Mixed Regression Models Research Articles

The Role of Whole Food Plant-Based Food Intake on Postprandial Glycemia in Type 1 Diabetes.

Whole food plant-based diet (WFPBD), minimally processed foods with limited consumption of animal products, is associated with improved health outcomes. The benefits of WFPBD are underexplored in individuals with type 1 diabetes (T1D). The primary objective of this analysis is to evaluate the association between WFPBD on glycemia in individuals with T1D. Utilizing prospectively collected meal events from the Type 1 Diabetes Exercise Initiative, we examined the effect of WFPBD intake on glycemia, determined by the Plant-Based Diet Index (PDI). The PDI calculates overall, healthful (hPDI), and unhealthy PDI (uPDI) to evaluate for degree of processed foods and animal products (i.e. WFPBD). Mixed effects linear regression model assessed time-in-range (TIR), time-above-range, and time-below-range. We analyzed 7,938 meals from 367 participants. TIR improved with increasing hPDI scores, conferring a 4% improvement in TIR between highest and lowest hPDI scores (high hPDI:75%, low hPDI:71%; p<0.001). Compared to meals with low hPDI, meals with high hPDI had lower glucose excursion (high hPDI:53mg/dL, low hPDI:62mg/dL; p<0.001) and less time >250mg/dL (high hPDI:8%, low hPDI:14%; p<0.001). These effects were present but less pronounced by PDI (high PDI:74%, low PDI:71%; p=0.01). No differences in time below 70mg/dL and 54mg/dL were observed by PDI or hPDI. Meal events with higher hPDI were associated with 4% postprandial TIR improvement. These benefits were seen primarily in WFPBD meals (captured by hPDI) and less pronounced plant-based meals (captured by PDI), emphasizing the benefit of increasing unprocessed food intake over limiting animal products alone.

Predicting Athlete Workload in Women's Rugby Sevens Using GNSS Sensor Data, Contact Count and Mass.

The use of session rating of perceived exertion (sRPE) as a measure of workload is a popular athlete load monitoring tool. However, the nature of sRPE means the contribution of salient, sport-specific factors to athlete load in field sports is challenging to isolate and quantify. In rugby sevens, drivers of load include high-speed running and physical contact. In soccer and men's rugby, union acceleration/deceleration also influences load. These metrics are evaluated using data from global navigation satellite system (GNSS) sensors worn by athletes. Research suggests that sensor data methods for identifying load in men's rugby do not accurately quantify female athlete loads. This investigation examined how mass, contact, and accelerations and decelerations at different speeds contribute to load in women's rugby sevens. The study evaluated 99 international matches, using data from 19 full-time athletes. GNSS measures, RPE, athlete mass, and contact count were evaluated using a linear mixed-model regression. The model demonstrated significant effects for low decelerations at low and high speeds, mass, distance, and contact count explaining 48.7% of the global variance of sRPE. The use of acceleration/deceleration and speed from GNSS sensors alongside mass, as well as contact count, presents a novel approach to quantifying load.

Recurrent Flooding and Household Food Access in Central Java, Indonesia.

It is unknown how recurring flooding impacts household diet in Central Java. We aimed to assess how recurrent flooding influenced household food access over 22 years in Central Java by linking the Global Surface Water dataset (GSW) to the Indonesian Family Life Survey. We examined linear and nonlinear relationships and joint effects with indicators of adaptive capacity. We measured recurrent flooding as the fraction of district raster cells with episodic flooding from 1984-2015 using GSW. Food access outcomes were household food expenditure share (FES) and dietary diversity score (DDS). We fit generalized linear mixed models and random forest regression models. We detected joint effects with flooding and adaptive capacity. Wealth and access to credit were associated with improved FES and DDS. The effect of wealth on FES was stronger in households in more flood-affected districts, while access to credit was associated with reduced odds of DDS in more flood-affected districts. Flooding had more predictive importance for FES than for DDS. Access to credit, a factor that ordinarily improves food access, may not be effective in flood-prone areas. Wealthier households may be better able to adapt in terms of food access. Future research should incorporate land use data to understand how different locales are affected and further understand the complexity of these relationships.

