Mixed-effects Ordinal Logistic Regression Research Articles

Multivariate mixed-effects ordinal logistic regression models with difference-in-differences estimator of the impact of WORTH Yetu on household hunger and socioeconomic status among OVC caregivers in Tanzania.

Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.

Everyday Discrimination Is Associated With Higher Odds of Hospitalizations Among Older African Americans.

Everyday discrimination-experiences of being treated unfairly based on background characteristics like race-is linked to poor physical and mental health throughout the lifespan. Whether more experiences of discrimination are associated with higher odds of being hospitalized in older African Americans has not been explored. Community-dwelling participants from 3 longitudinal cohort studies (N = 446, age 65+ years) with discrimination scores and ≥12 months of linked Medicare claims were included. Hospitalizations were identified using Medicare fee-for-service claims, available for an average of 6.2 (SD: 3.7) years of follow-up after baseline. In mixed-effects ordinal logistic regression models (outcomes of 0, 1, or 2+ hospitalizations per year) adjusted for age, sex, education, and income, higher discrimination was associated with higher odds of total annual hospitalizations (odds ratio [OR] per point higher = 1.09, 95% confidence intervals [95% CI]: 1.02-1.17). Results were similar when accounting for depressive symptoms. Higher exposure to everyday discrimination is associated with higher odds of hospitalization among older African Americans. Mechanisms underlying associations should be explored further to understand how hospitalizations may be reduced in older African Americans.

Invasive Fungal Infections in Inpatient Solid Organ Transplant Recipients With COVID-19: A Multicenter Retrospective Cohort.

The prevalence and outcomes of COVID-19-associated invasive fungal infections (CAIFIs) in solid organ transplant recipients (SOTRs) remain poorly understood. A retrospective cohort study of SOTRs with COVID-19 admitted to 5 hospitals within Johns Hopkins Medicine was performed between March 2020 and March 2022. Cox regression multilevel mixed-effects ordinal logistic regression was used. In the cohort of 276 SOTRs, 22 (8%) developed IFIs. The prevalence of CAIFIs was highest in lung transplant recipients (20%), followed by recipients of heart (2/28; 7.1%), liver (3/46; 6.5%), and kidney (7/149; 4.7%) transplants. In the overall cohort, only 42 of 276 SOTRs (15.2%) required mechanical ventilation; these included 11 of 22 SOTRs (50%) of the CAIFI group and 31 of 254 SOTRs (12.2%) of the no-CAIFI group. Compared with those without IFIs, SOTs with IFIs had worse outcomes and required more advanced life support (high-flow oxygen, vasopressor, and dialysis). SOTRs with CAIFIs had higher 1-y death-censored allograft failure (hazard ratio 1.65.116.4, P = 0.006) and 1-y mortality adjusting for oxygen requirement (adjusted hazard ratio 1.12.45.1, P < 0.001), compared with SOTRs without CAIFIs. The prevalence of CAIFIs in inpatient SOTRs with COVID-19 is substantial. Clinicians should be alert to the possibility of CAIFIs in SOTRs with COVID-19, particularly those requiring supplemental oxygen, regardless of their intubation status.

Mental Health Status by Race, Ethnicity and Socioeconomic Status among Young Adults in Texas during COVID-19.

