Bayesian Hierarchical Regression Model Research Articles

Assessing Preferences of Patients with Chronic Spontaneous Urticaria for Injectable Treatment Profiles.

In the context of injectable biologic products approved or in development for chronic spontaneous urticaria (CSU), it is important to capture which treatment attributes matter most to patient and what trade-offs patients are willing to make. The CHOICE-CSU study aimed to quantify patient preferences toward injectable treatment attributes among patients with CSU, inadequately controlled by H1-antihistamines. This was a two-phase cross-sectional patient preference study in adult patients with a diagnosis of CSU, inadequately controlled by H1-antihistamines. A qualitative phase collected patients' insights and relevant treatment attributes that mattered to them, and the outputs were used for the quantitative phase to create the actual injectable treatment profiles with attributes and levels such as: efficacy, safety, and mode of administration. The quantitative phase used discrete choice experiment (DCE) methodology. Eligible patients were asked to make hypothetical choices between 12 treatment profile pairs, created by Sawtooth SoftwareTM. The DCE data were analyzed using hierarchical Bayesian logistic regression models, enabling the quantification of the relative importance of each attribute/level during the decision-making process. A total of 450 respondents participated in the DCE. The key attributes driving respondent preference amongst injectable treatment options were type of administration device (relative importance 18.5%), complete control of urticaria (relative importance 17.4%), and resolution of angioedema (relative importance 16.4%). Keeping all other attributes and levels equal, the predicted choice share was higher for a profile with an auto-injector versus one with a pre-filled syringe (72.9% versus 27.1%). The CHOICE-CSU study is the first study to provide a quantitative assessment of preferences that patients with CSU, inadequately controlled by H1-antihistamines, have for injectable treatment attributes. Symptom-free periods are the most important overriding therapy goal for patients, and patients will accept some inconveniences, such as administration mode, to achieve this. Additionally, when efficacy is equivalent, administration ease of injectable therapies is valued by patients. As new CSU oral treatment options emerge, additional testing of patient preference toward oral treatments will be required.

Estimating the burden of RSV- and influenza-associated hospitalizations, ICU admissions, and deaths across age and socioeconomic groups in New York State, 2005-2019.

Multiple prophylactic products are now available to protect against respiratory syncytial virus (RSV) in different age groups. Assessing the pre-intervention burden of RSV infections across various severity levels and risk groups is crucial, as it provides a baseline for evaluating the impact of these products. We obtained monthly time series data on hospitalizations, intensive care unit (ICU) admissions, and deaths by age group, ZIP code, and cause for New York state from 2005 to 2019. Socioeconomic status (SES) of the ZIP codes was classified using supervised principal component analysis (PCA). We estimated the incidence of hospitalizations, ICU admissions, and deaths attributable to RSV and to influenza using hierarchical Bayesian regression models. Additionally, we assessed severity, defined by ICU admission and mortality risks, as well as recording fraction (i.e., percent of estimated virus-associated hospitalizations recorded as being due to the specific virus), stratified by age, SES, and over time. The estimated annual incidence of RSV-associated hospitalizations and ICU admissions were highest in infants under 1 in the low SES group (2,240 [95% credible interval (CrI): 2,200-2,290] hospitalizations and 330 [95% CrI: 320-350] ICU admissions per 100,000 person-years). The incidence of RSV-associated deaths was highest among adults ≥85 years old (61 [95% CrI: 49-74] per 100,000 person-years). In contrast to RSV, the burden of influenza was greatest in age groups ≥65 years. The risk of ICU admission varied by patients' age and SES, and the mortality risk increased dramatically with age for both pathogens (RSV: 11.9% [95% CrI: 9.6-14.3%], influenza: 14.4% [95% CrI: 13.1-15.6%] among ≥85 year age group). Incidence varied by epidemic year and season, and we observed an increasing recording fraction of RSV among all age groups over the study period. RSV and influenza contribute significantly to the burden of hospitalizations, ICU admissions, and deaths, particularly among infants and older adults. Although the recording fraction of RSV increased over the study period, it remains lower, particularly for adults. Our findings reveal a disparity in hospitalization burden by SES, particularly among younger age groups.

Demographic inequities and cumulative environmental burdens within communities near superfund sites on Long Island, New York.

