Mixed-effects Logistic Models Research Articles

Speckle tracking echocardiography as a predictor of location of ablation sites in candidates to catheter ablation for recurrent ventricular tachycardia

Abstract Background Preoperative imaging is essential before a ventricular tachycardia (VT) ablation procedure, to improve operative outcomes and reduce procedural times. Although MRI is the gold standard, it has several limitations, including patient compliance, possible presence of non-MRI-compatible devices, and long acquisition time. Speckle tracking echocardiography (STE) is a reliable and appealing technique that quantifies regional and global myocardial deformation, as well as layer-specific (endo-, mid- and epicardial) longitudinal strain, without MRI limitations. Purpose This study aimed to evaluate the efficacy of STE in predicting VT ablation sites. Methods In this study, we compared the bull’s eye segmentation of the left ventricle, global and layer-specific, obtained with STE (TomTec Arena), to investigate whether echocardiography can predict the areas of scar and late potential, as identified by electroanatomic mapping (EnSite X mapping, HD Grid mapping catheter, Abbott). Strain analysis and electroanatomic mapping data were matched segment-by-segment to obtain pairs of endocardial strain and bipolar substrate maps, as well as pairs of midmyocardial/epicardial strain and unipolar substrate maps. Results Twenty-three consecutive patients with an indication for catheter ablation for recurrent VT were enrolled. All patients were being treated with beta-blockers, 52% were taking amiodarone, and only 2 patients were on mexiletine. A total of 1170 pairs of bull’s eye segments were available for analysis. A binary logistic mixed-effects model was used to predict the presence of electroanatomical scar based on strain echocardiography data, to account for interpatient variability. The study findings highlighted a close correlation between the bipolar map and endocardial strain values, and between the unipolar map and midmyocardial strain values. Progressively higher (less negative) values of endocardial strain proved predictive of bipolar electroanatomical scar, with an increase in the odds ratio of bipolar electroanatomical scar equal to 6.2% (95% confidence interval 2.5%-10%) for each unit increase in strain values. Similarly, progressively higher values of midmyocardial strain were predictive of unipolar electroanatomical scar, with an increase in the odds ratio of unipolar electroanatomical scar equal to 6.2% (95% confidence interval 1.2%-11.4%) for each unit increase in strain values. Conclusions The data from our study showed an anatomical correspondence between the areas of low potential identified by electroanatomical mapping and the areas of anomalous longitudinal strain. In particular, the endocardial strain correlates with the bipolar map, and the meso-epicardial strain correlates with the unipolar map. These data may prove useful in the appropriate planning of the procedure in patients with an indication for catheter ablation in the context of recurrent VT.

Incidence of Concurrent Cerebral Desaturation and Electroencephalographic Burst Suppression in Cardiac Surgery Patients.

Increased intraoperative electroencephalographic (EEG) burst suppression is associated with postoperative delirium. Cerebral desaturation is considered as one of the factors associated with burst suppression. Our study investigates the association between cerebral desaturation and burst suppression by analyzing their concurrence. Additionally, we aim to examine their association with cardiac surgical phases to identify potential for targeted interventions. We retrospectively analyzed intraoperative 1-minute interval observations in 51 patients undergoing cardiac surgery. Processed EEG and cerebral oximetry were collected, with the anesthesiologists blinded to the information. The associations between cerebral desaturation (defined as a 10% decrease from baseline) and burst suppression, as well as with phase of cardiac surgery, were analyzed using the Generalized Logistic Mixed Effect Model. The results were presented as odds ratio and 95% confidence intervals (CIs). A value of P < .05 was considered statistically significant. The odds of burst suppression increased 1.5 times with cerebral desaturation (odds ratio [OR], 1.52, 95% CI, 1.11-2.07; P = .009). Compared to precardiopulmonary bypass (pre-CPB), the odds of cerebral desaturation were notably higher during CPB (OR, 22.1, 95% CI, 12.4-39.2; P < .001) and post-CPB (OR, 18.2, 95% CI, 12.2-27.3; P < .001). However, the odds of burst suppression were lower during post-CPB (OR, 0.69, 95% CI, 0.59-0.81; P < .001) compared to pre-CPB. Compared to pre-CPB, the odds of concurrent cerebral desaturation and burst suppression were notably higher during CPB (OR, 52.3, 95% CI, 19.5-140; P < .001) and post-CPB (OR, 12.7, 95% CI, 6.39-25.2; P < .001). During CPB, the odds of cerebral desaturation (OR, 6.59, 95% CI, 3.62-12; P < .001) and concurrent cerebral desaturation and burst suppression (OR, 10, 95% CI, 4.01-25.1; P < .001) were higher in the period between removal of aortic cross-clamp and end of CPB. During the entire surgery, the odds of burst suppression increased 8 times with higher inhalational anesthesia concentration (OR, 7.81, 95% CI, 6.26-9.74; P < .001 per 0.1% increase). Cerebral desaturation is associated with intraoperative burst suppression during cardiac surgery, most significantly during CPB, especially during the period between the removal of the aortic cross-clamp and end of CPB. Further exploration with simultaneous cerebral oximetry and EEG monitoring is required to determine the causes of burst suppression. Targeted interventions to address cerebral desaturation may assist in mitigating burst suppression and consequently enhance postoperative cognitive function.

