Autoregressive Correlation Structure Research Articles

Spatiotemporal multilevel joint modeling of longitudinal and survival outcomes in end-stage kidney disease.

Individuals with end-stage kidney disease (ESKD) on dialysis experience high mortality and excessive burden of hospitalizations over time relative to comparable Medicare patient cohorts without kidney failure. A key interest in this population is to understand the time-dynamic effects of multilevel risk factors that contribute to the correlated outcomes of longitudinal hospitalization and mortality. For this we utilize multilevel data from the United States Renal Data System (USRDS), a national database that includes nearly all patients with ESKD, where repeated measurements/hospitalizations over time are nested in patients and patients are nested within (health service) regions across the contiguous U.S. We develop a novel spatiotemporal multilevel joint model (STM-JM) that accounts for the aforementioned hierarchical structure of the data while considering the spatiotemporal variations in both outcomes across regions. The proposed STM-JM includes time-varying effects of multilevel (patient- and region-level) risk factors on hospitalization trajectories and mortality and incorporates spatial correlations across the spatial regions via a multivariate conditional autoregressive correlation structure. Efficient estimation and inference are performed via a Bayesian framework, where multilevel varying coefficient functions are targeted via thin-plate splines. The finite sample performance of the proposed method is assessed through simulation studies. An application of the proposed method to the USRDS data highlights significant time-varying effects of patient- and region-level risk factors on hospitalization and mortality and identifies specific time periods on dialysis and spatial locations across the U.S. with elevated hospitalization and mortality risks.

O89 POOLED, LONG-TERM ANALYSIS OF THE GLOBAL SYMPLICITY CLINICAL TRIAL PROGRAM OF RADIOFREQUENCY RENAL DENERVATION FOR THE TREATMENT OF UNCONTROLLED HYPERTENSION

Background/Objective: The Global Symplicity Clinical program is the largest investigation of radiofrequency renal denervation (RDN) to treat uncontrolled hypertension (HTN) to date. Over 4,000 patients enrolled into Spyral First-in-Man, Global SYMPLICITY Registry DEFINE, and multiple randomized, controlled and sham controlled trials including HTN-Japan, Symplicity HTN-3, SPYRAL HTN-OFF and -ON MED studies. We leveraged the entire Symplicity Global Clinical program dataset to develop a multivariate, patient-level, mixed model assessing (1) long-term BP reductions after RDN, and (2) whether specific patient characteristics correlate with future BP reductions after the procedure. Methods: Repeated BP measurements from each patient in the Global Symplicity Clinical program were analyzed using linear mixed models fitted with 24-h ambulatory systolic (S)BP and office SBP as outcome variables. Baseline SBP, baseline number of antihypertensive (AH) medications, and AH medications over time were included as fixed effects. Additional patient characteristics were included as potential significant fixed effects. To account for multiple BP measurements per patient and multiple studies, nested random effects were included using an auto-regressive correlation structure. Results: Data from 4156 patients treated with either the first-generation Symplicity Flex or the next-generation Symplicity Spyral catheter. Estimated, office and 24-h ambulatory SBP changes through 36 months, after adjusting for AH medication effects, were biphasic with a steep reduction after RDN through the first 6 months (Figure), followed by a steady reduction in SBP afterward through 36 months. Higher baseline SBP was correlated with greater BP reductions. AF history (-3.7 mmHg compared to no AF, p=0.0048) and increasing eGFR at baseline (-0.039 mmHg for every 1 ml/min increase in baseline eGFR, p=0.040) significantly correlated with lower 24-h ambulatory SBP. Conclusion: This is the most comprehensive analysis of radiofrequency RDN to date. Higher baseline SBP was strongly correlated with greater BP reductions. The results demonstrate the durability of RDN as an adjunctive therapy to treat HTN. Prospective studies need to validate whether certain patient characteristics are associated with improved response to RDN.

