bluuebunny/crossref_metadata_2025 huggingface dataset:
Nationwide incidence of anterior cruciate ligament reconstruction in higher-level athletes in Sweden: a cohort study from the Swedish National Knee Ligament Registry linked to six sports organisations
Authors: Castellanos Dolk Daniel , Hedevik Henrik , Stigson Helena , Wretenberg Per , Kvist Joanna , Stålman Anders
Published: November 2024

Objective

To determine and compare the incidence rate (IR) of anterior cruciate ligament reconstruction (ACL-R) among higher-level athletes across six sports in the Swedish National Knee Ligament Registry (SNKLR).

Methods

Patient data from the SNKLR, between 2005 and 2020, was linked to team and event data of six sports (football, handball, basketball, ice hockey, floorball and alpine sports) to identify higher-level athletes aged 15–40 with ACL-R. Unadjusted and adjusted IR ratios (IRRs) with 99% CIs were calculated between sports, sex, age and divisions.

Results

Female athletes had a 3.3 times higher ACL-R IR compared with males (1.08 vs 0.32, IRR=3.33, 99% CI: 2.65 to 4.19) per 1000 athlete exposures (AE). Basketball had the largest difference in ACL-R IR per 1000 AE between females and males (1.26 vs 0.22, IRR=5.69, 99% CI: 2.79 to 11.60). Female second-division athletes had higher ACL-R IR per 1000 AE compared with female highest-division athletes (1.27 vs 0.76, IRR=1.67, 99% CI: 1.30 to 2.15). No significant association between age and IR was observed. Compared with football, lower ACL-R IR was observed in floorball and ice hockey in females, as well as in floorball, basketball and ice hockey in males.

Conclusion

Female athletes had higher ACL-R IRs than males and second-division female athletes had higher ACL-R IRs than highest-division female athletes. Lower ACL-R IRs were observed in floorball and ice hockey compared with football for both sexes. The remaining sports had ACL-R IRs similar to football, except basketball where rates were lower for male athletes.
Undiagnosed major risk factors in acute ischaemic stroke patients in Qatar: analysis from the Qatar stroke registry
Authors: Tran Kim H , Akhtar Naveed , Joseph Sujatha , Morgan Deborah , Uy Ryan , Babu Blessy , Shuaib Ashfaq
Published: November 2024

Objective

We examined the presentation to hospital, subtypes of ischaemic stroke for patients admitted to stroke services in Qatar and their 90-day prognosis based on the modified Rankin Scale (mRS) for those with diagnosed and undiagnosed diabetes, hypertension and dyslipidaemia.

Methods

We conducted a retrospective analysis of patients admitted with acute ischaemic stroke from January 2014 to April 2024. The mRS was dichotomised with favourable outcome (0–2) and unfavourable outcome (3–6).

Results

A total of 9479 patients were included in the study. Patients with a prior history of hypertension and dyslipidaemia and untreated/undiagnosed for these risk factors on admission were more likely to present with a lower National Institute of Health Stroke Scale (NIHSS) score at admission (p<0.001). These patients were also more likely to present with small vessel disease (SVD) or subcortical stroke (p<0.001). Multivariate analysis revealed that age (adjusted OR 1.05, 95% CI 1.04 to 1.06) and hypertension (adjusted OR 1.44, 95% CI 1.07 to 1.96) were more likely to have an mRS score of 3–6 at 90 days while males (adjusted OR 0.56, 95% CI 0.46 to 0.69), prior antidiabetic therapy (adjusted OR 0.52, 95% CI 0.34 to 0.79) and undiagnosed diabetes (adjusted OR 0.46, 95% CI 0.22 to 0.99) were protective against an mRS score of 3–6 at 90 days after adjusting for covariates.

Conclusion

Patients with a prior history of hypertension and dyslipidaemia and undiagnosed on admission are more likely to present with a lower NIHSS score but have a worse outcome at 90 days. The lower NIHSS may be explained by a higher frequency of SVD.
Influence of learning stress on anxiety levels among high school students in China: the chain-mediated role of physical activity and mobile phone addiction
Authors: Chen Xianghe , Lu Pengcheng , Yi Xiaoyan , Zeng Xinyu , Shen Ziming , Li Wenxiu , Yin Rongbin
Published: November 2024

Objectives

The objectives are to explore the relationship between study stress and anxiety in high school students and the mediating role of physical activity and mobile phone addiction.

Design

A cross-sectional study.

Setting

129 high schools were randomly selected in 13 cities of Jiangsu province, China.

Participants

High school students aged 16–19 years, age and gender balance. A total of 40 000 questionnaires were distributed, with 32 974 effectively recovered.

Primary and secondary outcome measures

Questionnaires were administered offline, covering four parts: General Demographics, Learning Stress Scale, International Physical Activity Questionnaire, Mobile Phone Addiction Scale and Generalized Anxiety Scale-7. Data analysis included path analysis and correlation analysis, along with descriptive statistics, independent sample t-test, correlation analysis and structural equation model.