Differences in symptoms of depression and anxiety by race/ethnicity and socioeconomic status (SES) among a diverse cohort of young adults during the COVID-19 pandemic (Spring 2020-Fall 2021) have not been examined. We analyzed four waves of biannual, panel data from n = 2629 emerging adults (16-25years old) from the Texas Adolescent Tobacco and Marketing Surveillance study (TATAMS). We conducted a series of mixed effects ordinal logistic regression models to compare the independent and joint effects of race/ethnicity and SES on symptoms of (a) depression and (b) anxiety, adjusting for sex, cohort, and time. Symptoms of depression (aOR range: 1.54 - 2.19; 95% CI: 1.02 - 3.08) and anxiety (aOR range: 1.64 - 2.19; 95% CI: 1.22 - 2.79) were elevated among low SES young adults, across all racial/ethnic groups. Across SES groups, symptoms of depression were lower among non-Hispanic Blacks compared to non-Hispanic Whites (aOR range: 0.33 - 0.41; 95% CI: 0.18 - 0.62) and Hispanics /Latinos (aOR range: 0.33 - 0.38; 95% CI: 0.20 - 0.57); similarly, symptoms of anxiety were lower among non-Hispanic Blacks compared to non-Hispanic Whites (aOR range: 0.44; 95% CI: 25 - 0.77) and Hispanics/Latinos (aOR range: 0.47 - 0.56; 95% CI: 0.29 - 0.83). No significant interaction (joint effect) was observed between SES and race/ethnicity during this period. Low SES was persistently related to poor mental health. Lower odds of symptoms of anxiety and depression among non-Hispanic Black young adults may reflect the 'mental health paradox'. Overall, mental health policies should prioritize lower SES young adults regardless of race and ethnicity.

Implementation of a Mentoring Program for Mentee-Mentor Satisfaction: A Longitudinal Pilot Study

IntroductionMentoring is a unique educational workplace relationship that can support both the mentee and mentor’s skill, knowledge, social, and emotional needs. The primary aim of this longitudinal pilot study was to implement a formal mentoring program to assess its effect on mentee and mentor satisfaction.MethodsData was collected from two hospitals in New South Wales, Australia in late 2018 and early 2019. Junior doctors (mentees) and senior medical staff (mentors) were asked to complete pre-, mid-, and oost-program surveys, with questions relevant to mentee-mentor satisfaction, interactions, and participation. Mixed-effects ordinal logistic regression models were used to assess the program effect on mentee-mentor satisfaction, while Fishers’ exact test was used to evaluate mentee-mentor interactions and participation.ResultsAlthough there was evidence of upwards trends in the proportion of mentees and mentors who reported their satisfaction in the program as excellent and rated their work satisfaction as being very influenced by the program, both trends were statistically non-significant. While our study was likely underpowered, high participation rates provide promising evidence of the program’s acceptability and feasibility.ConclusionThough not reaching statistical significance, study results suggest that the implementation of a mentoring program has the potential to increase satisfaction levels among its participants, be they mentees or mentors. It is recommended that future studies recruit larger samples thereby having sufficient statistical power. Furthermore, causality should be explored in more detail through a multi-site randomized controlled trial design.

Is legal recreational cannabis associated with cannabis use during pregnancy, beliefs about safety, and perceived community stigma?

BackgroundAmong pregnant and recently pregnant people we investigated whether legal recreational cannabis is associated with pregnancy-related cannabis use, safety beliefs, and perceived community stigma. MethodsIn 2022, we surveyed 3571 currently and recently pregnant English- or Spanish-speaking adults in 37 states. Primary outcomes included cannabis use during pregnancy and two continuous scale measures of beliefs about safety and perceived community stigma. Using generalized linear models and mixed effects ordinal logistic regression with random effects for state, we assessed associations between legal recreational cannabis and outcomes of interest, controlling for state-level and individual-level covariates and specifying appropriate functional form. ResultsThose who reported cannabis use during pregnancy were more likely to believe it is safe and to perceive community stigma compared to those who did not report use during pregnancy. Legal recreational cannabis was not associated with cannabis use during pregnancy, continuation or increase in use, frequency of use, or safety beliefs. Legal recreational cannabis was associated with lower perceived community stigma (coefficient: −0.07, 95% CI: −0.13, −0.01), including among those who reported use during (coefficient = −0.22, 95% CI: −0.40, −0.04) and prior to but not during (coefficient = −0.19, 95% CI: −0.37, −0.01) pregnancy. ConclusionFindings do not support concerns that legal recreational cannabis is associated with cannabis use during pregnancy or beliefs about safety. Legal recreational cannabis may be associated with lower community stigma around cannabis use during pregnancy, which could have implications for pregnant people’s disclosure of use and care-seeking behavior.