Summer roost site selection of a declining bat species

AbstractSummer habitats are critical to bat population persistence as they support multiple life history stages, including maternity colonies, nursery sites, and foraging locations. The tricolored bat (Perimyotis subflavus) is a hibernating North American bat species that uses forested landscapes during summer months; however, information on the summer habitat requirements is limited. The objective of this work was to quantify the characteristics of roost sites selected by tricolored bats during summer months. We captured, tagged, and tracked 15 bats using radio-telemetry to 55 roost locations. At each roost, we recorded roost habitat characteristics and other forest characteristics within a 0.1 ha circular plot surrounding the roost tree and a 1 km buffer at the landscape scale. We repeated these measurements for three random trees per roost tree to characterize available habitat for selection. We used a suite of mixed conditional logistic regression models to test multiple factors known to influence roost-site selection for various bat species and compared using Akaike information criterion to select the best model. The top model at the roost scale demonstrated that roost selection was influenced by roost tree height, while the landscape scale was influenced by deciduous forest and distance to roads. There is a critical information gap for the ongoing recovery of tricolored bats; better understanding of summer habitat and proper forest management implications, as well as information on scale-specific habitat selection, is needed to better understand tricolored bat management needs.

Factors affecting prostate cancer detection through asymptomatic PSA testing in primary care in England: Evidence from the 2018 National Cancer Diagnosis Audit.

Background Prostate-Specific Antigen (PSA) is used in primary care for prostate cancer detection, either for symptomatic assessment or asymptomatic testing following an informed decision. Aim To estimate the proportion of prostate cancer cases diagnosed following asymptomatic PSA testing, and patient and practice factors influencing this route. Design and setting 2018 English National Cancer Diagnosis Audit (NCDA) data were analysed, with linkage to the national cancer registry, practice-level Quality Outcomes Framework (QOF), and General Practice Patient Survey (GPPS) data. All 2018 NCDA patients with a diagnosis of prostate cancer were included (n = 9,837). Method Patients with recorded biomarker testing and no recorded symptoms prior to diagnosis were classified as asymptomatic PSA detected prostate cancer. Patient (age, ethnicity, deprivation, co-morbidities) and GP practice (geographical location, area deprivation, list size, urgent suspected cancer referral rate, QOF outcomes, GPPS results) factors were analysed for association with asymptomatic PSA testing using mixed effects logistic regression models. Results 1,884 out of 9,837 (19%) prostate cancer cases were detected following asymptomatic PSA testing, 982 (52.1%) of whom were patients aged 50-69 years. Younger age, non-White ethnicity, lower deprivation, and lower co-morbidity count were associated with an increased likelihood of diagnosis following asymptomatic PSA testing. There was a 13-fold variation between practices in the odds of asymptomatic PSA-detected cases, without clear explanatory GP practice-level factors. Conclusion One in five patients with prostate cancer in England are diagnosed after asymptomatic PSA testing in primary care, with large variation in asymptomatic PSA detection between GP practices.

Expansion of Medicaid Coverage of Continuous Glucose Monitor Reduces Health Disparity in Children and Young Adults With Type 1 Diabetes.

