Worse Performance Research Articles

Marital dissolution and cognition: The mediating effect of Aβ neuropathology

AbstractINTRODUCTIONWidowhood and divorce are extremely stressful life events that are associated with dementia, but the neurobiological underpinnings of this risk remain unknown. Amyloid beta (Aβ) load may explain influences of chronic stress, commonly seen in disruptive marital transitions, on cognitive decline.METHODSWe examined whether Aβ quantified by tracer uptake on positron emission tomography mediates associations between marital dissolution and executive functioning and episodic memory performance using data from 543 cognitively normal (CN) participants from the Alzheimer's Disease Neuroimaging Initiative.RESULTSMarriage dissolution was associated with increased Aβ burden (β = 0.56; P = 0.015) and worse memory performance (β = –0.09; P = 0.003). Aβ levels were a significant mediator for the relationship between marriage dissolution and memory (average causal mediation effect = –0.007; P = 0.029).DISCUSSIONFindings suggest that stressful life events, such as the dissolution of one's marriage, might exert an effect on Alzheimer's disease proteinopathy, which may subsequently influence poor cognition.Highlights Marital dissolution was associated with increased amyloid beta (Aβ) and memory declines. Aβ burden mediated associations between marital dissolution and memory. Findings were robust to potential non‐linear influences of age. Mediation results were not observed when stratifying marital groups by sex.

Tailoring the Nutritional Composition of Italian Foods to the US Nutrition5k Dataset for Food Image Recognition: Challenges and a Comparative Analysis

Background: Training of machine learning algorithms on dish images collected in other countries requires possible sources of systematic discrepancies, including country-specific food composition databases (FCDBs), to be tackled. The US Nutrition5k project provides for ~5000 dish images and related dish- and ingredient-level information on mass, energy, and macronutrients from the US FCDB. The aim of this study is to (1) identify challenges/solutions in linking the nutritional composition of Italian foods with food images from Nutrition5k and (2) assess potential differences in nutrient content estimated across the Italian and US FCDBs and their determinants. Methods: After food matching, expert data curation, and handling of missing values, dish-level ingredients from Nutrition5k were integrated with the Italian-FCDB-specific nutritional composition (86 components); dish-specific nutrient content was calculated by summing the corresponding ingredient-specific nutritional values. Measures of agreement/difference were calculated between Italian- and US-FCDB-specific content of energy and macronutrients. Potential determinants of identified differences were investigated with multiple robust regression models. Results: Dishes showed a median mass of 145 g and included three ingredients in median. Energy, proteins, fats, and carbohydrates showed moderate-to-strong agreement between Italian- and US-FCDB-specific content; carbohydrates showed the worst performance, with the Italian FCDB providing smaller median values (median raw difference between the Italian and US FCDBs: −2.10 g). Regression models on dishes suggested a role for mass, number of ingredients, and presence of recreated recipes, alone or jointly with differential use of raw/cooked ingredients across the two FCDBs. Conclusions: In the era of machine learning approaches for food image recognition, manual data curation in the alignment of FCDBs is worth the effort.

Improved Urdu-English Neural Machine Translation with a fully Convolutional Neural Network Encoder

Neural machine translation (NMT) approaches driven by artificial intelligence (AI) has gained more and more attention in recent years, mainly due to their simplicity yet state-of-the-art performance. Despite NMT models with attention mechanism relying heavily on the accessibility of substantial parallel corpora, they have demonstrated efficacy even for languages with limited linguistic resources. The convolutional neural network (CNN) is frequently employed in tasks involving visual and speech recognition. Implementing CNN for MT is still challenging compared to the predominant approaches. Recent research has shown that the CNN-based NMT model cannot capture long-term dependencies present in the source sentence. The CNN-based model can only capture the word dependencies within the width of its filters. This unnatural character often causes a worse performance for CNN-based NMT than the RNN-based NMT models. This study introduces a simple method to improve neural translation of a low-resource language, specifically Urdu-English (UR-EN). In this paper, we use a Fully Convolutional Neural Network (FConv-NN) based NMT architecture to create a powerful MT encoder for UR-EN translation that can capture the long dependency of words in a sentence. Although the model is quite simple, it yields strong empirical results. Experimental results show that the FConv-NN model consistently outperforms the traditional CNN-based model with filters. On the Urdu-English Dataset, the FConv-NN model produces translation with a gain of 18.42 BLEU points. Moreover, the quantitative and comparative analysis shows that in a low-resource setting, FConv-NN-based NMT outperforms conventional CNN-based NMT models.