Taper functions to predict the upper stem diameter of Chir pine (Pinus roxburghii) in the mid-hills of Nepal

A function that predicts the upper stem diameters of an individual tree is helpful in better quantifying the volume and devising sustainable management of commercially and ecologically important species. This study compares three forms of the taper equation (single, variable-exponent, and segmented) using destructive sample data collected from 80 Chir pine (Pinus roxburghii Sarg.) trees across three adjacent stands in the Mid hills of Nepal. A mixed-effects modeling approach was used to evaluate the 13 different taper functions, selecting the best parameter association with the random effect to avoid overparameterization. Additionally, these models were fitted to minimize errors by modeling correlation structure with continuous autoregressive correlation structure of order 1 (corCAR1) and variance with a power variance function. All models were statistically significant at 5% level in the likelihood ratio test when compared with the models fitted without these error minimization. Furthermore, model performance (root mean square error, mean absolute error, and pseudo-R2) was evaluated using k-fold cross-validation procedure. Although all taper functions described more than 95% of the variation in upper stem diameter prediction, the single-form models of Bennett and Swindel (1972) and Amidon (1984), the variable-exponent model form of Sharma and Zhang (2004), and the segmented model form of Max and Burkhart (1976) explained more than 98% percent of the variability. Residual diagnostics indicated that Sharma and Zhang's (2004) model provided better constant and minimum errors in predicting the upper stem diameter along the 8 to 20 m stem length, whereas other models exhibited higher residual errors. Despite model's better performance, variability along the upper stem diameter prediction would affect its applicability in estimating the volume at any merchantable height of individual trees.

POOLED, LONG-TERM ANALYSIS OF THE GLOBAL SYMPLICITY CLINICAL TRIAL PROGRAM OF RADIOFREQUENCY RENAL DENERVATION FOR THE TREATMENT OF UNCONTROLLED HYPERTENSION

Objective: The Global Symplicity Clinical program is the largest investigation of radiofrequency renal denervation (RDN) to treat uncontrolled hypertension (HTN) to date. Collectively, over 4,000 patients enrolled into Spyral First-in-Man, the Global SYMPLICITY Registry (GSR) DEFINE, and multiple randomized controlled and sham controlled trials including HTN-Japan, Symplicity HTN-3, and the SPYRAL HTN-OFF and ON MED studies. We leveraged the entire Symplicity Global Clinical program patient dataset to develop a multivariate, patient-level, mixed model assessing (1) long-term BP reductions after RDN, and (2) whether specific patient characteristics correlate with future BP reductions after the procedure. Design and method: Repeated BP measurements from each patient in the Global Symplicity Clinical program were analyzed using linear mixed models fitted with 24-h ambulatory systolic (S)BP and office SBP as outcome variables. Baseline SBP, baseline number of antihypertensive (AH) medications, and AH medications over time were included as fixed effects. Additional patient characteristics were included as potential significant fixed effects. To account for multiple BP measurements per patient and multiple studies, nested random effects were included using an auto-regressive correlation structure. Results: The mixed model included data from 4156 patients treated with either the first-generation Symplicity Flex or the next-generation Symplicity Spyral catheter. Estimated, office and 24-h ambulatory SBP changes through 36 months, after adjusting for AH medication effects, were biphasic with a steep reduction after RDN through the first 6 months (Figure), followed by a steady reduction in SBP afterward through 36 months. Higher baseline SBP was correlated with greater BP reductions. History of AF (-3.7 mmHg compared to no AF, p=0.0048) and increasing eGFR at baseline (-0.039 mmHg for every 1 ml/min increase in baseline eGFR, p=0.040) significantly correlated with lower 24-h ambulatory SBP. Conclusions: This is the most comprehensive analysis of radiofrequency RDN to date. Higher baseline SBP was strongly correlated with greater BP reductions. The results demonstrate the durability of RDN as an adjunctive therapy to treat HTN patients. Prospective studies need to validate whether certain patient characteristics are associated with improved response to RDN.

Factors influencing how informal caregivers of people with multiple sclerosis access and use a curated intervention website: Analysis from an RCT.