Continuous glucose monitor (CGM) usage improves glycemia in people with type 1 diabetes (PWD) and is accepted as the standard of care. The CGM utilization is lower in patients with public insurance and minorized ethnicities. In 2022, California Medicaid reduced its barriers to obtaining CGM coverage for PWD. It is unknown whether this policy change is sufficient to increase CGM usage. We hypothesize that the change in Medicaid coverage improved CGM uptake in children and young adults with T1D. Data were extracted from electronic medical record of a large urban children's hospital in 2021 and 2022. The CGM usage was determined based on clinician documentation or the presence of CGM downloads. Kruskal-Wallis tests, Wald tests, and χ2 tests were used to test hypothesis (P < .05). Mixed effects logistical regression analyses were performed. We included 878 and 892 PWD (age ≤ 21 years) in 2021 and 2022, respectively. In 2022, Medicaid insured 59.3% of patients. Between 2021 and 2022, CGM usage did not change for privately insured patients (84%) but increased from 41% to 58% for patients receiving Medicaid. In our mixed effects logistic regression model, CGM usage was higher in 2022 and in English speakers. Public insurance, black race, and patients' age were negatively associated with CGM usage. Our results suggest that Medicaid expansion of CGM coverage increases its utilization for pediatric PWD but did not eliminate the disparity. Future studies are needed to identify barriers that preclude equity in technology uptake.

Negative wealth shocks and subsequent depressive symptoms and trajectories in middle-aged and older adults in the USA, England, China, and Mexico: a population-based, multinational, and longitudinal study.

The association between negative wealth shocks and depression among middle-aged and older individuals remains unclear. Our study aimed to assess the association between negative wealth shocks and depression and its trajectories, and to explore cross-national differences in these associations. Our sample included 21 999 participants, of which 9519 were from the Health and Retirement Study (2012-2020), 4936 from the English Longitudinal Study of Ageing (2012-2020), 2520 from the China Health and Retirement Longitudinal Study (2011-2020), and 5024 from the Mexican Health and Aging Study (2012-2021). We used latent class trajectory models to identify depressive trajectories, alongside mixed-model logistic regression and multinomial logistic regression to evaluate associations. In the USA (OR 1.73, 95% CI 1.40-2.16), England (OR 1.71, 95% CI 1.09-2.70), and China (OR 1.38, 95% CI 1.09-1.75), negative wealth shocks were associated with subsequent depressive symptoms, but not in Mexico (OR 1.06, 95% CI 0.86-1.29). Additionally, negative wealth shocks were associated with several depressive trajectories in the USA and China. This association occurred only in increasing-decreasing trajectory in England, while no significant association was found across any trajectory in Mexico. Negative wealth shocks were associated with subsequent depressive symptoms, with significant associations observed in some specific depressive trajectories. These associations exhibited cross-national differences, underscoring the importance of considering country-specific contexts when addressing the mental health impacts of wealth shocks.

Effect of touch on proprioception: non-invasive trigeminal nerve stimulation suggests general arousal rather than tactile-proprioceptive integration.

Proprioceptive error of estimated fingertip position in two-dimensional space is reduced with the addition of tactile stimulation applied at the fingertip. Tactile input does not disrupt the participants' estimation strategy, as the individual error vector maps maintain their overall structure. This relationship suggests integration of proprioception and tactile information improves proprioceptive estimation, which can also be improved with trained mental focus and attention. Task attention and arousal are physiologically regulated by the reticular activating system (RAS), a brainstem circuit including the locus coeruleus (LC). There is direct and indirect evidence that these structures can be modulated by non-invasive trigeminal nerve stimulation (nTNS), providing an opportunity to examine nTNS effect on the integrative relationship of proprioceptive and tactile information. Fifteen right-handed participants performed a simple right-handed proprioceptive estimation task with tactile feedback (touch) and no tactile (hover) feedback. Participants repeated the task after nTNS administration. Stimulation was delivered for 10 min, and stimulation parameters were 3,000 Hz, 50 μs pulse width, with a mean of 7 mA. Error maps across the workspace are generated using polynomial models of the participants' target responses. Error maps did not demonstrate significant vector direction changes between conditions for any participant, indicating that nTNS does not disrupt spatial proprioception estimation strategies. A linear mixed model regression with nTNS epoch, tactile condition, and the interaction as factors demonstrated that nTNS reduced proprioceptive error under the hover condition only. We argue that nTNS does not disrupt spatial proprioceptive error maps but can improve proprioceptive estimation in the absence of tactile feedback. However, we observe no evidence that nTNS enhances tactile-proprioceptive integration as the touch condition does not exhibit significantly reduced error after nTNS.

