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Unveiling high solifuge diversity: Review of the genus Pseudocleobis Pocock, 1900 (Ammotrechidae) in Chile with the description of nine new species

The Pseudocleobis from Chile are revised. Pseudocleobis morsicans (Gervais, 1849) and P. chilensis Roewer, 1934 are considered species inquerenda. Pseudocleobis andinus (Pocock, 1899) is removed from the Chilean fauna, and its previous records are considered misidentifications. Pseudocleobis alticola Pocock, 1900 is recorded from Chile for the first time. Nine new species are described, Pseudocleobis elongatus n. sp., P. atacamensis n. sp., P. puna n. sp., P. krausi n. sp., P. choros n. sp., P. lalackama n. sp., P. mumai n. sp., P. cekalovici n. sp. and P. escuadra n. sp. The species can be distinguished by the male chelicera morphology. We discuss the relationship of Chilean Pseudocleobis with other species of the genus, based on morphology. This work increases the number of known Chilean solifuge species by almost 70%, revealing the high degree of diversification of this group in Chile.

Nearby armed conflict affects girls’ education in Africa

Female education is a crucial input to women’s agency and empowerment, and has wide-ranging impacts, from improved labor market outcomes to reducing child mortality. Existing gender-specific evidence on the effect of armed conflict on education is conflict-specific and mixed. We link granular data on conflict events to georeferenced survey data on educational attainment from 28 countries in Africa, and use a regression-based approach to estimate the local effect of conflict exposure on female years of schooling. We find that conflict events occurring within 25 kilometers during a female child’s primary school years reduces years of schooling by 0.4 years by adolescence. We do not find the same effect for males. Exposure to only low intensity conflict events with at most two casualties has persistent negative and significant effects. Consecutive years of conflict, however, can have positive effects in later years, which offset earlier negative effects, suggesting a habituation to violence. In the past two decades, we estimate excess child mortality in Africa associated with the indirect channel of women’s education to be similar in magnitude to the number of direct child casualties due to conflict.

Correction: In search of autophagy biomarkers in breast cancer: Receptor status and drug agnostic transcriptional changes during autophagy flux in cell lines

Knowledge of and perception towards eclampsia among women and men in Unguja Island, Zanzibar: A qualitative study

Background Eclampsia is among the primary causes of maternal and perinatal morbidity and mortality in Zanzibar. Many women and men are not aware of the signs, symptoms and causes of eclampsia and may have different explanatory models. Therefore, this study aimed to describe the community understanding of pre-eclampsia, as a key stage to improve maternal and perinatal health in Unguja Island, Zanzibar. Methods A qualitative study design of six focus group discussions (FDGs) was performed using a focus group interview guide; 51 male and female respondents at three selected wards of Unguja Island, Zanzibar participated. Thematic analysis was applied using Qualitative data analysis (QDA Miner Lite software version 2.0.9). Results Overall participants demonstrated a lack of understanding regarding eclampsia. The majority of participants perceived that there are certain things related to eclampsia: Mjusi or Mdudu (devil/satanic), superstitious issues, tension/stress from partners, food consumption, eating slaughtered meat like chicken, cow and goat during pregnancy, nice smelling lotion, soap and perfumes have been stated to be the causes of eclampsia. Spiritual and traditional remedies were mentioned as a treatment for eclampsia, including herbs, makombe (written verses of the Qur’an) and steaming (smoked dry leaves). Local names of eclampsia used by the communities, in urban and rural areas are mjusi (lizard) or mdudu (bug), which means the devil enters a woman’s body, especially during pregnancy or within 42 days post-delivery. Conclusion Most participants had a lack of understanding of eclampsia and perceived that there are traditional and spiritual issues related to its causes, attributed risks and clinical presentation, which makes them rely more on traditional and spiritual treatments. Therefore, health educational programs in the community setting and at the antenatal clinics, aiming at improving knowledge and dismissing myths and misperceptions regarding eclampsia, are recommended in rural and urban areas of Unguja Zanzibar.