Nassau and Suffolk Counties of Long Island, New York are densely populated and contain 34 federally-designated and 449 state-designated Superfund sites, potentially exposing communities to toxic releases. We conducted a distributive justice analysis assessing proximity to Superfund sites, community socio-demographics, and other environmental burdens. Socio-demographic and environmental variables for 665 census tracts were obtained from the United States Census and Environmental Protection Agency's Environmental Justice Screening and Mapping Tool. Hierarchical Bayesian spatial Poisson regression models evaluated the relationship between socio-demographic and environmental variables and counts of Superfund sites per census tract. Analyses were further stratified by county and site type (Federal versus State). A 10% increase in low-income residents was associated with a 47% increase in Superfund sites (Risk Ratio [RR]: 1.47; 95% credible interval (CI): 1.20-1.81). A 10% increase in Hispanic/Latino residents was associated with a 20% increase (RR: 1.20; 95%CI: 1.02-1.42). Higher PM2.5 concentrations (RR:1.64, 95% CI: 1.09-2.48), higher toxic air releases (RR: 1.27, 95%CI: 1.03-1.61), and greater proximity to underground gas storage tanks (RR: 1.27, 95%CI: 1.09-1.48) were associated with increases in Superfund counts. Stratified analyses revealed that low-income residents are concentrated near state not federal Superfund sites. County stratification found that only Suffolk County residents near Superfund sites have increased lead exposure potential, and Black residents in Suffolk (not Nassau) were more likely to live near Superfund sites. We observed localized distributive inequities in community demographics near Superfund sites on Long Island, and communities near Superfund sites are more likely to experience other environmental burdens.

Approximate Cross-Validated Mean Estimates for Bayesian Hierarchical Regression Models

We introduce a novel procedure for obtaining cross-validated predictive estimates for Bayesian hierarchical regression models (BHRMs). BHRMs are popular for modeling complex dependence structures (e.g., Gaussian processes and Gaussian Markov random fields) but can be computationally expensive to run. Cross-validation (CV) is, therefore, not a common practice to evaluate the predictive performance of BHRMs. Our method circumvents the need to rerun computationally costly estimation methods for each cross-validation fold and makes CV more feasible for large BHRMs. We shift the CV problem from probability-based sampling to a familiar and straightforward optimization problem by conditioning on the variance-covariance parameters. Our approximation applies to leave-one-out CV and leave-one-cluster-out CV, the latter of which is more appropriate for models with complex dependencies. In many cases, this produces estimates equivalent to full CV. We provide theoretical results, demonstrate the efficacy of our method on publicly available data and in simulations, and compare the model performance with several competing methods for CV approximation. Code and other supplementary materials available online.

Burden of Parkinson’s disease in Central Asia from 1990 to 2021: findings from the Global Burden of Disease study

BackgroundCentral Asia is known to face various ecological challenges that constitutes major risk factors for Parkinson’s disease (PD). This study examines the burden of PD in Central Asia, a region where data on neurological disorders is notably sparse.MethodsBuilding on the latest Global Burden of Disease Study (GBD 2021), this study investigates the Years of Life Lost (YLLs), Years Lived with Disability (YLDs), and Disability-Adjusted Life Years (DALYs) associated with PD in Central Asia and its countries from 1990 to 2021. The authors calculated average annual percent change (AAPC) to analyze trends, and compared individual country estimates to global figures. Additionally, incorporating data from the World Bank, both Bayesian hierarchical and non-hierarchical frequentist regression models were employed to assess their impact on DALYs.ResultsThe DALYs varied across the study period, primarily driven by YLLs. While YLLs showed a uniform trend, YLDs were mostly incremental. Kazakhstan had the highest estimates across all metrics and was the only country aligned with global patterns. Age- and sex-specific estimates revealed substantial variations, with notably high figures found in male subjects from Tajikistan. The YLLs, YLDs, and DALYs for Kazakhstan, Uzbekistan, and Turkmenistan saw a significant increase in AAPCs. In contrast, Kyrgyzstan and Tajikistan saw declines, likely attributable to civic conflict and inter-country differences in population structure. Further comparison of DALY trends revealed significant deviations for all countries from the global pattern.ConclusionThis study showed an overall increase in PD burden from 1990 to 2021. These findings underscore the need for targeted strategies to reduce PD burden, with a particular focus on Kazakhstan. Integrating historical information is crucial for discussing the plausible mechanisms in studies sourced from the GBD.

