Log-linear Research Articles

Association between achieved cholesterol levels and the risk of major adverse cardiovascular events after acute coronary syndromes

Abstract Background European guidelines recommend reducing lipid levels to defined targets to lower cardiovascular risk after acute coronary syndromes (ACS). Purpose This study aims to evaluate the association of achieved and reduced lipid levels one year post-ACS with the risk of subsequent major adverse cardiovascular events (MACE) in a real-world setting. Methods Data from SPUM-ACS, a Swiss multicentric cohort of patients hospitalized with ACS between 2007 and 2021, were used to assess the association between lipid levels (LDL-C, non-HDL-C, HDL-C, triglycerides), relative difference from baseline lipid levels, and lipid targets achievement (LDL-C <1.8 and ≥50% reduction from baseline, non-HDL-C <2.2 and triglycerides <1.7mmol/l) one year after ACS with the risk of MACE (myocardial infarction, stroke, coronary revascularization, and cardiovascular death). The observation period for MACE started after a follow-up visit one year post-ACS, during which lipid levels were measured, extending over a median duration of 5.5 years. Cox proportional hazards models, adjusted age, sex, BMI, smoking status, statin therapy intensity, diabetes, systemic inflammatory disease, and creatinine were used. Predicted adjusted hazard ratios (HR) were represented graphically for continuous exposures. Analyses were repeated with interaction terms for predefined subgroups. Results 2579 ACS survivors (mean age 62 years; 80% male), primarily undergoing percutaneous revascularization, attended a follow-up visit one year after ACS and were followed up for a median of 5.5 years. 98% were prescribed statin therapy (59% high-intensity) at discharge. During the first year post-ACS, median LDL-C decreased from 3.7 to 2.4 mmol/l (-34%, p<0.001), non-HDL-C from 3.9 to 2.6 mmol/l (-32%, p<0.001), and triglycerides from 1.21 to 1.16 mmol/l (-6%, p<0.001); HDL-C increased from 1.1 to 1.2 mmol/l (+6%, p<0.001). 92% of patients were on statin therapy (50% high-intensity) one year after ACS. In log-linear models, one year after ACS, a 1 mmol/l reduction of LDL-C, non-HDL-C, and triglycerides levels to the target was associated with a lower risk of subsequent MACE by 23%, 24%, and 14%, respectively (p values <0.001). A 10% relative reduction from baseline levels of LDL-C, non-HDL-C and triglycerides was associated with a lower risk of MACE by 8%, 9%, and 4%, respectively (p values <0.001). Achieving LDL-C <1.8 mmol/l (21%, HR=0.71 [0.54, 0.93]), LDL-C reduction ≥50% from baseline (26%, HR=0.63 [0.48, 0.84]), non-HDL-C <2.2 mmol/l (30%, HR=0.65 [0.51, 0.83]), and triglycerides <1.7 mmol/l (76%, HR=0.76 [0.62, 0.94]) were all associated with a reduction in the risk of MACE. Neither age, sex, BMI, diabetes, or smoking status affected the results (p for interaction ≥0.05). Conclusion These findings affirm current recommendations and underscore lipid reduction and targets achievement as critical strategies for mitigating residual cardiovascular risk in patients with ACS.

Health disparities among in multicultural and non-multicultural families in South Korea

Abstract South Korea has experienced significant immigrant growth, with international marriages playing a key role in this demographic change. In 2019, international marriages accounted for 10.3% of all marriages, increasing the number of multicultural households. Multicultural families in Korea faced controversies over accepting new members in a society traditionally considered racially and ethnically homogenous. In rural areas, where patriarchal and conservative values prevail, there is greater discrimination and negative perception towards foreigners compared to urban areas, impacting access to healthcare. This potentially adversely affects the health of married immigrants. However, research on this issue is limited. This study aims to examine the differences in health behaviors, access to care, and health status between multicultural and non-multicultural families in rural and urban areas. Using a cross-sectional study design based on the 2023 Community Health Survey, the sample included 228,216 adults from non-multicultural families and 3,373 adults from multicultural families. Adjusted differences in outcome were estimated using regression models, including linear probability and logistic models. Overall, there were minimal or no differences in health behaviors and health status between adults from multicultural and non-multicultural families. However, significant differences were observed in access to care, such as annual health check-ups (0.72 [0.64, 0.81]) and vaccinations (0.84 [0.76, 0.94]). Non-multicultural families showed regional differences in all outcomes, whereas multicultural families exhibited minimal or no regional differences. These findings suggest that multicultural families may face barriers beyond regional environments, limiting their access to care and potentially leading to long-term negative health outcomes. Targeted policy development for multicultural families in Korea is necessary to address this issue. Key messages • Access to health care may vary for individual and local factors, especially for people with different ethnicities or cultures. • Multicultural families may encounter greater barriers than individual and regional characteristics, requiring the development of tailored policies for immigrants and multicultural families.