Prevalence and determinants of unhealthy feeding practices among young children aged 6–23 months in five sub-Saharan African countries

Introduction Despite the World Health Organization’s advice against unhealthy feeding, many low- and middle-income countries, including sub-Saharan Africa (SSA) countries, are experiencing a nutritional transition to high in sugar, unhealthy fats, salts, and processed carbohydrates for younger children. However, there is a scarcity of recently updated multicounty information on unhealthy feeding practices and determinants in SSA countries. Therefore, this study aimed to assess the pooled prevalence of unhealthy feeding practices and determinants among children aged 6–23 months in five SSA countries. Method A cross-sectional study design was employed with the most recent demographic and health survey secondary data (DHS) from five SSA countries. This secondary data was accessed from the DHS portal through an online request. The DHS is the global data collection initiative that provides detailed and high-quality data on population demographics, health, and nutrition in low- and middle-income countries. We used a weighted sample of 14,064 children aged 6–23 months. A multilevel mixed-effect binary logistic regression model was fitted to identify significant factors associated with unhealthy feeding practices. The level of statistical significance was declared with p-value < 0.05. Result This study found that overall, 62.4% (95% CI: 61.62–63.17) of children aged 6–23 months in five SSA countries had unhealthy feeding practices. Rural residents, lower-middle-income SSA countries, and children aged above 12 months had lower odds of unhealthy feeding practices. On the other hand, richer households and women who had not had an optimal antenatal care visit had higher odds of unhealthy feeding practices. Conclusion According to this study, nearly two out of three young children in five SSA countries had unhealthy feeding practices. Both individual and community-level factors are significantly associated with unhealthy feeding practices. As a result, responsible bodies shall make all efforts to reduce unhealthy feeding practices among young children in SSA countries.

Design and fabrication of novel microfluidic-based droplets for drug screening on a chronic myeloid leukemia cell line

Background The challenges associated with traditional drug screening, such as high costs and long screening times, have led to an increase in the use of single-cell isolation technologies. Small sample volumes are required for high-throughput, cell-based assays to reduce assay costs and enable rapid sample processing. Using microfluidic chips, single-cell analysis can be conducted more effectively, requiring fewer reagents and maintaining biocompatibility. Due to the chip’s ability to manipulate small volumes of fluid, high-throughput screening assays can be developed that are both miniaturized and automated. In the present study, we employ microfluidic chips for drug screening in chronic myeloid leukemia. This study aimed to establish a robust methodology integrating diverse assays, providing a holistic understanding of drug response. Material and methods Herein, we have used a chronic myeloid leukemia derived cell line (K562) for drug screening with an innovative microfluidic-based drug screening approach to investigate the efficacy of imatinib in K562 cells. Cell viability was assessed using MTT assay. Apoptosis was measured using Annexin/PI staining by flow cytometry. Results Significant increased apoptosis was seen in K562 cells treated with imatinib in the microfluidic device compared to cells treated with imatinib in 24- and 96-well plates. Moreover, in the microfluidic chip, drug screening time was reduced from 48 hours to 24 hours. Conclusion Compared to traditional approaches, microfluidic-based drug screening efficiently evaluates the efficacy of imatinib in K562 cells. This approach is promising for drug discovery and treatment optimization, as it increases sensitivity and streamlines the screening process.

Hear it here: Built environments predict ratings and descriptions of ambiguous sounds

The built environments we move through are a filter for the stimuli we experience. If we are in a darker or a lighter room or space, a neutrally valenced sound could be perceived as more unpleasant or more pleasant. Past research suggests a role for the layout and lighting of a space in impacting how stimuli are rated, especially on bipolar valence scales. However, we do not know how affective experiences and descriptions of everyday auditory stimuli are impacted by built environments. In this study, we examine whether listening to a series of ambiguously valenced sounds in an older, darker building leads these sounds to be rated as less pleasant—and described using more negatively valenced language—compared to listening to these sounds in a newer building with more natural light. In a between-subjects design, undergraduate participants at an older building or a newer building (nOld = 46, nNew = 46; nFemale = 71, nMale = 18, MAge = 21.18, RangeAge = 17-38) listened to ten sounds that had previously been rated as ambiguous in valence, then rated these sounds on a bipolar valence scale before being asked to describe, in writing, how they felt about each sound. Participants rated sounds as being more pleasant at the New site compared to the Old site, but the sentiment of their descriptions only differed between sites when controlling for collinearity. However, bipolar scale ratings and description sentiment were highly correlated. Our findings suggest a role for the features of built environments in impacting how we appraise the valence of everyday sounds.