Healthcare consumers and providers are increasingly turning to digital solutions, such as curated websites. Knowing who accesses/benefits from these may improve design and development. This study investigated website usage of informal caregivers of people with multiple sclerosis and shifts in outcome plausibly associated with usage. Secondary analysis of data from a randomized clinical trial of 148 caregivers compared effectiveness of a website + tele-coaching to a website only intervention for caregivers. Groupwise differences in means/proportions were tested using t-tests and chi-square. Modified Poisson regression with a robust variance estimator and ordinal logistic regression tested the relationship between group and likelihood of website log-in. Ordinal logistic regression models examined whether caregiver characteristics were associated with website use. Generalized estimating equations (GEE) with an autoregressive correlation structure modeled the relationship between website usage and outcomes. Females were more likely to access the website than males (60% vs. 43%; p = 0.05). Though not statistically significant, a possible association (POR: .85, 95% CI: .69, 1.03) between caregiver burden and website access emerged; caregivers experiencing highest levels of burden appeared less likely to engage. Usage patterns differed by treatment arm: the website-only group accessed the Caring for yourself topic significantly more (61.67% vs. 38.33%: p = .04) with similar, but insignificant, trends for other topics. Clinicians can be confident referring females with moderate levels of burden to website-based interventions. By contrast, male caregivers and those experiencing high levels of burden may be less likely to access these resources, pointing to the need for alternative interventions. Clinicaltrials.gov, registration number: NCT0466208.

Quality-of-life measurement in high-risk patients with uveal melanoma receiving adjuvant sunitinib or valproic acid.

e18692 Background: Despite the successful treatment of primary uveal melanoma (UM), metastasis occurs in up to half of the patients with UM. To delay metastasis for high-risk patients with UM, adjuvant therapy with sunitinib malate or valproic acid (VPA) is used. Therefore, assessing and addressing quality of life (QOL) during adjuvant therapy is essential to mitigate interferences that may prevent these patients from adherence to the therapy protocol and impair their well-being. The objective of this study is to analyze the QOL of these patients during adjuvant therapy with sunitinib or VPA, and to explore differences by the type of adjuvant therapy, age, sex, and the duration of adjuvant therapy. Methods: We analyzed longitudinal surveys of the FACT-G completed by high-risk patients with UM who participated in the randomized phase II clinical trial cohort 1 receiving 6 months of adjuvant sunitinib or VPA and Cohort 2 receiving 12 months of adjuvant sunitinib at a single center. Data were obtained before the initiation of adjuvant therapy and at 1, 3, and 6 months in cohort 1 and at 1, 3, 6, 9, and 12 months in cohort 2. We examined whether there were associations of QOL with the type of adjuvant therapy, age category, sex, and the time of adjuvant therapy using generalized estimating equations (GEE) modeling under the autoregressive working correlation structure (AR1) indexed within subjects by time. Results: There were 720 survey responses collected from 149 UM patients. In our sample, 70.4% (Cohort 1a, n = 45 and Cohort 2, n = 60) were treated with sunitinib and 29.5% (Cohort 1b, n = 44) with VPA. There was no significant difference in the QOL between the sunitinib group 1a and the VPA group 1b (p = 0.958). There was no significant difference in the overall QOL by age range (p = 0.093). However, participants aged 18 to 44 years had significantly lower emotional well-being mean scores (15.32, 95% Cl [13.53, 17.11]) compared to participants aged 65 years and above (19.06, 95% Cl [18.27, 19.86], p < 0.001) but no significant difference with participants aged 45 to 64 years (18.35, 95% Cl [17.53, 19.16], p = 0.193). There was no significant difference in the QOL by sex (p = 0.863) or trend in overall QOL means scores over time as the estimated slope of 0.02 QOL units per month was not significant (95% CI [-0.35, 0.38], p = 0.94). Conclusions: In our high-risk patients with UM, the type of adjuvant therapy, age, sex, and time of adjuvant therapy were not significantly differentiating factors for the QOL scores. Participants aged 18 to 44 years had significantly lower emotional well-being scores. We did not find enough evidence to suggest that there was a change in QOL during adjuvant therapy with sunitinib or VPA.

