Binomial Regression Research Articles

Dental Caries and Extrinsic Black Tooth Stain in Children With Primary, Mixed and Permanent Dentitions: A Cross-Sectional Study.

Dental caries and extrinsic black tooth stain (EBS) are prevalent among children, with current evidence suggesting a negative correlation between them. It is unclear whether the factors contributing to developing or preventing dental caries and EBS are connected or aligned. To investigate the prevalence and associated factors of caries and EBS among children with primary, mixed and permanent dentitions. This was designed as a cross-sectional study. Probability proportionate to size sampling and simple random sampling methods were used to recruit children aged 5, 9 and 12. Three calibrated paediatric dentists conducted intra-oral examinations. Nutritional supplements, oral health-related behaviours and family background were collected. Bivariate analysis, negative binomial and binary logistic regression were performed. Caries and EBS prevalence were 83.7% and 4.7%, respectively. A decreasing trend in caries and an increasing trend in EBS prevalence were observed across three dentitions. Caries were associated with EBS, oral hygiene, vitamin intake, gender, food-pocketing habits, toothbrushing duration, dental attendance and socioeconomic status. EBS was more likely to occur in caries-free children (OR = 4.42, 95% CI 2.97,6.58, p < 0.001) and children without vitamin consumption (OR = 1.59, 95% CI 1.07, 2.36, p = 0.021). The occurrence of caries and EBS varied across different dentition stages. Their risk and protective factors were not significantly aligned.

Single pass saltwater disinfection using low voltage electrolysis: Potential implications for aquaculture systems

Open net pen saltwater aquaculture faces criticism due to the potential transmission of pathogens between fish farms and to wild stocks. To address this issue and improve the sustainability and growth of net pen farming, closed containment farms have been suggested, but the cost and feasibility of disinfecting large volumes of water in these types of farms is problematic. We explored the potential for using electrolysis to disinfect saltwater in a flow-through system with water flow velocities between 47 and 105 cm/s. This was the first step to investigating whether this technology could be applied to saltwater flow-through closed containment systems. Various voltage levels (3.3–9.0 V) were applied to generate chlorine from saltwater. We found the disinfection properties of the system varied with wattage (i.e., voltage × ampere), velocity of water flow over the electrodes, salinity of water, and residual chlorine contact time. Wattage was highly correlated with the production of chlorine, and this relationship was dependent on water flow (p = 0.0398). A slower flow velocity led to higher chlorine concentration, and the effect was more pronounced at higher wattages. Using a zero-inflated negative binomial regression model, we found the probability of full disinfection was increased by increasing wattage (p < 0.001) and the residual chlorine contact time (p < 0.001). The level of disinfection (count model) suggested the number of bacteria in the treated samples was determined by the interaction between wattage and flow (p = 0.0056) and the interaction between wattage and salinity (p < 0.001). The bacterial count was also associated with residual chlorine contact time (p < 0.001). The results of this study, although preliminary and limited in their scale, offering a potential solution for disinfecting large volumes of seawater, which could make closed containment fish farming in the ocean viable for reducing bacterial transmission within a farm and to wild fish stocks.

Sociodemographic characteristics of maternal presence in neonatal intensive care: an intersectional analysis.

Maternal presence in the Neonatal Intensive Care (NICU) supports infant and maternal health, yet mothers face visitation challenges. Based on intersectionality theory, we hypothesized that mothers of Black infants with lower socioeconomic status (SES) living further from the hospital would demonstrate the lowest rates of maternal presence. We extracted infant race, Medicaid status, and maternal home address from 238 infant medical charts. The primary outcome was rate of maternal presence. Generalized linear modeling and binomial regression were employed for analysis. Medicaid status was the strongest single predictor of lower rates of maternal presence. Having lower SES was associated with lower rates of maternal presence in mothers of white infants, and living at a distance from the hospital was associated with lower maternal presence in mothers of higher SES. Interventions to support maternal presence in the NICU should address resource-related challenges experienced by mothers of lower SES.

