Using predictive models unravel the potential of titanium oxide-loaded activated carbon for the removal of leachate ammoniacal nitrogen.

The TiO2 nanocomposite efficiency was determined under optimized conditions with activated carbon to remove ammoniacal nitrogen (NH3-N) from the leachate sample. In this work, the facile impregnation and pyrolysis synthesis method was employed to prepare the nanocomposite, and their formation was confirmed using the FESEM, FTIR, XRD, and Raman studies. In contrast, Raman phonon mode intensity ratio ID/IG increases from 2.094 to 2.311, indicating the increase of electronic conductivity and defects with the loading of TiO2 nanoparticles. The experimental optimal conditions for achieving maximum NH3-N removal of 75.8% were found to be a pH of 7, an adsorbent mass of 1.75 mg/L, and a temperature of 30 °C, with a corresponding time of 160 min. The experimental data were effectively fitted with several isotherms (Freundlich, Hill, Khan, Redlich-Peterson, Toth, and Koble-Corrigan). The notably elevated R2 value of 0.99 and a lower ARE % of 14.61 strongly support the assertion that the pseudo-second-order model compromises a superior depiction of the NH3-N reduction process. Furthermore, an effective central composite design (CCD) of response surface methodology (RSM) was employed, and the lower RMSE value, precisely 0.45, demonstrated minimal disparity between the experimentally determined NH3-N removal percentages and those predicted by the model. The subsequent utilization of the desirability function allowed us to attain actual variable experimental conditions.

A dosimetric comparison of intensity-modulated radiotherapy versus rapid arc in gynecological malignancies: Dose beyond planning target volume, precisely 5Gy volume.

Introduction: Aim of radiotherapy is precise dose delivery with objective of achieving maximum local control and minimal toxicity by decreasing dose to organ at risk (OAR).This aim can be achieved by technologies like intensity-modulated radiotherapy (IMRT) and volumetric arc therapy. However, later offers comparable or even better plan quality with shorter treatment time. It is important to note that low dose regions are also a concern due long-term risk of developing a second cancer after radiotherapy. The objective of our study is to do dosimetric comparison of IMRT vs. Rapid arc (RA) plan in gynecology cancer and specifically to assess dose beyond planning target volume (PTV), precisely 5 Gy volume. Methods: Each 20 eligible patients underwent radiotherapy planning on eclipse by both IMRT and RA plans as per institution protocols. Comparative dosimetric analysis of both plans was done by paired sample t-test. PTV metrics compared were D95%, homogenecity index (HI), and conformity index (CI). OAR dose compared were bowel V40 Gy <30%, Rectum V30 Gy <60%, Bladder V45 Gy <35%, and bilateral femur head and neck V30 Gy < 50%. Futhermore, calculated monitor units (MUs) were also compared. Finally, volume of normal tissue beyond the PTV, specifically 5 Gy volume, was compared between plans. Results: Dosimetric plan comparison showed statistically significant difference in RA and IMRT plans with improved PTV coverage and better OAR tolerance with RA plan. In addition, MU used were significantly less in RA plan, coupled with reduced V5 Gy volume. Conclusion: In sum, RA plans are dosimetrically significantly better compared to IMRT plans in gynecological malignancies in terms of PTV coverage and OAR sparing. Importantly, not only less MU used but also significantly less normal tissue V5 Gy volume is less in RA compared to IMRT plans.

People's perceptions on COVID-19 vaccination: an analysis of twitter discourse from four countries.

More than six and half million people have died as a result of the COVID-19 pandemic till Dec 2022. Vaccination is the most effective means to prevent mortality and infection attributed to COVID-19. Identifying public attitudes and perceptions on COVID-19 vaccination is essential to strengthening the vaccination programmes. This study aims to identify attitudes and perceptions of twitter users towards COVID-19 vaccinations in four different countries. A sentiment analysis of 663,377 tweets from October 2020 to September 2022 from four different countries (i.e., India, South Africa, UK, and Australia) was conducted. Text mining using roBERTA (Robustly Optimized Bert Pretraining approach) python library was used to identify the polarity of people's attitude as "negative", "positive" or "neutral" based on tweets. A sample of 2000 tweets (500 from each country) were thematically analysed to explore the people's perception concerning COVID-19 vaccines across the countries. The attitudes towards COVID-19 vaccines varied by countries. Negative attitudes were observed to be highest in India (58.48%), followed by United Kingdom (33.22%), Australia (31.42%) and South Africa (28.88%). Positive attitudes towards vaccines were highest in the United Kingdom (21.09%). The qualitative analysis yielded eight themes namely (i) vaccine shortages, (ii) vaccine side-effects, (iii) distrust on COVID-19 vaccines, (iv) voices for vaccine equity, (v) awareness about vaccines, (vi) myth busters, (vii) vaccines work and (viii) vaccines are safe. The twitter discourse reflected the evolving situation of COVID-19 pandemic and vaccination strategies, lacunae and positives in the respective countries studied.