Temporal trends, regional and socio-economic disparities of colorectal cancer burden in Cyprus

Abstract Background Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide and it is the third most common cancer in Cyprus. Previous studies have documented variations in CRC burden over time, across regions and area-based socio-economic deprivation. The aim of this study was to analyse the burden of CRC over time, across regions and area-based socio-economic deprivation in Cyprus for the time period 2000 to 2015. Methods A small area ecological study was performed, with census tracts as units of spatial analysis. The incidence and death date, sex and age of CRC were obtained from the population-based cancer registry of Cyprus. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed estimates of SIRs and SMRs were derived from the Spatiotemporal Bayesian Poisson log-linear model. To investigate temporal trends in the association between area-based socioeconomic deprivation and CRC burden, we have used the national socio-economic index. Results The burden of CRC was rising over time. The CRC cumulative incidence increase from 243.7 in the time period 2000-2007 to 347.3 per 100,000 persons in the time period 2008-2015.There was also a more pronounced geographical variation in SIR and SMR in the time period 2008-2015. Four areas out of 369 had smoothed SIR>1.15 while twenty-six areas had smoothed SMR>1.15, with most of those areas located at the east coast of the island and around the capital city. There was a temporal trend in the socio-economic inequalities of CRC burden. The areas in the third and fourth quartile of the socio-economic index had 23% and 45% lower rates of CRC incidence, and 33% and 47% lower rates of CRC mortality in the period 2008-2015. Conclusions These findings could shape national prevention policies, such as the national screening program of CRC starting in 2025 and protection strategies for CRC mortality. Key messages • Colorectal cancer screening should be geographically targeted for efficient resource allocation. • Public health interventions to improve colorectal-specific mortality risk should be geographically targeted.

Influence of gender and bruxism on the masseter muscle: A population-based magnetic resonance imaging study

This study aimed to (1) examine the cross-sectional area (CSA) of the masseter muscle in relation to bruxism and (2) investigate if there are gender-related differences in the masseter muscle in a population-based magnetic resonance imaging (MRI) study. The study included 720 subjects aged 30-89 years (391 women and 329 men) from the Study of Health in Pomerania, a cross-sectional population-based study assessing the prevalence and incidence of common population-relevant diseases and their risk factors in Northeastern Germany. The participants underwent both a whole-body MRI and a full oral examination. The CSAs of the masseter muscles on both sides were measured from MRI images. The presence or absence of awake and/or sleep grinding and clenching, unilateral chewing, and other parafunctional activities were obtained from the dental interview. Linear and ordinal logistic regression models were used to examine the associations between the CSAs of the masseter, bruxism, and gender. The frequency of bruxism and reports of muscle or joint pain were significantly higher in women. The analysis revealed that a larger masseter CSA was significantly associated with bruxism only in men. The larger CSA was manifested only in the higher frequency bruxers. Bruxism had heterogeneous effects on the masseter muscle between genders. Although a higher prevalence of bruxism was reported by women, the larger CSA of the masseter muscle was significantly higher in bruxing men but not in women. This study emphasizes the need for a gender-specific approach when evaluating the clinical implications of bruxism on the masseter muscle.

Socioeconomic and Racial Disparities in Primary Open-Angle Glaucoma in the US.