How syntactic gradience in L1 affects L3 acquisition

Abstract The article reports on a longitudinal study of syntactic cross-linguistic influence (CLI) among L1 Polish learners of L2 English and L3 Norwegian. The study mainly aimed to determine the influence of gradience in L1 on third language acquisition. To this end, four syntactic properties were tested, two of which exhibit similarity between Polish and Norwegian (subject-oriented possessive pronouns and adverb placement), and the other two – between English and Norwegian (definite and indefinite articles). A group of 24 learners of Norwegian participated in an acceptability judgment task, which was administered at three data collection times in all three languages. It aimed not only to determine the presence (and sources) of CLI, but also to observe how gradience in L1 affects the assessment of equivalent properties in L3. In order to assess the role played by gradience, the trilinguals’ performance was compared to that of a control group of English-Norwegian bilinguals. The data were analyzed with mixed-effects ordinal logistic regression modelling, which showed statistically significant differences in the ratings of articles between the two groups. We attribute this finding to gradient acceptability characterizing subject-oriented pronouns and adverb placement in Polish, which is a potential source of non-facilitative CLI.

DISCRIMINATION IS ASSOCIATED WITH HIGHER ODDS OF HOSPITALIZATIONS AMONG OLDER AFRICAN AMERICANS

Abstract Everyday discrimination—experiences of being treated unfairly based on background characteristics like race—is linked to poor physical and mental health throughout the lifespan. Whether more experiences of discrimination are associated with higher likelihood of being hospitalized in older African Americans has not been explored. Hospitalization can represent both poor health and healthcare access. Participants were community-dwelling African Americans from the Rush Memory and Aging Project or Minority Aging Research Study, longitudinal studies of aging (N=301 with at least 12 months linked Medicare fee-for-service claims; mean age 72.5 years (standard deviation [SD]: 5.7), 79% female). Discrimination was assessed using the Detroit Area Study Everyday Discrimination Scale. Hospitalizations (sub-categorized as elective/non-elective, surgical) were quantified using Medicare claims. Mixed-effects ordinal logistic regression models tested associations between baseline discrimination and subsequent odds of hospitalizations per year (0, 1, 2+). The mean baseline discrimination score was 1.7 (SD: 2.2). Over an average 6.5 years (SD: 4.1), 160 participants had at least 1 hospitalization (respectively, 118, 87, and 127 participants had at least 1 nonelective, elective, or surgical hospitalization). Adjusting for age, sex, education, income, depressive symptoms, and medical comorbidity, more experiences of discrimination were associated with higher odds of hospitalization (odds ratio [OR] per point higher on discrimination score=1.12, 95% CI: 1.03-1.22), and higher odds of nonelective (OR=1.12, 95% CI: 1.01-1.24), but not surgical or elective hospitalizations. Drivers of these associations, which may include preventive healthcare avoidance due to discrimination or poor health due to the chronic stress response to discrimination, should be explored.