Contribution of Product, Price, Place, Promotion, and People (5P) Marketing Mix Strategy on Patients’ Interest To Revisit

In the National Health Insurance (JKN) era, hospitals in Indonesia rapidly grew in number and also developed. In order to stand out amongst the competition, hospitals often rely on marketing strategies through attractive advertisements, offering unique services, and also introducing their services to the public. One method often utilized in the 5P marketing mix consists of product, price, place, promotion, and people. This study aims to identify the impact of 5P marketing mix strategies on the patients’ interest in visiting Bandung Hospital in the city of Medan. Bandung Hospital in Medan conducted this quantitative study using a cross-sectional approach. This study involved 150 patients of Bandung Hospital’s inpatient unit, which is the whole outpatient clinic patient (total sampling) during the May 2023 period. Analysis was carried out using frequency distribution, chi-square, and binomial logistic regression analysis. This study found that the majority of patients visiting Bandung Hospital belong to the 30-39 years age group (62.0%), are female (58.7%), hold a bachelor's degree (48.0%), and are visiting Bandung Hospital for the first time (62.7%). Most of the patients in this study have a good perception toward all aspects of 5P marketing strategies in Bandung Hospital and are interested in visiting the hospital again in the future (p&lt;0.05), with place playing the biggest role in influencing patients’ interest (OR = 4.082). According to all findings in this study, it can be concluded that marketing strategies such as the 5P marketing mix strategy positively influence patients’ interest in visiting Bandung Hospital. It can also be inferred that this strategy would work in similar types of hospitals, not only in Bandung Hospital. Keywords: Marketing mix, Hospital, Product-Price-Place-Promotion-People (5P), Patients

Exploring the Effects of Variety and Amount of Mindfulness Practices on Depression, Anxiety, and Stress Symptoms: Longitudinal Study on a Mental Health-Focused eHealth System for Patients With Breast or Prostate Cancer.

Patients with cancer often face depression and anxiety, and mindfulness-based interventions, including internet-based versions, can effectively reduce these symptoms and improve their quality of life. This study aims to investigate the impact of internet-based mindfulness-based interventions (e-MBIs) on anxiety, depression, and stress symptoms in patients with prostate or breast cancer. The primary aims are to assess the association between the amount and variety of e-MBI practices and symptom reduction. Second, this study aims to examine how baseline information such as sociodemographic characteristics, dispositional mindfulness (DM), and dispositional self-compassion (DSC) correlate with both app usage and symptom reduction. Participants included 107 patients with cancer (68 women with breast cancer and 38 men with prostate cancer) enrolled in a hospital setting. They were assigned to the intervention group of the NEVERMIND project, using the e-BMI module via the NEVERMIND app. A longitudinal design involved Pearson correlation analysis to determine the relationship between the amount and duration of e-MBI practices. Linear regression analysis was conducted to gauge the dose-response effect, evaluating the impact of DM and DSC on depression, anxiety, and stress. Negative binomial regression was conudcted to study sociodemographic factors' influence on the amount of practice in e-MBIs. The participants with more diverse and sustained mindfulness practices experienced significant reductions in depression, anxiety, and stress. A high correlation (0.94) between e-MBI practices and symptom reduction was also highlighted. Male, married, and highly educated patients were more likely to engage in mindfulness. Even if DM and DSC did not impact the amount or variety of practices correlated, they were correlated with symptom reduction, showing that higher levels were associated with significant reductions in depression, anxiety, and stress. While more e-MBI practice is linked to reduced anxiety, depression, and stress, this study emphasizes the crucial role of variety of practice over amount. DM and DSC are key in shaping intervention effectiveness and may act as protectors against psychological distress. Using app log data, our research provides a unique perspective on e-MBI impact, contributing to cancer care understanding and guiding future studies.

Support or Strain?: Transnational Social Ties and Deviant Behaviors Among Multicultural Adolescents in South Korea

ABSTRACT Despite the increasing population of multicultural adolescents in Korea with foreign-born parents, research into their deviant behavior, particularly in relation to transnational ties with their mothers’ home countries, remains limited. Addressing this gap, our study investigated the impact of such ties on multicultural adolescents’ deviant behaviors. Utilizing waves 7–9 of the Multicultural Adolescent Panel Survey (N = 1,193, n = 3,330), we employed a hybrid random effects negative binomial regression to assess both between-individual effects and within-individual changes over time. Our main independent variable was adolescents’ transnational social ties with their mother’s home countries, encompassing both outbound ties (adolescent’s visit to the mother’s home country) and inbound ties (visits by grandparents or relatives from the mother’s home country). We found that transnational ties with the mother’s home country were more likely to induce stress than provide support for adolescents. Specifically, multicultural adolescents with transnational ties through visits from grandparents or relatives from their mother’s home country to Korea exhibited a higher propensity for deviant behaviors compared to those without such ties. Moreover, these transnational visits exacerbated the risk of delinquency over time. We did not find any moderating effect of self-esteem on the relationship between transnational ties and deviant behaviors. Our findings underscore the importance of fostering a social environment that embraces multicultural families as integral members of Korean society.