Socioeconomic status is a potentially significant, although difficult to isolate, factor in determining glaucoma severity. To analyze the level of glaucoma severity (mild, moderate, or severe) based on demographic factors, including age, gender, ethnicity, insurance profile, and zip code, and to use this data to extrapolate the effect of socioeconomic status (SES) and race on glaucoma severity at the community level in Memphis, TN. 2913 patients from a tertiary care center with three clinic locations in Memphis, TN who had been given the diagnosis of Primary Open Angle Glaucoma (POAG) through use of the ICD-10 codes for mild (H40.1111, H40.1121, H40.1131), moderate (H40.1112, H40.1122, H40.1132) and severe (H40.1113, H40.1123, H40.1133) POAG between January 2016 and July 2021 were included in this study. Diagnoses were made after a complete glaucoma workup consisting of Snellen visual acuity, applanation IOP measurement, gonioscopy, automated Humphreys Visual Fields (10-2 and 24-2), and optic nerve OCT. Demographic information, including age, gender, ethnicity, insurance profile, and zip code, was also collected with disease severity for each patient. SES was approximated using zip code-level census poverty data and insurance profiles. Statistical analyses were performed, including descriptive, multivariable ordinal logistic modeling and stepwise multivariable linear modeling. Glaucoma severity was shown to increase with poverty rate (OR=1.089, P<0.0071), age (OR=1.030, P<0.0001), male sex (OR=1.374, P<0.0001), and Black race (OR=1.896, P<0.0001). Severity was shown to be decreased in patients with private insurance compared to Medicare (OR=0.895, P<0.093) and those from Shelby County compared to other counties (OR=0.703, P<0.0001). Our findings indicate that worsening glaucoma severity was associated with higher poverty rates in our patient population. However, isolating socioeconomic status (SES) as an independent factor influencing the incidence and severity of glaucoma remains challenging, given the strong correlation between race and SES.

Characteristics and outcomes of inpatients aged 85 and older with thoracolumbar vertebral fractures: impact on hospital stay and mortality.

There is a gap in evidence about medical outcomes in oldest-old patients (aged 85 and older) with vertebral fractures (VFs). The aim of this study was to evaluate the impact of patient and fracture characteristics on "short-term" hospital outcomes. All patients aged ≥ 85 presenting an acute or subsequent VF at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were length of stay (LOS) and in-hospital mortality. Further outcome parameters were the occurrence of general (non-operative) complications and Intensive Care Unit (ICU) admission. For statistical analysis, linear and binary logistic regression modeling were performed. A total of 153 patients with an average age of 88.5 (range 85 to 99) met the inclusion criteria. Our patients were mostly female (68.6%) and moderately comorbid according to a Charlson Comorbidity Index (CCI) of 2.9. 58.8% had diagnosed osteoporosis. Fracture morphologies represented as "Osteoporotic Fracture" (OF) classification types were of central importance for undergoing operative treatment (OP) (p < 0.001), necessity for intensive care (p = 0.023), LOS (p = 0.014), and mortality (p = 0.018). 38.6% had OP. We recorded a complication rate of 59.5%, which highly influenced (p < 0.001) both primary outcome parameters. Overall, patients stayed 14.6 days with a mortality of 11.1%. VFs are a severe event in oldest-old patients with a crucial risk of poor medical outcomes during hospitalization. The fracture morphologies are of central importance. However, little is known about the hospital stay of oldest-old inpatients with VFs. Considering an aging population, further investigations would be recommended.

Determining the Identity of Nucleotides and the Energy of Binding of tRNAs to Their Aminoacyl-tRNA Synthetases Using a Simple Logistic Model

This study showed that the predictor in logistic regression can be applied to estimating the Gibbs free energy of tRNAs’ recognition of and binding to their aminoacyl-tRNA synthetases. Then, 24 linear logistic regression models predicting different classes of tRNAs loaded with a corresponding amino acid were trained in a machine learning classification method, reducing the misclassification error to zero. The models were based on minimal subsets of Boolean explanatory variables describing the favorite presence of nucleotides or nucleosides localized in the different parts of the tRNA. In 90% of cases, they agree with the components of the consensus strand in a class of tRNAs loaded by a given amino acid. According to the proposed theoretical model, the values of the free energy for the entry of the recognition state in the process of tRNA charging were obtained, and the inputs from identity nucleotides and the tRNA strand backbone were distinguished. Almost all the resulting models indicated leading anticodon tandems defining the first and second positions of the anticodon (positions 35 and 36 of the tRNA strand) and the small sets (up to six positions) of the other nucleotides as the natural identity nucleotides most influential in the free energy balance. The magnitude of their input to this energy depends on the position in the strand, favoring positions −1, 35, and 36. The role of position 34 is relatively smaller. These identity attributes may not always be fully arranged in a real single adaptor molecule but were comprehensively present in a given tRNA class. A detailed analysis of the resulting models showed that the absolute value of the energy of binding the tandem 35–36 decreases with the number of identity positions, as well as with the decreasing number of possible hydrogen bonds. On the other hand, in these conditions, the absolute value of the energy of binding of other identity nucleotides increases. All the models indicate that the nucleotide-independent energy of the repulsion tRNA backbone decreases with the number of identity nucleotides. It was also shown that the total free energy change in entering the recognition state increases with the amino acid mass, making this process less spontaneous, which may have an evolutionary reference.