Improved diagnostic performance of high-sensitivity cardiac troponins in muscle dystrophies using comprehensive definition criteria for cardiac involvement: A longitudinal study on 35 patients.

Sparse information is available on the correct interpretation of elevated high-sensitivity cardiac troponin (hs-cTn) in confirmed muscular dystrophies. Serum concentrations of hs-cTn T (hs-cTnT) and hs-cTn I (hs-cTnI) were determined in 35 stable outpatients with confirmed skeletal muscle dystrophies. We calculated sensitivities, specificities, and positive and negative predictive values of hs-cTnT and hs-cTnI for identification of cardiac involvement using a comprehensive definition that included diastolic left ventricular and right ventricular function, strain analysis using two-dimensional transthoracic echocardiogram and magnetic resonance imaging, myocardial biopsies, and consideration of a variety of triggers for cardiac injury, including arrhythmias, conduction disorders, and hypoxemia due to respiratory failure. Cardiac involvement was diagnosed in 34 of 35 cases. Specificities of hs-cTnT increased from 12.5% to 100% (p = 0.0006) applying the comprehensive definition compared to a definition based on electrocardiography and echocardiography alone. At the recommended 99th percentile upper limit of normal, sensitivities were significantly lower for hs-cTnI than for hs-cTnT (29.4% vs. 100%, p = 0.0164). Conversely, the specificities of hs-cTnT and hs-cTnI increased to 100% when using the comprehensive definition criteria for diagnosing cardiac involvement. Elevated hs-cTnT but not hs-cTnI discriminates cardiac involvement in cases with confirmed skeletal muscle dystrophies with very high sensitivity and 100% specificity. Prior reports on worse performance may be explained by the use of less sensitive imaging methods or incomplete assessment of cardiac involvement.

Aging Processes of Working Memory in Different Modalities.

Background: Working memory (WM) involves temporarily storing and manipulating information. Research on the impact of aging on WM has shown inconsistent results regarding the decline in visual and verbal WM, with a lack of studies on tactile WM. This study aimed to assess the effects of aging on WM across verbal, visuospatial, and tactile modalities using span tasks of forward (storage) and backward (manipulation) stages. Methods: A total of 130 participants, divided into four age groups of 20-29, 60-69, 70-79, and 80-89, completed the Digit, Visuospatial, and Tactual Spans. Performance was analyzed using a 3 (Task) × 4 (Group) × 2 (Stage) mixed design repeated measures ANOVA. Results: The analysis revealed significant main effects for modality (p < 0.001, ηp2 = 0.15), age (p < 0.001, ηp2 = 0.48), and stage (p < 0.001, ηp2 = 0.30). Digit Span outperformed the other modalities, while Tactual Span showed the worst performance. Additionally, task performance declined with age, and the forward stage was superior to the backward stage. Interaction effects indicated that Digit Span was less affected by aging compared to the Visuospatial and Tactual Spans (p = 0.004, ηp2 = 0.07). Post hoc analyses further revealed that the Digit Span consistently outperformed the other modalities in both stages, with more pronounced differences observed in the forward stage. Conclusions: Verbal WM is more resilient to aging compared to the other modalities while tactile WM declines with age in a manner similar to verbal and visuospatial WM, suggesting a modality-specific impact of aging on WM.

Information FOMO: The Unhealthy Fear of Missing Out on Information-A Method for Removing Misleading Data for Healthier Models.