Triage Accuracy in Pediatrics Using the Emergency Severity Index

IntroductionAlthough the Emergency Severity Index is the most widely used tool in the United States to prioritize care for patients who seek emergency care, including children, there are significant deficiencies in the tool’s performance. Inaccurate triage has been associated with delayed treatment, unnecessary diagnostic testing, and bias in clinical care. We evaluated the accuracy of the Emergency Severity Index to stratify patient priority based on predicted resource utilization in pediatric emergency department patients and identified covariates influencing performance. MethodsThis cross-sectional, retrospective study used a data platform that links clinical and research data sets from a single freestanding pediatric hospital in the United States. Chi-square analysis was used to describes rates of over- and undertriage. Mixed effects ordinal logistic regression identified associations between Emergency Severity Index categories assigned at triage and key emergency department resources using discrete data elements and natural language processing of text notes. ResultsWe analyzed 304,422 emergency department visits by 153,984 unique individuals in the final analysis; 80% of visits were triaged as lower acuity Emergency Severity Index levels 3 to 5, with the most common level being Emergency Severity Index 4 (43%). Emergency department visits scored Emergency Severity Index levels 3 and 4 were triaged accurately 46% and 38%, respectively. We noted racial differences in overall triage accuracy. DiscussionAlthough the plurality of patients was scored as Emergency Severity Index 4, 50% were mistriaged, and there were disparities based on race indicating Emergency Severity Index mistriages pediatric patients. Further study is needed to elucidate the application of the Emergency Severity Indices in pediatrics using a multicenter emergency department population with diverse clinical and demographic characteristics.

65 Associations Between Resilience to Weaning Stress and Startle Response in Nursery-Age Gilts

Abstract Resilience is the capacity of animals to return quickly to their pre-stress status following a disturbance, including social, physical, and/or disease challenges. Understanding impact of individual resilience on behavior is key to improving the performance and welfare of farm animals. The goal of the study was to assess whether behavioral response to an auditory stimulus during a startle test (acute stress) differed between pigs designated as stress-resilient (SR) or stress-vulnerable (SV). Blood samples were collected from female piglets (n = 170) from 26 litters on the day before weaning, the day of weaning, and four days after weaning. Using serum cortisol concentrations from these samples, female pigs (n = 52) were classified as either SR (n = 26) or SV (n = 26) and used for the startle test. The startle test was conducted when pigs were 6 weeks-of age while they were housed in the nursery room. Video recordings were made with ceiling-mounted cameras from 1.5h before the test to 1.5h after the test. Videos were decoded to determine the relaxed-tense score of the pigs (RT; 1: relaxed, 3: tense; scored 10 min before testing began to describe the underlying mood of the pig), orientation to stimulus (OS; direction pigs were facing when air horn sounded), and startle magnitude score (SM; 0: no response, 4: remained frozen &amp;gt;1min). A mixed-effects ordinal logistic regression model was fit for SM including fixed effects of stress group (resilience designation (SR/SV), OS, RT, and pen position (distance from the air horn) and random effect of pen composition (social group). SM was affected by RT (P = 0.02), with pigs that had the greatest levels of underlying tension expressing less response to the stimulus. Pen position also impacted the SM (P &amp;lt; 0.01), with pigs in pens closer to the air horn displaying a stronger startle response than those housed further away. However, SR/SV designation and OS had no influence on SM. Pigs that are already tense may not be responsive to changes in their surroundings, in this case showing little response to a startling noise. Pigs closer to a startling stimulus are likely to perceive it as more threatening than pigs further away from the potential danger. Our data suggest no relationship between intensity of behavioral response to an auditory startle test and resilience or vulnerability to weaning stress. Behavioral and physiological responses to acute stress are influenced by a number of confounding factors inherent in individual animal variability, including the personalities and experiences of the pigs. However, the startle test could be a relatively easy way to assess fearfulness of pigs on farm, as it requires no training of pigs and can be conducted in the home pen, but further methodological improvement is required to enable instantaneous data collection.

The Role of Gender Norms on Intimate Partner Violence Among Newly Married Adolescent Girls and Young Women in India: A Longitudinal Multilevel Analysis.

Gender norms have been posited to impact intimate partner violence (IPV), but there is scant evidence of the longitudinal association between community-level gender norms and IPV. Using longitudinal data on 3,965 married girls surveyed in India, we fitted mixed-effects ordinal and binary logistic regression models for physical IPV intensity and occurrence of sexual IPV. We found a 26% increase in the odds that women experience frequent physical IPV per one unit increase in greater community-level equitable gender norms. We did not find an association between community-level equitable gender norms and sexual IPV. Findings suggest that the relationship between gender norms and physical and sexual IPV differs, indicating the need for tailored interventions for different types of IPV.

