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In this analysis of data from two large studies, the more nuts were consumed, the lower the risk of death. People who ate a serving (28 g) of nuts seven or more times a week had a 20% lower risk of death than those who did not eat nuts. Nuts are nutrient-dense foods that are rich in unsaturated fatty acids, fiber, vitamins, minerals, and many other bioactive substances, such as phenolic antioxidants and phytosterols. 1 , 2 Observational studies and clinical trials have suggested that nut consumption has beneficial effects on coronary heart disease 1 and its intermediate biomarkers (e.g., blood cholesterol). 3 On the basis of these findings, the Food and Drug Administration concluded in 2003 that for most nuts, consumption of 43 g (1.5 oz) per day, as part of a low-fat diet, “may reduce the risk of heart disease.” 4 More recently, a randomized primary-prevention trial involving persons at high cardiovascular . . .

Objectives Psoriatic arthritis (PsA) is an inflammatory arthritis that is associated with psoriasis. Previous studies have found an association between smoking and psoriasis, but the association with PsA is unclear. The authors aimed to evaluate the association between smoking and the risk of incident PsA in a large cohort of women. Methods 94 874 participants were included from the Nurses' Health Study II over a 14-year period (1991–2005). Information on smoking was collected biennially during follow-up. The incidence of clinician-diagnosed PsA was ascertained and confirmed by self-reported questionnaires. Results During 1 303 970 person-years' follow-up, the authors identified 157 incident PsA cases. Among total participants, smoking was associated with an elevated risk of incident PsA. Compared with never smokers, the RR was 1.54 for past smokers (95% CI 1.06 to 2.24) and 3.13 for current smokers (95% CI 2.08 to 4.71). With increasing smoking duration or pack-years, the risk of PsA increased monotonically (p for trend <0.0001). The increase in risk was particularly significant for PsA cases with more severe phenotypes. Secondary analysis among participants developing psoriasis during the follow-up replicated the association, demonstrating an increased risk of PsA among psoriasis cases. The risk was significant for those with higher cumulative measures of smoking or PsA cases with more severe phenotypes. Conclusion In this study smoking was found to be associated with a risk of PsA and cumulative measures of smoking were also associated with a higher risk of PsA among women.

Alpine natural heritage sites hold significant value due to their unique global resources. Studying land cover changes in these areas is crucial for maintaining and preserving multiple their values. This study takes Kalajun-Kuerdening, one of the components of Xinjiang Tianshan World Natural Heritage Site, as an example to analyze land cover changes and their driving factors in alpine heritage sites. Highlights include: (1) Between 1994 and 2023, Forest and Grassland increased by 55.96 km 2 and 18.16 km 2 , with notable forest growth from 2007 to 2017. Trends in Forest changes align with forest protection policies, and a substantial amount of Bareland converted to Grassland indicates an increase in vegetation cover. (2) Elevation, precipitation, temperature, and evapotranspiration are key drivers of land cover changes, as validated by Random Forest algorithm and Geodetector model. (3) Favorable conditions for Grassland to Forest transition include annual precipitation between 275 and 375 mm, annual temperature between −2 and 3 °C, annual evapotranspiration between 580 and 750 mm, elevation between 1800 and 2600 m, and aspect between 0 to 110° and 220 to 259.9°. Continuous monitoring of land cover changes and their driving factors in mountain heritage sites contributes to the protection of the ecological environment and provides data and information support for addressing climate change, resource management, and policy making.

Against the backdrop of grassland ecological degradation, grassland transfer has become a crucial pathway for optimizing livestock resource allocation and promoting sustainable pastoral development. Based on survey data from 383 herder households in the farming–pastoral ecotone of Inner Mongolia, China, this study applies Heckman models, mediation models, and moderation models to examine the impact of digital technology on herders’ grassland leasing-in decisions and the underlying mechanisms. The results indicate that digital technology significantly increases both the probability and the scale of grassland leasing-in among herders. Moreover, digital technology indirectly promotes grassland leasing-in by enhancing scale efficiency. Notably, strong social networks weaken the facilitating role of digital technology in grassland transfer, whereas weak social networks strengthen it. The impact of digital technology on grassland leasing-in is especially pronounced under environmental regulations with weak incentives but strong constraints. Finally, compared with ordinary herders, digital technology has a significantly positive effect on grassland leasing-in only for new-type operators. In addition, the impact of digital technology is more pronounced among groups with higher levels of education.