Misleading or unnecessary data can have out-sized impacts on the health or accuracy of Machine Learning (ML) models. We present a Bayesian sequential selection method, akin to Bayesian experimental design, that identifies critically important information within a dataset while ignoring data that are either misleading or bring unnecessary complexity to the surrogate model of choice. Our method improves sample-wise error convergence and eliminates instances where more data lead to worse performance and instabilities of the surrogate model, often termed sample-wise "double descent". We find these instabilities are a result of the complexity of the underlying map and are linked to extreme events and heavy tails. Our approach has two key features. First, the selection algorithm dynamically couples the chosen model and data. Data is chosen based on its merits towards improving the selected model, rather than being compared strictly against other data. Second, a natural convergence of the method removes the need for dividing the data into training, testing, and validation sets. Instead, the selection metric inherently assesses testing and validation error through global statistics of the model. This ensures that key information is never wasted in testing or validation. The method is applied using both Gaussian process regression and deep neural network surrogate models.

Time reference in French-speaking people with fluent and non-fluent aphasia (part II): a cluster analysis

ABSTRACT Background Tense production is often impaired in people with aphasia (PWA). Interestingly, the literature suggests that not all tenses are affected in the same way, although the pattern of dissociation is still debated in the literature. The heterogeneity of tense production deficits in PWA might partly explain this lack of consensus in the literature. While this heterogeneity has been demonstrated by descriptive statistics or double dissociations in several studies, no study has used cluster analyses to highlight the main patterns of tense dissociation. Furthermore, the factors underlying this heterogeneity have been little explored. Aims Our study aimed to use cluster analyses on tense production performance to (1) identify the main patterns of dissociation between tenses in PWA and (2) explore the clinical (aphasia type and severity) and cognitive (executive disorders and temporality) factors that may underlie these patterns. Methods & procedures Twenty-one French-speaking participants with fluent and non-fluent aphasia completed a verb inflection production task, as well as language and cognitive tests. Cluster analyses were performed on the differences in performance between the tenses on the verb inflection production task. Generalized linear mixed models and nonparametric statistics were used to analyze the effect of tense and its interaction with the clusters, and to compare the clusters on the clinical and cognitive variables. Outcomes & results Cluster analyses revealed two main clusters, one with worse performances in the past and future than in the present (PWA_1 – 70% of the PWA), and the other with worse performances in the past and present than in the future (PWA_2 – 30%). The type and severity of aphasia, and cognitive test performance did not differ between the two clusters. On the other hand, the PWA_2 cluster had a longer time post-onset than the PWA_1 cluster. Conclusions Our results confirm the heterogeneity of verb inflection deficits in PWA. They suggest that most PWA would have difficulties with past and future tenses, questioning the presence of discourse linking in these two tenses. However, a minority of PWA, who are clinically and cognitively indistinguishable from the others, do not follow this pattern. Adopting the strategy of producing a morphologically simple tense in French – future – could explain the high performance in the future tense and the errors in substituting other tenses with the future in this subgroup. Finally, the clinical and research implications of this heterogeneity, in relation to therapies and the lack of consensus in the literature, are discussed.

Effect of EVA, CFROI, MVA and CVA Methods on Shareholders Value Maximization and Financial Performance Estimation: An Empirical Study

With the globalization of markets, competition and performance pressure have accelerated. Investors rightfully expect a reasonable return on the capital they make available to others. Since companies often achieve their growth through capital obtained from new shareholders, the pressure on company profitability increases significantly. The capital market rewards companies' good performance and also punishes their bad performance. At this point, Economic Value Added (EVA), Cash Flow Return on Investment (CFROI), Cash Value Added (CVA) and Market Value Added (MVA), which ensure value maximization, have become increasingly important problems. For this reason, company profitability and growth potential are important. Within the scope of this study, the importance of EVA, CFROI, CVA and MVA indicators and their comparison with traditional methods are discussed in the introduction part. Studies on these indicators that embody value maximization are examined through a literature review. In the methodology section, the data of 11 companies active in the healthcare sector listed on Borsa Istanbul are analyzed through regression and correlation analyzes on the basis of the 2015-2021 period, and the effects of these indicators on stock returns. As a result, when MVA, CVA, CFROI and EVA are positive, economic profit is achieved and shareholder value is expected to increase.