HIV-1 drug resistance in people on dolutegravir-based antiretroviral therapy: a collaborative cohort analysis

The widespread use of the integrase strand transfer inhibitor (INSTI) dolutegravir in first-line and second-line antiretroviral therapy (ART) might facilitate emerging resistance. The DTG RESIST study combined data from HIV cohorts to examine patterns of drug resistance mutations (DRMs) and identify risk factors for dolutegravir resistance. We included cohorts with INSTI resistance data from two collaborations (ART Cohort Collaboration, International epidemiology Databases to Evaluate AIDS in Southern Africa), and the UK Collaborative HIV Cohort. Eight cohorts from Canada, France, Germany, Italy, the Netherlands, Switzerland, South Africa, and the UK contributed data on individuals who were viraemic on dolutegravir-based ART and underwent genotypic resistance testing. Individuals with unknown dolutegravir initiation date were excluded. Resistance levels were categorised using the Stanford algorithm. We identified risk factors for resistance using mixed-effects ordinal logistic regression models. We included 599 people with genotypic resistance testing on dolutegravir-based ART between May 22, 2013, and Dec 20, 2021. Most had HIV-1 subtype B (n=351, 59%), a third had been exposed to first-generation INSTIs (n=193, 32%), 70 (12%) were on dolutegravir dual therapy, and 18 (3%) were on dolutegravir monotherapy. INSTI DRMs were detected in 86 (14%) individuals; 20 (3%) had more than one mutation. Most (n=563, 94%) were susceptible to dolutegravir, seven (1%) had potential low, six (1%) low, 17 (3%) intermediate, and six (1%) high-level dolutegravir resistance. The risk of dolutegravir resistance was higher on dolutegravir monotherapy (adjusted odds ratio [aOR] 34·1, 95% CI 9·93-117) and dolutegravir plus lamivudine dual therapy (aOR 9·21, 2·20-38·6) compared with combination ART, and in the presence of potential low or low (aOR 5·23, 1·32-20·7) or intermediate or high-level (aOR 13·4, 4·55-39·7) nucleoside reverse transcriptase inhibitor (NRTI) resistance. Among people with viraemia on dolutegravir-based ART, INSTI DRMs and dolutegravir resistance were rare. NRTI resistance substantially increased the risk of dolutegravir resistance, which is of concern, notably in resource-limited settings. Monitoring is important to prevent resistance at the individual and population level and ensure the long-term sustainability of ART. US National Institutes of Health, Swiss National Science Foundation.

Understanding feline feelings: An investigation of cat owners’ perceptions of problematic cat behaviors

Undesirable feline behaviors can detrimentally effects on the human-cat relationship, owner satisfaction, and animal welfare. This study explored cat owners’ perceptions of cat behavior and identified specific behaviors that owners found problematic. Cat owners voluntarily completed an online survey about their cat’s behavior (Fe-BARQ) between January 2016 and December 2022 (n = 4941). We examined owners’ perceptions of their cats’ behavior problems on an ordinal scale (no problems, minor problems, moderate to serious problems) relative to cat age, sex, neuter status, declaw status, outdoor access, Fe-BARQ subscales and miscellaneous items using Pearson Chi Square tests, Kruskal-Wallis tests, and mixed effects ordinal logistic regression models. Almost all Fe-BARQ subscales and miscellaneous items were associated with owners’ perceptions of their cats’ behavioral problems in the univariate analysis, excluding predatory behavior, prey interest, vocalizations, location preferences for resting, and lying on items when in use. Multivariate analysis showed owners were more likely to perceive their cat’s behavior as problematic if the cat exhibited owner-directed aggression (OR 2.31, 95% CI 2.01–2.65), familiar cat aggression (OR 1.75, 95% CI 1.55–1.96), urine spraying (OR 1.75, 95% CI 1.53–2.00), crepuscular activity (OR 1.38, 95% CI 1.24–1.53), fear of novelty (OR 1.14, 95% CI 1.05–1.24) or escaping behavior (OR 1.15, 95% CI 1.07–1.23). Cats who readily adapted to change (OR 0.81, 95% CI 0.74–0.89), slept on appliances/elevated spaces (OR 0.88, 95% CI 0.79–0.98), or kneaded (OR 0.90, 95% CI 0.85–0.96) were less likely to be perceived as problematic. Our results suggest cat owners were more likely to view their cat’s behavior as problematic if the behavior directly affected their lifestyle or environment, such as aggression, house soiling or activity during the night, while other behaviors, such as separation-related behavior, excessive self-grooming, and predatory behavior, did not influence owners’ perceptions of cat behavior within the multivariate models. Further education may help cat owners to recognize the importance of these other behaviors as indicators of animal welfare and understand the wider impacts of cat behavior, including through predation on wildlife.