Association of body index with fecal microbiome in children cohorts with ethnic-geographic factor interaction: accurately using a Bayesian zero-inflated negative binomial regression model.

The microbiome is closely associated with physical indicators of the body, such as height, weight, age and BMI, which can be used as measures of human health. Accurately identifying which taxa in the microbiome are closely related to indicators of physical development is valuable as microbial markers of regional child growth trajectory. Zero-inflated negative binomial (ZINB) model, a type of Bayesian generalized linear model, can be effectively modeled in complex biological systems. We present an innovative ZINB regression model that is capable of identifying differentially abundant taxa associated with distinctive host phenotypes and quantifying the effects of covariates on these taxa, and demonstrate that its accuracy is superior to traditional Hurdle and INLA models. Our pipeline of integrating bacterial differential abundance in microbiome data and relevant covariates is effective and feasible.

Clonal hematopoiesis of indeterminate potential: a risk factor for future exacerbation in patients with COPD

BackgroundThere is limited data regarding the clinical significance of clonal hematopoiesis of indeterminate potential (CHIP) in patients with COPD. We aimed to evaluate whether CHIP could serve as a biomarker for the long-term prognosis of patients with COPD.MethodsNext-generation sequencing was used to detect CHIP in peripheral blood mononuclear cell samples. Participants with COPD were enrolled in a prospective observational cohort between January 2013 and December 2023. We investigated the association of CHIP status with the risk of subsequent acute exacerbation and longitudinal changes in lung function, by using negative binomial regression and linear mixed regression models, respectively.ResultsAmong 125 patients with COPD, the CHIP-positive group was 32 (25.6%). Higher smoking intensity and CAT score were significantly associated with increased risk of positive CHIP status, especially in current smokers. Positive CHIP of specific genes was significantly associated with a higher risk of subsequent mild and total acute exacerbation. Positive CHIP of ASXL transcriptional regulator 1 (ASXL1) had a lower risk of subsequent total acute exacerbation (aOR, 0.19; 95% CI, 0.04–0.95). The CHIP status did not show a statistically significant association with longitudinal changes in lung function.ConclusionsIn patients with COPD, CHIP positivity was significantly associated with an increased risk of subsequent acute exacerbations, but not with longitudinal changes in lung function.

Zebrafish Larvae as a Predictive Model for the Risk of Chemical-Induced Cholestasis: Phenotypic Evaluation and Nomogram Formation.

Chemical-induced cholestasis (CIC) has become a concern in chemical safety risk assessment in pharmaceutical, food, cosmetic, and industrial manufacturing. Currently, known animal and in vitro liver models are unsuitable as high-throughput screening tools due to their high cost, time-consuming, or poor screening accuracy. Herein, a cohort of chemicals validated as cholestatic hepatotoxic in humans, rodents, and in vitro liver models was established for testing. The accuracy and reliability of the detection of CIC in zebrafish larvae were assessed by liver phenotype, bile flow inhibition rate, bile acid distribution, biochemical indices, and RT-qPCR. In addition, the nomogram prediction model was constructed using binomial logistic regression analysis. The model was constructed with three variables: aspartate aminotransferase (AST.FC) level, total bile acid (TBA.FC) level, and fold change in the number of bile acid nodes per unit of bile ducts in the zebrafish liver (NPL.FC), which showed high predictive power (areas under the ROC curve: 0.983). Furthermore, this study demonstrated that zebrafish larvae have some model specificity for CIC risk assessment of estrogen endocrine disruptors and that testing after 10 dpf provides more scientific results. Overall, combining zebrafish larval phenotyping and nomograms is an efficient and powerful tool for CIC risk monitoring of chemicals.

Randomized trial of BCG in healthcare workers to reduce absenteeism during the COVID-19 pandemic in sub-Saharan Africa.

