Logit Link Function Research Articles

Socioeconomic risk factors for cholera in different transmission settings: An analysis of the data of a cluster randomized trial in Bangladesh.

Cholera remains a threat globally, and socioeconomic factors play an important role in transmission of the disease. We assessed socioeconomic risk factors for cholera in vaccinated and non-vaccinated communities to understand whether the socioeconomic risk factors differ by transmission patterns for cholera. We used data from a cluster randomized control trial conducted in Dhaka, Bangladesh. There were 90 geographic clusters; 30 in each of the three arms of the study: vaccine (VAC), vaccine plus behavioural change (VBC), and non-intervention. The data were analysed for the three populations: (1) vaccinees in the vaccinated communities (VAC and VBC arms), (2) non-vaccinated individuals in the vaccinated communities and (3) all individuals in the non-vaccinated communities (non-intervention arm). A generalized estimating equation with logit link function was used to evaluate the risk factors for cholera among these different populations adjusting for household level correlation in the data. A total of 528 cholera and 226 cholera with severe dehydration (CSD) in 268,896 persons were observed during the two-year follow-up. For population 1, the cholera risk was not associated with any socioeconomic factors; however CSD was less likely to occur among individuals living in a household having ≤4 members (aOR=0.55, 95% CI=0.32-0.96). Among population 2, younger participants and individuals reporting diarrhoea during registration were more likely to have cholera. Females and individuals reporting diarrhoea during registration were at increased risk of CSD. Among population 3, individuals living in a household without a concrete floor, in an area with high population density, closer to the study hospital, or not treating drinking water were at significantly higher risk for both cholera and CSD. The profile of socioeconomic factors associated with cholera varies by individuals' vaccination status as well as the transmission setting. In a vaccinated community where transmission would be expected to be lower, socioeconomic factors may not increase the risk of the disease.

Compulsory military service as a measure of later physical and cognitive performance in male survivors of childhood cancer

Background: Compromised physical fitness and cognitive difficulties have been reported as late effects of cancer treatment during childhood. To assess this issue, the military rankings of cancer survivors in medical checkups at call-up, and conscripts’ physical and cognitive performance during the first weeks of compulsory military education were compared to those of matched population controls without a history of cancer.Material and methods: A total of 1680 male patients born between 1960 and 1992 with a malignancy diagnosed before the age of 16 who were alive at the call-up age (18 years) were identified using the Finnish Cancer Registry, and five age, sex and place of residence matched controls for each patient using the Population Register Centre. Data on military service were gathered from Finnish Defense Forces. A conditional logistic regression analysis, the GEE-method with the cumulative logit link function, the chi-square test, the chi-square test for trend and a one-way analysis of variance were used in different analyses.Results: Cancer survivors were exempted from military service more often than the controls (p < .001). The fit-for-service frequency was highest for survivors of kidney tumors (68%) and lowest after irradiated brain tumors (19%). In service, the results of the 12-min running test were poorer than those of controls for leukemia/non-Hodgkin lymphoma (p = .03) and brain tumor (p = .01) survivors. Interestingly, the standing long-jump test was the only muscle test for which survivor groups performed worse than controls. Performance on cognitive tests only differed from controls in brain tumor survivors.Conclusions: Exemption from service is still common under the current guidelines, but fit-for-service survivors do well in military education. These results can be used for reassuring survivors that completion of military service is possible for those fulfilling the national general guidelines for military fitness.