Results

In this study, the proportions of anxiety, high academic pressure, low physical activity level and high mobile phone addiction were 58.18%, 46.48%, 36.40% and 39.26%, respectively. Study stress was positively correlated with anxiety (r=0.130, p<0.01) and mobile phone addiction (r=0.049, p<0.01). Physical activity was negatively correlated with learning stress (r=−0.352, p<0.01), anxiety (r=−0.105, p<0.01) and mobile phone addiction (r=−0.040, p<0.01). The findings were tested by mediating effect analysis that the indirect effect size value of the path ‘learning stress → physical activity level → anxiety path’ was 0.461, 95% CI of Bootstrap (0.367, 0.554), the mediating effect was significant. The indirect effect size value of the path ‘learning stress → mobile phone addiction → anxiety’ was 0.072, 95% CI of Bootstrap (0.042, 0.102), and the mediating effect was significant. The indirect effect size value of the path ‘learning stress → physical activity level → mobile phone addiction → anxiety’ was 0.072, and the 95% CI of Bootstrap (0.226, 0.400), and the mediating effect was significant.

Conclusions

High school students’ learning stress can significantly positively predict anxiety levels. High school students learning stress indirectly predicts anxiety through the independent mediating effect of physical activity and mobile phone addiction, as well as the chain mediating effect of physical activity and mobile phone addiction.
Exploring the barriers and facilitators to HIV information and health services among youth in N’Djamena, Chad: a qualitative descriptive study
Authors: Bedingar Esias , Bedingar Ngarossorang , Seli Djimet , Sudfeld Christopher R
Published: November 2024

Objectives

Identifying the barriers and facilitators for Chadian youth (aged 15–24 years) along the pathway of access to HIV information and health services.

Study design

Qualitative descriptive study.

Study setting

The study was conducted in N’Djamena, Chad, with 20 high schools purposefully selected based on participation in a Blue Cross Chad (BCC) peer-to-peer education programme.

Participants

A total of four focus groups, each consisting of 12 participants, stratified by gender and BCC programme participation (two each among participating and non-participating high schools), were conducted.

Methods

A descriptive qualitative study using thematic analysis of content was conducted. The qualitative software ATLAS.ti V.22 was used to organise and code the data.

Results

Five main categories of barriers and facilitators for HIV information and health services were identified, including (1) societal expectations and norms; (2) power dynamics; (3) social networks; (4) peer-education programmes; and (5) bypassing the system. Barriers and facilitators to information information-seeking and access to health services were observed at individual, community and system levels. High school students expressed that access to information and health services were important when it comes to HIV and AIDS prevention and treatment. Societal expectations and power dynamics were identified as key barriers, while trust through social networks and peer-education programmes were key facilitators to accessing information and health services.

Conclusion

This study allowed for the identification of both barriers and facilitators of HIV information and health-seeking in the context of N’Djamena, Chad. Our findings highlight the importance of comprehensive community- and youth-led approaches that are youth-friendly and youth-centric and are needed to effectively communicate HIV information.
Evaluating the effectiveness of the National Health Insurance Subsidy Programme within Kenya’s universal health coverage initiative: a study protocol
Authors: Maritim Beryl , Nzinga Jacinta , Tsofa Benjamin , Musiega Anita , Mugo Peter Mwangi , Wong Ethan , Mazzilli Caitlin , Ng'an'ga Wangari , Hagedorn Brittany , Turner Gillian , Musuva Anne , Murira Felix , Ravishankar Nirmala , Barasa Edwine
Published: November 2024

Background

Low-income and middle-income countries, including Kenya, are pursuing universal health coverage (UHC) through the establishment of Social Health Insurance programmes. As Kenya rolls out the recently unveiled UHC strategy that includes a national indigent cover programme, the goal of this study is to evaluate the impact of health insurance subsidy on poor households’ healthcare costs and utilisation. We will also assess the effectiveness and equity in the beneficiary identification approach employed.

Methodology and analysis

Using a quantitative design with quasi-experimental and cross-sectional methods, our matched cohort study will recruit 1350 households across three purposively selected counties. The ‘exposure’ arm, enrolled in the UHC indigent programme, will be compared with a control arm of eligible but unenrolled households over 12 months. Coarsened exact matching will be used to pair households based on baseline characteristics, analysing differences in expenses and catastrophic health expenditure. A cross-sectional design will be employed to evaluate the effectiveness and equity in beneficiary identification, estimating inclusion errors associated with the subsidy programme while assessing gender equity.

Ethics and dissemination

Ethical approval has been obtained from the Scientific and Ethics Review Unit at Kenya Medical Research Institute, with additional permissions sought from County Health Departments. Participants will provide written informed consent. Dissemination strategies include peer-reviewed publications, conference presentations and policy-maker engagement for broad accessibility and impact.
Anifrolumab Study for Treatment Effectiveness in the Real World (ASTER) among patients with systemic lupus erythematosus: protocol for an international observational effectiveness study
Authors: Mosca Marta , Emmas Cathy , Nekeman-Nan Cassandra , Stirnadel-Farrant Heide , Chen Samuel , Carty Lucy , Waratani Miina , Seo Caroline , Chen Stephanie , Sorrentino Alessandro
Published: November 2024

Introduction

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a diverse clinical presentation that involves multiple organ systems and may lead to organ damage and increased risk of mortality. SLE is associated with a high burden of disease that can include loss of productivity and employment and reduced health-related quality of life. The current standard of care for SLE is primarily based on immunosuppression and glucocorticoids and is associated with risk of toxicities and poor tolerability. Anifrolumab, a human monoclonal antibody to type I interferon receptor subunit 1, was recently approved as a new treatment for patients with moderate-to-severe SLE.