Association Between Dietary Patterns and Subgingival Microbiota: Results From the Oral Infections, Glucose Intolerance, and Insulin Resistance Study (ORIGINS).

To study the association between dietary patterns and subgingival microbiota. Participants (n = 651) who were enrolled in the Oral Infections, Glucose Intolerance, and Insulin Resistance Study (ORIGINS) with subgingival plaque sampling (n = 890 plaques) and a dietary assessment were included. 16S rRNA gene amplicon sequences of subgingival plaque from sites with either probing depth <4 or ≥4 mm were processed separately and used to obtain α-diversity metrics (Faith, Shannon, Simpson, Observed) and taxa ratios (Red Complex to Corynebacterium [RCLR], Treponema to Corynebacterium [TCLR], and Treponema to Neisseria [TNLR]). Food frequency questionnaires (FFQs) were processed to calculate Alternate Healthy Eating Index (AHEI) and A Priori Diet Quality Score (APDQS) scores. Mixed regression models examined the mean levels of microbial metrics across quartiles of diet quality. Means ± standard errors are reported along with p-values. In multivariable models assessing the association between diet scores and α-diversity metrics, higher AHEI values were significantly associated with lower Faith (p-value = 0.01) and Observed (p-value = 0.04) diversity values; similar findings were observed for APDQS (p-value = 0.01, p-value = 0.04). In multivariable models assessing the association between diet scores (AHEI and APDQS) and taxa ratios (RCLR, TCLR and TNLR), as the AHEI quartile increased, all taxa ratios decreased significantly as follows: -1.06 ± 0.093 in Q1 to -1.34 ± 0.099 in Q4 (RCLR), -0.43 ± 0.077 in Q1 to -0.64 ± 0.083 in Q4 (TCLR) and -0.09 ± 0.083 in Q1 to -0.38 ± 0.089 in Q4 (TNLR), respectively. In contrast, as the APDQS quartiles increased, only TNLR decreased significantly from -0.08 ± 0.085 in Q1 to -0.34 ± 0.091 in Q4. Diets rich in fruits, vegetables, whole grains and other nutritionally rich plant foods are associated with lower oral microbial diversity and favourable ratios of pathogenic to commensal microbiota.

Leaving Against Medical Advice From Children's Hospitals.

Leaving the hospital against medical advice (AMA) reflects a breakdown in the family-clinician relationship and creates ethical dilemmas in inpatient pediatric care. There are no national data on frequency or characteristics of leaving AMA from US children's hospitals. We performed a retrospective cohort study of hospital discharges for children under 18 years old from January 1, 2018 to December 31, 2022 in 43 children's hospitals in the Pediatric Health Information System (PHIS) database. The primary outcome was leaving AMA. Exposures were demographic, geographic, and clinical characteristics. We used multivariable mixed effects logistic regression models to assess independent factors associated with leaving AMA and all-cause 14-day hospital readmission. Among 3 672 243 included inpatient encounters, 2972 (0.08%) ended in leaving AMA. Compared with non-Hispanic white patients, non-Hispanic Black patients had higher odds of leaving AMA (adjusted odds ratio [aOR] 1.31 [95% confidence interval (CI) 1.19-1.44]), whereas Hispanic patients (aOR 0.66 [95% CI 0.59-0.75]) had lower odds of leaving AMA. Hospitalizations for patients with noncommercial insurance were more likely to end in leaving AMA. Leaving AMA was associated with increased odds of 14-day inpatient readmission (aOR 1.41 [95% CI 1.24-1.61]) compared with patients who did not leave AMA. There was substantial interhospital variability in standardized rates of leaving AMA (range 0.18-2.14 discharges per 1000 inpatient encounters). Approximately 1 in 1235 inpatient encounters ended in leaving AMA. Non-Hispanic Black patients had increased odds of leaving AMA. Leaving AMA was associated with increased odds of 14-day readmission.