We tested whether providing BCG vaccine to healthcare workers (HCWs) could reduce non-planned absenteeism and thereby reduce the potential impact of the COVID-19 pandemic on healthcare systems in Africa. We conducted a multicenter, single-blinded, placebo-controlled randomized trial in Guinea-Bissau and Mozambique between December 2020 and June 2022. Participants were randomized 1:1 to BCG vaccine or placebo (saline) and followed by biweekly telephone calls for 6mo. The incidence of unplanned absenteeism due to illness was analyzed using Bayesian negative binomial regression yielding relative RRs. Secondary outcomes included infectious disease episodes, COVID-19 infection and all-cause hospitalizations. We enrolled 668 HCWs (Guinea-Bissau, n=503; Mozambique, n=165). The RR for absenteeism of BCG vs placebo was 1.29 (0.81 to 1.94) with comparable effects by country. No protection against infectious disease episodes (HR=1.18 [0.97 to 1.45]) or COVID-19 infection (HR=1.19 [0.80 to 1.75]) was observed. Two trial deaths (1 BCG, 1 control) were registered and nine admissions (3 BCG, 6 control), the all-cause admission HR being 0.51 (0.13 to 2.03). With 64% of the planned sample size and unplanned absenteeism rates lower than expected, BCG did not reduce self-reported absenteeism due to illness. Rather, BCG tended to increase the risk of self-reported absenteeism, infectious disease episodes and COVID-19 infections. This was a randomized control trial assessing non-specific effects of BCG vaccination in healthcare workers. There was no beneficial effect on self-reported absenteeism due to illness within 6mo of follow-up during the COVID-19 pandemic, but a trend towards fewer all-cause hospital admissions.

Variation in general practitioners' follow-up of depressed patients starting antidepressant medication: a register-based cohort study.

Guidelines recommend follow-up within 2 weeks for patients starting medication for depression. Knowledge is lacking about how general practitioners' (GPs) follow-up varies with patients' sociodemographic characteristics. To describe follow-up by GP and specialist in mental healthcare provided to men and women with depression within 3 months of starting drug therapy. Furthermore, to examine whether follow-up varied according to patients' age and education. Registry-based cohort study comprising all patients aged ≥18 years in Norway with a new depression episode in 2014 who started on antidepressants within 12 months from diagnosis. Patients' age and educational level were the exposures. Outcomes were follow-up by GP and/or mental healthcare specialist, and talking therapy with GP, within 90 days of first prescription. Cox proportional hazard models were used to estimate the likelihood of having follow-up contacts. Log binomial regression analysis was performed to explore the likelihood of having talking therapy with a GP. Time to first contact was illustrated by Kaplan-Meier survival curves. The study population comprised 17 000 patients, mean age 45.7 years, 60.6% women. Only 27.8% of the patients were followed up by GP and/or specialist within 2 weeks of the first drug dispensing, 67.1% within 90 days. Older or less educated men and women received less and later contacts than the younger or more highly educated. Differences in age and educational level were associated with follow-up of depressed patients who started medication. This may indicate unwarranted variation in depression care that GPs should consider when prescribing antidepressants.

Depolicing in historically marginalised communities: a neighbourhood-level analysis

ABSTRACT The murder of George Floyd prompted widespread calls for reform surrounding how police officers engage with members of historically marginalised communities. The increased scrutiny of police generated in the wake of the incident prompted depolicing – reductions in discretionary proactive policing driven by officers’ risk aversions. At present, despite a robust evidence base that policing is not applied evenly or consistently across diverse spaces – and amidst scrutiny that it is in interactions within specific sociodemographic populations that policing requires the greatest improvement – little research exists that examines depolicing impacts in neighbourhoods predominantly comprised of historically marginalised populations. This study is a quantitative examination of those depolicing impacts – measured in monthly counts of discretionary police stops and using a series of fixed effects negative binomial regression models – across ethnoracially and socioeconomically divergent neighbourhoods. The study, which spanned 50 months across 157 neighbourhoods in the city of Philadelphia, found a 34% post-Floyd reduction in the expected counts of monthly police stops in neighbourhoods which are both predominantly Black and economically disadvantaged, as well as a nearly 52% reduction in predominantly Hispanic neighbourhoods. The novel finding that depolicing impacts in predominantly Black communities were limited only to the most economically disadvantaged such neighbourhoods is discussed.