Methods and analysis

Here, we report the study design of the ongoing, multinational Anifrolumab Study for Treatment Effectiveness in the Real World (ASTER) that includes 3-years of follow-up beginning with the first infusion of anifrolumab and 1 year of retrospective baseline data. ASTER aims to enrol 500 adult patients receiving anifrolumab for SLE in Europe and Canada. The key study objective is to describe the real-world effectiveness of anifrolumab in routine clinical practice, including clinician-reported disease activity and patient-reported outcomes collected via mobile application. This mobile application also includes a medication diary, where patients report their prescription and non-prescription medication use for SLE on a weekly basis; these data will lend insights on treatment patterns for the study population.

Ethics and dissemination

The design of the ASTER study was informed through consultations with patients with SLE who provided important insights to help maximise patient engagement, retention and the collection of key, patient-relevant endpoints. ASTER enrolment began in February 2023 and the study is expected to finish in 2029.

Trial registration number

NCT05637112.
Longitudinal assessment of serum albumin levels with the risk of coronary artery calcification progression in an asymptomatic population of Korean adults: an observational cohort study
Authors: Won Ki-Bum , Choi Su-Yeon , Chun Eun Ju , Park Sung Hak , Sung Jidong , Jung Hae Ok , Chang Hyuk Jae
Published: November 2024

Objectives

This study evaluated the association between serum albumin levels and coronary artery calcification (CAC) progression in asymptomatic adults without hypoalbuminaemia at baseline.

Design

Observational cohort study.

Setting

Data from the Korea Initiatives on Coronary Artery Calcification (KOICA) which is a retrospective, single ethnicity, multicentre and observational registry were analysed.

Participants

A total of 12 344 Korean adults with baseline albumin level of ≥3.5 g/dL (51.7±8.5 years; 84.3% male) were included. The median interscan period was 3.0 (2.0–4.8) years. All participants were stratified into three groups based on serum albumin tertile.

Primary and secondary outcome measures

Association of serum albumin with the risk of CAC progression was analysed using multivariate logistic regression models with adjustment of interscan period. CAC progression was defined as a square root (√) transformed difference between the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS) of ≥2.5. Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by interscan period.

Results

With increasing serum albumin tertiles, the annualised Δ√transformed CACS (I (lowest): 0.16 (0–1.24) vs II: 0 (0–1.09) vs III (highest): 0 (0–1.01)) and the incidence of CAC progression (I: 36.6% vs II: 31.3% vs III: 25.0%) were decreased despite higher prevalence of hypertension, diabetes and hyperlipidaemia (all p<0.05). Serum albumin levels were inversely related to the annualised Δ√transformed CACS and the risk of CAC progression among overall participants. After adjusting for age, sex, hypertension, diabetes, hyperlipidaemia, obesity, current smoking, alcohol consumption, serum creatinine levels, baseline CACS and interscan period, this inverse association between serum albumin levels (per-1 g/dL increase) and the risk of CAC progression was consistently observed, especially in baseline CACS of 1–10 (OR: 0.392, 95% CI: 0.234 to 0.658) and 11–100 (OR: 0.580, 95% CI: 0.381 to 0.883) (all p<0.05).

Conclusions

Serum albumin levels were inversely associated with the risk of CAC progression. This phenomenon was predominantly observed in CACS of 1–100 at baseline.
Electronic health record data analysis on the impact of rescue-triggered inhaled corticosteroids on controller therapy in Black and Latinx individuals from a pragmatic, open-label, patient-level randomised trial
Authors: Callen Elisabeth , Israel Elliot , Cardet Juan Carlos , Fuhlbrigge Anne L , Manning Brian , Gaona Gabriela , Staton Elizabeth , Pace Wilson D
Published: November 2024

Objective

The Person Empowered Asthma Relief (PREPARE) study found that as-needed inhaled corticosteroid (ICS) supplementation combined with participants’ usual controller and rescue therapy reduced asthma exacerbations for Black and Hispanic/Latinx individuals. We aimed to determine whether treatment assignment to the intervention group (Patient Activated Reliever-Triggered ICS (PARTICS)) versus the control group (usual care) influenced controller therapy based on clinicians’ written prescriptions.

Design

Secondary data analysis of electronic health record data of a pragmatic, open-label, patient-level randomised trial.

Setting

Practices treating asthma.

Participants

PREPARE study participants— Black and Hispanic/Latinx individuals with asthma.

Interventions

Effects of adding ICS to rescue therapy among black and Hispanic adults with moderate-to-severe asthma.

Outcome measures

For PARTICS therapy impact on patients, each month is the 28-month period (12 months prior to enrolment, the month of enrolment and 15 months after enrolment), a patient was assigned to a controller step based on a six-step classification scheme. A linear mixed effect spline model was completed for before and after enrolment data to determine controller changes over a 28-month period between the two study arms.

Results

This analysis included 713 participants. Of these, 49.1% were usual care patients and 50.9% were PARTICS patients. Throughout the study, the majority of patients changed asthma controller medications in both arms. By the end of the study, the usual care patients were at a significantly higher asthma controller medication step (0.20 step higher) than the PARTICS patients.

Conclusions

Clinicians’ prescribing patterns showed significant changes over time. Compared with usual care patients, PARTICS patients were on lower doses of asthma controller medications by the end of the study.