Assessing the role of sow parity on PRRSv detection by RT-qPCR through weekly processing fluids monitoring in breeding herds

The use of processing fluids to monitor the breeding herd’s porcine reproductive and respiratory syndrome (PRRS) status has gained industry acceptance. However, little is known about PRRS virus RT-qPCR detection dynamics in processing fluids and factors that may contribute to maintain PRRS virus in the herd after an outbreak. This study aimed to describe weekly RT-qPCR processing fluid results in breeding herds after an outbreak and to evaluate the proportion of RT-qPCR positive results among parity groups. Processing tissues of 15 first parity (P1), 15 second parity (P2), and 15 third parity or higher (P3+) litters (parity groups) were collected weekly for between 19 and 46 weeks in nine breeding herds. Processing fluids were aggregated, and RT-qPCR tested by parity group weekly. Additionally, a subset of 743 processing fluid samples of litters that formed 50 parity groups, as previously described, were RT-qPCR tested individually at the litter level. The agreement between RT-qPCR results of processing fluid samples of parity groups (15 litters) and results based on individual litter testing was assessed using overall percent of agreement, Kappa statistic, and McNemar test. The association between RT-qPCR results and the parity group was evaluated using a generalized estimating equations model, after accounting for the effects of sampling week, breeding herd PRRS control strategy (i.e., open to replacements v/s closed) and herd. An autoregressive correlation structure was used to account for the repeated samplings within a herd in time. The overall agreement was 98 %, and Kappa statistic 0.955 (McNemar p = 1.0). Sensitivity of parity group processing fluid samples was estimated at 100 % (95 % CI 89–100 %), while specificity was estimated at 94 % (95 % CI 71–100 %). Although P1 aggregated litters had on average a higher proportion of RT-qPCR positive results from outbreak week 25 onwards, the proportion was not significantly different to the one observed for P2 and P3+ aggregated litters (p > 0.13). Additionally, herds that interrupted gilt entry had lower odds of PRRS RT-qPCR positivity than herds that continued entering gilts (OR = 0.35, 95 % CI 0.16–0.78). PRRS virus persistence in processing fluids was not affected by the sow parity effect in most of the breeding herds studied. No evidence of disagreement between RT-qPCR results of an aggregated sample of 15 litters and those of individual litters was observed. This level of litter aggregation testing strategy may be of particular use at the last stages of an elimination program under low PRRS virus prevalence.

Legal Firearm Sales at State Level and Rates of Violent Crime, Property Crime, and Homicides

IntroductionThe effects of firearm sales and legislation on crime and violence are intensely debated, with multiple studies yielding differing results. We hypothesized that increased lawful firearm sales would not be associated with the rates of crime and homicide when studied using a robust statistical method. MethodsNational and state rates of crime and homicide during 1999-2015 were obtained from the United States Department of Justice and the Centers for Disease Control and Prevention. National Instant Criminal Background Check System background checks were used as a surrogate for lawful firearm sales. A general multiple linear regression model using log event rates was used to assess the effect of firearm sales on crime and homicide rates. Additional modeling was then performed on a state basis using an autoregressive correlation structure with generalized estimating equation estimates for standard errors to adjust for the interdependence of variables year to year within a particular state. ResultsNationally, all crime rates except the Centers for Disease Control and Prevention–designated firearm homicides decreased as firearm sales increased over the study period. Using a naive national model, increases in firearm sales were associated with significant decreases in multiple crime categories. However, a more robust analysis using generalized estimating equation estimates on state-level data demonstrated increases in firearms sales were not associated with changes in any crime variables examined. ConclusionsRobust analysis does not identify an association between increased lawful firearm sales and rates of crime or homicide. Based on this, it is unclear if efforts to limit lawful firearm sales would have any effect on rates of crime, homicide, or injuries from violence committed with firearms.

Outcomes of partial fundoplication for GERD-related allograft decline after lung transplantation.