N-acetyl-L-cysteine and lauric acid; effective antioxidant and antimicrobial feed additives for juvenile Pacific white shrimp (Litopenaeus vannamei) cultured at high stocking density

Present study aimed at improving the immune and antioxidant response of Pacific white shrimp (Litopenaeus vannamei) cultured at high stocking density fed with 0.2% supplementation of lauric acid (LA) and N-acetyl-L-cysteine (NAC). Shrimp (initial average weight = 0.65 g; n = 270) were grown at low stocking density (LSD) (n = 10/0.80 ft3 per replicate) and high stocking density (HSD) (n = 20/0.80 ft3 per replicate). They were randomly distributed into five groups (T1: negative control at LSD, T2: positive control at HSD, T3: at HSD and fed with LA supplement diet, T4: at HSD and fed with NAC supplemented diet, T5: at HSD and fed with combination of LA and NAC). All these five treatments were studied in triplicates and study continued for eight weeks. Better growth and higher levels of glucose, total protein, total hemocyte count and phagocytic index were observed in shrimp fed with NAC and LA supplemented diets. Observed survival rate and feed conversion ratio in all treatments was 75–89% and < 0.82, respectively. All parameters indicating stress were observed to be higher in T1 as compared to T2. Improved expression of superoxide dismutase and glutathione peroxidase and lower levels of malondialdehyde genes in T3, T4 and T5 showed that supplementation with these nutraceuticals can improve antioxidant response at high stocking density. A parallel increase was observed in the profiles of prophenoloxidase and lysozyme, underscoring the immune-boosting effects of both NAC and LA. This finding was further supported by higher expression of innate immune signaling pathway-related gene, toll like receptor-2 in T3, T4 and T5. In conclusion, NAC and LA, can possibly improve the resistance of white pacific shrimp against oxidative stress and pathogens when cultured in intensive production system.

Nucleosome repositioning in cardiac reprogramming

Early events in the reprogramming of fibroblasts to cardiac muscle cells are unclear. While various histone undergo modification and re-positioning, and these correlate with the activity of certain genes, it is unknown if these events are causal or happen in response to reprogramming. Histone modification and re-positioning would be expected to open up chromatin on lineage-specific genes and this can be ascertained by studying nucleosome architecture. We have recently developed a set of tools to identify significant changes in nucleosome architecture which we used to study skeletal muscle differentiation. In this report, we have applied these tools to understand nucleosome architectural changes during fibroblast to cardiac muscle reprogramming. We found that nucleosomes surrounding the transcription start sites of cardiac muscle genes induced during reprogramming were insensitive to reprogramming factors as well as to agents which enhance reprogramming efficacy. In contrast, significant changes in nucleosome architecture were observed distal to the transcription start site. These regions were associated with nucleosome build-up. In summary, investigations into nucleosome structure do not support the notion that fibroblasts to cardiac muscle cell reprogramming involves chromatin opening and suggests instead long-range effects such as breaking closed-loop inhibition.

Spatiotemporal evolution of hedging effects in Asia-Pacific countries amid Sino-US competition: Insights from massive event data

Facing the pressure of Sino-US strategic competition, countries in the Asia-Pacific region often adopt hedging strategies to minimize risk and protect their interests. If implemented, these strategies could impact relationships between countries and lead to political instability. Owing to a lack of theoretical evaluation frameworks and methods, few studies have examined the implementation effects of hedging strategies adopted by Asia-Pacific countries amid Sino-US competition. This study proposes a novel four-quadrant evaluation theoretical framework, and constructs a Geopolitical Relation Index and a Comparative Relation Index based on the Global Database of Events, Language, and Tone massive event data. Since 2000, the effects of hedging strategies in 19 Asia-Pacific countries against China and the US have been dynamically quantified. The research reveals that Asia-Pacific countries’ dynamic performances over 24 years can be categorized into three groups: significantly closer to China, significantly closer to the US, and swinging. Since implementing the Belt and Road Initiative, countries close to China have deepened their ties, while those aligned with the US have strengthened their ties. Asia-Pacific countries have demonstrated similar characteristics from Obama’s presidency to Biden’s presidency. The results contribute to the dynamic assessment and ongoing monitoring of the execution effects of Asia-Pacific countries’ diplomatic strategies towards China and the US, offering valuable insights for timely refinement of their foreign policies.