Association between acute tobacco exposure and fractional exhaled nitric oxide in patients with chronic obstructive pulmonary disease: National health and Nutrition Examination Survey (NHANES) 2007–2012

BackgroundFractional exhaled nitric oxide (FeNO) is a marker of type 2 airway inflammation. Tobacco exposure can lower FeNO levels. However, the effect of acute tobacco exposure on FeNO in patients with chronic obstructive pulmonary disease (COPD) is unclear. This study aimed to investigate the relationship of acute tobacco exposure with FeNO and eosinophils in COPD patients. MethodsThis retrospective cohort study included 445 patients with COPD based on the 2007–2012 National Health and Nutrition Examination Survey. Serum cotinine levels were examined to assess environmental tobacco smoke exposure. The patients were divided into five groups based on cotinine levels: Q1 (first quintile), Q2 (second quintile), Q3 (third quintile), Q4 (fourth quintile) and Q5 (fifth quintile). Logistic regression models and linear logistic regression models were used to evaluate the relationship between serum cotinine and FeNO and EOS levels. ResultsApproximately 16.5 % (75/445) of the participants had elevated FeNO (>25 bbp). In the unadjusted model, COPD patients with the lowest quintile of serum cotinine levels (0.011–0.0185 ng/mL) had higher FeNO levels compared to those with the highest quintile (≥309 ng/mL) (odds ratios (OR), 5.86 [2.11–16.20]). These findings remained consistent even after adjusting for covariates of demographics, lifestyle, diabetes, coronary heart disease, tumours, hypertension, using oral or inhaled steroids within 2 days, asthma and respiratory symptoms within 7 days. Furthermore, a standard deviation increase of ln-transformed cotinine levels was associated with decreased FeNO levels (OR, 0.45 [0.33, 0.60]). No significant correlation was observed betweenserum cotinine and blood eosinophils. After high extents of tobacco exposure, no correlation was found between FeNO and eosinophils.Our findings indicate that high cotinine levels are associated with decreased FeNO in COPD patients but not with blood eosinophils. This reveals that smoking may affect FeNO levels in patients with COPD, whereas it does not appear to influence blood eosinophil levels.

Association between residential noise exposure and burnout among healthcare workers in Taiwan: a cross-sectional study

Few studies have explored the association between residential noise exposure and burnout. In this study, we investigated the association between residential noise exposure and burnout prevalence among 5416 health-care workers in Taiwan from 2012 to 2017. Burnout was evaluated using the Mandarin version of the Copenhagen Burnout Inventory by considering both continuous and binary measures. We applied ordinary Kriging models to calculate the annual average residential noise exposure at an individual level. Multivariable linear regression models and logistic regression models were employed. Restricted cubic splines were used to explore dose–response relationships. The median age of the health-care workers was 31.5 years. In the multivariable linear regression models, exposure to residential noise (per 1 dBA) was associated with increases in personal burnout and work-related burnout scores by 1.59 ± 0.25 and 1.38 ± 0.20, respectively. In the multivariable logistic regression models, the adjusted odds ratios were 1.24 (95% confidence interval [CI]: 1.16, 1.32) for personal burnout and 1.19 (95% CI: 1.13, 1.26) for work-related burnout per 1-dBA increase in residential noise exposure. Linear dose–response associations of burnout with residential noise level were detected. Our findings suggest that exposure to residential noise may increase the risk of burnout among health-care workers.