Quality of secondary prevention in centre-based cardiac rehabilitation: predictors and between-center variation

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Ministry of Health, Republic of Slovenia. Background Cardiac rehabilitation (CR) is a complex intervention, providing supervised exercise training, risk factor control, and secondary prevention. Centre-based outpatient CR provides the necessary structure to accomodate the delivery of several preventive interventions, but the quality of secondary prevention may vary. The present study sought to assess the impact of CR on the improvement and between-center variation of the quality of secondary prevention. Methods Data were extracted from the Slovenian National CR Registry for patients who completed CR between 2017 and 2020. A composite quality score (CQS) was calculated adjudicating one point for each of the following: non-smoking status, body mass index &amp;lt;25 kg/m2, systolic blood pressure &amp;lt;130 mmHg, low-density lipoprotein (LDL) cholesterol &amp;lt;1.4 mmol/L, antiplatelet therapy, and high-potency statin/combined lipid-lowering therapy. Predictors of CQS improvement were assessed using mixed-effects ordinal logistic regression model acknowledging the hierarchical nesting of patients within centres. Results A total of 1,952 patients from 5 centres were included (mean age 59.4±10.8 years; 22% women). Mean CQS improved from 3.16±1.11 to 3.53±1.21 (p&amp;lt;0.001), with CR associated with an OR 1.72 (95% confidence interval [CI] 1.49-2.00) for CQS improvement (Figure). Improvement of CQS was also positively associated with increasing number of sessions &amp;gt;12 (e.g., OR 6.06 [3.29-11.14] for 12-24 sessions) and total number of co-morbidities (OR 1.40 [95%CI 1.33-1.48]), and negatively associated with male sex (OR 0.78 [95%CI 0.65-0.92]), high cardiac risk (OR 0.83 [95%CI 0.68-0.99]), age &amp;gt;60 years (e.g., OR 0.62 [95% CI 0.41-0,94] for age group 60-69 years), and referral diagnosis other than STEMI (e.g., OR 0,56 [95%CI 0.39-0,72] for non-infarction coronary artery disease). Random-effects partitioning attributed 68.8% of variance to patient-level factors and 19.8% to between-center variability. Conclusions Centre-based CR is associated with improved quality of secondary prevention; factors affecting quality improvement range from patient-level (e.g., age and sex) to mode of provision (e.g., number of sessions). Up to one fifth of the variation, however, can be attributed to between-center variationm.