Optimizing leachate treatment with titanium oxide-impregnated activated carbon (TiO2@ASC) in a fixed-bed column: characterization, modeling, and prediction study.

This research focused on the application of a fixed bed column filled with immobilized titanium oxide-loaded almond shell carbon (TiO2@ASC) for the treatment of leachate. The adsorption performance of synthesized TiO2@ASC in fixed bed column is analyzed using adsorption experiments and modeling study. The characteristics of synthesized materials are determined by several instrumental techniques like BET, XRD, FTIR, and FESEM-EDX. The flow rate, initial concentration of COD and NH3-N, and bed height were optimized to determine the effectiveness of leachate treatment. The linear bed depth service time (BDST) plots equations with a correlation coefficient of greater than 0.98 confirmed the model's accuracy for COD and NH3-N adsorption in column structure. The adsorption process was found to be well predicted by an artificial neural network (ANN) model with a root mean square error of 0.0172 and 0.0167 for COD and NH3-N reduction, respectively. The immobilized adsorbent was regenerated using HCl and was found to be reusable for up to three cycles, promoting material sustainability. This study is aimed to contribute towards SDG 6 and SDG11 by United Nations Sustainable Development Goals.

Role of rapid arc-image-guided radiotherapy in hepatocellular carcinoma with portal vein tumor thrombosis: A study from tertiary care center in Punjab, India.

Background and Objectives: Treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is very challenging with poor outcome. In this situation, radiotherapy has become an alternative treatment modality, more precisely due to advances in radiation techniques. The goal of our study is to do analysis of these patients treated with rapid arc image-guided technology (RA-IGRT) at our institution. Materials and Methods: Thirteen patients were included in the study. As per intuition policy, patient set up, contouring, and treatment plans were generated. Radiological response assessment was done 1-month post-radiotherapy. Survival analysis curve along with Chi-square test for prognostic factors assessment was done using SPSS. Results: With median dose of 45 Gy in 20 fractions, we were able to achieve 27.3% objective response rate with median survival of 5 months in eligible patients. Conclusions: One-year overall survival up to 30% can be achieved in HCC with PVTT, especially in patients with objective response to radiotherapy with Japan Integrated Staging score 2, provided it is precisely hit by RA-IGRT.

Analysis of Rapid arc-based Radiation Therapy on Dosimetric Parameters in Cervical Cancer Patients with and without Bone Marrow Sparing.

BACKGROUND: The standard treatment for cervical cancer is chemoradiation therapy. Pelvic radiation is associated with higher dose to bone marrow (BM) causing interrupted treatment due to haematologic toxicity with inferior outcomes. This study aims to evaluate rapid arc technique in sparing pelvic BM and dosimetric parameters for pelvis V5GY, V10GY, V20GY, V30GY, and V40GY dose. METHOD: Twenty one cervical cancer patients were selected for the analysis. Planning target volume (PTV) contours, total pelvic BM and surrounding structures contours were standardised. Two rapid arc based procedures were designed for individual patient. One was done using bone marrow sparing (BMS) constraints while other was performed without BMS constraints. Data for both plans was calculated with regard to PTV, normal structures and pelvic BM. Difference in dose distribution in both groups was analysed using Wilcoxon and Friedman ANOVA test. RESULTS: In the presence of BM constraint a significant changes in pelvic BM dose for values of V10GY (p=0.002), V20GY (p=0.002) and V40GY (p=0.025) was observed. The coverage of PTV was found to be unaffected by adding BM constraint. CONCLUSION: The BM is radiosensitive structure so dosage is linked with haemtological toxicity. Increased dose is associated with higher grade of haematological toxicity in pelvic radiotherapy. The study suggests that adding BM constraint in plans reduced the pelvic BM dose while not affecting PTV coverage and dose to bowel, bladder and rectum. Bone marrow constraint in pelvic radiotherapy can be considered for better treatment toleration and to determine its role in decreasing haematological toxicity.