Does the impact of open innovation depend on contextual factors? A case of the Korean biopharmaceutical industry.

Investments in the strategic development of the biopharmaceutical industry are increasing in both developed and developing countries. The biopharmaceutical industry is a technology-intensive industry where securing original technology and intellectual property rights is important. The role of open innovation is becoming more important due to the enormous research and development (R&D) funds and long development period in the early development process, and open innovation (OI) is becoming more important in the corporate world. Many empirical studies have been conducted on the impact on performance. However, the contextual factors that affect the relationship between OI activities and innovation performance have received relatively little attention, and studies from the perspective of developing countries catching up with developed countries are even rarer. Accordingly, this study examined the moderating effects (government R&D support, absorptive capacity, and alliance management capacity) that affect open innovation and innovation performance in the biopharmaceutical industry using data from Korea, one of the most representative latecomer countries in the biopharmaceutical industry. The basic information, OI activities, and patent achievements of Korean biopharmaceutical firms were collected and organized into a database. Samples with missing or incorrect information were excluded, and 527 firms were analyzed. Negative binomial regression analysis was performed considering the characteristics of patent performance, which is the dependent variable, and a time lag of one to two years was assumed considering the time required to generate results. OI in the form of technological cooperation, rather than technology purchasing, has a positive effect on patent performance. Meanwhile, the greater the absorptive capacity and government R&D support, the greater the positive impact of technological cooperation on patent performance. Conversely, the greater the alliance management capacity, the greater the positive impact of technological cooperation. These results indicate that the impact of OI activities on technological innovation performance may vary depending on context.

Duration of kissing in different intimate positions among men who have sex with men: A cross-sectional study.

Despite mounting evidence showing that kissing (tongue-kissing) may transmit gonorrhoea between men who have sex with men (MSM), little data exists on factors influencing the duration of kissing while they are above and/or lying underneath a partner for this population group. Between May 2019 and March 2020, we invited MSM aged ≥18years who attended the Melbourne Sexual Health Centre (MSHC) to participate in a survey about the duration of their kissing (minutes) and intimate position while kissing (i.e., kissing while above, or while lying underneath) their most recent partner. Univariable and multivariable negative binomial regressions were performed to examine the associations between the duration of kissing in different intimate positions, and demographic and behavioural characteristics (including age, region of birth, HIV status or PrEP use, and role in anal sex). Of the 965 men with a recent male kissing partner, 89.0% (n = 859) also had sex with that partner. Of the 166 men with a recent female kissing partner, 71.7% (n = 119) also had sex with that partner. Our adjusted analyses showed that, on average, men born in Asia (mean 8.52 vs 11.69min, p < .001) and South America or the Caribbean (mean 8.61 vs 11.69min, p = .022) spent less time kissing compared to men born in Oceania, and the same was also observed for kissing while above or lying underneath. Men who had only receptive anal sex spent less time kissing while above than those who only had insertive anal sex (mean 3.04 vs 5.86min, p < .001). Our study is the first to examine factors that influence duration of kissing in different intimate positions. These factors could be associated with oropharyngeal gonorrhoea if saliva transmitted gonorrhoea and if gravity played a role.

Parental awareness on myopia prevention and control among 350 children.

To understand the current situation of parental perspectives, knowledge, and practices concerning myopia prevention and control for both pre- and school-aged children. This study was a cross-sectional survey that involved children aged 0 to 15y and their parents. Participants were required to respond to an online questionnaire by scanning a quick response (QR) code. The questionnaire consisted of 25 tick-box questions and was open to response from December 22, 2022, to January 5, 2023. The dioptric traits of the children, the visual status and educational background of the parents, the parental perspectives towards myopia and its risks, and the parents' knowledge and practices related to myopia prevention and control were recorded and measured. The Chi-square test and binomial logistic regression were used for statistics. Totally 350 parents responded to the questionnaire. The prevalence and severity of myopia among the surveyed children exhibited a positive correlation with advancing age (P<0.001 and P=0.004, respectively). Nearly half of parents with myopic children considered myopia did not pose any health threat and could be effectively corrected (P<0.001). Parents who held master's or doctoral degree demonstrated a better understanding of children's vision standards for each age group (P=0.001), and 31.63% of them could undergo initial vision screening for their children during the age of 0 to 3y while parents with bachelor's degree (34.04%) and below (32.43%) mainly initiated the vision examination for their children at the age of 4 to 6y (P=0.05). Parents with master's or doctoral degree also exhibited more rational practices concerning outdoor time (P=0.048) and sleep time (P=0.044). No other significant discrepancy among the different educational groups in additional conceptions of myopia, such as hyperopia reserve, axis length, and corneal curvature alterations. Most parents preferred to employ conventional interventions, such as enhancing indoor lighting condition (80.00%) and ensuring appropriate reading posture and distance (71.71%). The current status of parental knowledge and practices about myopia prevention and control remains outdated and deficient. The administrative department should implement efficacious and adaptable measures to enhance parental awareness and foster their commitment towards myopia prevention and control.