Gastroesophageal reflux disease contributes to allograft decline secondary to bronchiolitis obliterans after lung transplantation. Antireflux surgery (ARS) slows the decline in lung function related to GERD. ARS operations range from Nissen fundoplications to partial fundoplications, such as the Toupet and Dor. Research in the general population has indicated that partial fundoplication is effective at controlling reflux. We explored lung function and reflux outcomes in a cohort of lung transplant patients who received partial fundoplications. Data from an institutional lung transplant registry was reviewed for patients between 2009 and 2020 who underwent fundoplication after transplant. Lung transplant patients underwent routine pulmonary function testing. Patients with FEV1 values within 180days pre-fundoplication and two years post-fundoplication were included in the analysis. All patients referred for fundoplication underwent esophageal pH testing, manometry, UGI, and EGD. Most patients underwent Toupet fundoplication, but those with severe dysmotility underwent Dor fundoplication. 53 patients were included in the analysis. Median time to fundoplication after transplant was 403days. 48 patients underwent Toupet fundoplication. Five underwent Dor fundoplication. 40% of patients had abnormal high-resolution manometry. A linear mixed-effects model tested for a change in FEV1 trajectory up to two years post-fundoplication with an auto-regressive correlation structure. Post-fundoplication FEV1 values decreased by 7mL per month, and suggested a slow in the decline by 2mL per month, but this was not significant (p = 0.8). In patients for whom postoperative DeMeester scores were available (19), there was a decline in acid exposure from a median of 45.8to 1.8 after ARS (p = 0.0003). Although our results did not reach statistical significance, there was a trend towards a decrease in the rate of decline of allograft function before and after partial fundoplication. In the patients whom results were available, a partial fundoplication appropriately controlled acid exposure.

Effects of a Sociodrama-based Communication Enhancement Program on Mothers of Children with Neurodevelopmental Disorders: A Pilot Study

The incidence and prevalence of neurodevelopmental disorders have rapidly increased, indicating an urgent need for assistance through parenting interventions. This study aimed to evaluate the effects of a sociodrama-based communication enhancement program on mothers of children with neurodevelopmental disorders. A non-randomized controlled experimental study design was employed. The experimental and control groups had 16 and 18 participants, respectively. The once-a-week six-session intervention was conducted from September to November 2017, in South Korea. The effects of group, time, and group-by-time interactions among the groups were verified using generalized estimating equations with an autoregressive correlation structure. There was a significant decrease in the parenting burden, alongside a significant improvement in parent-child communication and parenting competence in the experimental group compared to the control group. The sociodrama-based communication enhancement program was found to positively influence the parenting burden, communication, and parenting competence of mothers of children with neurodevelopmental disorders. These findings suggest that sociodrama-based programs may be an effective intervention strategy for parents of children with neurodevelopmental disorders. The sociodrama-based communication enhancement program can be applied to decrease parenting burden and improve parent-child communication and parenting competence. Through continuous parenting interventions, an improvement in expressive language and an increase in the attachment behaviors of children with neurodevelopmental disabilities could be expected.

Patient Portal Use Near the End-of-Life

Adverse impacts of natural disasters are viewed as particularly concerning for older adults. Disaster preparedness is an important step towards offsetting potential harm. Research comparing different age groups with respect to their disaster preparedness has produced inconclusive evidence. Some studies found older adults more prepared than younger age groups, whereas others found them to be equally or less prepared. To shed light on this issue, we examined disaster preparedness among N = 16,409 adults age 40 and older from the American Housing Survey. Using logistic regression analyses, we compared preparedness levels of four groups – households of middle-aged adults (age 40-64), older adults (age 65-84), oldest old adults (age 85+), and mixed households comprised of both middle-aged and older adults. Findings showed that households of older adults and the oldest old had significantly higher preparedness levels compared to middle-aged and mixed households, accounting for demographics, living alone, and disability. However, the oldest old group appeared less prepared compared to the older adult group. Thus, while our findings suggest that older adults aged 65-84 may be better prepared for disasters than middle-aged adults, the oldest old group, who are likely at a higher risk of adverse impacts from natural disasters, may be less prepared than their relatively younger counterparts. Therefore, older adults should not be treated as a homogenous group when considering disaster preparedness. Rather, policies and interventions to improve disaster preparedness may benefit from focusing on specific high vulnerability groups.