A novel multi-user collaborative cognitive radio spectrum sensing model: Based on a CNN-LSTM model

Cognitive Radio (CR) technology enables wireless devices to learn about their surrounding spectrum environment through sensing capabilities, thereby facilitating efficient spectrum utilization without interfering with the normal operation of licensed users. This study aims to enhance spectrum sensing in multi-user cooperative cognitive radio systems by leveraging a hybrid model that combines Convolutional Neural Networks (CNN) and Long Short-Term Memory (LSTM) networks. A novel multi-user cooperative spectrum sensing model is developed, utilizing CNN’s local feature extraction capability and LSTM’s advantage in handling sequential data to optimize sensing accuracy and efficiency. Furthermore, a multi-head self-attention mechanism is incorporated to improve information flow, enhancing the model’s adaptability and robustness in dynamic and complex environments. Simulation experiments were conducted to quantitatively evaluate the performance of the proposed model. The results demonstrate that the CNN-LSTM model achieves low sensing error rates across various numbers of secondary users (16, 24, 32, 40, 48), with a particularly low sensing error of 9.9658% under the 32-user configuration. Additionally, when comparing the sensing errors of different deep learning models, the proposed model consistently outperformed others, showing a 12% lower sensing error under low-power conditions (100 mW). This study successfully develops a CNN-LSTM-based cooperative spectrum sensing model for multi-user cognitive radio systems, significantly improving sensing accuracy and efficiency. By integrating CNN and LSTM technologies, the model not only enhances sensing performance but also improves the handling of long-term dependencies in time-series data, offering a novel technical approach and theoretical support for cognitive radio research. Moreover, the introduction of the multi-head self-attention mechanism further optimizes the model’s adaptability to complex environments, demonstrating significant potential for practical applications.

Relationship between nocturnal blood pressure dip and β-parapapillary atrophy zone choroidal vessel density in normal-tension glaucoma patients

Purpose To investigate the relationship between nocturnal blood pressure (BP) dip and parapapillary choroidal vessel density (pCVD) in patients with normal-tension glaucoma (NTG) Methods This study analyzed 267 eyes of 267 untreated NTG patients who underwent 24-hour (h) intraocular pressure (IOP) and ambulatory BP monitoring in the habitual position. Patients were classified into 3 groups [non-dippers (nocturnal BP dip < 10%), dippers (nocturnal BP dip between 10% and 20%, and over-dippers (nocturnal BP dip > 20%)], and pCVDs were measured by using optical coherence tomography angiography (OCTA) images. Logistic regression analyses were performed to identify clinical factors associated with “over-dipper” cases. Linear regression analyses were conducted to determine the correlation between various clinical variables and pCVD. Results In clinical characteristics, over-dippers exhibited lower pCVD values compared to non-dippers or dippers (P = 0.004). High diurnal intraocular pressure (IOP) fluctuation (P = 0.031), high diurnal mean arterial pressure (MAP) fluctuation (P = 0.001), and low pCVD (P = 0.002) were identified as predictors of being “over-dipper” in multivariable logistic regression analyses. Moreover, peripapillary retinal vessel density (P = 0.040), presence of choroidal microvasculature dropout (P = 0.039), and nocturnal MAP dip % (P = 0.002) showed significant correlations with pCVD according to multivariable linear regression analyses. Conclusion Over-dippers presented with lower pCVD than non-dippers or dippers as measured by OCTA choroidal images. Low pCVD was a predictor of “over-dipper” cases and associated with a greater percentage of nocturnal MAP dip in NTG patients. 24-h ambulatory BP monitoring may provide further information for detecting low pCVD in NTG patients with nocturnal BP dip.