Examining real-time physical activity in adolescents using the Multi-Process Action Control Model: An ecological momentary assessment study

The purpose of this study was to examine real-time associations between reflective (i.e., state motivation), regulatory (i.e., self-control), and reflexive (i.e., habit) constructs from the Multi-Process Action Control (M-PAC) model and real-time moderate-to-vigorous physical activity (MVPA) behaviour among adolescents using ecological momentary assessments. One hundred and ninety adolescents (Mage = 15.76 ± .47 years; n = 101 males) wore an accelerometer for seven consecutive days and responded to digital survey prompts up to four times daily during the after-school periods. MVPA in the 60-minute time window following each survey prompt was recorded. Multilevel mixed-effects linear and logistic models were computed with disaggregated between- and within-person effects to analyze the data. Results from both linear and logistic multilevel models revealed adolescents with higher state motivation in general and experiencing higher state motivation than one’s typical levels were associated with engaging in more MVPA and higher likelihood of engaging in ≥10 minutes of MVPA. Engaging in activities less consistent with habitual behaviours were associated with more MVPA and higher likelihood of engaging in ≥10 minutes of MVPA. By contrast, self-control was not associated with MVPA. Results from this study extend previous work demonstrating the importance of conscious and non-conscious processes on MVPA behaviour by examining associations in real-time using intensive longitudinal methods. Collectively, this study provides partial support for use of the M-PAC framework to explain acute MVPA among adolescents in real-time and natural contexts.

Traffic Congestion and Safety: Mixed Effects on Total and Fatal Crashes

This paper examines the effects of traffic congestion on total crashes, fatal or serious injury (FSI) crashes, and fatal-only crashes in peak periods using a zone-level safety analysis in Greater Melbourne. Bayesian mixed-effect negative binomial models are employed to investigate the relationship between a congestion index and the frequency of total and FSI crashes. In addition, Bayesian mixed-effect binary logistic models are adopted to explore the association between the congestion index and the likelihood of having fatal crashes in Statistical Area Level 2 (SA2) zones. Modelling results indicate that traffic congestion tends to increase total crashes in both the AM and PM peak periods and FSI crashes in the AM peak period. In contrast, traffic congestion tends to decrease the likelihood of having fatal crashes at both the AM and PM peaks. These findings suggest that many policies to reduce traffic congestion may also enhance road safety by lowering the overall number of crashes. However, it is crucial to incorporate careful speed management within these policies to reduce the risk of fatal crashes effectively.

The Use of Cone-Beam Computed Tomography (CBCT) Arthrography for Wrist Ligamentous Injuries - A Diagnostic Test Accuracy Meta-analysis.