An Active and Low-cost Microwave Imaging System for Detection of Breast Cancer Using Back Scattered Signal.

A defected ground antenna with dielectric reflector is designed and investigated for breast tumour diagnosis. Ultra-wide band resonance (3.1 to 10.6 GHz) is achieved by etching two slots and adding a narrow vertical strip in a patch antenna. A high dielectric constant substrate is added below the antenna, which shows remarkable effect on performance. Antenna performance is verified experimentally on an artificially fabricated breast tissue and tumour. Malignant tissue has different dielectric properties than the normal tissue which causes deviation in the scattered antenna power. Average value of backscattered signal variation and ground penetrating radar (GPR) algorithm is used to localize the tumour of radius 4mm in breast tissue.

m-s-m cationic gemini and zwitterionic surfactants - a thermodynamic analysis of their mixed micelle formation.

Micelle formation enthalpies (Δmic H values) have been calorimetrically determined at 298 K for three sets of mixed zwitterionic/cationic gemini systems consisting of N-dodecyl-N,N-dimethyl-3-ammonio-1-propanesulfonate (ZW3-12) and a series of structurally related gemini surfactants, the N,N'-bis(dimethyldodecyl)-α,ω-alkanediammonium dibromide (12-s-12) systems. From the experimental and the estimated ideal micelle formation enthalpies, the excess enthalpies were obtained. The degrees of nonideality of the interaction in the mixed micelle (ß m) from our previous work was used along with the excess enthalpy values to determine excess thermodynamic quantities of the surfactants in the mixed system according to Regular Solution Theory (RST) and Motomura's theory. The excess enthalpies for the ZW3-12/12-4-12 were positive in magnitude and rose sharply when small amounts of the zwittergent were distributed into the gemini micelles. The excess enthalpies for the ZW3-12/12-5-12 and the ZW3-12/12-6-12 systems were also >0 kJ mol-1, and as a function of zwittergent composition, were quite different to those of the ZW3-12/12-4-12 mixed micelles. These results indicate that the heat of mixed micelle formation is strongly dependent on electrostatic interactions and the structure of the surfactants involved, specifically, the length of the tether group for the 12-s-12 gemini surfactants. From the calorimetric data and the application of RST and Motomura's theory, we have obtained estimates of the excess Gibbs energy and entropy of mixing. An analysis of the three thermodynamic properties suggests that the relative contributions of enthalpic and entropic effects to nonideal behavior for mixed micelles involving gemini surfactants are strongly dependent on the gemini structure.

m-s-m Cationic Gemini and Zwitterionic Surfactants-Spacer-Dependent Synergistic Interactions.

Critical micelle concentration (cmc) values were determined for the mixed zwitterionic/cationic gemini systems of N-dodecyl- N, N-dimethyl-3-ammonio-1-propanesulfonate (ZW3-12)/ N, N'-bis(dimethyldodecyl)-α,ω-alkanediammonium dibromide (12-s-12) systems. The cmc values for the mixed systems were determined through conductivity measurements. The degree of nonideality of the interaction in the mixed micelle (ßm), for each system, was determined according to Rubingh's nonideal solution theory. In most cases, the systems exhibited negative deviations (-ßm values) at high surfactant mole fractions of zwittergent (αZW3-12). Specifically, the ZW3-12/12-4-12 system displayed -ßm values at αZW3-12 ≥ 0.5, while both the ZW3-12/12-5-12 and the ZW3-12/12-6-12 systems displayed -ßm values over the entire mole fraction range. Except for the low mole fraction range in the 12-4-12 system, these mixed surfactant systems demonstrated almost identical behavior to the n-dodecyltrimethylammonium bromide/12-2-12 system studied by Bakshi et al. providing further evidence that ZW3-12 tends to behave as a cationic surfactant in mixed surfactant systems. The manner in which the cosurfactants aggregate in the micelles was determined via two-dimensional (2D) NOESY spectroscopy. In the case of both the ZW3-12/12-5-12 and the ZW3-12/12-6-12 systems, the 2D NOESY spectra exhibited strong cross peaks between the gemini and zwitterionic surfactants over the entire micellar composition range. In the case of the ZW3-12/12-4-12 system, little cross peak intensity was observed between the gemini and the zwitterionic surfactant at low micellar compositions of the zwittergent. The results suggest some micelle demixing is occurring between the gemini and the zwittergent certain micellar composition ranges, a phenomenon rarely associated with hydrocarbon surfactants.