Dental caries and related factors in the elderly of the Azar cohort population: A cross-sectional study

Objective Oral health is often overlooked among the elderly due to the numerous comorbidities prevalent in this population. However, oral health significantly influences quality of life by affecting both general health and psychological well-being. The present study aimed to assess dental caries in elderly individuals using the DMFT index (decayed, missing, and filled teeth) and to explore its relationship with various factors based on data from the Azar cohort study in Iran. Materials and methods In this cross-sectional study, data from the initial phase of the Azar cohort study, which involved 2629 elderly individuals (aged 60 years and older), were statistically analyzed. The Azar cohort study evaluated demographic factors, the history of chronic diseases, and behavioral habits using a well-designed questionnaire administered through face- to -face interviews. The DMFT index was evaluated through oral examination. A negative binomial regression analysis with a log link function was employed to investigate the relationship between the DMFT and related variables, including gender, age, marital status, level of education, socioeconomic status, chronic diseases, smoking, alcohol consumption, and body mass index. Results The mean (SD) age of elderly individuals was 64.15±2.91 years. The mean (SD) DMFT was 28.42±6, and the mean (SD) number of missing teeth was 26.58±8.36. Approximately 70.8% of elderly individuals were edentulous. Women exhibited a higher mean DMFT score and a greater number of missing teeth compared to men. The mean DMFT score and its components significantly differed based on the level of education and socioeconomic status. However, no significant relationship was found between the DMFT index and the variables in the multiple regression analysis. Conclusion The high prevalence of edentulism and the elevated DMFT scores in the elderly population of the Azar cohort indicate a poor oral health status among older individuals. Providing the dental services within the primary health care system for the adults, can be beneficial in improving oral health in old age.

Soil quality indicator-based land productivity modelling for agricultural sustainability

Rapid population expansion has made food security a global concern for humanity, necessitating a sustainable assessment of natural resources. Well evaluated and managed soil is one of the most significant resources that can assist close the gap between supply and demand for food to attain food security. A precise assessment of land productivity (LP) is essential for sustainable land use management. The primary aim of this research is to predict the land productivity index (LPI) for certain locations on Egypt’s northwest coast under current conditions using soil quality indicators (SQIs). Additionally, the study proposed relevant management actions to boost land productivity in the future. To achieve this aim, a spatial model was created to assess LPI for some areas in the north western coast of Egypt. LP equation was used to estimate current land productivity index (CLPI) and potential land productivity index (PLPI). Results found that the study area mainly located under two classes of CLPI, e.g., average (class ⅡⅠ) represents an area of 13322.63 ha (67.55%) and good grade (class Ⅱ) covers an area of 4339.78 ha (22%). PLPI grades were good (II) and average (III) with an area of 16192.54 ha (82.10%) and 1903.23 ha (9.65%), respectively. The finding showed that more than 60% of the studied area was converted from poor and average class to good class after applying the proposed solutions of soil improvement. The methodology presented here can easily be replicated under similar circumstances in arid zones, allowing local governments and decision-makers to utilize the quantitative results obtained to ensure sustainable development.

Expression of Concern: Sialidase NEU3 Dynamically Associates to Different Membrane Domains Specifically Modifying Their Ganglioside Pattern and Triggering Akt Phosphorylation

Impact of hysterectomy on opioid use in patients with adenomyosis: A nationwide register study