Background: Diagnosis of ligamentous wrist injuries can be challenging with the absence of dynamic instability on radiographs. Our aim was to evaluate the accuracy of cone-beam computed tomography (CBCT) arthrography in diagnosing scapholunate ligament (SLL), lunotriquetral ligament (LTL) and triangular fibrocartilage complex (TFCC) injuries. Methods: A systematic review and literature search were conducted in compliance with Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) and registered at the International Prospective Register of Systematic Reviews, PROSPERO (CRD42024517655). A mixed-effects logistic regression bivariate model was used to estimate summary sensitivity and specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were constructed to determine diagnostic accuracy of CBCT arthrography. Results: We identified five studies assessing the accuracy of CBCT arthrography against wrist arthrography or intraoperative findings as reference standard. The pooled estimates for sensitivity and specificity of CBCT arthrography was 93% (95% CI 40-100) and 91% (95% CI 81-96) for SLL injuries, 83% (95% CI 37-98) and 64% (95% CI 42-81) for LTL injuries and 78% (95% CI 57-91) and 80% (95% CI 54-93) for TFCC injuries. The area under the curve was 0.91 (95% CI 0.89-0.94), showing an excellent diagnostic accuracy of CBCT arthrography in SLL injuries. CBCT arthrography had an estimated mean effective dose of 3.2 mSv (2.0-4.8). Conclusions: Our study confirms that CBCT arthrography has an excellent diagnostic accuracy for wrist ligamentous injuries with comparably high sensitivity to conventional arthrography and a better specificity. While further studies with more robust methodology are required to support its implementation in clinical practice, our analysis shows that it is a reliable option and has a promising future. Level of Evidence: Level III (Diagnostic).

Cross-context equivalence and agreement of healthy diet metrics for national and global monitoring: a multicountry analysis of cross-sectional quantitative 24-hour dietary intake studies

BackgroundDespite national and global commitments to improve nutrition, there are no universally accepted indicators for at-scale monitoring of diets. Several metrics have been proposed and used, but they vary in their comprehensiveness and validity in capturing the properties of healthy diets and, potentially, their interpretability across contexts. ObjectiveThe objective of this study was to assess the cross-context equivalence and agreement of healthy diet metrics. DesignQuantitative 24-h dietary intake data from 57,456 nonpregnant females (15–49 y) in 21 countries were used to construct the food group diversity score (FGDS) and Minimum Dietary Diversity for Women indicator; the Global Diet Quality Score (GDQS) and its submetrics: GDQS+ and GDQS−; the Global Dietary Recommendations (GDR) score and its submetrics: noncommunicable disease (NCD)-Protect and NCD-Risk scores; and the All-5 indicator. Associations between (standardized) measures and indicators were quantified by fitting linear and logistic mixed-effect models across World Bank country income classifications, respectively. The levels of agreement between measures were assessed using Bland–Altman plots of z-scores, whereas rank correlations were assessed using Spearman’s ρ. ResultsThe consumption of healthy food groups was positively associated with concurrent intakes of unhealthy food groups, in particular in high-income countries. Hence, metrics constructed using both healthy and unhealthy food groups (i.e., GDR score and GDQS) showed relatively less discriminatory capacity across country income classifications than their respective submetrics or FGDS. Standardized metrics of healthy (e.g., FGDS and GDQS+) and unhealthy food group consumption (i.e., NCD-Risk and GDQS−) exhibited strong agreement and correlations. ConclusionComposite metrics weighting both healthy and unhealthy food groups have limited cross-context equivalence, because a wide range of diets can theoretically return similar scores. Healthy food group (sub)metrics performed comparably, likely indicating strong underlying construct validity (i.e., dietary diversity and nutrient adequacy). For national and global monitoring, refinement and validation of unhealthy food group metrics (i.e., moderation) is recommended to complement healthy food group metrics.

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.

Effectiveness of Integrating Suicide Care in Primary Care : Secondary Analysis of a Stepped-Wedge, Cluster Randomized Implementation Trial.