Curious Choices: Infants' moment-to-moment information sampling is driven by their exploration history

Infants explore the world around them based on their intrinsically motivated curiosity. However, the cognitive mechanisms underlying such curiosity-driven exploratory behaviour remain largely unknown. Here, infants could freely explore two novel categories, triggering a new exemplar from a category by fixating on either of the two associated areas on a computer screen. This gaze-contingent design enabled us to distinguish between exploration – switching from one category to another – and exploitation – consecutively triggering exemplars from the same category. Data from 10 to 12-month-old infants (N = 68) indicated that moment-to-moment sampling choices were non-random but guided by the infants' exploration history. Self-generated sequences grouped into three clusters of brief yet explorative, longer exploitative, and overall more balanced sampling patterns. Bayesian hierarchical binomial regression models indicated that across sequence patterns, infants' longer trigger time, shorter looking time, and more gaze-shifting were associated with trial-by-trial decisions to disengage from exploiting one category and making an exploratory switch, especially after consecutively viewed stimuli of high similarity. These findings offer novel insights into infants' curiosity-driven exploration and pave the way for future investigations, also regarding individual differences.

Mortality from type 2 diabetes mellitus across municipalities in Mexico

BackgroundOne in six Mexican adults’ lives with type 2 diabetes mellitus (T2DM), which is the third leading cause of death in the country. Analyzing the geographic distribution of T2DM mortality helps identify regions with higher mortality rates. This study aimed to examine the spatial patterns of mortality from type 2 diabetes mellitus (T2DM) across municipalities in Mexico and to analyze the main contextual factors linked to this cause of death in 2020.MethodsWe employed a spatial Bayesian hierarchical regression model to estimate the risk and probability of death from type 2 diabetes mellitus (T2DM) across Mexico’s municipalities.ResultsThe SMR results revealed geographic and age-specific patterns. Central Mexico and the Yucatán Peninsula exhibited the highest excess mortality rates. For the population under 50 years of age, municipalities in Oaxaca had the highest T2DM mortality rates, whereas those aged 50 years old and older had the highest rates in Tlaxcala and Puebla. Socioeconomic factors such as low levels of educational attainment, lack of health services, dietary deficiency, and marginalization were positively associated with increased T2DM mortality risk. By contrast, GDP per capita showed a negative association. High-risk areas for T2DM mortality were prominent along the south of the Pacific Coast, the Bajío, Central Mexico, and southern Yucatán for those under 50, and along a central strip extending to the Yucatán Peninsula for the older population. Significant uncertainties in mortality risk were identified, with Central Mexico, Oaxaca, Chiapas, and Tabasco showing high probabilities of excess risk for those under 50 years of age and extended risk areas along the Gulf of Mexico for those 50 years old and older.ConclusionsThe assessment and identification of spatial distribution patterns associated with T2DM mortality, and its main contextual factors, are crucial for informing effective public health policies aimed at reducing the impact of this chronic disease in Mexico.

Cardiac Resynchronization Therapy in Ischemic Versus Nonischemic Cardiomyopathy: Patient-Level Meta-Analysis of 7 Randomized Clinical Trials