Revealing the burden of chronic kidney disease in Mexican women, 1990–2021

BackgroundChronic kidney disease (CKD) has become a concerning public health issue, affecting people regardless of their sex, age, or socioeconomic status. We aimed to analyze the burden of female CKD in Mexico between 1990 and 2021, expressed in terms of years lived with disability (YLDs), mortality, years of life lost (YLLs), and disability-adjusted life-years (DALYs). Additionally, we evaluated the relationship between DALYs and the Socio-Demographic Index (SDI) and the Healthcare Access and Quality Index (HAQI).MethodsSecondary data analysis from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. We used mortality, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs to analyze CKD in women between 1990 and 2021. We used a log-linear segmented regression model to analyze trends in female CKD DALY rates over time. The information was disaggregated by age groups and sub-causes nationally and across the 32 states. Age-standardized rates (ASR) were used.ResultsBetween 1990 and 2021, the ASR mortality and ASR-DALYs due to CKD increased significantly at the national level. The DALYs are almost entirely explained by YLLs, indicating that a large proportion of women with CKD in Mexico die prematurely. Disparities in the burden of this disease were observed across different states and age groups within the country. In 2021, the highest ASR-DALY rate was recorded in Tabasco (1,972.0), while the lowest was in Sinaloa (865.1). The SDI and HAQI were associated with the CKD DALYs in most states.ConclusionsMexican women experience a significant burden due to CKD, reflected in premature deaths and years lived with disability, while disparities between states need to be addressed to reduce inequities. Over the past 32 years, improvements in socioeconomic indicators and the quality and access to healthcare have not contributed to reducing the DALYs rate due to CKD, indicating a need to redirect policies to impact women’s well-being and health positively.

An Improved Physics-Based Dual-Band Model for Satellite-Derived Bathymetry Using SuperDove Imagery

Shallow water bathymetry is critical for environmental monitoring and maritime security. Current widely used statistical models based on passive optical satellite remote sensing often rely on prior bathymetric data, limiting their application to regions lacking such information. In contrast, the physics-based dual-band log-linear analytical model (P-DLA) can estimate shallow water bathymetry without in situ measurements, offering significant potential. However, the quasi-analytical algorithm (QAA) used in the P-DLA is sensitive to non-ideal pixels, resulting in unstable bathymetry estimation. To address this issue and evaluate the potential of SuperDove imagery for bathymetry estimation in regions without prior bathymetric data, this study proposes an improved physics-based dual-band model (IPDB). The IPDB replaces the QAA with a spectral optimization algorithm that integrates deep and shallow water sample pixels to estimate diffuse attenuation coefficients for the blue and green bands. This allows for more accurate estimation of shallow water bathymetry. The IPDB was tested on SuperDove images of Dongdao Island, Yongxing Island, and Yongle Atoll. The results showed that SuperDove images are capable of estimating shallow water bathymetry in regions without prior bathymetric data. The IPDB achieved Root Mean Square Error (RMSE) values below 1.7 m and R2 values above 0.89 in all three study areas, indicating strong performance in bathymetric estimation. Notably, the IPDB outperformed the standard P-DLA model in accuracy. Furthermore, this study outlines four sampling principles that, when followed, ensure that variations in the spatial distribution of sampling pixels do not significantly impact model performance. This study also showed that the blue–green band combination is optimal for the analytical expression of the physics-based dual-band model.

Trends in intergenerational class mobility and education in Argentina, Chile, and Uruguay, over common birth cohorts

We compare intergenerational class mobility trends in Argentina, Chile, and Uruguay, exploring the effects of education over birth cohorts. After presenting descriptive measures of absolute mobility, we use log-linear models to study relative mobility and the mediating role of education. Then, we examine trends in intergenerational class mobility linked to educational levels over cohorts. Finally, counterfactual simulations show the net effects of education on mobility. Results show that intergenerational class mobility across cohorts occurred only for men in Argentina and Chile. Inequality trends in educational opportunities were only present for women. Class returns to education occurred among men in Chile and Uruguay, and women in Argentina. Social fluidity under the mediating effects of education did not show a clear pattern. The claim that educational expansion created more opportunities for intergenerational mobility does not find support in our data.

