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Utilization of transitional care management services and 30-day readmission

Transitional care management (TCM) visits have been shown to reduce 30-day readmissions, but it is unclear whether the decrease arises from the TCM visit itself or from clinic-level changes to meet the requirements of the TCM visits. We conducted a cross-sectional analysis using data from Northwell Health to examine the association between the type of post-discharge follow-up visits (TCM visits versus non-TCM visits based on billing) and 30-day readmission. Furthermore, we assessed whether being seen by a provider who frequently utilizes TCM visits or the TCM visit itself was associated with 30-day readmission. We included adult patients hospitalized to Medicine service and subsequent follow-up visits within two weeks of discharge between February 24, 2018, and February 24, 2020. We examined 1) post-discharge follow-up visit type (TCM visit versus non-TCM visit) and 2) provider characteristics (frequent TCM visit utilization or not). The primary outcome was unplanned hospital readmission within 30 days following hospital discharge. After propensity matching, TCM follow-up visits were associated with decreased 30-day readmissions (hazard ratio = 0.74 [0.63–0.88]) compared to non-TCM visits. Among patients with non-TCM follow-up visits, those seen by a provider who frequently used TCM visits had decreased odds (OR = 0.84 [0.71–0.99]) of 30-day readmission compared to those seen by providers who did not use TCM visits regularly. Among patients who followed up with providers who frequently use TCM visits, TCM visits were associated with decreased 30-day readmission compared to patients with non-TCM visits (OR = 0.78 [0.62–0.98]). The study has limitations, including the health system database not capturing all out-of-network follow-up visits. The reduction in 30-day readmission associated with TCM visits likely arises from both the visit itself and being seen by a provider who frequently uses TCM visits.

A NOTCH3 pathogenic variant influences osteogenesis and can be targeted by antisense oligonucleotides in induced pluripotent stem cells

Lateral Meningocele Syndrome (LMS), a disorder associated with NOTCH3 pathogenic variants, presents with neurological, craniofacial and skeletal abnormalities. Mouse models of the disease exhibit osteopenia that is ameliorated by the administration of Notch3 antisense oligonucleotides (ASO) targeting either Notch3 or the Notch3 mutation. To determine the consequences of LMS pathogenic variants in human cells and whether they can be targeted by ASOs, induced pluripotent NCRM1 and NCRM5 stem (iPS) cells harboring a NOTCH36692-93insC insertion were created. Parental iPSCs, NOTCH36692-93insC and isogenic controls, free of chromosomal aberrations as determined by human CytoSNP850 array, were cultured under conditions of neural crest, mesenchymal and osteogenic cell differentiation. The expected cell phenotype was confirmed by surface markers and a decline in OCT3/4 and NANOG mRNA. NOTCH36692-93insC cells displayed enhanced expression of Notch target genes HES1, HEY1, 2 and L demonstrating a NOTCH3 gain-of-function. There was enhanced osteogenesis in NOTCH36692-93insC cells as evidenced by increased mineralized nodule formation and ALPL, BGLAP and BSP expression. ASOs targeting NOTCH3 decreased both NOTCH3 wild type and NOTCH36692-93insC mutant mRNA by 40% in mesenchymal and 90% in osteogenic cells. ASOs targeting the NOTCH3 insertion decreased NOTCH36692-93insC by 70–80% in mesenchymal cells and by 45–55% in osteogenic cells and NOTCH3 mRNA by 15–30% and 20–40%, respectively. In conclusion, a NOTCH3 pathogenic variant causes a modest increase in osteoblastogenesis in human iPS cells in vitro and NOTCH3 and NOTCH3 mutant specific ASOs downregulate NOTCH3 transcripts associated with LMS.