Patient Portal Use Near the End-of-Life

Use of patient portals, personal health information websites linked to electronic health records, in seriously ill populations is unknown, as is use by caregivers. We described portal use patterns among adults with serious illness nearing end-of-life and their caregivers within Kaiser Permanente Colorado. Inclusion criteria were: 1) seriously ill patients (defined by KP’s “Care Group”), □18 years of age, who were registered for the portal, and died between 1/1/2016-6/30/2019; and 2) caregivers of these patients, □18 years of age, registered for a proxy account. Data included user characteristics and portal use metrics summarized monthly over the 12-month period prior to death. Models included an unadjusted linear trend of the days used by month using a generalized estimating equation Poisson model with a log link and an autoregressive correlation structure of order 1. We identified 6,517 seriously ill patients with portal registrations; 163 of these patients had proxy caregivers. Patient users were 77 years old, mostly frail and White, and caregivers were predominantly female. Average days of use among patients was 42.4 days and <1 day among their caregivers. Number of days used significantly increased by 0.7% per month from twelve months to one month prior to death (95% CI: 0.4%-1.0%; p-value <.0001) and peaked 3 months prior to the patient’s death. Average use was high in comparison to previous portal research and suggests that as the patient approaches death portal use increases. Future research should explore how portals may serve as indicators for identifying and addressing end-of-life care needs.

Environmental drivers of a decline in a coastal zooplankton community

Abstract Major changes in North Atlantic zooplankton communities in recent decades have been linked to climate change but the roles of environmental drivers are often complex. High temporal resolution data is required to disentangle the natural seasonal drivers from additional sources of variability in highly heterogeneous marine systems. Here, physical and plankton abundance data spanning 2003–2017 from a weekly long-term monitoring site on the west coast of Scotland were used to investigate the cause of an increasing decline to approximately -80± 5% in annual average total zooplankton abundance from 2011 to 2017. Generalized additive mixed models (GAMMs), with an autoregressive correlation structure, were used to examine seasonal and inter-annual trends in zooplankton abundance and their relationship with environmental variables. Substantial declines were detected across all dominant taxa, with ∼ 30–70% of the declines in abundance explained by a concurrent negative trend in salinity, alongside the seasonal cycle, with the additional significance of food availability found for some taxa. Temperature was found to drive seasonal variation but not the long-term trends in the zooplankton community. The reduction in salinity had the largest effect on several important taxa. Salinity changes could partly be explained by locally higher freshwater run-off driven by precipitation as well as potential links to changes in offshore water masses. The results highlight that changes in salinity, caused by either freshwater input (expected from climate predictions) or fresher offshore water masses, may adversely impact coastal zooplankton communities and the predators that depend on them.

576Is the method of longitudinal data analysis equally relevant for common versus uncommon endpoints?

Abstract Background We explored the effects of predominant breastfeeding on infection-related hospitalization (uncommon outcome), over the first year of life, using the Mother Infant Health cohort study (MIHS), and the effect of early antiretroviral treatment (ART) on viral suppression (&amp;lt; 400 copies/mL) (common outcome), in children aged 7 to 12 weeks, using a subset of the Children with HIV Early AntiRetroviral Treatment (CHER) clinical trial data. We assessed the sensitivity of findings to different models to account for dependency of uncommon and common binary outcome. Methods We fitted generalized linear mixed model with (1) random intercept and (2) random slope, generalized estimating equations (GEE) with 3) an exchangeable correlation structure; 4) autoregressive correlation structure of order 1 (AR1) and 5) unstructured correlation structure and 6) logistic regression model. Results Eighty four and 119 children from MIHS were non-predominantly and predominantly breastfed, respectively. There were 34 infection-related hospitalizations overall. Most infants were hospitalized once, except for four with two hospitalizations. We analysed 88 HIV-infected children from the CHER trial. On average, a child achieved viral suppression twice, range of one to four. The effect of predominant breastfeeding on infection-related hospitalization was similar across all models, except for the GEE with AR1 that had a high estimate (wider confidence intervals). The effect of early ART exposure on viral suppression varied across models. Conclusions The sensitivity of estimates to the method of analysis was driven by frequency of the outcome.