International comparison of experience-based health state values at the population level

BackgroundDecision makers need to know whether health state values, an important component of summary measures of health, are valid for their target population. A key outcome is the individuals’ valuation of their current health. This experience-based perspective is increasingly used to derive health state values. This study is the first to compare such experience-based valuations at the population level across countries.MethodsWe examined the relationship between respondents’ self-rated health as measured by the EQ-VAS, and the different dimensions and levels of the EQ-5D-3 L. The dataset included almost 32,000 survey respondents from 15 countries. We estimated generalized linear models with logit link function, including country-specific models and pooled-data models with country effects.ResultsThe results showed significant and meaningful differences in the valuation of health states and individual health dimensions between countries, even though similarities were present too. Between countries, coefficients correlated positively for the values of mobility, self-care and usual activities, but not for the values of pain and anxiety, thus underlining structural differences.ConclusionsThe findings indicate that, ideally, population-specific experience-based value sets are developed and used for the calculation of health outcomes. Otherwise, sensitivity analyses are needed. Furthermore, transferring the results of foreign studies into the national context should be performed with caution. We recommend future studies to investigate the causes of differences in experience-based health state values through a single international study possibly complemented with qualitative research on the determinants of valuation.

A Quality Analysis of Systematic Reviews in Dentistry, Part 1: Meta-Analyses of Randomized Controlled Trials

ObjectivesAs the volume of publications in dentistry continues to increase, clinicians are becoming increasingly reliant on systematic reviews and meta-analyses as their primary source of evidence. With an increase in the dependence on dental metaanalyses, it is important to ensure that they are being conducted with as little bias as possible. The objective of this systematic review is to assess the quality of therapeutic meta-analyses of randomized controlled trials (RCTs) on dental-related topics and to analyze how quality has changed over time. MethodsAll relevant studies were searched for through MEDLINE, Embase, PsycINFO, and the Cochrane Library. Title, abstract, and full-text review, as well as data extraction and quality assessment, were all conducted in duplicate. All reviewers used a pilot-tested extraction form that included the AMSTAR checklist to assess quality of systematic reviews. A logit link function ordinal regression was conducted to evaluate quality improvement trends over time. ResultsOf the 3832 studies identified, 208 studies were selected for review. Of these, 13% provided an a priori design, 53% screened and extracted data in duplicate, 29% included gray literature, 63% assessed the quality of included studies, and 39% assessed publication bias. As was indicated by the ordinal regression, the quality of meta-analyses, as per the AMSTAR criteria, has increased significantly with time (P < .001). ConclusionsThis investigation illustrates that although the quality of meta-analyses of RCTs has been increasing since the start of the millennium, there remains substantial room for improvement within all aspects of systematic review reporting and methodology. Therefore, it is critical for clinicians to take caution when reading systematic reviews and meta-analyses, ensuring that the principals of critical appraisal are applied when interpreting meta-analyses of RCTs.

Identifying independent risk factors for graft loss after primary liver transplantation.

The aim of the study is the identification of independent risk factors for re-transplantation after primary liver transplantation beyond the occurrence of hepatic artery thrombosis. Eight hundred thirty-four adult patients undergoing primary liver transplantation were analyzed. A propensity score was developed using multivariable binary logistic regression with hepatic artery thrombosis as the dependent variable. The logit link function of the propensity score was included into multivariable Cox regression analysis for graft survival to adjust the study population. Graft loss was observed in 134 patients (16.1%). Independent significant risk factors for graft loss were recipient platelet count (p=0.040; HR: 1.002; 95%-CI: 1.000-1.003), preoperative portal vein thrombosis (p=0.032; HR: 1.797; 95%-CI: 1.054-2.925), donor age (p<0.001; HR: 1.026; 95%-CI: 1.012-1.040), percentage of macrovesicular steatosis of the graft (p=0.011; HR: 1.037; 95%-CI: 1.009-1.061), early complications leading to revision surgery (p<0.001; HR: 2.734; 95%-CI: 1.897-3.956), duration of the transplant procedure (p<0.001; HR: 1.005; 95%-CI: 1.003-1.007) as well as transplantation of a split liver graft (p=0.003; HR: 2.637; 95%-CI: 1.420-4.728). The logit of the propensity score did not reach statistical significance in the final multivariable Cox regression model (p=0.111) indicating good adjustment for the occurrence of hepatic artery thrombosis. Liver transplant programs might benefit from regular donor organ biopsies to assess the amount of macrovesicular steatosis. An elevated recipient platelet count can promote reperfusion injury leading to graft loss. A liver graft from an elderly donor should not be split or be transplanted in a recipient with detected portal vein thrombosis.