Study of distribution and morphological characteristics of the trabecular bone in the uncinate process of the cervical spine using micro-computed tomography

The cervical uncinate process is a unique structure of the cervical spine that undergoes significant changes in its morphological characteristics with age, and these changes may be related to osteoporosis. This study aimed to observe the distribution of cancellous bone in the cervical uncinate process and its morphological features using micro-computed tomography (Micro-CT) to gain a deeper understanding of the morphological characteristics of the uncinate microstructure. We performed Micro-CT scans on 31 sets of C3-C7 vertebrae, a total of 155 intact bone samples, and subsequently used the measurement software with the Micro-CT system to obtain parameters related to the cancellous bone of the uncinate process. We found that the cancellous bone of the uncinate process was predominantly longitudinally cross-aligned and continuous with the cancellous bone within the vertebral body. Comparisons between the left and right sides of each parameter showed significant differences only in the bone surface area, and the peaks of each parameter were primarily concentrated in C4-C6. In this study, we found that the C5 uncinate process is the site of most significant stress in the cervical vertebrae, which leads to the earliest occurrence of osteoporosis, and this study provides experimental, theoretical bases for the prevention of cervical spondylosis and osteoporosis, and the diagnosis and treatment of related diseases.

Recovery time and predictors of severe acute malnutrition in children aged 6–59 months via an outpatient therapeutic program in Borena zone: A prospective cohort study

Background Severe acute malnutrition (SAM) is a severe condition causing bilateral pitting edema or signs of wasting in children, with a high mortality risk. An outpatient therapeutic program is recommended for managing SAM children without complications, but there is limited information on recovery time and its determinants. Objective This study aims to assess the time to recovery and its predictors among children aged 6–59 months with SAM admitted to the Outpatient therapeutic program in the Borena zone, Oromia region, Southern Ethiopia in 2023. Methods A prospective follow-up study was carried out from March 1–30, 2023, on 322 children aged 6–59 months in health facilities in the Borena zone. After being collected using a structured questionnaire, the data was imported into Epi Data Manager version 3.1 and exported to SPSS version 26 for analysis. Model fitness was assessed using the log rank test, and time-to-recovery from SAM was found to be predicted by Cox regression analysis. Lastly, the study used the Adjusted Hazard Ratio with a p-value < 0.05 and a 95% confidence interval to describe the connection. Results The median duration for recovery was found to be 42 days with an interquartile range of 35 to 49. Children who received Amoxicillin had a four-times higher recovery rate (AHR = 4.09; 95% CI: 2.75, 6.07). The presence of diarrhea prolonged the recovery time by 53.0% (AHR = 0.47; 95% CI: 0.36, 0.62), while vomiting prolonged the recovery time by 58.0% (AHR = 0.42; 95% CI: 0.32, 0.55). Edema reduced the chances of recovery by 48% (AHR = 0.52; 95% CI: 0.36, 0.62). Conclusion The study found that recovery time for children with severe acute malnutrition is consistent with prior research. Key factors influencing recovery duration include the prompt administration of Amoxicillin upon admission and the presence of symptoms like diarrhea, vomiting, and edema. The findings emphasize the critical role of specific symptoms in predicting recovery times for children with SAM. By understanding these relationships, healthcare providers can enhance treatment strategies, improve resource management, and ultimately contribute to better health outcomes for affected children.

Correction: Mitochondrial DNA barcoding of mosquito species (Diptera: Culicidae) in Thailand

Analysis of the stability of a predator-prey model including the memory effect, double Allee effect and Holling type-I functional response

This study proposes and analyses a revised predator-prey model that accounts for a twofold Allee impact on the rate of prey population expansion. Employing the Caputo fractional-order derivative, we account for memory impact on the suggested model. We proceed to examine the significant mathematical aspects of the suggested model, including the uniqueness, non-negativity, boundedness, and existence of solutions to the noninteger order system. Additionally, all potential equilibrium points for the strong and weak Allee effect are examined under Matignon’s condition, along with the current state of conditions and local stability analysis. Analytical results are also provided for the necessary circumstances for the Hopf bifurcation initiated by the fractional derivative order to occur. We also demonstrated the global asymptotic stability for the positive equilibrium point in both the strong and weak Allee effect cases by selecting an appropriate Lyapunov function. This study’s innovation is its comparative investigation of the stability of the strong and weak Allee effects. To conclude, numerical simulations validate the theoretical findings and provide a means to investigate the system’s more dynamical behaviours.