Time reference in French-speaking people with fluent and non-fluent aphasia (part I): tense dissociations, task effects and cognitive predictors

ABSTRACT Background People with fluent and non-fluent aphasia frequently have time reference deficits, which could be more pronounced for the past than for the present and future tenses. However, this performance pattern (past < non-past) is not consensual and might depend on the type of task used. Furthermore, the influence of cognitive processes on time reference deficits remains little explored, as does the origin of these difficulties (e.g. pre-phonological, morpho-phonological). Aims The primary aims of the study were (1) to identify time reference deficits and (2) dissociations between tenses in French speakers with fluent and non-fluent aphasia and (3) to specify the effect of tasks on performance and tense dissociations. Secondly, our study also aimed to determine whether time reference deficits were (4) influenced by cognitive functions and (5) explained by pre-phonological or morpho-phonological deficits. Methods & procedures Twenty-one French-speaking participants with fluent and non-fluent aphasia and 21 matched control subjects performed three tasks assessing time reference (verb inflection production, verb inflection selection, and adverb selection) and five neuropsychological tests (verbal and non-verbal working memory, inhibition, flexibility, and temporality). Quantitative and qualitative analyses were conducted. Outcomes & results Participants with fluent and non-fluent aphasia had worse performances than controls on the three time-reference tasks. The performance of the participants with fluent and non-fluent aphasia was quantitatively similar but qualitatively different on the verb inflection production task (i.e. different error types). A main task effect was also found: the verb inflection production task was the only one to show worse performances in the past than in the present and future. Regarding cognitive predictors, verbal working memory and temporality were linked to the three tasks assessing time reference. In contrast, non-verbal working memory was associated only with the two selection tasks, possibly related to the mental timeline. Finally, task analysis suggested a pre-phonological (encoding of diacritic features deficit) rather than a morpho-phonological origin. Conclusions Our study is the first to replicate time reference deficit in French speakers with aphasia. It suggests that the type of task might influence the performance profiles observed and help to shed light on the origin of the difficulties. Cognitive functions that have rarely been investigated before may also influence performance. These results have important clinical implications by questioning the tasks used to assess time reference. They also underline the importance of identifying the origin of difficulties in proposing targeted treatment.

Balance, Gait, Functionality and Fall Occurrence in Adults and Older Adults with Type 2 Diabetes Mellitus and Associated Peripheral Neuropathy.

Body balance is regulated by sensory information from the vestibular, visual and somatosensory systems, and changes in one or more of these sensory systems can trigger balance disorders. Individuals with type 2 Diabetes Mellitus (DM2) often present peripheral neuropathy, a condition that alters foot sensory information and can negatively influence balance and gait performance of these subjects. To evaluate and compare balance, gait, functionality and the occurrence of falls between individuals with and without a clinical diagnosis of DM2 with associated peripheral neuropathy. Cross-sectional study, which evaluated seventy individuals, thirty-five with and thirty-five without a clinical diagnosis of DM2, of both sexes and age range between 50 and 85 years, who were recruited from Basic Health Units of Serra Talhada, Pernambuco state, Brazil. The volunteers' balance was analyzed using the Berg Balance Scale, gait-related functional tasks were measured using the Dynamic Gait Index, functional mobility was assessed using the Timed Up and Go test and functionality was assessed using the Katz Index. The occurrence of falls was recorded by the volunteers' self-report. Individuals with DM2 demonstrated the worst performance in balance (p = 0.000) and in gait-related functional tasks (p = 0.000), slower functional mobility (p = 0.000) and worse functionality (p = 0.016) compared to the group without DM2, demonstrating significant differences for all analyzed outcomes. A greater occurrence of falls was observed in individuals with DM2, compared to those without the disease (p = 0.019). Individuals with DM2 demonstrated worse performance on balance, gait-related functional tasks, slower functional mobility and worse functionality compared to those without the disease. Individuals with DM2 had the highest occurrence of falls in this study.