When Articulating Populist Dichotomies is Paramount: Exploring the Effects of Explicit and Implicit Populist Styles on User Engagement in Turkish Election Tweets

This paper analyzes whether articulated populist dichotomies or fractured populist styles attract more user engagement on social media focusing on the 2023 Turkish presidential and parliamentary elections via Twitter, considering the tweets of individual candidates and parties ( n = 4,139). Negative binomial regressions revealed that the explicit populist style, which articulates “the people” and “the harmful others” in the same message unit, predicts user engagement. The study shows that explicit populism triggers more favorites, retweets, and replies than any other populist style. Although implicit people-centrism has positive associations with retweets and replies, implicit antagonism has no effect on user engagement data.

Socioeconomic deprivation and suicide in Appalachia: The use of three socioeconomic deprivation indices to explain county-level suicide rates.

West Virginia's (WV) suicide rate is 50% higher than the national average and is the highest in the Appalachian Region. Appalachia has several social factors that have contributed to greater socioeconomic deprivation, a known contributor of suicide. Given WV's high prevalence of suicide and poverty, the current study aims to examine the relationship between socioeconomic deprivation and suicide rates in WV. The Townsend Deprivation Index (TDI), Social Deprivation Index (SDI), and Social Vulnerability Index (SVI) measured socioeconomic deprivation. Negative binomial regression models assessed the relationship between socioeconomic deprivation scores, individual index items, and suicide rates. Model comparisons evaluated the indices' ability to assess suicide rates. A backward selection strategy identified additional key items for examining suicide rates. There was a significant increase in suicide rates for every 10% increase in TDI (β = 0.04; p < 0.01), SDI (β = 0.03; p = 0.04), and SVI scores (β = 0.05; p < 0.01). Household overcrowding and unemployment had a positive linear relationship with suicide in TDI (β = 0.04, p = 0.02; β = 0.07, p = 0.01), SDI (β = 0.10, p = 0.02; β = 0.01, p<0.01), and the SVI (β = 0.10, p = 0.02; β = 0.03, p<0.01). The backwards selection strategy identified additional key items included by the SVI when assessing suicide. Greater socioeconomic deprivation, measured by the TDI, SDI, and SVI, was significantly associated with higher suicide rates. Expanding unemployment benefits and increasing the availability of affordable housing, especially in rural areas, may be useful in reducing suicide rates. Our results suggest racial and ethnic minorities and adults living with a disability may benefit from targeted suicide prevention strategies.

Educators’ Responses to Gender and Emotion in Educator-Child Reminiscing Vignettes

ABSTRACT Research Findings: Elaborative, emotion-rich reminiscing between parents and young children has important developmental benefits, and emerging research has extended this work to early childhood educators. This study investigated how educators’ self-reported preferred reminiscing style and emotional language differed according to children’s gender and emotion. Participants included 168 Australian early childhood educators, each of whom completed the Gendered Emotion Beliefs Scale, the Caregiver-Child Reminiscence Scale, and responded to six reminiscing vignettes with varied protagonist gender and emotion. The four response options for each vignette mapped educator preferences for high or low elaboration and high or low emotion content. A binomial logistic regression revealed that educators’ reminiscing preferences showed no significant relationship with the protagonist child’s gender. However, participants favored responses with emotion language, particularly when the child displayed sadness or anger, and this preference was associated with having a university qualification. Practice or Policy: Findings show that educators did not differentiate responses based on gender but were more likely to respond in an emotionally coaching manner to children expressing negative emotions. This highlights the potential for reminiscing to contribute to supportive classroom environments for socio-emotional development, with a connection to educator qualifications suggesting that higher qualifications lead to enhanced classroom practices.