Creating simple solutions for safe naloxone use.

e18185 Background: Naloxone is sometimes required to reverse acute intoxication from opioid pain medications. Although clinical guidelines exist, naloxone dosing is variable in practice. Higher doses can cause pain crisis, acute withdrawal, and possibly increased patient risk. We developed a multi-faceted intervention to increase guideline-concordant naloxone dosing. Methods: We surveyed medical staff and retrospectively collected 6 months of naloxone prescribing data to assess knowledge and frequency of guideline-concordant dosing. We reviewed the electronic order for naloxone and interviewed experienced nurses to facilitate mapping of the process of naloxone administration. We then designed 4 interventions aimed at adult inpatients on medical oncology, general medical and ICU services: 1. Simplify wording of naloxone guidelines; 2. Create naloxone kit containing all necessary equipment and instructions; 3. Auto-populate dose into electronic naloxone order; 4. Administer 5-minute educational inservice to staff (RN, NP, PA, MD). To assess rate of guideline concordance, naloxone prescribing data was collected for the pre-intervention (12 months), intervention (6 weeks), and post-intervention (8.5 months) groups. The survey was repeated after the intervention. For analysis, a generalized linear regression with logit link function and a generalized estimating equation method were used. Results: Over the 22-month study period, 137 patients received 148 naloxone doses. Patients were mean age 63.1 y/o, 54.7% female, and 75.9% white. Of the 90 naloxone doses given pre-intervention, only 24.4% were guideline-concordant. The 10 doses of naloxone given during the intervention period were guideline-concordant in 40% of the cases. Of the 48 naloxone doses given post-intervention, 62.5% were guideline-concordant, a significant increase compared to the pre-intervention group (p &lt; 0.001). The improvement was most dramatic in the non-ICU services (26.4% to 73.5%, p &lt; 0.001). Increases were maintained at 8 months (median concordant rate 53.5%/month (range: 33%-100%). Conclusions: A simple, inexpensive intervention can be used to increase guideline-concordant naloxone dosing and potentially avoid adverse effects of naloxone.

Euploidy rates in donor egg cycles significantly differ between fertility centers.

Do external factors affect euploidy in egg donor cycles? The study demonstrates that during human assisted reproduction, embryonic chromosome abnormalities may be partly iatrogenic. Chromosome abnormalities have been linked in the past to culture conditions such as temperature and Ph variations, as well as hormonal stimulation. Those reports were performed with older screening techniques (FISH), or ART methods no longer in use, and the subjects studied were not a homogeneous group. A total of 1645 donor oocyte cycles and 13 282 blastocyst biopsies from 42 fertility clinics were included in this retrospective cohort study. Samples from donor cycles with PGS attempted between September 2011 and July 2015 were included. PGS cycles from multiple fertility clinics referred to Reprogenetics (Livingston, NJ) that involved only oocyte donation were included in this study. Testing was performed by array comparative genomic hybridization (aCGH). Ploidy data were analyzed using Generalized Linear Mixed Models with logistic regression using a logit link function considering a number of variables that represent fixed and random effects. Euploidy rate was associated with the referring center and independent of almost all the parameters examined except donor age and testing technology. Average euploidy rate per center ranged from 39.5 to 82.5%. The mean expected rate of euploidy was 68.4%, but there are variations in this rate associated with the center effect. Data set does not include details of the donor selection process, donor race or ethnic origin, ovarian reserve or ovarian responsiveness. Due to the retrospective nature of the study, associations are apparent, however, causality cannot be established. Discrepancies in regard to completeness and homogeneity of data exist due to data collection from over 40 different clinics. This is the first study to show a strong association between center-specific ART treatment practices and the incidence of chromosome abnormality in human embryos, although the meiotic or mitotic origin of these abnormalities could not be determined using these technologies. Given the widespread applications of ART in both subfertile and fertile populations, our findings should be of interest to the medical community in general as well as the ART community in particular. No external funds were used for this study. S. Munne is a founding principle of Reprogenetics/current employee of Cooper Genomics. M Alikani's spouse is a founding principle of Reprogenetics/current consultant for Cooper Genomics. The remaining authors have no conflicts to declare.