Objectives Both overall and central obesity have been associated with the risk of psoriasis in a prospective study. Data on the association between obesity and psoriatic arthritis (PsA) have been sparse and no evidence on obesity measures and the risk of incident PsA is available now. This study aimed to evaluate the association between obesity and the risk of incident PsA in a large cohort of women. Methods 89 049 participants were included from the Nurses Health Study II over a 14-year period (1991–2005). Information on body mass index (BMI), weight change and measures of central obesity (waist circumference, hip circumference and waist–hip ratio) was collected during the follow-up. The incidence of clinician-diagnosed PsA was ascertained and confirmed by supplementary questionnaires. Results 146 incident PsA cases were identified during 1 231 693 person-years of follow-up. Among all participants, BMI was monotonically associated with an increased risk of incident PsA. Compared with BMI less than 25.0, the RR was 1.83 for BMI 25.0–29.9 (95% CI 1.15 to 2.89), 3.12 for BMI 30.0–34.9 (95% CI 1.90 to 5.11) and 6.46 for BMI over 35.0 (95% CI 4.11 to 10.16). There was a graded positive association between weight change from age 18 years, measures of central obesity and risk of PsA (p for trend <0.001). The analysis among participants developing psoriasis during follow-up revealed a similar association (p for trend <0.01), indicating an increased risk of PsA associated with obesity among patients with psoriasis. Conclusion This study provides further evidence linking obesity with the risk of incident PsA among US women.

Speech is easily interfered by external environment in reality, which results in the loss of important features. Deep learning has become a popular speech enhancement method because of its superior potential in solving nonlinear mapping problems for complex features. However, the deficiency of traditional deep learning methods is the weak learning capability of important information from previous time steps and long-term event dependencies between the time-series data. To overcome this problem, we propose a novel speech enhancement method based on the fused features of deep neural networks (DNNs) and gated recurrent unit (GRU). The proposed method uses GRU to reduce the number of parameters of DNNs and acquire the context information of the speech, which improves the enhanced speech quality and intelligibility. Firstly, DNN with multiple hidden layers is used to learn the mapping relationship between the logarithmic power spectrum (LPS) features of noisy speech and clean speech. Secondly, the LPS feature of the deep neural network is fused with the noisy speech as the input of GRU network to compensate the missing context information. Finally, GRU network is performed to learn the mapping relationship between LPS features and log power spectrum features of clean speech spectrum. The proposed model is experimentally compared with traditional speech enhancement models, including DNN, CNN, LSTM and GRU. Experimental results demonstrate that the PESQ, SSNR and STOI of the proposed algorithm are improved by 30.72%, 39.84% and 5.53%, respectively, compared with the noise signal under the condition of matched noise. Under the condition of unmatched noise, the PESQ and STOI of the algorithm are improved by 23.8% and 37.36%, respectively. The advantage of the proposed method is that it uses the key information of features to suppress noise in both matched and unmatched noise cases and the proposed method outperforms other common methods in speech enhancement.

Current evidence about the association between pioglitazone and bladder cancer risk remains conflict. We aimed to assess the risk of bladder cancer associated with the use of pioglitazone and identify modifiers that affect the results. We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials from inception to 25 August 2016 for randomized controlled trials (RCTs) and observational studies that evaluated the association between pioglitazone and bladder cancer risk. Conventional and cumulative meta‐analyses were used to calculate the odds ratio (OR) with 95% confidence interval (CI). A restricted spline regression analysis was used to examine the dose–response relationship with a generalized least‐squares trend test. We included two RCTs involving 9114 patients and 20 observational studies (n = 4,846,088 individuals). An increased risk of bladder cancer in patients treated with pioglitazone versus placebo was noted from RCTs (OR, 1.84; 95%CI, 0.99 to 3.42). In observational studies, the increased risk of bladder cancer was slight but significant among ever‐users of pioglitazone versus never‐users (OR, 1.13; 95%CI, 1.03 to 1.25), which appeared to be both time‐ (P = 0.003) and dose‐dependent (P = 0.05). In addition, we observed the association differed by region of studies (Europe, United States, or Asia) or source of funding (sponsored by industry or not). Current evidence suggests that pioglitazone may increase the risk of bladder cancer, possibly in a dose‐ and time‐dependent manner. Patients with long‐term and high‐dose exposure to pioglitazone should be monitored regularly for signs of bladder cancer. Current evidence about the association between pioglitazone and bladder cancer risk remains inconsistent. This meta‐analysis of two randomized controlled trials and 20 observational studies showed that use of pioglitazone might increase risk of bladder cancer. Our findings suggest a close monitoring of bladder cancer in patients with long‐term and high‐dose exposure to pioglitazone.