Introduction Dysmenorrhea and heavy menstrual bleeding are the most common symptoms in adenomyosis, in addition to infertility and chronic pelvic pain. Hysterectomy is a common treatment for adenomyosis symptoms with curative effect on heavy menstrual bleeding but with less studied effects on pain reduction. Material and methods This is a nationwide retrospective register-based cohort study including all hysterectomized patients with pathology-verified adenomyosis between 1 January 2012 and 31 December 2015 with a long-term follow-up three years pre- and three years postoperatively. Two national registers were linked in order to describe the primary outcome of proportion with use of opioids among hysterectomized patients with and without adenomyosis pre- and postoperatively. Logistic and multinomial regression models were used. Results A total of 2,228 (15%) patients had pathology-verified adenomyosis. Overall opioid use was 18.6% and 21.1% three years before and three years after surgery, respectively. Results showed a significantly increased risk of opioid use three years after hysterectomy in patients with preoperative use of opioids and antidepressants (adjusted Odds Ratio (aOR) 5.7, 95% Confidence Interval (CI) 4.5–7.2 and aOR 1.4, 95% CI 1.1–1.8). The risk of needing long-term opioids was higher among patients with smaller uteri (<300g, aOR 2.8, 95% CI 1.7–4.7) compared to women with uterine sizes ≥600g. Conclusions Hysterectomy does not reduce opioid use among adenomyosis patients in long-term follow-up, although the subjective reduction of pain was not investigated in this study. Women with preoperative use of opioids/antidepressants and uterine size <300g are at increased risk for chronic opioid use.

Shell colour luminance of Cuban painted snails, Polymita picta and Polymita muscarum (Gastropoda: Cepolidae)

Climate change is a global environmental threat, directly affecting biodiversity. Terrestrial gastropods are particularly susceptible to alterations in temperature and humidity and have develop morph-physiological and behavioural adaptations in this regard. Shell colour polymorphism and its potential implication for thermoresistance constitute an unexplored field in Neotropical land snails. The variation in shell colour luminance is characterized in the threatened endemic Eastern Cuban tree snails Polymita picta and Polymita muscarum using digital tools; being able to discriminate shell luminance between colour morphs for both species, under different image-taking conditions. For P. muscarum, the albino morph presented the highest luminance values (152.7 ± 0.4); while the lowest values correspond to the brown morph with dark bands (112.9 ± 0.8). Otherwise, for P. picta, the morphs showing the highest luminance were yellow with a pink sutural band (112.8 ± 7.1) and pale yellow (112.6 ± 10.3) and the lowest luminance corresponded to the black morph (44.5 ± 1.2). The presence of dark bands decreased the luminance values regardless of their position in the shell, the morph and the species analysed. In general, the shells of P. muscarum have higher luminance than those of P. picta. Luminance variations demonstrate the ’indiscrete’ nature of this trait and highlight the complex interactions between evolutionary mechanisms and shell color polymorphism in Polymita. This supports the hypothesis that colour has adaptive value for thermoregulation, encompassing not only the background colour but also the coloration of the bands. The differences in the shell luminance in both species suggest a correlation with the geographical distribution and corresponding habitats. Based on our findings, yellowish morphs will be more resistant to future climatic conditions in their respective habitats on the island.

Similarities and differences in waste composition over time and space determined by multivariate distance analyses

The composition of solid waste affects technology choices and policy decisions regarding its management. Analyses of waste composition studies are almost always made on a parameter by parameter basis. Multivariate distance techniques can create wholisitic determinations of similarities and differences and were applied here to enhance a series of waste composition comparisons. A set of New York City residential waste composition studies conducted in 1990, 2004, 2013, and 2017 were compared to EPA data and to 88 studies conducted in other US jurisdictions from 1987–2021. The total residential waste stream and the disposed wastes in NYC were found to be similar in nature, and very different from the composition of wastes set out for recycling. Disposed wastes were more similar across the five NYC boroughs in a single year than in one borough over the 28-year time period, but recyclables were more similar across 14 years than across the boroughs in a single year. Food and plastics percentages in total and disposed waste streams increased over time, and paper percentages fell. The food disposal rate in NYC over time increased much less than EPA data show. The rate of plastics and paper disposal in NYC decreased. NYC data largely conformed to trends from the 88 other waste composition studies and did not generally agree with EPA data sets. The use of novel-to-waste studies multivariate distance analyses offers the promise of simplifying the identification of overall similarities and differences across waste studies, and so improving management and planning for solid waste.