Referral Sources Across Racial and Ethnic Groups at Alzheimer's Disease Research Centers.

Despite the need to increase engagement of underrepresented groups (URG) in Alzheimer's disease and related dementias (ADRD) studies, enrollment remains low. Compare referral sources across racial and ethnic groups among participants enrolled in ADRC studies. Data for this cross-sectional secondary analysis were extracted from the National Alzheimer's Coordinating Center Uniform Data Set. We performed mixed effects logistic regression models using generalized estimating equations for professional referral versus non-professional referral by racial and ethnic group, adjusted for age, gender, education, visit year, and Clinical Dementia Rating scale (CDR) with a random effect for study site. Included in the analysis were 48,330 participants across 46 ADRCs (mean [SD] age, 71.3 [10.5] years; 20,767 female [57%]; 4,138 Hispanic [8.6%]; 1,392 non-Hispanic Asian [2.9%]; 6,766 non-Hispanic Black [14%] individuals; and 676 individuals [1.4%] of other races. Non-Hispanic Black and Asian participants had lower odds of being referred by a professional contact compared to non-Hispanic White participants (Black: adjusted OR = 0.61, 95% CI = 0.44-0.86, p = 0.005; Asian: adjusted OR = 0.65, 95% CI, p = 0.004). In participants who had completed an MRI, there was no significant difference in referral source across ethnic and racial groups. Further studies are needed to better understand the systemic and structural factors that contribute to differences in referral sources and disparities in recruitment of URG into ADRD studies.

Association of ART regimen and adherence to viral suppression: an observational study of a clinical population of people with HIV

Adherence to antiretroviral therapy (ART) is essential for the effective management of HIV, which includes keeping the HIV viral load undetectable. This study aimed to determine whether certain ART medications are more “forgiving” of poor adherence in achieving viral suppression. We identified subgroups of ART medication usage and determined the extent to which ART adherence is associated with viral suppression across those subgroups. Data came from claims and clinical records (2017–2019) of 3,552 HIV-positive adult members of a Medicaid managed care plan. Pharmacy fill data were examined to characterize ART medications using latent class analysis (LCA), which captures the complexity of real-world ART usage (i.e., multiple medications, ART switching). LCA yielded five ART medication patterns over three years, mostly characterized by recent medications and formulations of ART, though they varied in number of tablets and in medication class. Mixed effects logistic regression models were estimated to determine whether odds of viral suppression differed by ART adherence level. After adjusting for covariates, those with at least 90% adherence (i.e., 90 to < 95%) did not significantly differ from those with 95% adherence or greater in terms of viral suppression, which corroborates existing clinical recommendations. These findings can inform provider-patient communication for people with HIV, especially those who have difficulty maintaining adherence. This includes those experiencing unstable housing, mental health conditions, or substance use.

Sub- and supratherapeutic efavirenz plasma concentrations with risk for HIV therapy failure are mainly genetically explained in Ugandan children: The prospective GENEFA cohort study.