Primary care encounters are common among patients at risk for suicide. To evaluate the effectiveness of implementing population-based suicide care (SC) in primary care for suicide attempt prevention. Secondary analysis of a stepped-wedge, cluster randomized implementation trial. (ClinicalTrials.gov: NCT02675777). 19 primary care practices within a large health care system in Washington State, randomly assigned launch dates. Adult patients (aged ≥18 years) with primary care visits from January 2015 to July 2018. Practice facilitators, electronic medical record (EMR) clinical decision support, and performance monitoring supported implementation of depression screening, suicide risk assessment, and safety planning. Clinical practice and patient measures relied on EMR and insurance claims data to compare usual care (UC) and SC periods. Primary outcomes included documented safety planning after population-based screening and suicide risk assessment and suicide attempts or deaths (with self-harm intent) within 90 days of a visit. Mixed-effects logistic models regressed binary outcome indicators on UC versus SC, adjusted for randomization stratification and calendar time, accounting for repeated outcomes from the same site. Monthly outcome rates (percentage per 10 000 patients) were estimated by applying marginal standardization. During UC, 255 789 patients made 953 402 primary care visits and 228 255 patients made 615 511 visits during the SC period. The rate of safety planning was higher in the SC group than in the UC group (38.3 vs. 32.8 per 10 000 patients; rate difference, 5.5 [95% CI, 2.3 to 8.7]). Suicide attempts within 90 days were lower in the SC group than in the UC group (4.5 vs. 6.0 per 10 000 patients; rate difference, -1.5 [CI, -2.6 to -0.4]). Suicide care was implemented in combination with care for depression and substance use. Implementation of population-based SC concurrent with a substance use program resulted in a 25% reduction in the suicide attempt rate in the 90 days after primary care visits. National Institute of Mental Health.

Impact of duodenoscope reprocessing factors on duodenoscope contamination: a retrospective observational study

Despite adherence to reprocessing protocols, duodenoscopes often remain contaminated, highlighting significant knowledge gaps in reprocessing efficiency. This study aims to identify risk factors in duodenoscope reprocessing procedures affecting contamination rates. We included cultures from Pentax ED34-i10T2 duodenoscopes collected between February 2022 and December 2023. Contamination was determined by the presence of microorganisms of gut or oral origin (MGO). Data on duodenoscope use, reprocessing lead times and personnel were retrieved from electronic medical records. Risk factors were derived from reprocessing guidelines and literature. These included a delay over 30 minutes in initiating manual cleaning, manual cleaning duration of five minutes or less, drying time under 90 minutes, personnel reprocessing frequency, and storage exceeding seven days. A logistic mixed-effects model evaluated these factors' impact on duodenoscope contamination. Out of 307 duodenoscope cultures, 58 (18.9%) were contaminated with MGO. Throughout the study period, the duodenoscopes underwent 1296 reprocessing cycles. Manual cleaning times of five minutes or less significantly increased contamination odds (aOR = 1.61, 95%CI:1.10-2.34, p=0.01). Interestingly, increased usage of a duodenoscope was associated with reduced odds of contamination (aOR= 0.80, 95%CI:0.64-0.995, p=0.045). Other studied risks showed no clear association with contamination rates. Manual cleaning times of five minutes or less increased the odds of contamination with MGO. Delays in reprocessing initiation and incomplete drying, traditionally considered as risk factors, were not associated with an increased risk of contamination in this study. Future research should explore whether enhanced surveillance of reprocessing times can mitigate duodenoscope contamination.

Pooled analysis of the MANTICO2 and MONET randomized controlled trials comparing drug efficacy for early treatment of COVID-19 during Omicron waves

BackgroundThe clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves. Methods The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500mg of intravenous sotrovimab (SOT) or 600mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI.Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixedeffects logistic model. These trials are registred with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021-004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2) Findings Between March 2022 and February 2023, 991 patients (SOT=332, TGM/CGM =327, NMV/r=332) were enrolled in 15 Italian centersThe overall mean age was 66 years; 482 participants (48.80%) were male and 856 vaccinated with at least a primary course ( 86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35-1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p=0.015) and 2.42 (95% CI 0.19 to infinity; p=0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032-1.83; p=0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the other two groups at the 21-day follow-up (P=0.039) and a higher prevalence of nausea at the 7-day follow-up in the NMV/r group compared to the mAbs group (p=0.036). Interpretation NMV/r was superior to TGM/CGM in reducing hospital admission or death in clinical vulnerable patients with SARS-CoV-2 infection treated within 5 days of symptoms’ onset. No significant difference in symptom prevalence over time across the arms was found. Funding: The trials were funded by the Italian Agency of Drugs (AIFA) in 2021.