Correction: Music listening evokes story-like visual imagery with both idiosyncratic and shared content

Quantitative expression of estrogen, progesterone and human epidermal growth factor receptor-2 and their correlation with immunohistochemistry in breast cancer at Uganda Cancer Institute

The detection of Estrogen Receptor (ER), Progesterone Receptor (PR), and Human epidermal growth factor receptor 2 (HER-2) is important for the stratification of breast cancer and the selection of therapeutic modalities. This study aimed to determine the quantitative expression of ER, PR and HER-2 using Immunohistochemistry and their correlation with quantitative baseline Ct values measured using Quantitative Polymerase Chain Reaction (PCR). This study also assessed the use of fresh breast tissue biopsies preserved in RNAlater solution in the quantitative detection of these receptors using PCR technique. The study evaluated 20 matched formalin fixed paraffin embedded and RNAlater preserved samples for ER, PR, and HER-2 using IHC and quantitative PCR technique. One portion of the breast tissue biopsy was fixed immediately in 10% neutral buffered formalin and another was preserved in RNAlater. After the histological confirmation of breast cancer by the H&E technique, formalin fixed paraffin embedded tissues (FFPE)—positive cases were matched with their corresponding RNAlater samples for IHC and qPCR. The extracted RNA was quantified using Nanodrop technology, resulting into complementary DNA. ER and PR using IHC were expressed in 60% (n = 12) of the study samples and were negative in 40% (n = 8) of samples. HER-2 was negative in 70% (n = 14) of study samples, 25% (n = 5) positive, and 5% (n = 1) equivocal. With the quantitative expression of ER, PR, and HER-2 being reported in the IHC triple—negative breast cancer cases. The mean Ct values for the hormonal receptors correlated with what has been previously studied with ER at 19.631, PR at 25.410 and HER-2 at 25.695. There was no statistically significant difference between the mean Ct values of RNAlater and FFPE with their P-values being 0.9919, 0.0896 and < 0.0001 for ER, PR, and HER-2 respectively. P-values; 0.9919 and 0.0896 for ER and PR respectively being greater than 0.05 it’s a borderline significance although HER-2 had a statistical significance. With a concordance in the detection of these breast cancer hormonal receptors, qPCR can be used in our setting considering the delays that may be associated in following the samples through IHC processing.

Whole genome sequences of nine Taylorella equigenitalis strains isolated in the Czech Republic between 1982–2021: Molecular dating suggests a common ancestor at the time of Roman Empire

Taylorella equigenitalis is the causative agent of sexually transmitted contagious equine metritis. Infections manifest as cervicitis, vaginitis and endometritis and cause temporary infertility and miscarriages of mares. While previous studies have analyzed this organism for various parameters, the evolutionary dynamics of this pathogen, including the emergence of antibiotic resistance, remains unresolved. The aim of this study was to isolate contemporary strains, determine their genome sequences, evaluate their antibiotic resistance and compare them with other strains. We determined nine complete whole genome sequences of T. equigenitalis strains, mainly from samples collected from Kladruber horses in the Czech Republic. While T. equigenitalis strains from Kladruby isolated between 1982 and 2018 were inhibited by streptomycin, contemporary strains were found to be resistant to streptomycin, suggesting the recent emergence of this mutation. In addition, we used the collection dates of Kladruber horse strains to estimate the genome substitution rate, which resulted in a scaled mean evolutionary rate of 6.9×10−7 substitutions per site per year. Analysis with other available T. equigenitalis genome sequences (n = 18) revealed similarity of the Czech T. equigenitalis genomes with the Austrian T. equigenitalis genome, and molecular dating suggested a common ancestor of all analyzed T. equigenitalis strains from 1.5–2.6 thousand years ago, dating to the first centuries A.D. Our study revealed a recently emerged streptomycin resistance in T. equigenitalis strains from Kladruber horses, emphasizing the need for antibiotic surveillance and alternative treatments. Additionally, our findings provided insights into the pathogen’s evolution rate, which is important for understanding its evolution and preparing preventive strategies.