Electronic Nudges and Influenza Vaccination Among Patients With a History of Myocardial Infarction

Influenza vaccination in patients with acute myocardial infarction (AMI) reduces major adverse cardiac events and is strongly recommended in clinical practice guidelines. Effective strategies to improve vaccination are needed in these high-risk patients. To evaluate whether electronically delivered behavioral nudges improve influenza vaccine uptake in patients with AMI across 3 nationwide implementation randomized clinical trials (RCTs). Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake (NUDGE-FLU), Nationwide Utilization of Danish Government Electronic Letter System for Confirming the Effectiveness of Behavioral Nudges in Increasing Influenza Vaccine Uptake Among Older Adults (NUDGE-FLU-2), and Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake Among Adults With Chronic Disease (NUDGE-FLU-CHRONIC) were RCTs conducted during the 2022 to 2023 and 2023 to 2024 influenza seasons in Denmark. Participants were randomized to either usual care or various behaviorally informed, electronically delivered, letter-based nudges. In a prespecified participant-level pooled meta-analysis, interaction of AMI status on the effects of letter-based nudges vs usual care was examined. Pooled treatment effects were estimated using binomial regression models with identity link, adjustment for trial, and 2-way clustered SEs at the household and participant levels. Effect modification by recency of AMI as a continuous variable was assessed using restricted cubic spline modeling in NUDGE-FLU-CHRONIC. Behaviorally informed, electronically delivered, letter-based nudges or usual care. The primary end point was influenza vaccination receipt. Of 2 146 124 individual randomizations (mean [SD] age, 71.1 [11.6] years; 1 114 725 female [51.9%]) across all 3 trials, 59 458 (2.8%) had a history of AMI. Improvement in vaccine uptake was similar in patients with vs without a history of AMI who received any nudge letter compared with usual care (+1.81 vs +1.32 percentage points; P for interaction by AMI status = .09). A letter highlighting the cardiovascular benefits of vaccination (ie, cardiovascular-gain frame) resulted in larger improvements in vaccine uptake among patients with (vs without) a history of AMI (+3.91 vs +2.03 percentage points; P for interaction by AMI status = .002). Among patients with AMI, the benefits of the cardiovascular-gain frame letter were more pronounced in those not vaccinated in the prior season (+13.7 vs +1.48 percentage points; P for interaction <.001). Among younger participants with chronic disease, the cardiovascular-gain frame letter was particularly effective in patients with more recent AMI (P for interaction by continuous recency of AMI <.001). Across 3 nationwide RCTs of Danish citizens, messaging emphasizing the cardiovascular benefits of vaccination improved influenza vaccination uptake, with greater benefits observed in patients with a history of AMI. This low-cost, scalable implementation strategy should be considered to encourage influenza vaccination in high-risk patients. ClinicalTrials.gov Identifiers: NCT05542004, NCT06030726, NCT06030739.

Radiology resident proficiency in pediatric trauma cases: a comparative analysis based on trauma center status using the WIDI SIM exam.

To investigate the correlation between pediatric and adult trauma center status and radiology resident performance on pediatric trauma cases using the WIDI SIM exam. The WIDI SIM is a validated computer-aided simulation that assesses radiology residents' preparedness for independent call duty. It includes 65 cases across various imaging modalities derived from actual patient encounters. Faculty score free-text responses using a standardized 0-10 scale rubric. We analyzed 8,488 WIDI SIM exam scores from 35 pediatric trauma cases across 52 programs. A negative binomial regression model adjusting for resident level, imaging modality, and case specialty was employed to evaluate the impact of pediatric and adult trauma center status on resident performance. Both pediatric trauma center status (p = 0.0005) and adult trauma center status (p = 0.0003) were significant predictors of higher resident scores. Resident level was also significant, with higher-level residents performing better than first-year residents (p < 0.001). Residents performed worse on MR and US modalities compared to CT, and performance varied by case specialty. Radiology residents' pediatric trauma imaging skills are significantly linked to pediatric and adult trauma center status. Given most pediatric traumas occur outside pediatric trauma centers, targeted training strategies should be considered to ensure residents develop essential diagnostic skills.