Student mobility in Southern Italy: An empirical analysis of preferential patterns

This paper presents an empirical analysis aimed at identifying chain migration patterns among university students from Sicily, Sardinia, and Apulia. Utilizing data from the national archive of university students enrolled in an Italian university from 2008 to 2017, we construct origin–destination matrixes and calculate residuals from a log-linear model to detect key student routes. Positive residuals between specific origin–destination pairs that persist over time can suggest significant attraction and potential chain migration. The results support a “large to large” and “small to small” city mobility model, particularly for Sicily and Sardinia. Students from Palermo, Catania, Messina, and Cagliari show strong connections with large cities such as Rome and Milan. Furthermore, results show historical links between Sardinia and Tuscany date back to the 1950s, and the enduring connections between Apulian students and universities in Emilia-Romagna, Veneto, and Lombardy have been evident since the 1970s. In Sicily, mobility patterns towards the Polytechnic of Turin began in the 1970s and persist today. These patterns underscore the influence of prior migrants on the mobility decisions of university students in Southern Italy, highlighting a potential chain migration effect.

Postoperative outcomes after receipt of ertapenem antimicrobial prophylaxis for colon surgery: a multicenter retrospective cohort study.

To evaluate postoperative outcomes among patients undergoing colon surgery who receive perioperative prophylaxis with ertapenem compared to other antibiotic regimens. Multicenter retrospective cohort study among adults undergoing colon surgery in seven hospitals across three health systems from 1/1/2010 to 9/1/2015. Generalized linear mixed logistic regression models were applied to assess differential odds of select outcomes among patients who received perioperative prophylaxis with ertapenem compared to other regimens. Postoperative outcomes of interest included surgical site infection (SSI), Clostridioides difficile infection (CDI) and clinical culture positivity for carbapenem-resistant Enterobacteraciae (CRE). Inverse probability weights were applied to account for differing covariate distributions across ertapenem and non-ertapenem groups. A total of 2,109 patients were included for analysis. The odds of postoperative SSI was 1.56 times higher among individuals who received ertapenem than among those receiving other perioperative antimicrobial prophylaxis regimens in our cohort (46 [3.5%] vs 20 [2.5%]; IPW-weighted OR 1.56, [95% CI, 1.08-2.26], P = .02). No statistically significant differences in odds of postoperative CDI (24 [1.8%] vs 16 [2.0%]; IPW-weighted OR 1.07 [95% CI, .68-1.68], P = .78) were observed between patients who received ertapenem prophylaxis compared to other regimens. Clinical CRE culture positivity was rare in both groups (.2%-.5%) and did not differ statistically. Ertapenem use for perioperative prophylaxis was associated with increased odds of SSI among patients undergoing colon surgery in our study population, though no differences in CDI or clinical CRE culture positivity were identified. Further study and replication of these findings are needed.

Parameter estimation for second-order SPDEs in multiple space dimensions

AbstractWe analyse a second-order SPDE model in multiple space dimensions and develop estimators for the parameters of this model based on discrete observations of a solution in time and space on a bounded domain. While parameter estimation for one and two spatial dimensions was established in recent literature, this is the first work which generalizes the theory to a general, multi-dimensional framework. Our approach builds upon realized volatilities, enabling the construction of an oracle estimator for volatility within the underlying model. Furthermore, we show that the realized volatilities have an asymptotic illustration as response of a log-linear model with spatial explanatory variable. This yields novel and efficient estimators based on realized volatilities with optimal rates of convergence and minimal variances. For proving central limit theorems, we use a high-frequency observation scheme. To showcase our results, we conduct a Monte Carlo simulation.

Factors affecting Kaposi’s sarcoma-associated herpesvirus transmission in rural Ugandan households, a longitudinal study