Factors affecting behaviors during complementary feeding in infants and children aged 6–24 months

The process that begins around the 6th month of life and continues until the 24th month is called the complementary feeding period. During this period, infants and children start receiving foods that complement breast milk or formula for the first time. The psychosocial factors the infants and children encounter during this period may affect their growth and health in later life. This cross-sectional and descriptive study aimed to examine the factors influencing behaviors of infants and children during complementary feeding. The study sample included 345 mothers with infants and children aged 6–24 months. The research data were collected using two forms and one scale. The first form contained questions about the mothers’ sociodemographic characteristics, sources of support in childcare, and information sources related to complementary feeding. The second form contained questions about the sociodemographic characteristics of infants and children, the presence of allergies, breastfeeding, and feeding status. The scale used was the validated Behaviors of Transition to Complementary Feeding Scale. The effect of independent variables on behavior of infants and children during complementary feeding was examined using multiple linear regression analysis. Infants/children older than 12 months exhibited more negative behaviors during complementary feeding compared with those aged 6–12 months. The study also found that being the first infant/child in the family had a negative impact on behaviors during complementary feeding. Infants and children currently receiving only complementary feeding displayed more positive behaviors during the complementary feeding process. Paternal support in childcare positively influenced behaviors during this period. In conclusion, complementary feeding is a multifaceted process influenced by various factors, including the infant’s and child’s age, family dynamics, and parental support. Strategies to support mothers, involve fathers, and provide reliable information can facilitate a smoother process of complementary feeding and promote healthier feeding behaviors in infants and children. Descriptive, interventional, qualitative, and mixed-methods studies are required to analyze these factors in detail and improve the complementary feeding process.

Finite element analysis of the plantar support for the medial longitudinal arch with flexible flatfoot

Purpose The present study is to explore the appropriate plantar support force for its effect on improving the collapse of the medial longitudinal arch with flexible flatfoot. Methods A finite element model with the plantar fascia attenuation was constructed simulating as flexible flatfoot. The appropriate plantar support force was evaluated. The equivalent stress of the articular surface of the joints in the medial longitudinal arch and the maximum principal stress of the ligaments around the ankle were obtained. Results The height fall is smaller when applying 15% of body-weight-bearing force as the plantar support for the medial longitudinal arch compared with 10% of the body-weight-bearing while 20% of body-weight-bearing force is over plantar support. The equivalent stress on the articular surface of each joint is smallest when applying 15% of body-weight-bearing force compared with 10% or 20% of the body-weight-bearing force. The maximum principal stress of the anterior talofibular ligament is decreased while other ligaments increased when the plantar fascia attenuation under loading. The maximum principal stress of the tibiocalcaneal ligament and the posterior tibiotalar ligament are decreasing while other ligaments increased with the force increasing gradually. Conclusions Applying 15% of body-weight-bearing to the sole of the foot can restore the height fall of the medial longitudinal arch, and relieve the equivalent articular stress of the talonavicular joint and the talocalcaneal joint as well as the tension stress of the tibiocalcaneal ligament and the posterior tibiotalar ligament.

Relationship between middle school students’ academic stress and physical exercise behavior from the perspective of Self-Determination Theory: The chained mediation of motivation and intention

Academic stress is associated with lower engagement in healthy behaviors, including physical exercise, among middle school students. Based on Self-Determination Theory, this study examines the association between academic stress and physical exercise behavior among middle school students, exploring the mechanisms through the chained mediation of motivation and intention. Scales used in this study include the Academic Stress Scale, Autonomous and Controlled Motivation Scales, and Physical Exercise Intention and Behavior Scales to measure relevant variables. This cross-sectional study involve 290 middle school students (116 males, age = 13.76±0.96 years, grades 7–9) selected from a middle school in Xiamen, China. Structural equation modeling is used to analyze the data, revealing the following results: (1) Academic stress is significantly associated with middle school students’ exercise behavior through the mediating role of exercise intention; (2) Controlled motivation, autonomous motivation, and exercise intention serve as chained mediators between academic stress and exercise behavior; (3) Academic stress is not associated with exercise intention through the parallel mediation of controlled and autonomous motivations. These findings provide new insights into the relationship between academic stress and physical exercise behavior in middle school students.