Interindividual variations in efavirenz (EFV) plasma concentrations are extensive, but paediatric data on its consequences for viral control are scarce. The aim of this study was to explore the role of genetic variation in achieving therapeutic efavirenz plasma concentrations in a cohort of Ugandan children and the linkage between genetic CYP2B6 variants, EFV plasma variability, viral resistance and viral outcome. Ninety-nine treatment-naïve children, aged 3-12 years and living with HIV, were followed for 24 weeks after ART initiation assessing mid-dose efavirenz plasma concentrations, HIV RNA, HIV drug resistance and adherence. Polymorphisms in genes coding for drug-metabolizing enzymes were genotyped. Efavirenz concentrations were determined by liquid chromatography coupled with high-resolution tandem mass spectrometry. Metabolizer phenotype was predicted from composite genotypes of CYP2B6 (c.516G>T and c.983 T>C). A mixed effects restricted maximum likelihood regression model was used to identify important factors for efavirenz exposure. Efavirenz plasma concentrations were below the therapeutic interval (1000-4000 mg/mL) in 12-17% and above in 21-24% of measurements. Eight children had persisting subtherapeutic concentrations, five of which failed virologically and three acquired at least one new resistant mutation. Multivariate modelling explained 70% of interindividual variation in plasma concentration, with treatment duration, adherence, CYP2B6c.136A>G, and metabolizer phenotype as independent predictors of EFV concentration. In univariate analysis, metabolizer phenotype explained 50% of interindividual variation. Metabolizer phenotype explained 50% of interindividual variation in efavirenz plasma concentration. Autoinduction was not confirmed and >33% of the concentrations were outside the therapeutic interval. Subtherapeutic concentrations worsened virological resistance and outcomes. Genotype-based dosing may help avert both sub- and supratherapeutic efavirenz plasma concentrations in Ugandan children.

Exploring environmental and climate features associated with yellow fever across space and time in the Brazilian Atlantic Forest biome.

The Atlantic Forest Biome (AFB) creates an ideal environment for the proliferation of vector mosquitoes, such as Haemagogus and Sabethes species, which transmit the Yellow Fever virus (YFV) to both human and non-human primates (NHP) (particularly Alouatta sp. and Callithrix sp.). From 2016 to 2020, 748 fatal cases of YF in humans and 1,763 in NHPs were reported in this biome, following several years free from the disease. This underscores the imminent risk posed by the YFV. In this study, we examined the spatiotemporal distribution patterns of YF cases in both NHPs and humans across the entire AFB during the outbreak period, using a generalized linear mixed regression model (GLMM) at the municipal level. Our analysis examined factors associated with the spread of YFV, including environmental characteristics, climate conditions, human vaccination coverage, and the presence of two additional YFV-affected NHP species. The occurrence of epizootics has been directly associated with natural forest formations and the presence of species within the Callithrix genus. Additionally, epizootics have been shown to be directly associated with human prevalence. Furthermore, human prevalence showed an inverse correlation with urban areas, temporary croplands, and savannah and grassland areas. Further analyses using Moran's Index to incorporate the neighborhoods of municipalities with cases in each studied host revealed additional variables, such as altitude, which showed a positive correlation. Additionally, the occurrence of the disease in both hosts exhibited a spatio-temporal distribution pattern. To effectively mitigate the spread of the virus, it is necessary to proactively expand vaccination coverage, refine NHP surveillance strategies, and enhance entomological surveillance in both natural and modified environments.

Save sight keratoconus registry study: Transepithelial versus epithelium-off corneal crosslinking

PurposeCorneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus and can be performed with the epithelium on or off. Evidence is needed to guide clinicians and patients on whether they should have transepithelial or epithelium-off CXL. The aim of this study was to determine the safety and efficacy of transepithelial and epithelium-off CXL. DesignAn observational prospective study was conducted using real-world data from patients in the Save Sight Keratoconus Registry. MethodsPatients with no previous intervention before CXL were included. The primary outcomes were adverse events, change in Kmax, habitual visual acuity and minimum corneal thickness from baseline to 12 months follow up. Mixed effects regression models evaluated changes in outcomes adjusted for age, sex, eye laterality, practices, and baseline outcomes. ResultsThere were 46 eyes (37 patients) and 1203 eyes (976 patients) included treated with transepithelial and epithelium-off CXL, respectively. At 12 months follow up, the habitual visual acuity, pinhole visual acuity, Kmax, K2 and minimum corneal thickness were not significantly different between epithelium-off and transepithelial CXL. There were fewer adverse events recorded in transepithelial compared to epithelium-off CXL. ConclusionEpithelium-off and transepithelial CXL were similarly effective, measured by visual acuity and corneal curvature, to stabilise and prevent progression between baseline and 12 months follow-up in keratoconus. Transepithelial CXL had fewer adverse events compared to epithelium-off CXL.