BackgroundData on whether cardiac resynchronization therapy (CRT) results in better clinical and echocardiographic outcomes in patients with nonischemic cardiomyopathy (NICM) vs ischemic cardiomyopathy (ICM) are conflicting. ObjectivesThe authors conducted this meta-analysis of 7 clinical trials of CRT to determine the association between etiology of cardiomyopathy and clinical and echocardiographic outcomes. MethodsThe authors analyzed patient-level data using Bayesian Hierarchical Weibull survival regression modeling to determine the association between etiology of cardiomyopathy and time to all-cause death or heart failure hospitalization (HFH). Linear regression was used to assess the association between etiology of cardiomyopathy and echocardiographic measurements. ResultsOf 6,252 patients included, 4,717 (75%) were men, median age was 66 years (IQR: 58-73 years), 3,704 (59%) had ICM, and 3,778 (60%) received CRT. CRT increased the time to HFH or all-cause death (HR: 0.67; 95% credible interval [CrI]: 0.56-0.82; P < 0.001) with no difference by etiology of cardiomyopathy (HR ratio: 1.06 [95% CrI: 0.87-1.29]; P = 0.57). Likewise, CRT increased the time to all-cause death (HR: 0.71 [95% CrI: 0.55-0.93]; P = 0.019) with no difference by etiology of cardiomyopathy (HR ratio: 1.06 [95% CrI: 0.80-1.43]; P = 0.70). Echocardiographic data that were available for 2,430 (39%) patients showed that CRT improvements in left ventricular ejection fraction, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter were larger for patients with NICM. ConclusionsAlthough CRT led to greater increases in left ventricular ejection fraction and reductions in ventricular dimensions for patients with NICM compared with those with ICM, CRT significantly increased the time to HFH or all-cause death independently of the etiology of cardiomyopathy. Further studies on improving patient selection for CRT are needed.

Progress and scenario-based projections of health service availability and coverage towards UHC in the post-conflict and post-pandemic Iraq: a Bayesian hierarchical regression approach

BackgroundTwo decades have passed since the beginning of the Iraq War in 2003. Iraq has long suffered from conflicts and instability, where the people have limited access to healthcare. The...

Relationships between regional burden of tau pathology and age at death and disease duration in PSP

BackgroundA definitive diagnosis of progressive supranuclear palsy (PSP) can only be established through neuropathological evaluations where four cardinal tau lesions are identified. Relationships between regional tau burden and disease duration/age at death is unclear. ObjectiveTo investigate relationships between tau burden in different brain regions and disease duration and age at death in PSP and determine whether association are influenced by PSP subtype (subcortical/cortical) or co-pathologies. MethodsWe identified 45 patients with definite PSP who were evaluated at Mayo Clinic between 2009 and 2023, died and underwent histopathological evaluation. We performed semi-quantitative lesion count for each of four cardinal lesions (pretangles/globose neurofibrillary tangles, threads, tufted astrocytes, and coiled bodies) across 10 brain regions. We fit Bayesian linear hierarchical regression models to estimate the relationship between total pathological burden, and disease duration and age at death by region and the influence of subtype and co-pathologies. ResultsOf the 45 patients, 18 (40 %) were female. Median age at death was 75 (56–87) years and median disease duration was 8 (3,15) years. Younger age at death was associated with greater total tau burden in the pallidum, red nucleus, striatum, and subthalamic nucleus (all p ≤ 0.01). Shorter disease duration was associated with greater total tau burden in the red nucleus (p = 0.05). There was no evidence for a difference in association between lesion types. PSP subtype and co-pathologies did not influence associations. ConclusionsThe findings from this study suggest that age and disease duration influence burden of tau pathology in subcortical regions in PSP.

Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient-Level Meta-Analysis.

Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory New York Heart Association (NYHA) IV versus III functional class at the time of device implantation. In this meta-analysis, we pooled patient-level data from the MIRACLE (Multicenter InSync Randomized Clinical Evaluation), MIRACLE-ICD (Multicenter InSync Implantable Cardioversion Defibrillation Randomized Clinical Evaluation), and COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trials. Outcomes evaluated were time to the composite end point of the first heart failure hospitalization or all-cause mortality, and time to all-cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian hierarchical Weibull survival regression model. We assessed if this association differed between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure). Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to heart failure hospitalization or all-cause mortality (adjusted hazard ratio [aHR], 0.79 [95% credible interval [CI], 0.64-0.99]; posterior probability or P=0.044), with a similar association with time to all-cause mortality (aHR, 0.78 [95% CI, 0.59-1.03]; P=0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR, 0.72 [95% CI, 0.30-1.27]; P=0.23 for heart failure hospitalization/mortality; ratio of aHR, 0.70 [95% CI, 0.35-1.34]; P=0.27 for all-cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes. Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV.