Live-cell time-lapse imaging and single-cell tracking of in vitro cultured neural stem cells - Tools for analyzing dynamics of cell cycle, migration, and lineage selection.

Neural stem cell (NSC) cultures have been considered technically challenging for time-lapse analysis due to high motility, photosensitivity, and growth at confluent densities. We have tested feasibility of long-term live-cell time-lapse analysis for NSC migration and differentiation studies. Here, we describe a method to study the dynamics of cell cycle, migration, and lineage selection in cultured multipotent mouse or human NSCs using single-cell tracking during a long-term, 7-14 day live-cell time-lapse analysis. We used in-house made PDMS inserts with five microwells on a glass coverslip petri-dish to constrain NSC into the area of acquisition during long-term live-cell imaging. In parallel, we have defined image acquisition settings for single-cell tracking of cell cycle dynamics using Fucci-reporter mouse NSC for 7 days as well as lineage selection and migration using human NSC for 14 days. Overall, we show that adjustments of live-cell analysis settings can extend the time period of single-cell tracking in mouse or human NSC from 24-72 h up to 7-14 days and potentially longer. However, we emphasize that experimental use of repeated fluorescence imaging will require careful consideration of controls during acquisition and analysis.

Improved JPEG anti-forensics with better image visual quality and forensic undetectability.

There is an immediate need to validate the authenticity of digital images due to the availability of powerful image processing tools that can easily manipulate the digital image information without leaving any traces. The digital image forensics most often employs the tampering detectors based on JPEG compression. Therefore, to evaluate the competency of the JPEG forensic detectors, an anti-forensic technique is required. In this paper, two improved JPEG anti-forensic techniques are proposed to remove the blocking artifacts left by the JPEG compression in both spatial and DCT domain. In the proposed framework, the grainy noise left by the perceptual histogram smoothing in DCT domain can be reduced significantly by applying the proposed de-noising operation. Two types of denoising algorithms are proposed, one is based on the constrained minimization problem of total variation of energy and other on the normalized weighted function. Subsequently, an improved TV based deblocking operation is proposed to eliminate the blocking artifacts in the spatial domain. Then, a decalibration operation is applied to bring the processed image statistics back to its standard position. The experimental results show that the proposed anti-forensic approaches outperform the existing state-of-the-art techniques in achieving enhanced tradeoff between image visual quality and forensic undetectability, but with high computational cost.

A Retrospective Comparison of Ultrasound-Assisted Catheter-Directed Thrombolysis and Catheter-Directed Thrombolysis Alone for Treatment of Proximal Deep Vein Thrombosis.

BACKGROUND: Recent studies have suggested that catheter-directed thrombolysis (CDT) reduces development of post-thrombotic syndrome (PTS). Ultrasound-assisted CDT (USCDT) might enhance the efficiency of thrombolysis. We aimed to compare USCDT with CDT on efficacy, safety, development of PTS, and quality of life after long-term follow-up. METHODS: We describe a retrospective case series of 94 consecutive patients admitted with iliofemoral or more proximal deep vein thrombosis (DVT) to the University Hospital from 2002 to 2011, treated either with CDT or USCDT. Scheduled follow-up visits took place between April 2013 and January 2014. Venography measured the degree of residual luminal obstruction of the affected veins. Each patient completed the Short Form 36-item health survey assessment and the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms questionnaires. PTS was assessed using the Villalta scale. RESULTS: Risk factors of DVT were equally distributed between groups. In the USCDT group, we observed a significant decline in the duration of thrombolytic treatment (<48 h: 27 vs. 10 %), shortened hospital stay (median 6.0 days (IQR 5.0-9.0) vs. 8.0 (IQR 5.8-12.0)), and less implantation of (intravenous) stents (30 vs. 55 %). There was no difference in patency (76 vs. 79 % fully patent), prevalence of PTS (52 vs. 55 %), or quality of life between groups after long-term follow-up (median 65 months, range: 15-141). CONCLUSIONS: In this observational study, USCDT was associated with shortened treatment duration, shorter hospital stay, and less intravenous stenting, compared to CDT alone without affecting the long-term prevalence of PTS or quality of life.