The physiological stress response of juvenile nurse sharks (Ginglymostoma cirratum) to catch-and-release recreational angling

Nurse sharks (Ginglymostoma cirratum), especially juveniles, are often encountered by near-shore and shore-based recreational anglers and are suggested to exhibit minimal behavioral and physiological responses to capture, largely based on studies of adults using commercial or scientific fishing methods. To quantify the sub-lethal effects of recreational angling on juvenile nurse sharks, 27 individuals (across 31 angling events) were caught using hook-and-line fishing methods. Over a 30-min period, 4 blood samples were taken with variable time intervals between sampling (i.e., randomized ordering of an interval of 5, 10, and 15 min between each sampling event). Lactate increased by 611% (6.7 ± 2.17 mmol/L) on average over the 30-min fight, and significant relationships were identified between lactate and blood draw number, fight time, and temperature, with large effect sizes. Significant relationships were also detected between blood draw number, glucose, and hematocrit, while osmolality was only affected by fishing site. These results suggest juvenile nurse sharks may exhibit a greater physiological stress response when exposed to recreational angling than adults captured with other fishing methods.

Association between early life second-hand smoke exposure on child sleep and psychoactive substance use on adult sleep patterns in an urban informal settlement in Uganda

Background Psychoactive substance use in adults and second-hand smoke (SHS) exposure among children are leading contributors to sleeping problems. Despite this, there is limited data on how these exposures influence sleep patterns in informal settings. Our study assessed the associations between substance use, SHS exposure and sleep disturbances among adults and children in an urban informal settlement in Uganda. Methods We conducted a cross-sectional study in an urban informal settlement in Kampala, Uganda. Data was collected on self-reported sleep problems among adults including sleep duration, insomnia and sleep dissatisfaction, as well, as sleep-disordered breathing (SDB) in children. We evaluated children’s early-life SHS exposure and psychoactive substance use in adults using questionnaires. We modelled the associations between the exposures and sleep problems in adults and children using modified Poisson regression. Results Data were collected from 284 adults, who also reported on their children’s sleep experience. Among adults, 59.2% reported insufficient sleep (less than 7 hours), 34.9% experienced insomnia, and 28.3% were dissatisfied with their sleep patterns. Active smoking was associated with insomnia (Prevalence Ratio (PR) = 2.74, 95% Confidence Interval (CI): 1.14–6.59), and alcohol use was associated with sleep dissatisfaction (PR = 1.81, 95% CI 1.23–2.69). In children, 40.0% (88/220) exhibited SDB problems. Those exposed to SHS either during pregnancy or within six months post-birth had a higher risk of SDB than unexposed children (PR = 1.78, 95% CI 1.21–2.61). The risk was also elevated for children exposed to SHS during both periods (PR = 1.48, 95% CI 1.02–2.13). Conclusions Our findings suggest that smoking was associated with insomnia and alcohol with sleep dissatisfaction among adults. Early-life SHS exposure was associated with an increased risk of SDB in children. These results emphasize the need to support ongoing public health initiatives and maintain a smoke-free environment, particularly for children in their early life.

The association between helicobacter pylori infection and Triglyceride-Glucose (TyG) index in US adults: A retrospective cross-sectional study

Background The Triglyceride-glucose (TyG) index is a marker for insulin resistance and metabolic syndrome, while Helicobacter pylori is linked to gastrointestinal diseases and may affect metabolic risks. This study examined the association between the TyG index and H. pylori infection in adults. Methods Data from 3797 participants in the NHANES 1999–2000 cycle were analyzed. The relationship between the TyG index and H. pylori infection was assessed using multivariate logistic regression and a two-piecewise logistic model to explore non-linear effects. Subgroup analyses were conducted based on age, sex, glucose levels, BMI, and CKD. Results A linear association between the TyG index and H. pylori infection was found. Subgroup analyses revealed significant interactions with a few variables. Conclusions This study indicates a linear relationship between the TyG index and H. pylori infection, suggesting metabolic influences on H. pylori infection and potential for targeted interventions in at-risk groups.