As very fragile natural ecological areas, the spatiotemporal ecological environment (EE) analysis of World Natural Heritage Sites (WNHSs) is particularly important for their conservation and sustainable development. Timely, objective and quantitative evaluation of the spatiotemporal EE change characteristics of WNHSs is of great significance for ecological, environmental protection and government policy formulation. This study quantitatively evaluates the spatiotemporal distribution characteristics of the EE of the Kalajun–Kuerdening WNHS by selecting the Remote Sensing Ecological Environment Index (RSEI) for 2006, 2011, 2016 and 2021. We studied the spatiotemporal differences of the EE in buffer zones and nominated sites in the heritage sites and their change patterns and trends. The EE changes and land use changes from 2006–2011, 2011–2016 and 2016–2021 were overlaid and analyzed to explore the relationship between EE evolution and land use changes in the heritage site. The results show that (1) the heritage site was in a state of ecological change equilibrium from 2006 to 2011, and a form of slight decline in EE quality from 2011 to 2016 under the influence of natural factors, but it maintained a stable state with a small degree of fluctuation, and a state of ecological change recovery from 2016 to 2021. The areas with better EE grades were located in the northwest region (Kalajun) and northeast region (Kuerdening) of the heritage site. (2) The EE grade change in the heritage site shows the characteristics of neighborhood change without a large number of leap changes. (3) From 2006 to 2021, the EE quality in the nominated site was better than that of the buffer zone, but from 2016 onward, the difference between the two gradually decreased until 2021. The average EE quality was basically the same until 2021, but, spatially, the EE quality of most areas in the buffer zone was better than that in the nominated area. (4) The types of land use transformation that caused EE enhancement in the heritage sites were barren–grassland, snow/ice–barren and barren–snow/ice, while the types of land use transformation that caused EE quality reduction were grassland–barren and barren–snow/ice. The results of this study help improve the knowledge of the EE background of the WNHS and its evolutionary process and provide scientific guidance for ecologically related decision making and management of global natural heritage sites. The change in snow and ice cover is an essential factor in the shift of the EE of the Kalajun–Kuerdening World Natural Heritage Site.

Background Frequent exposure to ultraviolet light has more detrimental and longer-term effects on the skin in early life than in adulthood. Teenagers with strong sun-seeking behaviors may be more likely to use an indoor tanning bed than those who seek less sun. We aimed to examine associations between sun-seeking behaviors and indoor tanning behavior during high school/college in US females. Methods In this cross-sectional study, we used data from The Nurses’ Health Study II, a large prospective cohort of US female nurses. We included a total of 81,746 white females who provided responses on the average annual frequency of indoor tanning during high school/college. Our study exposures were number of times/week spent outdoors in a swimsuit and percentage of time wearing sunscreen at the pool/beach as a teenager, weekly hours spent outdoors in direct sunlight during the daytime during high school/college, and number of severe sunburns that blistered between ages 15–20 years. The main outcome was annual frequency of indoor tanning bed usage during high school/college. Results In multivariable-adjusted logistic regression, we demonstrated positive associations between sun-seeking behaviors and indoor tanning use. Specifically, teenagers who spent 7 times/week outdoors in a swimsuit (adjusted odds ratio [aOR], 95% confidence interval [CI] for daily vs. <1/week: 2.68, 1.76–4.09) were more likely to use indoor tanning beds ≥ 12 times/year. Teenagers with ≥ 10 sunburns (aOR, 95% CI for ≥ 10 vs. never: 2.18, 1.53–3.10) were more likely to use indoor tanning beds ≥ 12 times/year. Also, teenagers/undergraduates who spent ≥ 5 h/week outdoors in direct sunlight (aOR, 95% CI for ≥ 5 h/week vs. <1 h/week: 2.18, 1.39–3.44) were more likely to use indoor tanning ≥ 12 times/year. However, there was not a significant association between average usage of sunscreen at the pool/beach and average usage of indoor tanning beds. Multivariable-adjusted linear regression models also showed similar results. Conclusions Teenagers who spent more time outdoors in a swimsuit/direct sunlight or got more sunburns tended to use indoor tanning more frequently. These findings provide evidence that teenagers with stronger sun-seeking behaviors may have more exposure to artificial ultraviolet radiation as well. Key points Question: How are outdoor sun-seeking behaviors associated with indoor tanning behavior? Findings: This large study using data from the Nurses’ Health Study II (NHSII) found that females who spent more time outdoors or got more sunburns tended to use indoor tanning more frequently than those who rarely or never engaged in outdoor sun-seeking behaviors. Meaning: The findings reveal the associations between outdoor sun-seeking behaviors and indoor tanning behavior, which could increase awareness of UV-seeking behaviors and underscore appropriate interventions directed at adolescent and young adult females with such behaviors.