The Influence of Gentrification on Adverse Birth Outcomes in California.

Evidence has documented the effects of place on perinatal outcomes, but less is known about the sociopolitical mechanisms, such as gentrification, that shape neighborhood context and produce spatialized inequities in adverse birth outcomes. Leveraging a diverse sample in California, we assessed theassociations between gentrification and birth outcomes: preterm birth, small-for-gestational-age, and low birth weight. Gentrification was measured using the Freeman method and the Displacement and Gentrification Typology. Descriptive analysis assessed outcome prevalence and race and ethnicity distribution by exposure and participant characteristics. Overall and race and ethnicity-stratified mixed effects logistic models examined associations between gentrification and birth outcomes, sequentially adjusting for sociodemographic status and pregnancy factors, with a random intercept to account for clustering by census tract. In a sample of 5,116,131 births, outcome prevalence ranged from 1.0% for very preterm birth, 5.0% for low birth weight, 7.9% for preterm birth, and 9.4% for small-for-gestational-age. Adjusting for individual-level factors, gentrification was associated with increased odds of preterm birth (Freeman OR = 1.09, 95% CI 1.07-1.10; Displacement and Gentrification Typology OR = 1.11, 95% CI 1.09-1.13). While Displacement and Gentrification Typology-measured gentrification was consistently associated with greater odds of adverse outcomes, Freeman-measured gentrification was associated with slightly lower odds ofsmall-for-gestational-age and low birth weight. Furthermore, gentrification was associated with birth outcome odds across multiple racial and ethnic groups, but the directions and magnitudes of the associations varied depending on the gentrification assessment methodology and the outcome assessed. Results demonstrate that gentrification plays a role in shaping adverse birth outcomes in California.

Associations of childhood household dysfunction and healthy lifestyle with depressive symptoms in adolescents

ObjectiveLimited understanding exists regarding the cumulative impact of childhood household dysfunction (CHD) on adolescent depressive symptoms in developing countries, as well as the role of lifestyles in this association. This study aims to explore the associations of individual and cumulative CHD indicators with depressive symptoms among Chinese adolescents. Additionally, we investigate potential interactions and joint associations of CHD and lifestyles on depressive symptoms. MethodsIn the second phase of the Longitudinal Study of Adolescents’ Mental and Behavioral Well-being Research, data on depressive symptoms, CHD indicators, lifestyle factors, and other covariates were collected from 3106 students (mean [SD] age, 15.16 [1.52] years). Linear and logistic mixed-effects models were employed, with both stratified and joint analyses conducted. ResultsExcept for parental death, each CHD indicator was associated with an increased risk of depressive symptoms. The accumulation of CHD indicators exhibited a positive, graded association with depressive symptoms scores (β = 3.22, 95% CI: 2.48 to 3.97 for one CHD indicator; β = 5.45, 95% CI: 4.41 to 6.49 for two or more CHD indicators, all P < 0.01). A significant interaction was found between the number of CHD indicators and the healthy lifestyle score (interaction β = −0.40, 95% CI: −0.78 to −0.03, P < 0.05), indicating that healthy lifestyles may mitigate the risk of depressive symptoms in individuals experiencing CHD. For example, the OR for having depressive symptoms among adolescents with favourable lifestyles compared with those with unfavourable lifestyles was 0.21 (95% CI: 0.10 to 0.45, P < 0.01) among those experiencing CHD. Moreover, adolescents with two or more CHD indicators and unfavourable lifestyles faced the highest risk of having depressive symptoms (OR = 8.03, 95% CI: 4.83 to 13.34, P < 0.01) compared with those with no CHD indicator and favourable lifestyles. ConclusionsThese findings underscore the importance of promoting comprehensive healthy lifestyles and reducing CHD exposure for the prevention of depressive symptoms in adolescents.

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

We report the impact of HIV infection within a household on oral Kaposi's sarcoma-associated herpesvirus (KSHV) shedding. We 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. Analyses 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. KSHV 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.