A general instrumental variable framework for regression analysis with outcome missing not at random.

The instrumental variable (IV) design is a well-known approach for unbiased evaluation of causal effects in the presence of unobserved confounding. In this article, we study the IV approach to account for selection bias in regression analysis with outcome missing not at random. In such a setting, a valid IV is a variable which (i) predicts the nonresponse process, and (ii) is independent of the outcome in the underlying population. We show that under the additional assumption (iii) that the IV is independent of the magnitude of selection bias due to nonresponse, the population regression in view is nonparametrically identified. For point estimation under (i)-(iii), we propose a simple complete-case analysis which modifies the regression of primary interest by carefully incorporating the IV to account for selection bias. The approach is developed for the identity, log and logit link functions. For inferences about the marginal mean of a binary outcome assuming (i) and (ii) only, we describe novel and approximately sharp bounds which unlike Robins-Manski bounds, are smooth in model parameters, therefore allowing for a straightforward approach to account for uncertainty due to sampling variability. These bounds provide a more honest account of uncertainty and allows one to assess the extent to which a violation of the key identifying condition (iii) might affect inferences. For illustration, the methods are used to account for selection bias induced by HIV testing nonparticipation in the evaluation of HIV prevalence in the Zambian Demographic and Health Surveys.

Abstract P1-02-06: Serial monitoring of circulating tumor DNA in patients with metastatic breast cancer

Abstract Background: For patients with MBC, there is currently no evidence that changing therapy on the basis of biomarker results improves outcome. Clinical benefit of treatment is defined as complete response, objective response, or stable disease as determined by RECIST criteria on radiological evaluation. Serial measurements of serum biomarkers such as CA2729 and CTCs have proven unsuccessful in predicting clinical benefit. Circulating tumor DNA(ctDNA) has emerged as a potential biomarker that may predict response to therapy or progression of disease. The present retrospective study was conducted to evaluate the relationship between change in ctDNA with clinical benefit determined by clinical and radiological evaluations of patients with MBC patients. Methods: We conducted a retrospective, single-institutional study to determine if serial monitoring of ctDNA allele frequency levels predict clinical benefit of a treatment. 55 patients with measurable MBC who had serial monitoring of ctDNA between August 2014 and May 2016 were included. The median age was 55.9 (27–94) years). Clinical outcomes were determined as per standard guidelines. The analysis was performed on all cases that had serial measurements of ctDNA with no change in therapy in between and the repeat blood draw was done within 30 days of repeat radiographic evaluation. The dataset contained 125 observations from 48 unique patients. The relationship between the change in ctDNA and clinical benefit was analyzed using a generalized linear model with a random subject effect to account for the intrapatient dependence occurring from obtaining multiple evaluations from the same patient. A logit link function was used akin to logistic regression and a compound symmetric correlation structure was assumed. Results: 68.8% of the cases were hormone receptor-positive, 18.8% HER2-positive, and 27.1% TNBC. The treatments received were 58.4% hormonal therapy, 31.2% chemotherapy, 26.4% included anti-HER2 therapy, 2 cases were on targeted therapy, and 1 case was not on any treatment. Three patients had stage 4 disease in complete remission. ctDNA analysis was repeated on average 4 days prior to radiological evaluation. The average time between repeat assessments was 108.5 days. 93% of the patients had a genomic alteration detected at some point during their course of disease. The most common mutations detected were TP53 41.7%, PIK3CA 35.4%, ESR1 18.8%, and ERBB2 amplifications 6.3%. A dichotomized change in ctDNA is a significant predictor of clinical benefit (p &amp;lt; 0.0001). The intrapatient correlation is estimated to be 0.273 for the transformed variable. The model yields a predicted probability of clinical benefit of 26.9% when the increase in ctDNA is greater than or equal to 0.5 and when the increase in ctDNA is less than 0.5, the a predicted probability of clinical benefit is 78.4%. The concordance of change in ctDNA and change in CA 27-29 was 76.2%. Conclusions: Serial evaluation of serum ctDNA may be useful to evaluate molecular response to treatment which may correlate with clinical benefit and potentially guide treatment decisions. Early indication that a chosen therapy is not effective may lead to avoidance of overtreatment and initiation of an alternative regimen. Further, prospective studies are needed. Citation Format: Patel A, Mukherjee A, Hwang D, Ensor J, Patel TA, Chang JC, Rodriguez AA. Serial monitoring of circulating tumor DNA in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-02-06.