Swyer-James-Macleod Syndrome: A Rare Entity.

Swyer-James-MacLeod syndrome is a radiological entity characterised by hyperlucency of one or more lobes or of the entire lung associated with decreased number and diameter of ipsilateral peripheral pulmonary vessels resulting in difficult visibility of the arterial network, and unobstructed bronchial system. We report the case of a 12-year-old girl who presented with chief complaint of pain in the chest. Chest radiograph (postero-anterior view) showed hyperlucent left lung field with increased lung volume and shift of the mediastinum to the right side. Contrast-enhanced computed tomography (CECT) of the chest showed hyperlucency and diminished vascularity in the upper lobe and lingula of left lung with hyperinflation of the pulmonary parenchyma. On the basis of clinical and radiological findings, the patient was diagnosed to have Swyer-James-MacLeod syndrome.

Idiopathic pulmonary artery aneursym.

Idopathic pulmonary artery aneurysm (PAA) is a rare lesion. Clinical experience with this condition is limited and current knowledge is mainly derived from autopsy findings. We report a patient who came to us with complaints of chest pain, breathlessness on exertion and pedal oedema and was diagnosed to have PAA.

Nonaromatic hydrotropic cationic ammonium salts as a rheology modifier for an anionic/zwitterionic surfactant mixture.

In this article, we report additive-induced micellar growth and rheology modification for mixtures of anionic (sodium dodecyl sulfate, SDS) and zwitterionic (N-alkylated glycine derivative, Empigen BB or EBB) surfactants. Two nonaromatic hydrotropic salts (hexyltrimethylammonium bromide, C6TAB, and/or dibutylenebis(dimethylbutylammonium bromide), 4-4-4) are used as novel additives to induce micellar growth in these systems. Nuclear magnetic resonance (NMR), photon correlation spectroscopy (PCS), transmission electron microscopy (TEM), the Weissenberg effect, and rheology measurements were employed to assess mixed micelle formation, micellar growth, and rheology modifications. Finally, the manner in which the surfactants and hydrotropes self-assemble into aggregates has also been deduced from 2D NMR NOESY measurements. In this study, both hydrotropic ions have been found to contribute to similar structural modifications in the mixed micelles of the anionic and zwitterionic surfactants. However, the extent of the rheology modification in solution is found to be quite different when the gemini hydrotrope (4-4-4) versus the monomeric hydrotrope (C6TAB) is employed.

Assessment of SpondyloArthritis International Society criteria for axial spondyloarthritis in chronic back pain patients with a high prevalence of HLA-B27.

OBJECTIVE: The Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (SpA) allow SpA classification of HLA-B27-positive patients if ≥2 specific clinical SpA features are present. We investigated the performance of these clinical ASAS criteria in a population with a high prevalence of HLA-B27. METHODS: A total of 807 persons reporting chronic back pain (CBP) lasting for >4 weeks during a population survey underwent a clinical, laboratory, and radiologic evaluation. The ASAS criteria for axial SpA were then used to determine classification status. RESULTS: Only 332 patients (41% of all CBP patients) fulfilled the prerequisite ASAS definitions for CBP (duration of ≥3 months and onset at age <45 years). In this ASAS-defined CBP cohort (51% women, CBP onset at age 27.2 years, 17% HLA-B27 positive), ASAS classification criteria for axial SpA were met by 8.4% of patients. Radiographic SpA by the modified New York criteria was present in 2.4%, while 6% fulfilled the clinical arm of the ASAS SpA criteria only. One-fifth of patients with clinical SpA developed radiographic evidence of SpA after a median of 8 years. CONCLUSION: Application of the clinical ASAS classification criteria in an area with a high prevalence of HLA-B27 leads to significant increases in the prevalence of axial SpA compared to radiologic SpA among CBP patients. This increase in the prevalence of disease is likely to have significant ramifications for patient management and health care systems.