Point prevalence survey of antibiotic use in Mexican secondary care hospitals

Introduction Tackling the inertia of growing threat of antimicrobial resistance (AMR) requires changes in how antibiotics are prescribed and utilized. The monitoring of antimicrobial prescribing in hospitals is a critical component in optimizing antibiotic use. Point prevalence surveys (PPSs) enable the surveillance of antibiotic prescribing at the patient level in small hospitals that lack the resources to establish antimicrobial stewardship programs (ASP). In this study, we analyzed antibiotic use at two public secondary care hospitals in Mexico using PPSs. Methods Following WHO methodology, we conducted four cross-sectional PPSs on antibiotic use in two public secondary care facilities in Mexico: two surveys in a women’s specialty hospital (H1) and two in a general referral hospital (H2). We collected data from clinical records of all patients with active antibiotic prescriptions (APs) across the medical, surgical, and mixed (MIX) wards, and intensive care units (ICUs). Descriptive statistics were computed to analyze the PPSs data using Stata. Results The PPSs collected data on 127 patients, and 283 active APs. The prevalence of antibiotic use was 60.4% (H1, n = 29/48) and 70.5% (H2, n = 98/139). Antibiotics were more frequently used among patients in the MIX wards (H1: 87.5%, n = 14/16) and ICUs (H2: 90%, n = 9/10). The most frequent patient indications for antibiotic use were medical prophylaxis (H1: 51.7%, n = 15/29), community-acquired infections (H2: 42.9%, n = 42/98), and preoperative prophylaxis (H1: 27.6%, n = 8/29; H2: 23.5%, n = 23/98). The APs were mostly empirical (H1: 97%, n = 64/66; H2: 98.2%, n = 213/217), and parenterally administered (H1: 90.9%, n = 60/66; H2: 96.8%, n = 210/217). Most clinical records lacked documented post-prescription reviews (H1: 82.8%, n = 24/29; H2: 98%, n = 96/98). Preoperative prophylaxis was predominantly administered as multiple doses for more than one day. Penicillins with extended-spectrum (24.2%, n = 16/66), aminoglycosides (22.7%, n = 15/66), and first-generation cephalosporins (16.7%, n = 11/66) were the most prescribed antibiotic classes in H1, while third-generation cephalosporins (35%, n = 76/217), fluoroquinolones (14.3%, n = 31/217), and carbapenems (13.4%, n = 29/217) were the most prescribed in H2. No hospital had formally established ASP. Conclusions This study shows high prevalence rates of antibiotic use and variations in commonly prescribed antibiotic classes in public Mexican secondary care hospitals, along with shared practices in broad-spectrum antibiotic prescription. PPS-based surveillance enables the identification of specific targets to optimize antibiotic use according to the healthcare needs of patients in each hospital and facilitates comparative evaluations across hospitals.

An end-to-end implicit neural representation architecture for medical volume data

Medical volume data are rapidly increasing, growing from gigabytes to petabytes, which presents significant challenges in organisation, storage, transmission, manipulation, and rendering. To address the challenges, we propose an end-to-end architecture for data compression, leveraging advanced deep learning technologies. This architecture consists of three key modules: downsampling, implicit neural representation (INR), and super-resolution (SR). We employ a trade-off point method to optimise each module’s performance and achieve the best balance between high compression rates and reconstruction quality. Experimental results on multi-parametric MRI data demonstrate that our method achieves a high compression rate of up to 97.5% while maintaining superior reconstruction accuracy, with a Peak Signal-to-Noise Ratio (PSNR) of 40.05 dB and Structural Similarity Index (SSIM) of 0.96. This approach significantly reduces GPU memory requirements and processing time, making it a practical solution for handling large medical datasets.

Cracking susceptibility of full-sibs of a cross of a cracking tolerant and cracking susceptible sweet cherry: Relation to cuticle characteristics, microcracking and calcium

Rain cracking compromises quality and quantity of sweet cherries worldwide. Cracking susceptibility differs among genotypes. The objective was to (1) phenotype the progeny of a cross between a tolerant and a susceptible sweet cherry cultivar for cuticle mass per unit area, strain release on cuticle isolation, cuticular microcracking and calcium/dry mass ratio and (2) relate these characteristics to cracking susceptibilities evaluated in laboratory immersion assays and published multiyear field observations. Mass of the dewaxed cuticle per unit area and strain release upon cuticle isolation were significantly related to cracking susceptibility in lab or field. Cuticular microcracking in the stylar end region as indexed by infiltration with acridine orange was more severe in susceptible than in tolerant genotypes and significantly correlated with susceptibility to cracking in lab and field. The Ca/dry mass ratio was lower (-8%) for susceptible than for tolerant genotypes. Fruit that cracked early had less Ca than those that cracked later. Only the Ca/dry mass ratio of the stylar end region was significantly correlated with cracking susceptibility in the field. Based on stepwise regression analyses microcracking of the cuticle accounted for most of the cracking susceptibilities in field and lab (partial r2 = 0.331 to 0.338 for field vs. r2 = 0.326 to 0.453 for lab). The variability in cracking susceptibility accounted for increased to a r2 = 0.571 (lab) when adding mass of dewaxed cuticle, up to r2 = 0.421 (field) when adding the Ca/dry mass ratio in the stylar end region or up to r2 = 0.478 (field) when entering the strain release on isolation into the model. A protocol for phenotyping is suggested that allows larger progenies to be phenotyped for microcracking, DCM mass and strain release.