Age differences in the responses of vervet monkeys, Chlorocebus pygerythrus, to terrestrial alarm calls

The high costs of predation and the opportunity costs associated with predator avoidance are likely to select for flexibility in the development of antipredator responses based on local socioecological conditions. As group size is hypothesized to vary across populations as a function of predation risk, the development of antipredator behaviours throughout ontogeny may be influenced by the size of an individual's social group. Here, we explore the development of alarm call responses in wild vervet monkeys living at the Samara Game Reserve, South Africa. Vervet monkeys at this site live in relatively large social groups, and adult responses to alarms have previously shown less uniformity than in other sites where group sizes are smaller. We presented monkeys playback recordings of terrestrial alarm calls produced by individuals of different age–sex classes. We then videorecorded and scored the responses of receivers along an ordinal maturity scale. We used a mixed-effects ordinal logistic regression model within a Bayesian framework to explore how response intensity is affected by the age–sex of the caller, and the age of receivers. Our analysis showed that younger monkeys (<2 years old) exhibit strong evasive responses to call stimuli, regardless of the age–sex class of the caller. The intensity of these responses decreases with age, with responses to nonalarm calls decreasing earlier in development than responses to alarm calls. Adult responses to alarm calls in this population are as likely to be characterized by a general increase in vigilance as they are to consist of an evasive response. We suggest that responses in younger individuals at Samara are mediated by generalized startle responses to loud, plosive noises. Development of more specific responses throughout ontogeny is likely to be dependent on learning from adult models, whose milder responses reflect local socioecological conditions specific to Samara.

Prevalence and Its Related Factors of Undernutrition among Under 5-Year-Old Children, Fars, Iran 2017-2018

Background: The present study aimed to investigate the prevalence and related factors of under-nutrition among under 5-year-old children in Fars province, Iran.&#x0D; Methods: This cross-sectional survey was conducted during 2017-2018 in Fars province of Iran. The study consisted of 606 children (0-59 months) from 13 regions of Fars province. A structured questionnaire collected the data, and under-nutrition indices, including stunting, wasting, and underweight, were investigated by the mixed-effects ordinal logistic regression model.&#x0D; Results: The prevalence of stunting, underweight, and wasting were 2%, 4%, and 4.1%, respectively. Low birth weight was a risk factor for three undernutrition indices (P &lt; 0.001; P &lt; 0.001; and P = 0.004). Urban children were significantly more underweight and wasted than rural children (P = 0.001; and P = 0.002, respectively). Under-nutrition rates were impressed by the family size, mother's education, and father's occupation.&#x0D; Conclusion: The prevalence of undernutrition in children can be reduced by identifying and controlling significant factors, including birth weight, maternal education, type of settlement, family size, and father's occupation.

Assessment of Pain in Glaucoma Patients Undergoing Micropulse Transscleral Laser Therapy

This study aimed to assess the pain experienced during micropulse transscleral laser therapy (MPTLT) and overnight thereafter and explore the factors associated with the pain. This prospective study included 100 eyes of 81 glaucoma patients undergoing MPTLT under retrobulbar anesthesia. All patients were asked to rate both types of pain using a numerical rating scale (NRS). The risk factors were explored using multivariable mixed-effects ordinal logistic regression. The mean (SD) NRS pain score during the procedure was 3.57 (3.41) (range 0-10), which included no, mild, moderate, and severe pain in 30 (30%), 33 (33%), 17 (17%), and 20 (20%) eyes, respectively. The mean (SD) NRS score of overnight pain was 2.99 (2.28) (range 0-9), which included no, mild, moderate, and severe pain in 17 (17%), 59 (59%), 17 (17%), and 7 (7%) eyes, respectively. Twenty-seven (27%) eyes reported worse pain overnight than during the procedure. Increased age, initial intraocular pressure, and pain during the procedure were significantly associated with increased overnight pain (p < 0.05). Up to a fourth of eyes had worse pain after discharge. Older age, initial intraocular pressure, and pain during the procedure were risk factors for higher levels of overnight pain.