Trial registration number

NCT02995733.
Comparing safety, performance and user perceptions of a patient-specific indication-based prescribing tool with current practice: a mixed methods randomised user testing study
Authors: Feather Calandra , Clarke Jonathan , Appelbaum Nicholas , Darzi Ara , Franklin Bryony Dean
Published: November 2024

Background

Medication errors are the leading cause of preventable harm in healthcare. Despite proliferation of medication-related clinical decision support systems (CDSS), current systems have limitations. We therefore developed an indication-based prescribing tool. This performs dose calculations using an underlying formulary and provides patient-specific dosing recommendations. Objectives were to compare the incidence and types of erroneous medication orders, time to prescribe (TTP) and perceived workload using the NASA Task Load Index (TLX), in simulated prescribing tasks with and without this intervention. We also sought to identify the workflow steps most vulnerable to error and to gain participant feedback.

Methods

A simulated, randomised, cross-over exploratory study was conducted at a London NHS Trust. Participants completed five simulated prescribing tasks with, and five without, the intervention. Data collection methods comprised direct observation of prescribing tasks, self-reported task load and semistructured interviews. A concurrent triangulation design combined quantitative and qualitative data.

Results

24 participants completed a total of 240 medication orders. The intervention was associated with fewer prescribing errors (6.6% of 120 orders) compared with standard practice (28.3% of 120 orders; odds ratio 0.18, p<0.01), a shorter TTP and lower overall NASA-TLX scores (p<0.01). Control arm workflow vulnerabilities included failures in identifying correct doses, applying maximum dose limits and calculating patient-specific dosages. Intervention arm errors primarily stemmed from misidentifying patient-specific information from the medication scenario. Thematic analysis of participant interviews identified six themes: navigating trust and familiarity, addressing challenges and suggestions for improvement, integration of local guidelines and existing CDSS, intervention endorsement, ‘search by indication’ and targeting specific patient and staff groups.

Conclusion

The intervention represents a promising advancement in medication safety, with implications for enhancing patient safety and efficiency. Further real-world evaluation and development of the system to meet the needs of more diverse patient groups, users and healthcare settings is now required.

Trial registration number

NCT05493072.
The Edinburgh Gastric Ulcer Score (EGUS): evaluation of a risk tool for gastric ulcer follow-up
Authors: Grant Rebecca K , Brindle William M , Watson Eleanor F , Penman Ian D , Church Nicholas I , Plevris John N , Shandro Benjamin M , McGowan Aaron P , Gordon-Walker Timothy T , Williams Michael J , Blair Carol S , Noble Colin L , Masterton Gail S M , Kalla Rahul
Published: November 2024

Objective

In May 2021 we implemented a locally developed gastric ulcer protocol. Patients with low Edinburgh Gastric Ulcer Scores (EGUS) and benign biopsy results at index oesophagogastroduodenoscopy (OGD1) were recommended to not undergo follow-up OGD (OGD2). We aimed to validate the EGUS and identify any gastric cancer diagnoses since protocol adoption.

Design

Patients diagnosed with a gastric ulcer at OGD1 in NHS Lothian from 24 May 2021 to 24 June 2023 were identified. Data regarding the EGUS and biopsy rates were gathered and compared with the protocol. Electronic patient records were reviewed for subsequent diagnoses of gastric cancer.

Results

In total, 236 patients were diagnosed with a gastric ulcer; 9.7% (n=23) were diagnosed with gastric cancer at OGD1. The EGUS produced a negative predictive value of 95.7%.

OGD2s were performed in 46.0% (n=98/213) of patients; in 61.2% (n=60/98) this was in accordance with the protocol. No new pathology was identified at follow-up for OGD2s performed contrary to the protocol (median follow-up time 22 months (IQR 17–27)).

OGD2s were not performed in 54.0% (n=115/213) of patients; in 83.5% (n=96/115) this was in accordance with the protocol. At follow-up (median 22 months, IQR 17–29), there were no gastric cancer diagnoses in these patients.

Conclusion

The protocol is a safe and effective method to reduce the burden of repeat OGDs. Crucially, protocol adherence has demonstrated no missed gastric cancer diagnoses. Continued monitoring of patient outcomes is essential.
Characteristics and predictors of major occupational injuries in Korean farmers
Authors: Lee Minji , Jung Wongeon , Choi Dongphil , Shin Yongsuk , Park Jinwoo , Youn Kanwoo
Published: November 2024

Farmers are exposed to various risks due to the nature of the agricultural environment, and occupational injuries occur consistently. Hence, this study aimed to investigate the characteristics and predictors of major non-fatal occupational injuries among farmers by analysing incidents of non-fatal occupational injuries resulting in at least 1 day off work using the Korean Agricultural Workers’ Occupational Disease and Injury Survey data. Multivariate logistic regression was performed to identify the predictors of agricultural occupational injuries, and the results indicated that the risk for non-fatal injuries was higher among older individuals, individuals with pre-existing physical limitations and individuals who use agricultural machinery. The predictors were generally similar for most types of non-fatal injuries. By type of injuries, the risk for trip or slip was higher among women than men. The risk for injuries caused by excessive force or motion was higher among farmers doing rice farming, which is substantially mechanised, than field crop farmers or livestock farmers. The risk of falling from a height was higher among male orchard and greenhouse farmers. The risk of solo farm vehicle crash was higher among male farmers, older farmers, rice farmers, farmers with pre-existing physical limitations and farmers using agricultural machinery. The findings of this study may be useful for developing tailored policies and supportive projects for the Korean farmer population.
Housing instability and concern about firearm victimisation among Asian Americans
Authors: Siddiqui Shan Mohammed , Gao Xiang
Published: November 2024

Background

Rising costs of living, coupled with housing shortages across the USA, have made housing instability a key issue over the past few years. Alongside this problem has also been a steady rise in violence against (and gun deaths among) Asian Americans. Limited scholarship, however, has examined these issues in the context of this increasingly stigmatised population. The objective of this study was to investigate the association between housing instability and firearm victimisation among Asian Americans. We further assessed how being worried about victimisation may vary by ethnicity.

