm receives informational sessions on the role of exercise in cancer and principles of habit and self-efficacy. The primary endpoint is 16 week change in fitness on a ramp treadmill test between the exercise and control arms. Secondary endpoints include change in a physical function, muscle mass assessed by CT scans, and PROs of fatigue and quality of life. Exploratory analysis includes behavioral modifiers of exercise adherence and effectiveness and serologic measures of inflammatory, metabolic, and immune pathway biomarkers.DiscussionThe EMBody trial evaluates exercise in a unique patient population with indolent, non-progressive MBC. Patients living with MBC experience similar symptom burden to those undergoing therapy for early-stage disease and the benefits achieved with exercise could be similarly impactful. This trial will contribute evidence to support expansion of exercise recommendations, among other survivorship care efforts, to those living with metastatic disease. Clinical trial information: NCT05468034.Trial registrationNCT05468034. Date of registration: 7/12/2022.

Variation in 10 year birth trajectories of mothers involved in family court care proceedings and their peers in England.

ObjectiveFamily court (FC) care proceedings decide on removing children from parental care in response to concerns about risks of harm. Courts and social care report frequent births, often after short birth intervals as a key problem among mothers presenting to FCs. ApproachWe used a cohort of mothers with a first live birth (FLB) between 2007 and 2019 to estimate the cumulative incidence of FC within 10 years and compare birth trajectories with peers. Results3,118,327 women (15-50 years) had a FLB, of whom 34,062 had FC involvement. Cumulative incidence of FC within 10 years from FLB was 1.3% (95% Confidence Interval [CI]; 1.3-1.3) overall but highest in mothers who were younger (6.7% if &lt;20 years), more deprived (2.5% in most deprived areas) and with morbidity (22.7% with learning or multiple disability, 12.8% with adversity-related injuries or 5.7% with mental health admissions). If followed for 10 years from FLB, 58.4% (8,889/15,229) of women with FC involvement had ≤2 deliveries, compared to 82.2% otherwise (1,007,365/1,225,163). If &lt;25years at FLB, women involved in FC had more deliveries than their peers (3+ deliveries: 47.8%, 5,853/12,255 vs 29.5%, 123,092/416,904), however, if 25+, they had fewer deliveries if involved in FC (1 delivery: 49.6% 1,475/2,974 vs 39.2% 316,976/808,259). Conclusions and ImplicationsAt-risk mothers may benefit from early, targeted health and social care interventions to prevent FC involvement. Birth data highlights variation in birth trajectories and dispels the stereotype of women involved in FCs having many children, particularly if older at FLB.