An empirical analysis of worldwide impunity

Our research investigates the relationship between economic and social development indicators and the prevalence of impunity within a country. As countries develop, their institutions tend to function more efficiently and impartially, resulting in less impunity as crimes and violations are more efficiently investigated and prosecuted. We describe a country’s level of economic and social development along seven dimensions and use such a description in a beta regression analysis to predict the level of impunity in 119 countries. We estimate the elasticities of impunity with respect to the variables representing the different dimensions of economic and social progress. We present plots with the estimated elasticity curves for scenarios indicative of less and more socially and economically developed societies and also for the scenario indicative of societies in transition between the two groups. We also identify the countries with the best and worst performance in terms of their levels of impunity in relation to the levels of the conditioning variables. It is shown that Nordic countries exhibit lower impunity than expected based on their economic and social development factors. Conversely, the United States displays a significantly higher level of impunity than expected from its development indicators.

Efficacy and Toxicity of [177Lu]Lu-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer: Results from the U.S. Expanded-Access Program and Comparisons with Phase 3 VISION Data.

The phase 3 VISION trial demonstrated that [177Lu]Lu-PSMA-617 prolonged progression-free survival and overall survival (OS) in prostate-specific membrane antigen [PSMA]-positive metastatic castration-resistant prostate cancer (mCRPC) patients who progressed on taxane-based chemotherapy and androgen receptor-signaling inhibitors (ARSIs). The U.S. expanded-access program (EAP; NCT04825652) was opened to provide access to [177Lu]Lu-PSMA-617 for eligible patients until regulatory approval was obtained. This study aimed to evaluate the efficacy and safety profile of [177Lu]Lu-PSMA-617 within the EAP and compare the results with those from the VISION trial. Methods: Patients enrolled in the EAP at 4 institutions in the United States with available toxicity and outcome data were included. Outcome measures included OS, a prostate-specific antigen (PSA) response rate (RR) of at least 50%, and incidences of toxicity according to Common Terminology Criteria for Adverse Events version 5.0. Differences in baseline characteristics, outcome data, and toxicity between the EAP and VISION were evaluated using t testing of proportions and survival analyses. Results: In total, 117 patients with mCRPC who received [177Lu]Lu-PSMA-617 within the EAP between May 2021 and March 2022 were eligible and included in this analysis. Patients enrolled in the EAP were more heavily pretreated with ARSI (≥2 ARSI regimens: 70% vs. 46%; P < 0.001) and had worse performance status at baseline (Eastern Cooperative Oncology Group score ≥ 2: 19% vs. 7%; P < 0.001) than VISION patients. EAP and VISION patients had similar levels of grade 3 or higher anemia (18% vs. 13%; P = 0.15), thrombocytopenia (13% vs. 8%; P = 0.13), and neutropenia (3% vs. 3%; P = 0.85) and similar PSA RRs (42% vs. 46%; P = 0.50) and OS (median: 15.1 vs. 15.3 mo; P > 0.05). Conclusion: Patients with PSMA-positive mCRPC who received [177Lu]Lu-PSMA-617 within the EAP were later in their disease trajectory than VISION patients. Patients enrolled in the EAP achieved similar PSA RRs and OS and had a safety profile similar to that of the VISION trial patients.

Further validation of the association between MAPT haplotype-tagging polymorphisms and Alzheimer's disease: neuropsychological tests, cerebrospinal fluid biomarkers, and APOE genotype.

Genetic studies have shown that variants in the microtubule-associated protein tau (MAPT) gene, which encodes tau protein, can increase the risk for Alzheimer's disease (AD). Additionally, two haplotypes of the MAPT gene (H1 and H2) are associated with various neurodegenerative disorders, including AD. This study aimed to test the association of MAPT haplotypes (H1 and H2) and MAPT haplotype-tagging polymorphisms (rs1467967, rs242557, rs3785883, rs2471738, del-In9, rs7521) with AD. The study included 964 individuals: 113 with AD, 53 with mild cognitive impairment (MCI), 54 with other dementias, and 744 healthy controls. The results showed that individuals carrying the A allele in the MAPT rs1467967 polymorphism, the GG genotype in the MAPT rs7521 polymorphism, and the G allele in the MAPT rs242557 polymorphism had worse performance on various neuropsychological tests. Carriers of the C allele in MAPT rs2471738 polymorphism and CC homozygotes also showed worse performance on neuropsychological tests and pathological levels of several cerebrospinal fluid (CSF) biomarkers. However, T allele carriers in the MAPT rs2471738 polymorphism were more represented among patients with dementia and apolipoprotein E (APOE) ɛ4 carriers. Carriers of the H2 MAPT haplotype had worse performance on various neuropsychological tests, consistent with our previous study, which associated the H2 MAPT haplotype with pathological levels of CSF AD biomarkers. Regarding the MAPT rs3785883 polymorphism, further research is needed since both the AA and GG genotypes were associated with pathological levels of CSF and plasma AD biomarkers. In conclusion, further genetic studies are needed to elucidate the role of MAPT haplotypes and MAPT haplotype-tagging polymorphisms in the development of AD.