Methods

We conducted secondary data analysis, using the 2021–2022 California Health Interview Survey. We used weighted logistic regression to assess the association between housing instability and firearm victimisation among Asian Americans.

Results

Asian respondents experiencing housing instability had significantly greater odds of worrying about firearm victimisation, compared with those with a stable home, even after accounting for various sociodemographic and health-related factors (adjusted OR (AOR)=1.79, p<0.05). Additionally, the odds of being concerned about firearm victimisation were significantly lower among Japanese (AOR=0.64) and Vietnamese (AOR=0.72) participants, compared with Chinese respondents (both p<0.05).

Discussion and conclusions

Our findings confirm that not having a stable home is strongly linked to worrying about firearm victimisation among Asian Americans. This concern varies significantly by ethnicity. We highlight the importance of disaggregating data on Asian Americans and discuss broader implications for public health.
Social isolation and firearm secure storage in the USA: results from the 2022 BRFSS
Authors: Testa Alexander , Semenza Daniel , Jackson Dylan B , Fu Karyn , McKay Sandra , Ganson Kyle T , Nagata Jason M , Tsai Jack
Published: November 2024

Background

Firearm secure storage (ie, storing firearms unloaded and locked) is recommended to reduce unintentional injuries and suicides. However, the relationship between psychological states, such as social isolation, and firearm secure storage practices is under-researched.

Methods

Data are from 7136 individuals with firearms in their households from the 2022 Behavioral Risk Factor Surveillance System. Multinomial logistic regression was used to explore the relationship between social isolation and firearm storage.

Results

Among respondents, 71.6% reported storing firearms unloaded, 14.2% stored firearms loaded and locked and 14.2% stored firearms loaded and unlocked. Most respondents reported feeling ‘never’ (40.7%) or ‘rarely’ (33.3%) socially isolated, with 18.7% reporting ‘sometimes’, 4.3% ‘usually’ and 3.0% ‘always’ feeling socially isolated. Covariate-adjusted multinomial logistic regression analysis revealed that respondents who felt ‘always’ socially isolated had an over threefold greater risk of storing firearms loaded and unlocked (relative risk ratio=3.733, 95% CI 1.443 to 9.662, p=0.007) compared with unloaded.

Conclusion

Results suggest a link between feelings of social isolation and unsecured firearm storage. Public health strategies should address both firearm safety education and the underlying issue of social isolation.
Number of children and risk of dementia: a cohort study
Authors: Wolfova Katrin , Hubbard Rebecca A , Brennan Kearns Pavla , Chang Virginia W , Crane Paul , LaCroix Andrea Z , Larson Eric B , Tom Sarah
Published: November 2024

Background

Findings on the link between the number of children and dementia risk are inconsistent, mostly studied in females, suggesting pregnancy-related changes may be a key factor in this association.

Methods

The Adult Changes in Thought Study is a cohort of adults aged ≥65 years from Kaiser Permanente Washington. The primary exposure was the number of children (0, 1, 2, 3 or ≥4), and the outcome was an incident dementia diagnosis. Cox proportional-hazards models were adjusted for demographic and early-life socioeconomic confounders. Models were then stratified by sex and by birth year <1928 versus ≥1928.

Results

Among 4668 participants (average age at enrolment 74.1±SD 6.3 years; 59% female), 967 (21%) had 0 children, 484 (10%) had one child, 1240 (27%) had two children, 968 (21%) had three children and 1009 (22%) had four or more children. We found no association between the number of children and dementia overall or after stratification by birth cohort. When stratified by sex and adjusting for confounders, having ≥4 children compared with two children was associated with a higher rate of dementia in males (HR=1.31, 95% CI 1.01 to 1.71).

Conclusions

The number of children was not consistently associated with the risk of dementia. We observed a greater risk of dementia only among males who had ≥4 children, with the lower bound of the 95% CI marginally exceeding 1. These findings suggest that the number of children may influence the risk of dementia through other than pregnancy-related pathways.
Associations between sleep, energy balance, and obesity markers over 6 months in Black emerging adults—pilot study findings from the Sleep, Health Outcomes, and Body Weight (SHOW) study
Authors: Koch Hannah R. , Sims Jesse N.L. , Pickett Stephanie , Wideman Laurie , McNeil Jessica
Published: November 2024