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

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

Gradient boosting: A computationally efficient alternative to Markov chain Monte Carlo sampling for fitting large Bayesian spatio-temporal binomial regression models

Disease forecasting and surveillance often involve fitting models to a tremendous volume of historical testing data collected over space and time. Bayesian spatio-temporal regression models fit with Markov chain Monte Carlo (MCMC) methods are commonly used for such data. When the spatio-temporal support of the model is large, implementing an MCMC algorithm becomes a significant computational burden. This research proposes a computationally efficient gradient boosting algorithm for fitting a Bayesian spatio-temporal mixed effects binomial regression model. We demonstrate our method on a disease forecasting model and compare it to a computationally optimized MCMC approach. Both methods are used to produce monthly forecasts for Lyme disease, anaplasmosis, ehrlichiosis, and heartworm disease in domestic dogs for the contiguous United States. The data have a spatial support of 3108 counties and a temporal support of 108–138 months with 71–135 million test results. The proposed estimation approach is several orders of magnitude faster than the optimized MCMC algorithm, with a similar mean absolute prediction error.

Sociodemographic and dietary predictors of maternal and placental mycoestrogen concentrations in a US pregnancy cohort.

Zearalenone (ZEN) is a mycotoxin contaminating grains and processed foods. ZEN alters nuclear estrogen receptor α/β signaling earning its designation as a mycoestrogen. Experimental evidence demonstrates that mycoestrogen exposure during pregnancy is associated with altered maternal sex steroid hormones, changes in placental size, and decreases in fetal weight and length. While mycoestrogens have been detected in human biospecimens worldwide, exposure assessment of ZEN in US populations, particularly during pregnancy, is lacking. To characterize urinary and placental concentrations of ZEN and its metabolites in healthy US pregnant people and examine demographic, perinatal, and dietary predictors of exposure. Urine samples were collected in each trimester from pregnant participants in the UPSIDE study and placenta samples were collected at delivery (Rochester, NY, n = 317). We used high performance liquid chromatography and high-resolution tandem mass spectrometry to measure total urinary (ng/ml) and placental mycoestrogens (ng/g). Using linear regression and linear mixed effect models, we examined associations between mycoestrogen concentrations and demographic, perinatal, and dietary factors (Healthy Eating Index [HEI], ultra-processed food [UPF] consumption). Mycoestrogens were detected in 97% of urines (median 0.323 ng/ml) and 84% of placentas (median 0.012 ng/g). Stability of urinary mycoestrogens across pregnancy was low (ICC: 0.16-0.22) and did not correlate with placental levels. In adjusted models, parity (multiparous) and pre-pregnancy BMI (higher) predicted higher urinary concentrations. Birth season (fall) corresponded with higher placental mycoestrogens. Dietary analyses indicated that higher HEI (healthier diets) predicted lower exposure (e.g., Σmycoestrogens %∆ -2.03; 95%CI -3.23, -0.81) and higher percent calories from UPF predicted higher exposure (e.g., Σmycoestrogens %∆ 1.26; 95%CI 0.29, 2.24). The mycotoxin, zearalenone (ZEN), has been linked to adverse health and reproductive impacts in animal models and livestock. Despite evidence of widespread human exposure, relatively little is known about predictors of exposure. In a pregnant population, we observed that maternal ZEN concentrations varied by maternal pre-pregnancy BMI and parity. Consumption of ultra-processed foods, added sugars, and refined grains were linked to higher ZEN concentrations while healthier diets were associated with lower levels. Our research suggests disparities in exposure that are likely due to diet. Further research is needed to understand the impacts of ZEN on maternal and offspring health.