Relapses in canine leishmaniosis: risk factors identified through mixed-effects logistic regression

BackgroundCanine leishmaniosis (CanL), caused by Leishmania infantum, is an important vector-borne parasitic disease in dogs with implications for human health. Despite advancements, managing CanL remains challenging due to its complexity, especially in chronic, relapsing cases. Mathematical modeling has emerged as a powerful tool in various medical fields, but its application in understanding CanL relapses remains unexplored.MethodsThis retrospective study aimed to investigate risk factors associated with disease relapse in a cohort of dogs naturally infected with L. infantum. Data from 291 repeated measures of 54 dogs meeting the inclusion criteria were included. Two logistic mixed-effects models were created to identify clinicopathological variables associated with an increased risk of clinical relapses requiring a leishmanicidal treatment in CanL. A backward elimination approach was employed, starting with a full model comprising all potential predictors. Variables were iteratively eliminated on the basis of their impact on the model, considering both statistical significance and model complexity. All analyses were conducted using R software, primarily employing the lme4 package, and applying a significance level of 5% (P < 0.05).ResultsThis study identified clinicopathological variables associated with an increased risk of relapses requiring a leishmanicidal treatment. Model 1 revealed that for each 0.1 increase in the albumin/globulin ratio (A/G) ratio, the odds of requiring treatment decreased by 45%. Conversely, for each unit increase in the total clinical score (CS), the odds of requiring treatment increase by 22–30%. Indirect immunofluorescence antibody test (IFAT) was not a significant risk factor in model 1. Model 2, incorporating individual albumin and globulins values, showed that dogs with high IFAT titers, hyper beta-globulinemia, hypoalbuminemia, anemia, and high CS were at increased risk of relapse. Both models demonstrated a good fit and explained a substantial amount of variability in treatment decisions.ConclusionsDogs exhibiting higher CS, dysproteinemia, anemia, and high IFAT titers are at increased risk of requiring leishmanicidal treatment upon clinical relapse in CanL. Regular monitoring and assessment of risk factors prove essential for early detection of relapses and effective intervention in CanL cases. The contrasting findings between the two models highlight the complexity of aspects influencing treatment decisions in this disease and the importance of tailored management strategies to improve outcomes for affected dogs.Graphical

Factors influencing pregnancy loss between days 30 and 70 in a single cattle herd: A comprehensive analysis of sire, cow, and other contributing factors

This retrospective study utilized a mixed-effects logistic model analysis to investigate variables associated with the probability of pregnancy loss (PL) between days 30 and 70 in a dataset comprising 9507 pregnancies from a single cattle herd over 10 years. The model incorporated fixed-effect variables including cow breed (Holstein, Crossbred, and Brown Swiss), parity (1st, 2nd, 3rd, and 4th or more), insemination seasons, insemination number (≤3 vs >3), estrus nature (spontaneous vs synchronized), postpartum problems, sire breed (Holstein, Fleckvieh, Brown Swiss, and Montbéliarde), zygote genotypic (pure vs crossbred), days in milk (DIM) at insemination, actual 305-day milk yield, and sire conception rate. Additionally, random effects included sire (n = 129), cow (n = 3463), and production years (n = 10). The results revealed that cows inseminated with Brown Swiss sires or sires with lower initial conception rates had higher PL rates. Biparous cows, cows with lower 305-day milk yield, cows inseminated later in DIM, cows receiving the 4th or subsequent insemination, and cows inseminated during winter or autumn had lower PL rates. The estrus type and zygote genotype did not significantly impact PL. The random effects of cow, sire, and production years were estimated at 0.230, 0.054, and 0.112, respectively. In conclusion, the study findings suggested that improving management practices for high-yielding cows, cows in early lactation stages, and cows exposed to thermal stress conditions, along with utilizing Brown Swiss cows and sires with high initial conception rates per insemination, could potentially decrease overall PL rates on the farm. Nonetheless, the results did not support the use of Crossbred cows, sires from different breeds, or specific sires to mitigate PL rates on the farm.

Racial Disparities in Pulse Oximetry, in COVID-19 and ICU Settings.