BackgroundWe report the impact of HIV infection within a household on oral Kaposi’s sarcoma-associated herpesvirus (KSHV) shedding.MethodsWe enrolled 469 individuals from 90 households. Mouthwash rinse samples collected at three monthly visits were analyzed for KSHV DNA using quantitative polymerase chain reaction (qPCR). Generalized linear mixed effects logistic models were applied to analyze factors associated with KSHV ever shedding, and among shedders, always versus intermittent shedding. Linear mixed effects models were applied to models of KSHV viral loads. Intraclass correlation coefficients (ICCs) were calculated to assess the contribution of household-level factors to variations in shedding probabilities. Hotspot analyses of geospatial feature clusters were calculated using Getis-Ord Gi* statistic and visualized using inverse distance weighted interpolation.ResultsAnalyses included 340 KSHV seropositive individuals, aged 3 + years, with qPCR results from 89 households. Forty households had 1 + persons living with HIV (PLWH), while 49 had none. Among participants, 149(44%) were KSHV ever shedders. Of 140 who shed KSHV at two or more visits, 34(24%) were always shedders. Increasing number of KSHV seropositive household members was significantly associated with ever shedding [Odds ratio(OR) (95% Confidence Interval(95%CI)):1.14(1.03,1.26);p = 0.013]. Among KSHV shedders, a statistically significant age-related trend was identified with 10–19 years being more likely to be always shedders (type III test p = 0.039) and to have higher viral loads (type III test p = 0.027). In addition, higher viral loads were significantly associated with increasing number of household members [coefficient(95%CI):0.06(0.01,0.12);p = 0.042], increasing number of KSHV seropositive members [coefficient(95%CI):0.08(0.01,0.15);p = 0.021], and living in households with 1 + PLWH [coefficient(95%CI):0.51(0.04,0.98);p = 0.033]. Always shedders exhibited higher viral loads than intermittent shedders [coefficient(95%CI):1.62(1.19,2.05);p < 0.001], and viral loads increased with the number of visits where KSHV DNA was detected in saliva (type III test p < 0.001). Household-level factors attributed for 19% of the variability in KSHV shedding (ICC:0.191;p = 0.010). Geospatial analysis indicated overlapping hotspots of households with more KSHV seropositive individuals and KSHV shedders, distinct from areas where PLWH were clustered.DiscussionKSHV oral shedding is influenced by multiple factors at the individual, household, and regional levels. To mitigate ongoing KSHV transmission a comprehensive understanding of factors contributing to oral KSHV reactivation and transmission within households is needed.

Associations between birthweight and preterm birth and the ages at menarche and menopause

BackgroundWomen who reach menarche and menopause at earlier ages have been shown to be at increased risk for numerous conditions including cardiovascular disease, cancer, depression, and obesity; however, risk factors for earlier ages of menarche and menopause are not fully understood. Therefore, we aimed to perform a retrospective investigation of the associations between a personal birthweight and/or being born preterm and the age of and menarche and menopause and related events in the Women’s Health Initiative, a large, racially and ethnically diverse cohort of postmenopausal women.MethodsAt study entry, women reported their birthweight by category (< 6 lbs., 6–7 lbs. 15 oz, 8–9 lbs. 15 oz, or ≥ 10 lbs.) and preterm birth status (4 or more weeks premature). Ages at events related to menarche and menopause were also self-reported. Linear regression and logistic regression models were used to estimate unadjusted and adjusted effect estimates (β) and odds ratios (OR), respectively (n ≤ 86,857). Individuals born preterm were excluded from all birthweight analyses.ResultsAfter adjustments, individuals born weighing < 6lbs. were more likely to reach natural menopause at an earlier age (adjusted β=-0.361, SE = 0.09, P = < 0.001) and have a shorter reproductive window (adjusted β = -0.287, SE = 0.10, p < 0.004) compared to individuals weighing 6–7 lbs. 15 oz. Individuals born preterm were also more likely to reach natural menopause at an earlier age (adjusted β=-0.506, SE = 0.16, P = 0.001) and have a shorter reproductive window (adjusted β = -0.418, SE = 0.17, p < 0.006).ConclusionsThese findings raise concerns that, as more preterm and low birthweight individuals survive to adulthood, the prevalence of earlier-onset menarche and menopause may increase. Clinical counseling and interventions aimed at reducing the incidence of preterm and low birthweight births, as well as intensification of lifestyle modifications to reduce CVD risk among women with these early-life risk factors, should be prioritized.

Varieties of Number-Line Estimation: Systematic Review, Models, and Data

The psychophysical function that best fits human data from number-line estimation is the subject of a lively, on-going debate with important theoretical and practical implications. We comprehensively reviewed articles which tested competing psychophysical functions and found systematic variablility in task design. To test whether one function could account for data across diverse tasks, we examined 158 children’s and adults’ estimates using two 2 × 2 designs, crossing symbol (symbolic, non-symbolic) and boundedness (bounded, unbounded) on free number-line tasks (Experiment 1) and crossing the same factors on anchored tasks (Experiment 2). This yielded eight varieties of number-line estimation: four old varieties for testing replicability and four new varieties for testing generalizability. Across the eight varieties, 88.84 % of participants provided estimates better fit by a mixed log-linear model than competing models, with weights of the logarithmic component (λ) decreasing with age in each task. Unlike parameters of competing models, λ on any given task significantly predicted λ on the other 7 tasks, as well as predicting arithmetic skills. Results suggest that representations of numerical magnitude play the largest part in number-line estimation, and the “logarithmic-to-linear shift” provides the most accurate and generalizable description of how number-line estimation develops. (196 words)