Seed viability, germination and seedling emergence of the critically endangered stem succulent, Adenium swazicum, in South Africa

The regeneration ecology of many southern African threatened plant species is poorly understood. Temperature is considered the most important environmental factor governing seed germination. The germination temperature requirements of the critically endangered stem succulent, Adenium swazicum, were determined under controlled conditions, together with tetrazolium staining protocol tests to assess seed viability. The effects of soil medium, watering levels, depth of sowing and shading on germination/seedling emergence were also determined at the Lowveld National Botanical Garden (LNBG). Germination/seedling emergence was compared under nursery conditions within (Skukuza Nursery in Kruger National Park) and outside (LNBG) the natural distribution range of A. swazicum. The germination of viable seeds ranged 96.5–100% for a broad range of temperatures from 20 to 35°C as well as for 30/20°C (light/dark) alternating temperature. No germination was recorded at 5°C and 10°C, and relatively limited germination at 15°C (42.9%) and 40°C (15.4%). These results were modelled using a Generalized non-linear model, with a binomial error and a logit link function, best-fit models were second-order polynomials (i.e., quadratic). Mean Germination Time ranged from 2 to 6days among temperature treatments. Tetrazolium together with germination results for the 20−35°C temperatures showed moderate to high seed viability across populations and between years within the same population. Seedlings readily emerged irrespective of soil media (3 types) or planting depth (surface, 5 and 10mm) but higher emergence occurred under more frequent watering. Seedlings emerged equally well under sun or shade conditions, but only subsequently survived in the shade. Despite lower temperatures recorded during October/November 2010 at LNBG (outside range: 27.2±0.9°C) compared to Skukuza (within range: 32.6±0.9°C), final germination/seedling emergence was high at both locations (LNBG: 82%; Skukuza: 94%). Together with field observations, this study shows that (a) seed germination is rapid and with high percentages after being cued by warm to hot summer temperatures, a period when rainfall is also at its highest, and (b) that seedling recruitment depends on the availability of suitably shaded microsites. This is the first study on the regeneration ecology of an Adenium sp. and will aid both in situ and ex situ conservation of A. swazicum.

Caregiver report of child’s asthma control predicts future acute visits, independent of guideline-based measures of asthma control