Insufficient sleep (short sleep duration and poor sleep quality) is associated with obesity risk. Emerging adults (ages 18–28 years) have a greater risk of excess weight gain and insufficient sleep, and these risks are higher in Black individuals. Using a measurement burst design, we assessed associations between sleep with energy balance components and obesity marker changes over 6 months in 15 Black emerging adults (12 females; age: 21 ± 2.5 years; body mass index: 25.7 ± 4.5 kg/m2; body fat: 25.8 ± 11.9%). Since our sample was predominantly female (80%), we repeated our analyses for females only. Participants completed the following measurements at baseline (BLN) and 6 months later (6MO): 7 days of actigraphy-based sleep and physical activity energy expenditure (EE) and 2 nights of in-home polysomnography-based sleep; resting EE and thermic effect of food with indirect calorimetry; ad libitum energy intake (EI) via self-reported methods over 4 days and directly measured over 3 days with provided meals. Body weight (2.6 kg, p = 0.01) and waist circumference (2.4 cm, p = 0.03) increased from BLN to 6MO. Changes in actigraphy-based sleep duration were associated with changes in body weight (β = 0.03, standard error (SE) = 0.02, p = 0.04) and fat mass (β = 0.07, SE = 0.03 p = 0.03) in females only. Greater rapid eye movement sleep duration was associated with increases in resting EE (β = 2.24, SE = 0.84, p = 0.02). Greater slow-wave sleep was associated with increases in self-reported EI (β = 18.34, SE = 4.7, p < 0.01). Sleep may impact components of energy balance and risk of weight gain in Black emerging adults. Additional research is needed to confirm our pilot findings.
Thermodynamic topology of topological charged dilatonic black holes
Authors: Hazarika B. , Panah B. Eslam , Phukon P.
Published: November 2024

The aim of this paper is to explore the thermodynamic topology of topological charged dilatonic black holes. To achieve this, our study will begin by examining the characteristics of topological charged black holes in dilaton gravity. Specifically, we will concentrate on the impact of the topological constant on the event horizon of these black holes. Subsequently, we will analyze these black holes, considering their thermodynamic and conserved quantities, in order to assess the validity of the first law of thermodynamics. We explore the thermodynamic topology of these black holes by treating them as thermodynamic defects. For our study, we examine two types of thermodynamic ensembles: the fixed q ensemble and the fixed $$\phi $$
ϕ
ensemble. To study the impact of the topological constant (k) on thermodynamic topology, we consider all possible types of curvature hypersurfaces that can form in these black holes. By calculating the topological charges at the defects within their thermodynamic spaces, we analyze both the local and global topology of these black holes. We also investigate how the parameters of dilaton gravity affect the thermodynamic topology of black holes and highlight the differences compared to charged black holes in the General Relativity.
An investigation of errors in ellipse-fitting for cold-atom interferometers
Authors: Ridley Kevin , Rodgers Anthony
Published: November 2024

Ellipse fitting is a technique which is used to extract differential phase in cold-atom interferometers, particularly in situations where common-mode noise needs to be suppressed. We use numerical simulation to investigate errors in the ellipse fitting process; specifically, errors due to the presence of additive noise, linear drift in ellipse offset and amplitude, as well as an error that can arise from fringe normalisation. Errors are found to manifest in two ways: bias in the ellipse phase measurement and incomplete suppression of common mode phase noise. We quantify these errors for three different ellipse fitting algorithms and discuss the applicability of these results to future cold atom sensors.
Adaptive Time-Delay Control for Cooperative Platooning Considering Slip
Authors: Sarkar Rajasree , Banerjee Arunava , Hashemi Ehsan
Published: November 2024

This article introduces a slip-aware networked vehicle model and proposes an adaptive time-delay control framework for connected autonomous driving systems’ cooperative adaptive cruise control and safety of the intended functionality. In order to improve the vehicular network safety by conveying the amount of longitudinal slip ratio along with the vehicle kinematic states, the innovative slip-aware model makes use of an auxiliary state variable representation that includes wheel slips. The proposed framework enables the formation of platoons consisting of vehicles from multiple manufacturers with similar dynamics, with each vehicle requiring state measurements and longitudinal slip information only from its preceding vehicle. To ensure robustness against external disturbances and model uncertainties, an artificial time-delayed control-based technique is implemented to control the entire networked vehicle system. In order to achieve disturbance rejection along the string of vehicles, control protocols have to be designed to ensure string stability of the whole vehicle platoon. The robust law is augmented with a dual-rate adaption law in order to tackle the overestimation and underestimation problem of switching gain. Subsequently, Lyapunov stability analysis is conducted to show that the inter-vehicular states are steered within a small region in the neighborhood of the origin, under the proposed adaptive-robust control scheme. Numerical simulations are also carried out to validate the robustness of the developed distributed control framework.
Centennial Drama Reimagined: An Immersive Experience of Intangible Cultural Heritage through Contextual Storytelling in Virtual Reality
Authors: Yu Jian , Wang Zhan , Cao Yifan , Cui Hao , Zeng Wei
Published: November 2024

The excavation of intangible cultural heritage (ICH) contextual information carried by cultural heritage (CH) presents new possibilities with the continuous advancement of digital technology. However, when visiting CH sites, due to physical limitations or conservation principles, audiences often focus only on the tangible aspects of CH, while neglecting or struggling to interpret the intangible cultural background. Therefore, presenting the rich intangible cultural contextual information associated with tangible CH is growing in significance, and virtual display methods are gaining prominence. In this work, we select the Shiwan pottery sculptures from over 100 years ago, located in the Chen Clan Ancestral Hall in China, as the subject of our CH research. We conduct a narrative analysis of the intended interpretation of its historical storytelling context. Based on this, we design a new system for embedding ICH narrative information into tangible CH, enabling their aligned comprehension, using 3D scene construction technology, motion capture and virtual reality (VR) technology. The system reimagines the storyline and spatial theatrical scene of Chinese local drama (Cantonese Opera) as ICH in the tangible CH. Results of a comparative user experiment show that the VR immersive interactive system enhances audiences’ aligned understanding of ICH contextual storytelling when visiting CH, and it generates a deep interest in ICH.
Effect of Silver Chloride Content on the Performance of Fully Printed Fabric Electrodes for ECG Monitoring
Authors: Tu Huating , Xu Tianzhao , Xuan Fuzhen , Gao Yang , Yang Hui
Published: November 2024