Assessment of a Modified Sandwich Estimator for Generalized Estimating Equations with Application to Opioid Poisoning in MIMIC-IV ICU Patients

Longitudinal data is encountered frequently in many healthcare research areas to include the critical care environment. Repeated measures from the same subject are expected to correlate with each other. Models with binary outcomes are commonly used in this setting. Regression models for correlated binary outcomes are frequently fit using generalized estimating equations (GEE). The Liang and Zeger sandwich estimator is often used in GEE to produce unbiased standard error estimation for regression coefficients in large sample settings, even when the covariance structure is misspecified. The sandwich estimator performs optimally in balanced designs when the number of participants is large with few repeated measurements. The sandwich estimator’s asymptotic properties do not hold in small sample and rare-event settings. Under these conditions, the sandwich estimator underestimates the variances and is biased downwards. Here, the performance of a modified sandwich estimator is compared to the traditional Liang-Zeger estimator and alternative forms proposed by authors Morel, Pan, and Mancl-DeRouen. Each estimator’s performance was assessed with 95% coverage probabilities for the regression coefficients using simulated data under various combinations of sample sizes and outcome prevalence values with independence and autoregressive correlation structures. This research was motivated by investigations involving rare-event outcomes in intensive care unit settings.

Changes in Core Competencies among Korean University Students Due to Remote Learning during the COVID-19 Pandemic

This study aimed to determine the academic performance and learning skills of students who studied through remote teaching methods during the coronavirus disease 2019 (COVID-19) pandemic. It was conducted in February 2021 with 398 university students in South Korea. Data were collected through online surveys. Generalized estimating equations (GEEs) with an autoregressive correlation structure were employed to distinguish differences in core competencies, academic performance, satisfaction, and usefulness of teaching methods before 2019 and after the COVID-19 pandemic. The findings revealed that the overall core competencies of participants were significantly lower in 2020 than before the COVID-19 pandemic. Furthermore, knowledge construction, responsibility practice, and socialization were significantly low during the COVID-19 pandemic, whereas information management and identity value did not show a significant difference. However, problem-solving was higher during the COVID-19 pandemic. Enhancing the core competencies of university students is integral in the new learning environment of the post-COVID-19 era. It is necessary to devise approaches that improve the effectiveness of remote teaching methods and simultaneously augment student satisfaction.

Associations of air pollution and greenness with the nasal microbiota of healthy infants: A longitudinal study

BackgroundAir pollution and greenness are associated with short- and long-term respiratory health in children but the underlying mechanisms are only scarcely investigated. The nasal microbiota during the first year of life has been shown to be associated with respiratory tract infections and asthma development. Thus, an interplay between greenness, air pollution and the early nasal microbiota may contribute to short- and long-term respiratory health. We aimed to examine associations between fine particulate matter (PM2.5), nitrogen dioxide (NO2) and greenness with the nasal microbiota of healthy infants during the first year of life in a European context with low-to-moderate air pollution levels. MethodsMicrobiota characterization was performed using 16 S rRNA pyrosequencing of 846 nasal swabs collected fortnightly from 47 healthy infants of the prospective Basel-Bern Infant Lung Development (BILD) cohort. We investigated the association of satellite-based greenness and an 8-day-average exposure to air pollution (PM2.5, NO2) with the nasal microbiota during the first year of life. Exposures were individually estimated with novel spatial-temporal models incorporating satellite data. Generalized additive mixed models adjusted for known confounders and considering the autoregressive correlation structure of the data were used for analysis. ResultsMean (SD) PM2.5 level was 17.1 (3.8 μg/m3) and mean (SD) NO2 level was 19.7 (7.9 μg/m3). Increased PM2.5 and increased NO2 were associated with reduced within-subject Ružička dissimilarity (PM2.5: per 1 μg/m3 -0.004, 95% CI -0.008, −0.001; NO2: per 1 μg/m3 -0.004, 95% CI -0.007, −0.001). Whole microbial community comparison with nonmetric multidimensional scaling revealed distinct microbiota profiles for different PM2.5 exposure levels. Increased NO2 was additionally associated with reduced abundance of Corynebacteriaceae (per 1 μg/m3: −0.027, 95% CI -0.053, −0.001). No associations were found between greenness and the nasal microbiota. ConclusionAir pollution was associated with Ružička dissimilarity and relative abundance of Corynebacteriaceae. This suggests that even low-to-moderate exposure to air pollution may impact the nasal microbiota during the first year of life. Our results will be useful for future studies assessing the clinical relevance of air-pollution-induced alterations of the nasal microbiota with subsequent respiratory disease development.