Comparison of three approaches for treating the bony access window in lateral sinus floor elevation: a retrospective analysis

The aim of this study was to retrospectively determine the effects of applying different treatment methods to the bony access window on the healing outcomes in lateral sinus floor elevation (SFE). Lateral SFE with implant placement was performed in 131 sinuses of 105 patients. The following three treatment methods were applied to the bony access window: application of a collagen barrier (group CB), repositioning the bone fragment (group RW) and untreated (group UT). Radiographic healing in the window area, augmented bone height changes and marginal bone level changes were examined. Mixed logistic and mixed linear models were analyzed. Over 4.3 ± 1.4 years of follow-up, the implant survival rate was 100% in groups CB and UT, and 96.9% in group RW. The treatment applied to the window did not significantly influence the radiographic healing in the window area, augmented bone height changes or marginal bone level changes (p > 0.05). The healed window areas had generally flat morphologies and were fully corticalized. The mean changes in the augmented bone were less than 1.5 mm in all groups. Marginal bone level changes were minimal. In conclusion, Healing outcomes were not different among three different methods to treat the bony access window in lateral SFE.

A-321 Rethinking the Role of Race in Prenatal AFP Screening for Open Neural Tube Defects

Abstract Background The quantification of alpha-fetoprotein (AFP) in maternal serum is commonly used in prenatal screening to estimate the risk of fetal open neural tube defects (ONTDs). This involves comparing a patient’s measured AFP concentration to the median AFP for women of similar gestational age and weight, reported in AFP multiples of the median (MoM). Current guidelines recommend establishing population medians separately grouped by patients’ race, based on historical reports documenting differences in median AFP concentrations across different populations. We aimed to reevaluate this practice of race based ONTD risk stratification given the limited and questionable historical evidence as well as the small observed differences in AFP concentrations in our practice and in a recent report. Methods We collected maternal serum AFP screening data for patients between 12/30/19 and 2/9/24. Informed by the statistical methods used for clinical risk stratification, we developed two log-linear multiple variable regression models for estimating AFP: gestational age (GA), weight, and interaction terms (Model 1) and Model 1 predictors, race, and interaction terms (Model 2). AFP MoMs were calculated by dividing the measured AFP concentration by the model-estimated AFP. Results We analyzed maternal ONTD screening for 7,702 patients with singleton pregnancies. The current clinical process uses race and ethnicity as documented in the electronic health record, which was categorized as Black (N = 2,360), White (N = 3,734), Hispanic (N = 209), Asian (N = 641), and Other (N = 758). The addition of race in Model 2 included statistically significant predictors (p &amp;lt; 0.001) for Black (β = 0.2), Asian (β = 0.05), and Black:weight interaction (β = -5.9 x 10-4). Between Model 1 and Model 2, the mean change in AFP MoMs was -0.05, +0.03, 0.0, -0.02, and +0.01 for Black, White, Hispanic, Asian, and Other patients, respectively. 95% of Black patients had a change &amp;lt; 0.12 in AFP MoM and &amp;gt; 99% of all other patients had a change &amp;lt; 0.1. Using the clinical interpretative threshold, 56 (0.7%) results were considered elevated in both models, 4 (0.05%) elevated in Model 1 only (3 Black, 1 Other), and 4 (0.05%) elevated in Model 2 only (3 White, 1 Hispanic). Chart review of the 8 discordant interpretations showed small changes in MoMs (mean absolute difference = 0.09) and no cases of ONTDs. Conclusions In our health system’s population, maternal race appears to have a small statistically significant association with maternal AFP concentration, even after adjustment for weight and maternal GA. However, preliminary analyses indicate that this difference has a small impact on the clinical interpretation of these studies, with most patients classified similarly when race is not accounted for in the calculation. Further investigation is needed to clarify whether this small impact on estimation of risk warrants the continued inclusion of race in NTD screening, as well as whether other clinical, social, or community factors available for inclusion in this clinical risk stratification model would be better predictors than the poorly defined and discriminatory concept of race.