Silver/silver chloride (Ag/AgCl)‐coated electronic textiles (e‐textiles) provide breathable, flexible, and stable substitutes to traditional medical gel electrodes or flexible film‐based electrodes for electrocardiogram (ECG) monitoring. In this electrode system, Ag transfers electrons to maintain strong electrical conductivity, while AgCl converts ions to electrons at the skin–electrode interface to ensure good electrochemical properties. Nevertheless, the fabrication techniques and electronical characteristics are the main focus, which ignores the impact of the amount of AgCl on the performances of textile electrodes. In this paper, three different weight percentages of Ag/AgCl textile electrodes were compared here; the weight percentage of Ag/AgCl is 8/2, 7/3, and 6/4, respectively. The surface and cross‐section morphology, elemental content, and electrical/electrochemical properties and the ability of ECG signal acquisition were comprehensively characterized. The results show that all the three textile electrodes fabricated by microelectronic printer exhibited uniform surfaces and outstanding electrical/electrochemical properties, and all of them were able to acquire ECG signals effectively. Furthermore, with the increase of AgCl content, the electrochemical performance of textile electrode is more excellent and the better the quality signal acquisition, especially under dynamic conditions with minimal motion artifacts. By analyzing the acquired signals and metrics such as signal‐to‐noise ratio (SNR) and mean square deviation of R‐wave peaks, it can be concluded that when the proportion of AgCl for a textile electrodes is 40%, the level of ECG signal acquisition can be comparable to that of medical disposable gel electrodes. This research offers constructive guidance for material selection of wearable electrodes and electrophysiological sensing platforms.
Predictors for the Level of Quality of Life Among Older Adults: Approaches to the Effect of Sociodemographic and Chronic Diseases
Authors: Rezq Khulud Ahmad , Algamdi Maadiah M. , Alatawi Futun , Altamimi Danah , Albalawi Nouf , Albalawi Atheer , Abed Taghreed , Alatawi Dana , Alhthli Reem
Published: November 2024

Objectives: This cross‐sectional study aimed to assess the quality of life (QOL) and chronic disease prevalence among 265 individuals over the age of 60.

Methods: Utilizing the quality‐of‐life index (QLI), data were collected through an online questionnaire from eligible participants, not mentally disabled.

Results: Significant variations in chronic conditions were found based on marital status, education, employment, and daily activities. QOL declined with age, divorce, unemployment, and dependency on caregivers but improved with a university degree. Living with family positively impacted overall QOL, while older age, unemployment, dependency, hypertension, and kidney disease were associated with lower QOL scores across various domains.

Conclusion: Sociodemographic factors and chronic conditions had pivotal role in shaping the QOL for individuals over the age of 60, emphasizing the importance of targeted interventions for improved well‐being in this population.
Existence of Multiple Solutions for Certain Quasilinear Elliptic Problems Under Flux Boundary Conditions
Authors: Ahmed Ahmed , Ahmedatt Taghi
Published: November 2024

In this paper, we consider the following quasilinear ‐elliptic problems with flux boundary conditions of the type . Using the Fountain theorem and dual Fountain theorem, we prove the existence and multiplicity of solutions for a given problem, subject to different hypotheses. Specifically, this problem has already been resolved within the anisotropic variable exponent Sobolev space , with the aforementioned tools serving as the primary techniques. By employing these methods, we demonstrate that the problem has solutions that can take on multiple forms, depending on the underlying assumptions.
Computationally Efficient Design Optimization of Multiband Antenna Using Deep Learning–Based Surrogate Models
Authors: Palandöken Merih , Belen Aysu , Tari Ozlem , Mahouti Peyman , Mahouti Tarlan , Belen Mehmet A.
Published: November 2024

In this paper, deep learning–based data‐driven surrogate modeling approach is proposed for enhancing cost‐efficiency of multiband antenna design optimization. The proposed surrogate model–assisted design approach has achieved a computational cost reduction of almost 40% compared to the conventional direct electromagnetic solver–based design methodologies in case of single design example. As for the validation of the proposed method, the obtained optimal design parameters from the surrogate model are used to manufacture an antenna design. The obtained results from the experimental measurement are compared with counterpart results from the literature.
A Novel Designed Anti–PD-L1/OX40 Bispecific Antibody Augments Both Peripheral and Tumor-Associated Immune Responses for Boosting Antitumor Immunity
Authors: Li Baocun , Gong Shiyong , Zhang Nianying , Shi Beilei , Lv Zhou , Zhang Yu , Gaowa Naren , Dong Liqin , Wu Danqing , Wu Jianfu , Liu Fan , Zhang Rui , Behzadigohar Ramin , Ganju Vinod , Wu Chengbin , Wu Xuan
Published: November 2024