Metabolic risk factors among prediabetic individuals and the trajectory toward the diabetes incidence.

This study investigates the trajectory of the risk factors of prediabetes progression to overt diabetes. The study retrospectively investigated 1610 prediabetic individuals. The trajectory of metabolic indicators was investigated using the generalized estimated equation method with autoregressive working correlation structure through a linear model with the identity link function. During 15 years of follow-up, the trajectories of metabolic risk factors changed from 3 years before diabetes occurrence for fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG), 6 years for waist circumference (WC), 9 years for high-density lipoprotein cholesterol (HDL-C), and earlier for body mass index, triglyceride (TG), and TG:HDL ratio. It was shown that the differences in the trajectory of WC and HDL were stable after adjustment for other metabolic risk factors. The trajectories of FPG and 2hPG remained stable after considering multiple insulin resistance markers. Deterioration of metabolic risk factor status can be a predictor of diabetes many years before its occurrence, but the abrupt change in plasma glucose is evident 3 years before diabetes mellitus onset. It seems that the HDL-C and WC trajectories are two independent predictors for diabetes incidence. It was also found that when the rising trend in plasma glucose starts, preventive strategies to lessen insulin resistance might not be efficient.

Effects of flipped-learning-based simulation for nursing students: a retrospective survey.

This study analysed whether Situation-Background-Assessment-Recommendation (SBAR) simulation, which uses a flipped learning method, improves undergraduate nursing students' academic performance and core competencies when applied in the mental health nursing practicum, as compared with traditional in-person simulations. To this end, a retrospective survey was employed. A group of 37 students who participated in the flipped learning-based SBAR simulation practicum was compared with a group of 37 students who participated in the practicum using a traditional learning method, in terms of their academic performance and core competencies. The 90-h practicum included four three-hour SBAR simulation sessions. Students were assessed at baseline, immediately after the two-week practicum, and four weeks later. The effects of group, time, and group-by-time interactions between the groups were verified using generalized estimating equations with an autoregressive correlation structure. Data were collected between March and July 2017, in South Korea. The results indicated that SBAR simulation significantly improved nursing students' communication performance compared with the traditional learning method. The clinical practicum based on SBAR improved core competencies at the post-practicum and four weeks later. In conclusion, the application of the flipped learning-based SBAR simulation can improve nursing students' communication skills and can be utilized as an effective teaching method to promote higher order competencies to apply, analyse, and evaluate knowledge beyond simple understanding and information recall. This study has addressed how academic performance and core competencies in nursing can be improved through SBAR simulation using a flipped learning method and shown its positive impact on nursing students' communication skills and higher order competencies.

Effects of an Existential Nursing Intervention for College Students in the COVID-19 Pandemic Situation.

This study designed an intervention based on logo-autobiography to reduce Korean college students’ stress and depression and help them find meaning in their lives amidst the COVID-19 pandemic. A quasi-experimental design was used to conduct group interventions among college students. A total of 22 and 26 participants were included in the experimental and control groups, respectively. The experimental group received six sessions of a logo-autobiography for college students (LAC). The effects of the LAC interventions were assessed at baseline, post-intervention, and four weeks after the program’s end to determine their retention rate. The effects of group, time, and the group-by-time interaction were verified using generalized estimating equations with an autoregressive correlation structure. The experimental group exhibited significantly lower levels of stress and depression and higher levels concerning the meaning of life than the control group. However, only the effects on stress and the meaning of life continued four weeks after the intervention’s end. Based on this study’s results, LAC can be considered a useful method for reducing stress and depression in college students who have just started their adult life, as well as for aiding them in their pursuit for the meaning of life.