Boring finance. Petroleum exploration and firm debt: Evidence from Norway

The role of financing in petroleum exploration has gained prominence due to sustainability commitments by major financing institutions. Yet the relationship between exploration and financing has been little explored and poorly understood. I create a novel data set combining detailed exploration data with financial register data on all public and private firms operating on the Norwegian Continental Shelf to analyze the relationship between debt and drilling decisions. I make use of both an over-dispersed Poisson regression model estimated by maximum likelihood and a Bayesian hierarchical negative binomial regression model where key elements of the industry microstructure are specified and explicitly modeled. I find evidence that short-term debt is associated with lower rates of drilling and more modest evidence that long-term debt has a slightly positive relationship with exploratory drilling. This evidence is consistent with a financial constraints theory of oil drilling, and supports the argument that exploration drilling is dependent on a firms access to financing.

A Systematic Review and Bayesian Meta-Analysis of Acoustic Measures of Prosody in Parkinson's Disease.

Linguistic prosody is affected in Parkinson's disease (PD), which implicates the basal ganglia's role in the production of prosody. However, there is no recent systematic synthesis of the available acoustic evidence of prosodic impairment in PD. This study aimed to identify the acoustic features of linguistic prosody that are consistently affected in PD. The authors systematically reviewed articles that reported acoustic features of prosodic production in PD. Articles focused on fundamental frequency (F0) and its variability, intensity and its variability, speech and articulation rate, and pause duration and ratio. From a total of 648 records identified, 36 met criteria for inclusion and exclusion. For each acoustic measurement and task, data from people with PD (PwPD) were compared with those from controls to extract effect sizes. Pooled effect sizes were estimated using robust Bayesian hierarchical regression models. PD was associated with decreased F0 variability and increased pause duration. There was limited evidence of reduced intensity variability and speech rate in PwPD. No evidence was found to suggest that PD affects articulation rate or pause ratio. The primary acoustic parameters of prosody affected by PD are F0 variability and pause duration. The identification of these acoustic parameters has important clinical implications for the selection of PD management strategies. The association of F0 variability and pause duration with PD suggests that the neural circuits controlling these parameters are at least partly shared and might include the basal ganglia. While the current study focused on the phonetic realization of prosodic cues, future studies should examine whether and how PD affects prosody at higher levels of processing. https://doi.org/10.23641/asha.25892923.

Probabilistic Modelling of the Food Matrix Effects on Curcuminoid's In Vitro Oral Bioaccessibility.

The bioaccessibility of bioactive compounds plays a major role in the nutritional value of foods, but there is a lack of systematic studies assessing the effect of the food matrix on bioaccessibility. Curcuminoids are phytochemicals extracted from Curcuma longa that have captured public attention due to claimed health benefits. The aim of this study is to develop a mathematical model to predict curcuminoid's bioaccessibility in biscuits and custard based on different fibre type formulations. Bioaccessibilities for curcumin-enriched custards and biscuits were obtained through in vitro digestion, and physicochemical food properties were characterised. A strong correlation between macronutrient concentration and bioaccessibility was observed (p = 0.89) and chosen as a main explanatory variable in a Bayesian hierarchical linear regression model. Additionally, the patterns of food matrix effects on bioaccessibility were not the same in custards as in biscuits; for example, the hemicellulose content had a moderately strong positive correlation to bioaccessibility in biscuits (p = 0.66) which was non-significant in custards (p = 0.12). Using a Bayesian hierarchical approach to model these interactions resulted in an optimisation performance of r2 = 0.97 and a leave-one-out cross-validation score (LOOCV) of r2 = 0.93. This decision-support system could assist the food industry in optimising the formulation of novel food products and enable consumers to make more informed choices.

Incorporating spatial autocorrelation in dasymetric mapping: A hierarchical Poisson spatial disaggregation regression model

The growing demand for spatially detailed population products in various fields continues to rise, as users shift their focus from aggregated areal totals to high-resolution grid estimates. Aggregating demographic data to areas, such as census tracts or block groups, can mask localized heterogeneities within those areas. This paper presents a new pycnophylactic (density-preserving) geospatial model for disaggregating population to high-resolution grids. We describe a Bayesian Hierarchical Poisson Spatial Disaggregation Regression Model (HPSDRM), which incorporates land cover covariates and two levels of spatial autocorrelation. We evaluated the model's predictive ability first with simulation studies, and then by disaggregating census population data for Davidson County, TN, from the census tract-level to a fine grid and comparing predicted to actual block-level population counts. The interpolated population map successfully identified spatial heterogeneities, such as hot- and cold-spots within census tracts. The HPDSRM model out-performed three other types of disaggregation modeling, which suggests the value of incorporating spatial autocorrelation. Based upon this study, HPSDRM has potential for disaggregating other demographic data, such as socioeconomic indicators.