It is unknown whether caregiver perception of a child’s asthma control, independent of National Asthma Educational and Prevention Program (NAEPP) control measures, is a predictor of future acute visits. 150 Baltimore children (5-17y) with persistent asthma were enrolled in a prospective cohort study. Questionnaires administered at baseline, 3, 6, 9, and 12 months captured symptoms, rescue medication use, asthma-related acute visits in the previous 3 months, and caregiver-reported asthma control. Controlled, uncontrolled, and poorly controlled asthma were defined based on days of symptoms, activity limitation, albuterol use, and nighttime awakenings in the past two weeks and FEV1/FVC . Relationships between caregiver-reported control and acute visits in the subsequent 3 months were analyzed using generalized estimating equations with a logit link function and a lagged caregiver-reported asthma control variable. 43.3% were female, 91.3% black, and 85.3% had public insurance. At baseline, 80% met NAEPP criteria for uncontrolled asthma, 20% had caregiver-reported uncontrolled asthma and 27.5% had an acute visit within the subsequent 3 months. In unadjusted models, caregiver-reported uncontrolled asthma was a predictor of an acute visit in the subsequent 3 months (OR [95% CI]: 2.4 [1.4-4.1], p = 0.001) and remained a predictor after adjusting for age, gender, insurance, NAEPP-based asthma control, and rhinitis (OR [95% CI]: 2.1 [1.2-3.6] p=0.01). Caregiver-reported asthma control is a predictor of future acute asthma visits, independent of NAEPP guideline asthma control measures, suggesting that eliciting caregivers’ report of asthma control may be important in identifying children at high risk for future acute visits.

Parsimonious model for analyzing parent-of-origin effects related to beef traits in dual-purpose Simmental.

Genomic imprinting occurs when allelic effects depend on their parental origin. These parent-of-origin effects (POE) occur because of epigenetic DNA modifications during gametogenesis according to the sex of an animal. Animal breeding programs give little consideration to imprinting, although its relationship to important traits has been shown in different agricultural species. To incorporate imprinting, a previously proposed model (imprinting model) contains the genetic effects of the sire and dam, and it provides an estimate of the variance component due to POE, which is referred to as imprinting variance. Large volumes of data are sometimes available for commercial populations, so the dimension of mixed-model equations can become very large or even excessively large when estimating imprinting variances and other genetic parameters. To address this issue, we replaced the genetic effect as dam with the effect of the maternal grandsire in the imprinting model. When combined with appropriate weightings of the observations, this replacement yields an imprinting model with a parsimonious number of genetic effects for male parents and ancestors of slaughter animals, and it enables the inclusion of large volumes of data. In addition, we derived an equivalent model to facilitate the direct estimation of POE and their prediction error variances. We applied the parsimonious model to 1,366,160 fattening bulls as well as a pedigree of 2,637,761 ancestors to investigate the relevance of POE for beef performance in dual-purpose Simmental. We analyzed the killing-out percentage, net BW gain, carcass muscularity, and fat score as slaughter traits. The parsimonious model was applied as both linear and generalized linear versions with a logit-link function. The proportions of the total genetic variance attributable to POE ranged between 8.6% and 17.1%. For 3 of the 4 traits, the maternal gamete accounted for a greater proportion of the imprinting variance. The effects of POE and their reliabilities were estimated for up to 27,567 bulls and all traits, where the reliabilities ranged between 0.38 and 0.99. Thus, our new parsimonious model is appropriate for estimating the imprinting variance using large pedigree data sets. Our results highlight the need to consider POE in genetic evaluations.

The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study

BackgroundPhysical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily.MethodsWe conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated.ResultsThe prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7–88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1–87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents.ConclusionsThe prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.

Excess Consult Volume for Hospital-Based Palliative Care Teams in the U.S. (S774)

•Review current estimates of palliative care consult volume across the U.S.•Determine predictors of self-reported excess palliative care consult volume.•Describe strategies to manage excess consult volume implemented by palliative care programs. The surge in demand for palliative care consultation over the past decade has quickly outstripped the supply of available palliative care specialists. We sought to understand how this imbalance impacts hospital-based palliative care teams and their perceptions of consult volume. We invited American Academy of Hospice and Palliative Medicine members and affiliates to complete a confidential, web-based survey querying demographic factors, job responsibilities, and information about inpatient palliative care consults. We used a generalized linear model with logit link function and robust standard errors to identify predictors of self-reported excess volume, defined as the proportion of time teams are inadequately staffed to see new consults. We received 884 responses (response rate 11.4%). Majorities of respondents were physicians (86.9%), female (60.8%), had <10 years’ experience post-training (73.3%), and spent ≥6 months per year on an inpatient consult team (62.9%). Palliative care teams see a mean of 16.2 (standard deviation 13.1) total consults per day, including 5.4 new consults. Respondents reported inadequate staffing to see new consults in a timely fashion a mean of 35.8% (95% confidence interval 33.6%-38.1%) of the time. In the multivariable model, women and respondents with ≥10 years of experience reported having inadequate staffing more commonly (both p=0.04). For example, clinicians with ≥10 years of experience reported inadequate staffing 39.4% of the time, while those with <10 years reported it 33.9% of the time. Most (84.9%) of palliative care teams have implemented at least one strategy to manage excess workload, including triaging consults (62.6%), dividing them among team members (59.7%), signing off earlier (45.3%), and setting a formal consult cap (9.9%). Most hospital-based palliative care teams have already implemented strategies to address the problem of excess consult volume.