Effect of cholecalciferol supplementation on PTH and increasing the glomerular filtration rate in kidney transplant patients at King Faisal Specialist Hospital and Research Center

The association between oral cholecalciferol and GFR has been identified in various renal transplant populations around the globe. This study aimed to evaluate the effect of oral cholecalciferol supplementation on the GFR and serum PTH levels, with other parameters in the Saudi kidney transplant population. A retrospective observational study was conducted on a cohort of 174 kidney recipients who underwent transplantation and had serum 25-Hydroxy VD level tests performed (2018-2022) at King Faisal Specialist Hospital and Research Center in Jeddah, KSA. Generalized and linear mixed effects regression models were conducted. The percentage of GFR &gt;60 (25.86% vs 78.16%, P&lt;.0001) and VD insufficiency (&lt; 30 ng/mL) (36.21% vs 6.90%, P&lt;.0001) were significantly different between pre-&amp; post-transplant periods, respectively. After adjustment, significant changes were found in post-transplant GFR, hemoglobin levels, serum creatinine levels, blood urea nitrogen levels, hematocrit levels, PTH levels, and VD 25-Hydroxy from the baseline. Calciferol 1000/2000 IU and 50,000 IU (P&lt;.0001) were significantly more effective in increasing the odds of having GFR &gt;60 as compared to other supplements (P=0.75). VD supplementations may be particularly beneficial in improving kidney function in kidney transplant patients, as this contributes to normalizing GFR levels and creatinine levels and reducing PTH levels.

An easier life to come for mosquito researchers: field-testing across Italy supports VECTRACK system for automatic counting, identification and absolute density estimation of Aedes albopictus and Culex pipiens adults

BackgroundDisease-vector mosquito monitoring is an essential prerequisite to optimize control interventions and evidence-based risk predictions. However, conventional entomological monitoring methods are labor- and time-consuming and do not allow high temporal/spatial resolution. In 2022, a novel system coupling an optical sensor with machine learning technologies (VECTRACK) proved effective in counting and identifying Aedes albopictus and Culex pipiens adult females and males. Here, we carried out the first extensive field evaluation of the VECTRACK system to assess: (i) whether the catching capacity of a commercial BG-Mosquitaire trap (BGM) for adult mosquito equipped with VECTRACK (BGM + VECT) was affected by the sensor; (ii) the accuracy of the VECTRACK algorithm in correctly classifying the target mosquito species genus and sex; (iii) Ae. albopictus capture rate of BGM with or without VECTRACK.MethodsThe same experimental design was implemented in four areas in northern (Bergamo and Padua districts), central (Rome) and southern (Procida Island, Naples) Italy. In each area, three types of traps—one BGM, one BGM + VECT and the combination of four sticky traps (STs)—were rotated each 48 h in three different sites. Each sampling scheme was replicated three times/area. Collected mosquitoes were counted and identified by both the VECTRACK algorithm and operator-mediated morphological examination. The performance of the VECTRACK system was assessed by generalized linear mixed and linear regression models. Aedes albopictus capture rates of BGMs were calculated based on the known capture rate of ST.ResultsA total of 3829 mosquitoes (90.2% Ae. albopictus) were captured in 18 collection-days/trap/site. BGM and BGM + VECT showed a similar performance in collecting target mosquitoes. Results show high correlation between visual and automatic identification methods (Spearman Ae. albopictus: females = 0.97; males = 0.89; P < 0.0001) and low count errors. Moreover, the results allowed quantifying the heterogeneous effectiveness associated with different trap types in collecting Ae. albopictus and predicting estimates of its absolute density.ConclusionsObtained results strongly support the VECTRACK system as a powerful tool for mosquito monitoring and research, and its applicability over a range of ecological conditions, accounting for its high potential for continuous monitoring with minimal human effort.Graphical