Learning effects in visual grading assessment of model-based reconstruction algorithms in abdominal Computed Tomography

ObjectivesImages reconstructed with higher strengths of iterative reconstruction algorithms may impair radiologists’ subjective perception and diagnostic performance due to changes in the amplitude of different spatial frequencies of noise. The aim of the present study was to ascertain if radiologists can learn to adapt to the unusual appearance of images produced by higher strengths of Advanced modeled iterative reconstruction algorithm (ADMIRE). MethodsTwo previously published studies evaluated the performance of ADMIRE in non-contrast and contrast-enhanced abdominal CT. Images from 25 (first material) and 50 (second material) patients, were reconstructed with ADMIRE strengths 3, 5 (AD3, AD5) and filtered back projection (FBP). Radiologists assessed the images using image criteria from the European guidelines for quality criteria in CT. To ascertain if there was a learning effect, new analyses of data from the two studies was performed by introducing a time variable in the mixed-effects ordinal logistic regression model. ResultsIn both materials, a significant negative attitude to ADMIRE 5 at the beginning of the viewing was strengthened during the progress of the reviews for both liver parenchyma (first material: −0.70, p < 0.01, second material: −0.96, p < 0.001) and overall image quality (first material:−0.59, p < 0.05, second material::−1.26, p < 0.001). For ADMIRE 3, an early positive attitude for the algorithm was noted, with no significant change over time for all criteria except one (overall image quality), where a significant negative trend over time (−1.08, p < 0.001) was seen in the second material. ConclusionsWith progression of reviews in both materials, an increasing dislike for ADMIRE 5 images was apparent for two image criteria. In this time perspective (weeks or months), no learning effect towards accepting the algorithm could be demonstrated.

THE RELATIONSHIP BETWEEN THE FEAR OF FALLING AND QUALITY OF LIFE IN NURSING HOME RESIDENTS: THE ROLE OF ACTIVITY RESTRICTION

Abstract Falls among older adults are a significant later life course event with detrimental impacts on health, quality of life (QOL), and mortality. Fear of falling (FOF) is a common problem, which can lead to physical and social activity restriction and poor QOL. However, few studies have comprehensively explored the relationships among FOF, activity restriction, and QOL among nursing home residents. This study aimed to investigate: 1) whether FOF is negatively associated with QOL; and 2) the mediating role of activity restriction in the relationship between FOF and QOL among nursing home residents in mainland China. This is a cross-sectional study. A total of 316 residents from 27 nursing homes participated in this study. The mixed-effects multivariate linear or ordinal logistic regression models were conducted. All statistical models were adjusted for resident- and facility-level variables. More than half of nursing home residents (55.4%) reported they often or always reduced their activities. As expected, FOF was directly associated with lower levels of QOL (β = -0.19, p = 0.010). However, the strength of this association was attenuated and no longer significant with the inclusion of activity restriction in the model. FOF was positively associated with activity restriction (β = 0.33, p &amp;lt; 0.001) and activity restriction was negatively associated with QOL (rarely/sometimes reduced activity: β = -1.23, p = 0.386; often/always reduced activity: β = -3.85, p = 0.014). Given the aging of our populations, it is important to take FOF and activity restriction into account when caring for older people.

The prevalence of mental distress changes before and during the COVID-19 pandemic: a study on physicians in Turkey

Background The emergence of the COVID-19 pandemic may adversely affect the physicians’ mental health differently.Aims This study aimed to investigate the degree of changes in mental distress in physicians through two cross-sectional studies before and during the COVID-19 pandemic and explore factors associated with the change of mental distress status of participants between two-time periods.Methods This cross-sectional, web-based survey collected demographic data and mental health measurements with the 12-item General Health Questionnaire from 416 and 522 physicians before and during COVID-19, respectively. Mixed-effects ordinal logistic regression analyses were performed to assess the factors associated with the change of mental distress status.Results During the outbreak, a total of 319 of the 522 participants reported a clinically significant level of mental distress compared with 123 of 416 participants before COVID-19. Higher levels of mental distress were observed in all socio-demographic groups during COVID-19 compared with before, with more than two-fold higher prevalence of mental health deterioration in general.ConclusionsThis study suggests a significant deterioration in mental health status after the occurrence of COVID-19 compared with before. The mental health of physicians working in all medical specialty groups, especially those in internal and surgical specialties, may require special attention.