Bayesian hierarchical profile regression for binary covariates.

Dysphagia, a common result of other medical conditions, is caused by malfunctions in swallowing physiology resulting in difficulty eating and drinking. The Modified Barium Swallow Study (MBSS), the most commonly used diagnostic tool for evaluating dysphagia, can be assessed using the Modified Barium Swallow Impairment Profile (MBSImP™). The MBSImP assessment tool consists of a hierarchical grouped data structure with multiple domains, a set of components within each domain which characterize specific swallowing physiologies, and a set of tasks scored on a discrete scale within each component. We lack sophisticated approaches to extract patterns of physiologic swallowing impairment from the MBSImP task scores within a component while still recognizing the nested structure of components within a domain. We propose a Bayesian hierarchical profile regression model, which uses a Bayesian profile regression model in conjunction with a hierarchical Dirichlet process mixture model to (1) cluster subjects into impairment profile patterns while respecting the hierarchical grouped data structure of the MBSImP, and (2) simultaneously determine associations between latent profile cluster membership for all components and the outcome of dysphagia severity. We apply our approach to a cohort of patients referred for an MBSS and assessed using the MBSImP. Our research results can be used to inform appropriate intervention strategies, and provide tools for clinicians to make better multidimensional management and treatment decisions for patients with dysphagia.

Risk Factors for Development of Incisional Hernia after Aortic Aneurysm Repair: Secondary Analysis of the OVER Randomized Controlled Trial

Since the risk of mortality from rupture is elevated, elective repair of abdominal aortic aneurysms (AAAs) is often recommended. Currently, over 80% of elective repairs are carried out using an endovascular approach. While open repair has similar late survival and fewer reintervention outcomes when compared to endovascular repair, incisional hernia is a frequent complication with morbidity and cost implications. The Open versus Endovascular Repair (OVER) trial was the largest randomized trial of endovascular versus open repair of AAA in the United States. The purpose of this study was to determine risk factors associated with incisional hernia development following AAA repair via secondary analysis of the OVER data. This was a multisite trial conducted within the Veterans Affairs health-care system. Study participants (N=881) were enrolled from 2002 to 2008 and followed until 2011 with additional administrative data collection until 2016. Eligible patients had AAA for which elective repair was planned and randomized 1:1 to either open or endovascular repair. Incisional hernia was a prespecified end point in the OVER protocol, specifically assessed at each protocol follow-up visit. Technical details were extracted from each operative report, repair case report form(s), and adverse event form(s). Patient demographics, comorbid conditions, reported preoperative activity level, and operative details including initial approach, blood loss, and closure methods were analyzed using Bayesian hierarchical Weibull survival regression modeling. Incisional hernias were recorded among 46 participants (5.2%). The average time to hernia diagnosis was 3.5years. Of the 437 participants randomized to open treatment, 427 received an open repair including crossovers from endovascular treatment assignment. Transperitoneal repair was performed in 81%, running suture in 96%, and absorbable suture in 71% of cases. Randomization to endovascular repair was associated with reduced risk of hernia (hazard ratio [HR] 0.70, 95% credible interval [CI] 0.49-0.94). Higher activity level was associated with increased hernia risk (HR 1.39, 95% CI 1.06-1.84). Approach, suture closure techniques, body mass index, diabetes, and smoking status were not associated with increased risk of hernia development. Incisional hernia is a frequent complication associated with open repair of abdominal aortic aneurysm and commonly required reintervention. Endovascular repair was associated with reduced risk of hernia. Patients with increased activity experienced a higher incidence of hernia. However, no other modifiable patient, operative, or technical factors were found to be associated with hernia development.

Trends and projections of age-appropriate vaccination coverage in 41 low- and middle- income countries in Asia and Sub-Saharan Africa, 2000-2030.