Evaluating socioeconomic inequalities in self-rated oral health and its contributing factors in Brazilian older adults

Objectives This study aimed to evaluate socioeconomic inequalities in self-reported oral health among community-dwelling Brazilian older adults and evaluate the oral health factors contributing to the inequalities. Methods This was a cross-sectional study with data from the Brazilian National Health Survey conducted in 2019. The dependent variable is the self-report of oral health categorized as good or poor. Household per capita income in quintiles and schooling were used as socioeconomic variables. The explanatory covariates were age; gender; limitation in basic activities of daily living; number of teeth, use of dental prostheses; difficulty in eating; and recent dental visit. The Oaxaca-Blinder two-fold decomposition for binary outcomes was used to evaluate the factors contributing to the inequalities in self-reported oral health. Results Self-reported poor oral health was found among 35.8% of the dentate and 29.6% of the edentulous individuals. Poor self-reported oral health was more prevalent among older adults with low income and educational levels. Among dentate individuals, the difference in the proportion of poor self-reported oral health (the gap) between those with no schooling and those with some schooling was 12.8 percent points (p.p.), favoring the poor. The gap between dentate in the lowest and highest income groups was 14.8 p.p. favoring the poor. Among edentulous individuals, those with no schooling had a higher proportion of self-reported oral health (total gap 10.6 p.p.). Concerning income inequalities, the gap favored the poorer group and was 5.4 p.p. higher among individuals in the lowest income group. Conclusion The decomposition analyses suggested that oral health variables explained most of the education and income inequalities; difficulties in eating were the most contributing factor in both the dentate and edentulous groups. There was a relatively reduced contribution of recent dental visits to socioeconomic inequality.

Gender disparities in application and admission to the medical residency program in Peru: A cross sectional study from 2016 to 2023

Objective To investigate gender disparities in applications and admissions to the medical residency programs in Peru, focusing on differences in application and admission proportions between male and female. Methods We conducted a cross-sectional study to assess the proportions of female applicants and admissions to medical residency programs in Peru from 2016 to 2023. Bayesian multilevel linear models were employed, incorporating random intercepts and slopes by specialty to account for variability across specialties. This approach provided initial proportions of female in 2016 (intercepts) and annual percentage changes (beta coefficients) for each specialty. A multilevel Poisson regression model with robust variance was used to determine if being female was associated with higher admission frequency. Results Of the 48,013 applicants, 48% were considered female applicants. Most specialties exhibited an increasing trend in female applicants (+0.2% to +2% annually), except for Family Medicine, Hematology, Pediatric Neurology, and Pathological Anatomy (-0.6%, -0.6%, -0.7%, and -0.9% annually, respectively). The specialties with the highest proportions of female admissions were in Physical Medicine and Rehabilitation (71.9%), Dermatology (71.2%), and Pathological Anatomy (71.2%). In contrast, the lowest proportions were observed in Neurosurgery (18.9%), Thoracic and Cardiovascular Surgery (17.7%), and Urology (15.6%). Declining trends in female admissions were noted in Family Medicine, Hematology, and Pathological Anatomy (-0.6%, -0.6%, and -0.8% annually, respectively). In addition, being female was associated with an 18% lower probability of admission to the medical residency program (prevalence ratio: 0.82; 95% CI: 0.78–0.85; p-value: <0.001). Conclusion This study identified persistent gender disparities in medical residency programs in Peru, with female applicants facing reduced probabilities of admission and exhibiting specialty-specific trends from 2016 to 2023.