The impact of reduced skeletal muscle mass at stroke onset on 3-month functional outcomes in acute ischemic stroke patients

Introduction Sarcopenia, characterized by reduced skeletal muscle mass (RMM), is increasingly recognized as a significant factor influencing outcomes in various health conditions, including stroke. Although most studies focus on sarcopenia developing during stroke rehabilitation, the impact of sarcopenia present at the onset of acute ischemic stroke remains underexplored. This study aims to evaluate the effect of RMM at stroke onset on 3-month functional outcomes in acute ischemic stroke patients. Materials and methods We prospectively enrolled acute ischemic stroke patients admitted between May 2019 and December 2019. Muscle mass was accessed early during hospitalization using whole-body dual-energy X-ray absorptiometry (DXA), and patients were categorized into RMM and normal muscle mass (NMM) groups based on the Asian Working Group for Sarcopenia (AWGS) criteria. Functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS), with unfavorable outcomes defined as mRS scores 2–5. Multivariable logistic regression and SHAP (Shapley Additive exPlanations) analyses were used to evaluate the independent impact of RMM on 3-months functional outcomes. Results A total of 99 patients were analyzed. The RMM group had a significantly higher prevalence of unfavorable outcomes at 3 months compared to the NMM group (p < 0.001). Patients with RMM were older and presented with more severe strokes. Multivariable analysis confirmed RMM as an independent predictor of unfavorable outcomes (adjusted OR: 8.07, 95% CI: 1.603–40.66, p = 0.011), even after adjusting for age and initial stroke severity. SHAP analysis ranked RMM as the second most influential predictor of unfavorable outcomes, following NIHSS on admission. These findings indicate that RMM not only worsens initial stroke severity but also independently hinders post-stroke recovery. Conclusions Reduced muscle mass at the onset of acute ischemic stroke is a significant, independent predictor of unfavorable outcomes at 3 months. In addition to its impact on recovery, RMM is linked to older age and more severe strokes, worsening prognosis. Maintaining muscle mass is also crucial for stroke prevention, as it supports cardiovascular health and resilience. Early identification and intervention for sarcopenia can improve recovery and reduce future stroke risk.

Estimating the burden of underdiagnosis within England: A modelling study of linked primary care data

Introduction Undiagnosed chronic disease has serious health consequences, and variation in rates of underdiagnosis between populations can contribute to health inequalities. We aimed to estimate the level of undiagnosed disease of 11 common conditions and its variation across sociodemographic characteristics and regions in England. Methods We used linked primary care, hospital and mortality data on approximately 1.3 million patients registered at a GP practice for more than one year from 01/04/2008–31/03/2020 from Clinical Practice Research Datalink. We created a dynamic state model with six states based on the diagnosis and mortality of 11 conditions: coronary heart disease (CHD), stroke, hypertension, chronic obstructive pulmonary disease, type 2 diabetes, dementia, breast cancer, prostate cancer, lung cancer, colorectal cancer, and depression/anxiety. Undiagnosed disease was conceptualised as those who died with a condition but were not previously diagnosed. This was combined with observed data on the incidence of diagnosis, the case fatality rate in the diagnosed, and an assumption about how that rate varies with diagnosis to estimate the number of undiagnosed disease cases over the total number of disease cases (underdiagnosis) in each population group. We estimated underdiagnosis by year, sex, 10-year age group, relative deprivation, and administrative region. We then applied small-area estimation techniques to derive underdiagnosis estimates for health planning areas (CCGs). Results Levels of underdiagnosis varied between 16% for stroke and 69% for prostate cancer in 2018. For all diseases, the level of underdiagnosis declined over time. Underdiagnosis was not consistently concentrated in areas with high deprivation. For depression/anxiety and stroke, underdiagnosis was estimated to be higher in less deprived CCGs, whilst for CHD and T2DM, it was estimated to be higher in more deprived CCGs, with no apparent relationships for other conditions. We found no uniform spatial patterns of underdiagnosis across all diseases, and the relationship between age, deprivation and the probability of being undiagnosed varied greatly between diseases. Discussion Our findings suggest that underdiagnosis is not consistently concentrated in areas with high deprivation, nor is there a uniform spatial underdiagnosis pattern across diseases. This novel method for estimating the burden of underdiagnosis within England depends on the quality of routinely collected data, but it suggests that more research is needed to understand the key drivers of underdiagnosis.