Routine immunization programs have focused on increasing vaccination coverage, which is equally important for decreasing vaccine-preventable diseases (VPDs), particularly in low- and lower-middle-income countries (LMICs). We estimated the trends and projections of age-appropriate vaccination coverage at the regional and national levels, as well as place of residence and wealth index in LMICs. In total, 174 nationally representative household surveys from 2000 to 2020 from 41 LMICs were included in this study. Bayesian hierarchical regression models were used to estimate trends and projections of age-appropriate vaccination. The trend in coverage of age-appropriate Bacillus Calmette-Guérin (BCG), third dose of diphtheria, tetanus, and pertussis (DTP3), third dose of polio (polio3), and measles-containing vaccine (MCV) increased rapidly from 2000 to 2020 in LMICs. Findings indicate substantial increases at the regional and national levels, and by area of residence and socioeconomic status between 2000 and 2030. The largest rise was observed in East Africa, followed by South and Southeast Asia. However, out of the 41 countries, only 10 countries are estimated to achieve 90% coverage of the BCG vaccine by 2030, five of DTP3, three of polio3, and none of MCV. Additionally, by 2030, wider pro-urban and -rich inequalities are expected in several African countries. Significant progress in age-appropriate vaccination coverage has been made in LMICs from 2000 to 2020. Despite this, projections show many countries will not meet the 2030 coverage goals, with persistent urban-rural and socioeconomic disparities. Therefore, LMICs must prioritize underperforming areas and reduce inequalities through stronger health systems and increased community engagement to ensure high coverage and equitable vaccine access.

Mesoscale activity drives the habitat suitability of yellowfin tuna in the Gulf of Mexico

Yellowfin tuna, Thunnus albacares, represents an important component of commercial and recreational fisheries in the Gulf of Mexico (GoM). We investigated the influence of environmental conditions on the spatiotemporal distribution of yellowfin tuna using fisheries’ catch data spanning 2012–2019 within Mexican waters. We implemented hierarchical Bayesian regression models with spatial and temporal random effects and fixed effects of several environmental covariates to predict habitat suitability (HS) for the species. The best model included spatial and interannual anomalies of the absolute dynamic topography of the ocean surface (ADTSA and ADTIA, respectively), bottom depth, and a seasonal cyclical random effect. High catches occurred mainly towards anticyclonic features at bottom depths > 1000 m. The spatial extent of HS was higher in years with positive ADTIA, which implies more anticyclonic activity. The highest values of HS (> 0.7) generally occurred at positive ADTSA in oceanic waters of the central and northern GoM. However, high HS values (> 0.6) were observed in the southern GoM, in waters with cyclonic activity during summer. Our results highlight the importance of mesoscale features for the spatiotemporal distribution of yellowfin tunas and could help to develop dynamic fisheries management strategies in Mexico and the U.S. for this valuable resource.

Effects of IV fluid restriction according to site-specific intensity of standard fluid treatment-protocol.

Variation in usual practice in fluid trials assessing lower versus higher volumes may affect overall comparisons. To address this, we will evaluate the effects of heterogeneity in treatment intensity in the Conservative versus Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care trial. This will reflect the effects of differences in site-specific intensities of standard fluid treatment due to local practice preferences while considering participant characteristics. We will assess the effects of heterogeneity in treatment intensity across one primary (all-cause mortality) and three secondary outcomes (serious adverse events or reactions, days alive without life support and days alive out of hospital) after 90 days. We will classify sites based on the site-specific intensity of standard fluid treatment, defined as the mean differences in observed versus predicted intravenous fluid volumes in the first 24 h in the standard-fluid group while accounting for differences in participant characteristics. Predictions will be made using a machine learning model including 22 baseline predictors using the extreme gradient boosting algorithm. Subsequently, sites will be grouped into fluid treatment intensity subgroups containing at least 100 participants each. Subgroups differences will be assessed using hierarchical Bayesian regression models with weakly informative priors. We will present the full posterior distributions of relative (risk ratios and ratios of means) and absolute differences (risk differences and mean differences) in each subgroup. This study will provide data on the effects of heterogeneity in treatment intensity while accounting for patient characteristics in critically ill adult patients with septic shock. The European Clinical Trials Database (EudraCT): 2018-000404-42, ClinicalTrials. gov: NCT03668236.