Interaction and solubilization of some phenolic antioxidants in Pluronic® micelles.

The solubilization of four phenolic antioxidants, namely p-hydroxybenzoic acid (PHBAA), syringic acid, sinapic acid, and quercetin in micelles of an ethylene oxide (EO)-propylene oxide (PO) triblock copolymer Pluronic® P104 (EO27-PO61-EO27, PPO mol wt=3540, % PEO=40) was examined at different temperatures, pHs, and in the presence of sodium chloride. The nano-size core-shell micelles of P104 characterized by dynamic light scattering had hydrodynamic diameter of about 18-20 nm with low polydispersity. Antioxidants induced micellization and micellar growth were observed. The critical micellar concentration (CMC), critical micellar temperature (CMT), cloud point (CP) of P104 decreased due to solubilization and interactions of antioxidants. The solubilization was favored at higher temperature, pH and in the presence of salt and follows the order PHBA>syringic acid>sinapic acid>quercetin which corresponds to the trend in their aqueous solubility. The location of antioxidant in micelles observed from NOESY spectra. Structure and hydrophobicity of antioxidants were found to be governing factors for their interaction and location in the micelles.

Atherosclerosis in abdominal aortic aneurysms: a causal event or a process running in parallel? The Tromsø study.

OBJECTIVE: The pathogenesis of abdominal aortic aneurysm (AAA) formation is poorly understood. We investigated the relationship between carotid, femoral, and coronary atherosclerosis and abdominal aortic diameter, and whether atherosclerosis was a risk marker for AAA. METHODS AND RESULTS: Ultrasound of the right carotid artery, the common femoral artery, and the abdominal aorta was performed in 6446 men and women from a general population. The burden of atherosclerosis was assessed as carotid total plaque area, common femoral lumen diameter, and self-reported coronary heart disease. An AAA was defined as maximal infrarenal aortic diameter > or =30 mm. No dose-response relationship was found between carotid atherosclerosis and abdominal aortic diameter <27 mm. However, significantly more atherosclerosis and coronary heart disease was found in aortic diameter > or =27 mm and in AAAs. The age- and sex-adjusted odds ratio (OR) (95% CI) for AAA in the top total plaque area quintile was 2.3 (1.5 to 3.4), as compared with subjects without plaques. The adjusted OR (95% CI) was 1.7 (1.1 to 2.6). No independent association was found between femoral lumen diameter and AAA. CONCLUSIONS: The lack of a consistent dose-response relationship between atherosclerosis and abdominal aortic diameter suggests that atherosclerosis may not be a causal event in AAA but develops in parallel with or secondary to aneurismal dilatation.

Abdominal aortic aneurysms, or a relatively large diameter of non-aneurysmal aortas, increase total and cardiovascular mortality: the Tromsø study.

BACKGROUND: In a population-based study in Tromsø, Norway, the authors assessed whether an abdominal aortic aneurysm (AAA) or the maximal infrarenal aortic diameter in a non-aneurismal aorta influence total and cardiovascular disease (CVD) mortality. METHODS: A total of 6640 men and women, aged 25-84 years, were included in a 10-year mortality follow-up: 345 subjects with a diagnosed AAA and 6295 subjects with a non-aneurismal aorta. Non-aneurismal aortic diameter and prevalent AAAs were categorized into seven groups. RESULTS: In subjects without an AAA, an aortic diameter > or =30 mm increased age- and sex-adjusted total mortality [mortality rate ratio (MRR) = 3.73, 95% confidence interval (CI) 1.77-7.89] and CVD mortality (MRR = 9.24, 95% CI 4.07-20.97) compared with subjects with aortic diameter of 21-23 mm. An AAA at screening was strongly associated with deaths from aortic aneurysm and was associated with total (MRR = 1.60, 95% CI 1.31-1.96) and CVD mortality (MRR = 2.41, 95% CI 1.81-3.21). This was not explained by deaths due to an AAA. Adjustments for CVD risk factors could fully explain the increased total, but not CVD mortality in subjects with an AAA. CONCLUSIONS: An AAA increases total and CVD mortality. In the large majority of subjects with a non-aneurysmal aorta, the diameter does not influence total or CVD mortality. However, in individuals with a maximal diameter >26 mm (2% of the population), a positive relationship is found.