Cannabis Use and Cannabidiol Modulate HIV-Induced Alterations in TREM2 Expression: Implications for Age-Related Neuropathogenesis.

Triggering receptor expressed on myeloid cells 2 (TREM2) is involved in neuroinflammation and HIV-associated neurocognitive impairment (NCI). People with HIV (PWH) using cannabis exhibit lower inflammation and neurological disorders. We hypothesized that TREM2 dysfunction mediates HIV neuropathogenesis and can be reversed by cannabinoids. EcoHIV-infected wildtype (WT) and TREM2R47H mutant mice were used to study HIV's impact on TREM2 and behavior. TREM2 and related gene expressions were examined in monocyte-derived macrophages (MDMs) from PWH (n = 42) and people without HIV (PWoH; n = 19) with varying cannabis use via RNA sequencing and qPCR. Differences in membrane-bound and soluble TREM2 (sTREM2) were evaluated using immunocytochemistry (ICC) and ELISA. EcoHIV increased immature and C-terminal fragment forms of TREM2 in WT mice but not in TREM2R47H mice, with increased IBA1 protein in TREM2R47H hippocampi, correlating with worse memory test performance. TREM2 mRNA levels increased with age in PWoH but not in PWH. Cannabidiol (CBD) treatment increased TREM2 mRNA alone and with IL1β. RNA-seq showed the upregulation of TREM2-related transcripts in cannabis-using PWH compared to naïve controls. IL1β increased sTREM2 and reduced membrane-bound TREM2, effects partially reversed by CBD. These findings suggest HIV affects TREM2 expression modulated by cannabis and CBD, offering insights for therapeutic strategies.

Retinal Microvasculature Changes Linked to Executive Function Impairment after COVID-19

Background/Objectives: Studies using optical coherence tomography angiography (OCTA) have revealed that individuals recovering from COVID-19 have a reduced retinal vascular density (VD) and larger foveal avascular zones (FAZs) than healthy individuals, with more severe cases showing greater reductions. We aimed to examine aspects of the retinal microvascularization in patients with post-COVID-19 condition (PCC) classified by COVID-19 severity and how these aspects relate to cognitive performance. Methods: This observational cross-sectional study included 104 PCC participants from the NAUTILUS Project, divided into severe (n = 59) and mild (n = 45) COVID-19 groups. Participants underwent cognitive assessments and OCTA to measure VD and perfusion density (PD) in the superficial capillary plexus (SVP) and FAZ. Analysis of covariance and partial Pearson and Spearman correlations were used to study intergroup differences and the relationships between cognitive and OCTA variables. Results: Severe PCC participants had significantly lower central (p = 0.03) and total (p = 0.03) VD, lower central (p = 0.02) PD measurements, and larger FAZ areas (p = 0.02) and perimeters (p = 0.02) than mild cases. Severe cases showed more cognitive impairment, particularly in speed processing (p = 0.003) and executive functions (p = 0.03). Lower central VD, lower central PD, and larger FAZ areas and perimeters were associated with worse executive function performance in the entire PCC sample and in the mild COVID-19 group. Conclusions: Retinal microvascular alterations, characterized by reduced VD and PD in the SVP and larger FAZ areas, were associated with cognitive impairments in PCC individuals. These findings suggest that severe COVID-19 leads to long-lasting microvascular damage, impacting retinal and cognitive health.

Fulvestrant en la práctica clínica: análisis de efectividad en pacientes uruguayas con cáncer de mama HR+/HER2.