Phenotypic, genetic, and single nucleotide polymorphism marker associations between calf diseases and subsequent performance and disease occurrences of first-lactation German Holstein cows

A total of 31,396 females born from 2010 to 2013 in 43 large-scale Holstein-Friesian herds were phenotyped for calf and cow disease traits using a veterinarian diagnosis key. Calf diseases were general disease status (cGDS), calf diarrhea (cDIA), and calf respiratory disease (cRD) recorded from birth to 2 mo of age. Incidences were 0.48 for cGDS, 0.28 for cRD, and 0.21 for cDIA. Cow disease trait recording focused on the early period directly after calving in first parity, including the interval from 10 d before calving to 200 d in lactation. For cows, at least one entry for the respective disease implied a score = 1 (sick); otherwise, score = 0 (healthy). Corresponding cow diseases were first-lactation general disease status (flGDS), first-lactation diarrhea (flDIA), and first-lactation respiratory disease (flRD). Additional cow disease categories included mastitis (flMAST), claw disorders (flCLAW), female fertility disorders (flFF), and metabolic disorders (flMET). A further cow trait category considered first-lactation test-day production traits from official test-days 1 and 2 after calving. The genotype data set included 41,256 single nucleotide polymorphisms (SNP) from 9,388 females with phenotypes. Linear and generalized linear mixed models with a logit link-function were applied to Gaussian and categorical cow traits, respectively, considering the calf disease as a fixed effect. Most of the calf diseases were not significantly associated with the occurrence of any cow disease. By trend, increasing risks for the occurrence of cow diseases were observed for healthy calves, indicating mechanisms of disease resistance with aging. Also by trend, occurrence of calf diseases was associated with decreasing milk, protein, and fat yields. Univariate linear and threshold animal models were used to estimate heritabilities and breeding values (EBV) for all calf and cow traits. Heritabilities for cGDS and cRD were 0.06 and 0.07 for cDIA. Genetic correlations among all traits were estimated using linear-linear animal models in a series of bivariate runs. The genetic correlation between cDIA and cRD was 0.29. Apart from the genetic correlation between flRD with cGDS (-0.38), EBV correlations and genetic correlations between calf diseases with all cow traits were close to zero. Genome-wide association studies were applied to estimate SNP effects for cRD and cDIA, and for the corresponding traits observed in cows (flRD and flDIA). Different significant SNP markers contributed to cDIA and flDIA, or to cRD and flRD. The average correlation coefficient between cRD and flRD considering SNP effects from all chromosomes was 0.01, and between cDIA and flDIA was -0.04. In conclusion, calf diseases are not appropriate early predictors for cow traits during the early lactation stage in parity 1.