This study aimed to assess the impact of race on pulse oximetry reliability, taking into account Spo2 ranges, COVID-19 diagnosis, and ICU admission. Retrospective cohort study covering admissions from January 2020 to April 2024. National COVID Cohort Collaborative (N3C) database, consisting of electronic health records from 80 U.S. institutions. Patients were selected from the N3C database based on the availability of data on self-identified race and both pulse oximetry estimated Spo2 and Sao2. Subgroups included patients in ICU and non-ICU settings, with or without a diagnosis of COVID-19 disease. None. The agreement between Spo2 and Sao2 was assessed across racial groups (American Indian or Alaska Native, Asian, Black, Hispanic or Latino, Pacific Islander, and White). Each patient's initial Sao2 measurement was matched with the closest Spo2 values recorded within the preceding 10-minute time frame. The risk of hidden hypoxemia (Spo2 ≥ 88% but Sao2 < 88%) was determined for various Spo2 ranges, races, and clinical scenarios. We used a generalized logistic mixed-effects model to evaluate the impact of relevant variables, such as COVID-19, ICU admission, age, sex, race, and Spo2, on the risk of hidden hypoxemia, while accounting for the random effects within each hospital. A total of 80,541 patients were included, consisting of 596 American Indian or Alaska Native, 2,729 Asian, 11,889 Black, 13,154 Hispanic or Latino, 221 Pacific Islander, and 51,952 White individuals. Discrepancies between Spo2 and Sao2 were observed across all racial groups, with the most pronounced bias in Black patients. Hidden hypoxemia rates were higher in Black patients across all Spo2 subgroups, for all clinical scenarios. The odds of hidden hypoxemia were higher for Black and Hispanic or Latino patients and for those with COVID-19 disease. Race significantly impacts pulse oximetry reliability. Not only Black and Hispanic or Latino patients were at higher risk for hidden hypoxemia, but also those admitted with a COVID-19 diagnosis. Future in-depth explorations into the underlying causes and potential solutions are needed.

Psychotherapy Engagement Before and After a Rapid Transition to Telehealth During COVID-19 for Older Adults With Dementia.

Objective: To understand the impact of the transition to telehealth during COVID-19 on psychotherapy visits for patients with dementia. Method: Retrospective study of older adults with dementia who had at least one psychotherapy visit in the 9months before and after the onset of COVID-19 at 3 U.S. health systems. Care disruptions were gaps of 45+days. Descriptive statistics and logistic mixed-effects models examined factors associated with care disruption. Results: 4953 patients with dementia made 19,902 psychotherapy visits. Gaps in psychotherapy were less frequent during COVID-19 (29.4%) than before (48.9%), with the odds of a patient experiencing a care disruption during COVID-19 0.54 times the odds prior to COVID-19 (95% CI: 0.50-0.59). Almost all patient subgroups had lower adjusted odds of care disruption during COVID-19. Discussion: There were fewer disruptions in psychotherapy care following the rapid shift to virtual care. Telehealth may be a viable option for patients with dementia.

Association of Intensive Care Unit Case Volume With Mortality and Cost in Sepsis Based on a Japanese Nationwide Medical Claims Database Study.

Background The impact of intensive care unit (ICU) case volume on the mortality and medical costs of sepsis has not been fully elucidated. We hypothesized that ICU case volume is associated with mortality and medical costs in patients with sepsis in Japan. Methodology This retrospective nationwide study used the Japanese administrative data from 2010 to 2017. The ICU volume categorization into quartiles was performed according to the annual number of sepsis cases. The primary and secondary outcomes were in-hospital mortality and medical costs, respectively. A mixed-effects logistic model with a two-level hierarchical structure was used to adjust for baseline imbalances. Fractional polynomials were investigated to determine the significance of the association between hospital volume and clinical outcomes. Subgroup and sensitivity analyses were performed for the primary outcome. Results Among 317,365 sepsis patients from 532 hospitals, the crude in-hospital mortality was 26.0% and 21.4% in the lowest and highest quartile of sepsis volume, respectively. After adjustment for confounding factors, in-hospital mortality in the highest quartile was significantly lower than that of the lowest quartile (odds ratio = 0.829; 95% confidence interval = 0.794-0.865; p < 0.001). Investigations with fractional polynomials revealed that sepsis caseload was significantly associated with in-hospital mortality. The highest quartile had higher daily medical costs per person compared to the lowest quartile. Subgroup analyses showed that high-volume ICUs with patients undergoing mechanical ventilation, vasopressor therapy, and renal replacement therapy had a significantly low in-hospital mortality. The sensitivity analysis, excluding patients who were transferred to other hospitals, demonstrated a result consistent with that of the primary test. Conclusions This nationwide study using the medical claims database suggested that a higher ICU case volume is associated with lower in-hospital mortality and higher daily medical costs per person in patients with sepsis.