Fulvestrant demonstrated benefits in overall survival and progression-free survival in patients with advanced breast cancer, who are hormone receptor-positive and human epidermal growth factor receptor 2 negative. The characteristics, evolution, and survival of patients with hormone receptor-positive, HER2-negative breast cancer treated with fulvestrant were evaluated according to the national treatment coverage protocols of the National Resources Fund, with the aim of understanding the efficacy of fulvestrant in patients treated in usual clinical practice and comparing our results with those from pivotal studies. A database from the National Resources Fund covering the period from 2009 to 2022 was used. Survival curves were assessed using the Kaplan-Meier method, and differences were analyzed using the Log-Rank test. A total of 1085 patients with an average age of 63,66 years were included. Following a follow-up of 14 months, the median overall survival was 16 months, and the median progression-free survival was 6 months. The presence of liver and bone metastases was associated with a shorter overall survival. Patients from the public sector and those with a better performance status experienced longer overall survival. Our findings provide a valuable perspective for treatment management in a context of limited resources. Overall survival and progression-free survival were somewhat lower than those reported in pivotal clinical trials. The presence of liver and bone metastases was associated with worse prognosis and survival; additionally, patients with worse performance status had shorter overall survival. These findings underscore the need for personalized therapies, opening new lines of future research.

Analyzing the effects of competitive fatigue on body composition and functional capacities of youth elite handball players

Handball demands intense movements like rapid direction changes and physical contact. Consecutive competitions expose player fatigue and weaknesses due to the sport’s exhaustive nature. Therefore, the aims of this study are twofold: (i) to investigate the impact of competitive fatigue on the body composition of youth elite handball players, and (ii) to analyze the impact of concentrated competition on their functional capacity performance. Seventeen young male handball players (age: 16.2 years, height; 177.8 cm, body mass: 73.0 kg) were assessed twenty-four hours before (TM1) and after the competitive period (TM2) in body composition, static strength, lower- and upper-body explosive strength, speed, agility, balance, and flexibility indicators. A Wilcoxon Signed Rank Test was conducted to assess differences in body composition and functional capacities assessment between TM1 and TM2. Regarding results, body mass significantly increased in TM2 (p &lt; 0.01), while increases in waist circumference and body fat percentage were not statistically significant. Functional capacity assessments revealed a significant decline in jumping performance (CMJ and SJ; p ≤ 0.01). Speed and agility assessments showed worse performance in TM2, significantly increasing 30 m sprint time (p ≤ 0.01). Balance indicators showed no significant differences, with mixed results in performance across different conditions. In sum, evaluating vertical jumps and long-distance maximum speed (i.e., 30 meters) could be valid tests for measuring and controlling fatigue in young elite handball players. Future research should regularly monitor young handballers after the competition to analyze the entire fatigue recovery process.

Physical Function, Self-Perceived Physical Fitness, Falls, Quality of Life and Degree of Disability According to Fear and Risk of Falling in Women with Fibromyalgia.

Background: People with fibromyalgia (FM) experience a range of symptoms (chronic widespread pain, fatigue, mood disorder, sleep problems, muscle stiffness) that promote deterioration of physical condition and function. With impaired physical function, fear of falling and risk of falling increases. This study evaluated physical function, self-perceived physical fitness, falls, quality of life, and the degree of disability caused by FM according to fear and risk of falling in Spanish adult women with FM. Methods: Cross-sectional study involving 84 Spanish adult women with FM. Participants completed tests to assess their physical function and completed questionnaires to evaluate self-perceived physical fitness, falls, the disabling effect of FM, quality of life, fear of falling, and risk of falling. Nonparametric statistical tests were used to analyze possible intergroup differences (Mann-Whitney U test) and correlations between variables (Spearman's Rho). Results: Women with a fear of falling and at risk of falling presented a worse performance in physical tests, worse self-perceived physical fitness, greater number of falls, lower quality of life, and greater degree of disability due to FM. Weak and moderate correlations were found for fear of falling and fall risk and the variables of interest. However, no intergroup differences were found, nor significant correlations in all variables. Conclusions: Women with FM who present fear of falling and risk of falling tend to have worse performance in physical function tests, in addition to worse self-perceived physical fitness, higher number of falls, poorer quality of life, and greater disabling effect of FM.