A new model for parent-of-origin effect analyses applied to Brown Swiss cattle slaughterhouse data

Genomic imprinting is a phenomenon that arises when the expression of genes depends on the parental origin of alleles. Epigenetic mechanisms may induce the full or partial suppression of maternal or paternal alleles, thereby leading to different types of imprinting. However, imprinting effects have received little consideration in animal breeding programmes, although their relevance to some agricultural important traits has been demonstrated. A recently proposed model (imprinting model) with two path-of-transmission (male and female)-specific breeding values for each animal accounts for all types of imprinting simultaneously (paternal, maternal, full and partial). Imprinting effects (or more generally: parent-of-origin effects (POE)) are determined by taking the difference between the two genetic effects in each animal. However, the computation of their prediction error variance (PEV) is laborious; thus, we propose a new model that is equivalent to the aforementioned imprinting model, which facilitates the direct estimation of imprinting effects instead of taking the differences and the PEV is readily obtained. We applied the new model to slaughterhouse data for Brown Swiss cattle, among which imprinting has never been investigated previously. Data were available for up to 173 051 fattening bulls, where the pedigrees contained up to 428 710 animals representing the entire Brown Swiss population of Austria and Germany. The traits analysed comprised the net BW gain, fat score, EUROP class and killing out percentage. The analysis demonstrated that the net BW gain, fat score and EUROP class were influenced significantly by POE. After estimating the POE, the new model yielded estimates with reliabilities ranging between 0.4 and 0.9. On average, the imprinting variances accounted for 9.6% of the total genetic variance, where the maternal gamete was the main contributor. Moreover, our results agreed well with those obtained using linear models when the EUROP class and fat score were treated as categorical traits by applying a GLMM with a logit link function.

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

Proportions of Atlantic sailfish (Istiophorus platypterus) and spearfish (Tetrapturus pfluegeri) caught in tuna longline fisheries

The reliability of estimations of catches of pelagic longline fisheries is especially worrying in the case of non-target species such as the sailfish (Istiophorus platypterus) and spearfish (Tetrapturus pfluegeri), because they are often recorded aggregated in onboard maps. For this reason, generalized linear models were used to identify a number of important explanatory variables and their effect on sailfish and spearfish proportions. The response variable (number of sailfish in the aggregate capture) is assumed as binomial using the logit link function. The explanatory variables used were foram year, qrt (quarter), fleet, de (distance from equator) and d (distance from areas above sea level). The selected models showed that the equatorial and coastal regions presented higher densities or catchabilities of sailfish when compared to spearfish, as in the case for fleets of China Taipei and the United States. The lowest mean proportion of sailfish [sailfish/(sailfish + spearfish)] of the third quarter were driven mostly by the low estimations calculated for Japan and Brazil.

Self-rated health, multimorbidity and depression in Mexican older adults: Proposal and evaluation of a simple conceptual model.

Self-rated health is an individual and subjective conceptualization involving the intersection of biological, social and psychological factors. It provides an invaluable and unique evaluation of a person's general health status. To propose and evaluate a simple conceptual model to understand self-rated health and its relationship to multimorbidity, disability and depressive symptoms in Mexican older adults. We conducted a cross-sectional study based on a national representative sample of 8,874 adults of 60 years of age and older. Self-perception of a positive health status was determined according to a Likert-type scale based on the question: "What do you think is your current health status?" Intermediate variables included multimorbidity, disability and depressive symptoms, as well as dichotomous exogenous variables (sex, having a partner, participation in decision-making and poverty). The proposed conceptual model was validated using a general structural equation model with a logit link function for positive self-rated health. A direct association was found between multimorbidity and positive self-rated health (OR=0.48; 95% CI: 0.42-0.55), disability and positive self-rated health (OR=0.35; 95% CI: 0.30-0.40), depressive symptoms and positive self-rated health (OR=0.38; 95% CI: 0.34-0.43). The model also validated indirect associations between disability and depressive symptoms (OR=2.25; 95% CI: 2.01- 2.52), multimorbidity and depressive symptoms (OR=1.79; 95% CI: 1.61-2.00) and multimorbidity and disability (OR=1.98; 95% CI: 1.78-2.20). A parsimonious theoretical model was empirically evaluated, which enabled identifying direct and indirect associations with positive self-rated health.

Corrigendum

Corrigendum