Bispecific antibodies (BsAb) combining simultaneous PD-L1 blockade and conditional costimulatory receptor activation have been developed to improve immune checkpoint therapy response. However, several PD-L1–based BsAbs have encountered clinical challenges, including insufficient activity or unexpected toxicity. In this study, we propose OX40 as a more suitable target partner for PD-L1–based BsAb design compared with ongoing clinical partners (CD27 and 4-1BB). We present a novel Fc-silenced tetravalent PD-L1/OX40 BsAb (EMB-09), which efficiently blocks PD-1/PD-L1 interactions and induces PD-L1–dependent OX40 activation, leading to enhanced T-cell activation. EMB-09 demonstrated improved antitumor activity compared with the anti–PD-L1 mAb. Significantly, EMB-09 activated effector memory T cells in the peripheral immune system and promoted the influx of stem-like CD8+ T cells into the tumor site, resulting in a more active phenotype of CD8+ tumor-infiltrating lymphocytes. In an ongoing first-in-human study in patients with advanced refractory solid tumors (NCT05263180), EMB-09 demonstrated a consistent pharmacodynamic response and early efficacy signals.
Table S5 from ETx-22, a Novel Nectin-4–Directed Antibody–Drug Conjugate, Demonstrates Safety and Potent Antitumor Activity in Low-Nectin-4–Expressing Tumors
Authors: Lopez Marc , Crompot Emerence , Josselin Emmanuelle , Farina Anne , Rubis Marion , Castellano Remy , Fares Joanna , Wehbe Maria , Collette Yves , Charafe Emmanuelle , Blanchin Stéphanie , Romagne François , Pálfi Anikó , Hechler Torsten , Pahl Andreas , Azim Hatem A. , Lhospice Florence , Mamessier Emilie , Bertucci François , Elands Jack , Préville Xavier , Olive Daniel
Published: November 2024

Supplementary Table 5 shows the analysis of average Drug Antibody Ratio in monkey plasma 
Figure S4 from ETx-22, a Novel Nectin-4–Directed Antibody–Drug Conjugate, Demonstrates Safety and Potent Antitumor Activity in Low-Nectin-4–Expressing Tumors
Authors: Lopez Marc , Crompot Emerence , Josselin Emmanuelle , Farina Anne , Rubis Marion , Castellano Remy , Fares Joanna , Wehbe Maria , Collette Yves , Charafe Emmanuelle , Blanchin Stéphanie , Romagne François , Pálfi Anikó , Hechler Torsten , Pahl Andreas , Azim Hatem A. , Lhospice Florence , Mamessier Emilie , Bertucci François , Elands Jack , Préville Xavier , Olive Daniel
Published: November 2024

Supplementary Figure 4 shows the analysis of ETx-22 infiltration in SUM190PT tumors
Figure S3 from ETx-22, a Novel Nectin-4–Directed Antibody–Drug Conjugate, Demonstrates Safety and Potent Antitumor Activity in Low-Nectin-4–Expressing Tumors
Authors: Lopez Marc , Crompot Emerence , Josselin Emmanuelle , Farina Anne , Rubis Marion , Castellano Remy , Fares Joanna , Wehbe Maria , Collette Yves , Charafe Emmanuelle , Blanchin Stéphanie , Romagne François , Pálfi Anikó , Hechler Torsten , Pahl Andreas , Azim Hatem A. , Lhospice Florence , Mamessier Emilie , Bertucci François , Elands Jack , Préville Xavier , Olive Daniel
Published: November 2024

Supplementary Figure 3 shows the internalization of 15A7.5 and Ha22
Figure 5 from ETx-22, a Novel Nectin-4–Directed Antibody–Drug Conjugate, Demonstrates Safety and Potent Antitumor Activity in Low-Nectin-4–Expressing Tumors
Authors: Lopez Marc , Crompot Emerence , Josselin Emmanuelle , Farina Anne , Rubis Marion , Castellano Remy , Fares Joanna , Wehbe Maria , Collette Yves , Charafe Emmanuelle , Blanchin Stéphanie , Romagne François , Pálfi Anikó , Hechler Torsten , Pahl Andreas , Azim Hatem A. , Lhospice Florence , Mamessier Emilie , Bertucci François , Elands Jack , Préville Xavier , Olive Daniel
Published: November 2024

ETx-22 mechanism of action. PDX TNBC400-bearing NSG mice (n = 3 per time point) were injected intravenously when tumors averaged 150 mm3 (T0) with 10 mg/kg of ETx-22 (from humanized 15A7.5 mAb). At the indicated time points, animals were euthanized, and their tumors were collected, measured, and weighted. A, IHC analysis of ETx-22 infiltration and PD in PDX TNBC400 tumors. Tumors were fixed and embedded in paraffin. ETx-22 was detected with rabbit anti-human IgG which was revealed with a secondary anti-rabbit IgG coupled to HRP and a ChromoMap DAB kit. Phosphorylated H2A.X, which is a marker of topoisomerase I inhibitor activity, was detected with mouse anti–phospho-Histone H2A.X which was revealed with a secondary rabbit anti-mouse IgG and a tertiary anti-rabbit IgG coupled to HRP and a ChromoMap DAB kit. Scale bar, 50 μm. B, Western blot analysis of tumor lysates. ETx-22 was detected with a goat anti-human IgG conjugated to HRP. C, Quantification of phosphorylated H2A.X-positive cells. Slides in A were numerized using a Hamamatsu scanner, and Tribun Calopix software was used to quantify the percentage of phosphorylated H2A.X-positive cells. D, LC/MS determination of exatecan amount per gram of tumor. E, tumor volume measured using a caliper [V = (L × W × H) × π/6)].