Grey matter ageing-related tau astrogliopathy: associations with brain pathologies and cognitive decline.

Grey matter ageing-related tau astrogliopathy (ARTAG) pathology is common in aged brains and detected in multiple brain regions. However, the associations of grey matter ARTAG with Alzheimer's disease and other common age-related proteinopathies, in addition to clinical phenotypes, including Alzheimer's dementia and cognitive decline, remain unclear. We examined 442 decedents (mean age at death = 90 years, males = 32%) from three longitudinal community-based clinical-pathological studies. Using AT8 immunohistochemistry, grey matter ARTAG pathology was counted in the superior frontal region, anterior temporal tip and amygdala and summarized as a severity score ranging from zero (none) to six (severe). Alzheimer's disease and other common age-related neuropathologies were also evaluated. The diagnosis of Alzheimer's dementia was based on clinical evaluations; annual tests of cognitive performance were summarized as global cognition and five cognitive domains. Multivariable logistic regression tested the associations of grey matter ARTAG pathology with an array of age-related neuropathologies. To evaluate associations of grey matter ARTAG pathology with Alzheimer's dementia and cognitive decline, we used logistic regression and linear mixed-effect models. Grey matter ARTAG pathology was seen in 324 (73%) participants, of which 303 (68%) participants had ARTAG in the amygdala, 246 (56%) in the anterior temporal tip and 137 (31%) in the superior frontal region. Grey matter ARTAG pathology from each of the three regions was associated with a pathological diagnosis of Alzheimer's disease and limbic-predominant age-related TAR DNA-binding protein 43 encephalopathy-neuropathological change but not with vascular pathology. In fully adjusted models that controlled for demographics, Alzheimer's disease and common age-related pathologies, an increase in severity of grey matter ARTAG pathology in the superior frontal cortex, but not in the amygdala or the anterior temporal tip, was associated with higher odds of Alzheimer's dementia and faster decline in global cognition, episodic memory and semantic memory. These results provide compelling evidence that grey matter ARTAG, specifically in the superior frontal cortex, contributes to Alzheimer's dementia and cognitive decline in old age.

Impact of Weekly Training-Load Structure and Content on the Risk of Injury in Professional Rugby Union Match-Play.

Chéradame, J, Loursac, R, Piscione, J, Carling, C, Decq, P, and Jacqmin-Gadda, H. Impact of weekly training-load structure and content on the risk of injury in professional Rugby Union match-play. J Strength Cond Res 38(9): 1613-1619, 2024-The aim of this study was to investigate the impact of different components of daily training load during the week preceding the match on the risk of sustaining a match injury in professional rugby union. A cohort of 72 players from a single professional French club participated. Global positioning system-derived data including total distance (TD) and high-speed distance in addition to ratings of perceived effort (RPE) for both on- and off-pitch (gym-based strength conditioning work) training were collected for each training session over 3 seasons (2017-2020). The association between the daily measures of external and internal training load over the week preceding the day of the match (MD) and the subsequent risk of injury in match-play was estimated using a mixed-effects logistic model adjusted for contextual and individual factors. A total of 184 injuries were sustained in 128 matches (incidence: 81.2 injuries per 1,000 player hours). Higher RPE values for the strength conditioning session on MD-5 ( p < 0.001) and for the on-pitch session on MD-1 ( p = 0.04) were associated with an increased risk of injury in matches. On MD-2, a higher TD covered and that run at high speed (>MAS) were, respectively, associated with a higher ( p = 0.03) and lower risk ( p = 0.02) of injury in matches played. This study in professional rugby union shows that different components of external and internal load had varying influences on injury risk and particularly in relation to the day on which these were performed in the week leading up to the next match. At MD-2, training load favoring intensity rather than volume could reduce the risk of match-play injury.