Relationships Between Hearing Status, Cognitive Abilities, and Reliance on Visual and Contextual Cues

Objectives: Visual and contextual cues facilitate speech recognition in suboptimal listening conditions (e.g., background noise, hearing loss, hearing aid signal processing). Moreover, successful speech recognition in challenging listening conditions is linked to cognitive abilities such as working memory and fluid intelligence. However, it is unclear which cognitive abilities facilitate the use of visual and contextual cues in individuals with normal hearing and hearing aid users. The first aim was to investigate whether individuals with hearing aid users rely on visual and contextual cues to a higher degree than individuals with normal hearing in a speech-in-noise recognition task. The second aim was to investigate whether working memory and fluid intelligence are associated with the use of visual and contextual cues in these groups. Design: Groups of participants with normal hearing and hearing aid users with bilateral, symmetrical mild to severe sensorineural hearing loss were included (n = 169 per group). The Samuelsson and Rönnberg task was administered to measure speech recognition in speech-shaped noise. The task consists of an equal number of sentences administered in the auditory and audiovisual modalities, as well as without and with contextual cues (visually presented word preceding the sentence, e.g.,: “Restaurant”). The signal to noise ratio was individually set to 1 dB below the level obtained for 50% correct speech recognition in the hearing-in-noise test administered in the auditory modality. The Reading Span test was used to measure working memory capacity and the Raven test was used to measure fluid intelligence. The data were analyzed using linear mixed-effects modeling. Results: Both groups exhibited significantly higher speech recognition performance when visual and contextual cues were available. Although the hearing aid users performed significantly worse compared to those with normal hearing in the auditory modality, both groups reached similar performance levels in the audiovisual modality. In addition, a significant positive relationship was found between the Raven test score and speech recognition performance only for the hearing aid users in the audiovisual modality. There was no significant relationship between Reading Span test score and performance. Conclusions: Both participants with normal hearing and hearing aid users benefitted from contextual cues, regardless of cognitive abilities. The hearing aid users relied on visual cues to compensate for the perceptual difficulties, reaching a similar performance level as the participants with normal hearing when visual cues were available, despite worse performance in the auditory modality. It is important to note that the hearing aid users who had higher fluid intelligence were able to capitalize on visual cues more successfully than those with poorer fluid intelligence, resulting in better speech-in-noise recognition performance.

Increased oxygen partial pressure enhances toxicity reduction by membrane aerated biofilm reactor treating oil and gas industrial wastewater

Wastewater produced during oil and gas extraction processes is one of the largest residual water streams. Also known as produced water (PW), it has a complex composition and is typically toxic to aquatic ecosystems. This study explores the use of membrane aerated biofilm reactors (MABR) for biological removal of dissolved organic compounds and associated toxicity. Three different oxygen partial pressures (0.2, 0.6 and 1 bar), the last two mimicking subsea pressures at 20 and 40 m below the sea level, respectively, were tested at three different hydraulic retention times (HRT of 24, 12 and 6 h). Reactors were fed both with onshore and offshore PW. Removal rates for organic carbon increased at decreasing HRT. Highest oxygen partial pressure led to best performance at 6 h HRT (30.1 ± 3.0 g-COD m−2 d−1) when treating onshore PW and at all HRT when treating offshore PW, with highest COD removal rate still at 6 h HRT (9.4 ± 1 g-COD m−2 d−1). Removal efficiencies ranged from 78 % when treating onshore PW at 24 h HRT to 36–49 % when treating offshore PW at 6 h HRT. All treatments led to a reduction in toxicity (>92 % reduction for offshore PW), with 0.2 bar oxygen partial pressure showing worst performance, while 0.6 and 1 bar did not show significant differences. The biofilms were dominated by hydrocarbonoclastic, responsible of hydrocarbons biodegradation, and sulfur cycling bacteria. Overall, MABR were effective treating PW and operating at higher oxygen partial pressures yield to better performance, especially at high volumetric loading rates.