Mixed Effects Research Articles

Enhancing Cardiovascular Risk Prediction: Development of an Advanced Xgboost Model with Hospital-Level Random Effects.

Ensemble tree-based models such as Xgboost are highly prognostic in cardiovascular medicine, as measured by the Clinical Effectiveness Metric (CEM). However, their ability to handle correlated data, such as hospital-level effects, is limited. The aim of this work is to develop a binary-outcome mixed-effects Xgboost (BME) model that integrates random effects at the hospital level. To ascertain how well the model handles correlated data in cardiovascular outcomes, we aim to assess its performance and compare it to fixed-effects Xgboost and traditional logistic regression models. A total of 227,087 patients over 17 years of age, undergoing cardiac surgery from 42 UK hospitals between 1 January 2012 and 31 March 2019, were included. The dataset was split into two cohorts: training/validation (n = 157,196; 2012-2016) and holdout (n = 69,891; 2017-2019). The outcome variable was 30-day mortality with hospitals considered as the clustering variable. The logistic regression, mixed-effects logistic regression, Xgboost and binary-outcome mixed-effects Xgboost (BME) were fitted to both standardized and unstandardized datasets across a range of sample sizes and the estimated prediction power metrics were compared to identify the best approach. The exploratory study found high variability in hospital-related mortality across datasets, which supported the adoption of the mixed-effects models. Unstandardized Xgboost BME demonstrated marked improvements in prediction power over the Xgboost model at small sample size ranges, but performance differences decreased as dataset sizes increased. Generalized linear models (glms) and generalized linear mixed-effects models (glmers) followed similar results, with the Xgboost models also excelling at greater sample sizes. These findings suggest that integrating mixed effects into machine learning models can enhance their performance on datasets where the sample size is small.

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.

Albuminuria and Rapid Kidney Function Decline as Selection Criteria for Kidney Clinical Trials in Type 1 Diabetes Mellitus.

The optimal criteria to select individuals with type 1 diabetes mellitus (T1D) and albuminuric or normoalbuminuric diabetic kidney disease (DKD), who are at risk of rapid kidney function decline, for clinical trials are unclear. This study analyzed data from the Preventing Early Renal Loss in Diabetes (PERL) clinical trial, which investigated whether allopurinol slowed kidney function decline in persons with T1D and early-to-moderate DKD. Rates of iohexol GFR (iGFR) and estimated GFR (eGFR) decline during the three-year study were compared by linear mixed effect regression between participants enrolled based on a history of moderately or severely increased albuminuria (N=394) and those enrolled based on a recent history of rapid kidney function decline (≥3 ml/min/1.73 m2/year) in the absence of a history of albuminuria (N=124). The association between baseline albuminuria and iGFR/eGFR decline during the trial was also evaluated. Rates of eGFR decline during the trial were higher in participants with a history of albuminuria than in those with a history of rapid kidney function decline (-3.56 [95% confidence intervals {CI} -3.17, -3.95] versus -2.35 [95% CI: -1.86, -2.84] ml/min/1.73 m2/year, p=0.001). Results were similar for iGFR decline, although the difference was not significant (p=0.07). Within the history of albuminuria group, the rate of eGFR decline was -5.30 (95% CI -4.52, -6.08) ml/min/1.73m2/year in participants with severely increased albuminuria as compared to -2.97 (95% CI 2.44, -3.50) and -2.32 (95% CI -1.61, -3.03) ml/min/1.73m2/year in those with moderately increased or normal/mildly increased albuminuria at baseline (p<0.001). Severely increased albuminuria at screening is a powerful criterion for selecting persons with T1D at high risk of kidney function decline. A history of rapid eGFR decline without a history of albuminuria is less effective for this purpose but it can still identify individuals with T1D who will lose kidney function more rapidly than expected from physiological aging. ClinicalTrials.gov, NCT02017171.

Association between clinician team segregation, receipt of cardiovascular care and outcomes in valvular heart diseases.

Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race. We also evaluated the association between clinician segregation, race and care by a cardiologist on 30-day readmission and 1-year survival. Using Optum's Clinformatics® Data Mart Database (CDM, US commercial and Medicare beneficiaries) from 2010 to 2018, we identified patients with a primary diagnosis of VHD. Hospitals were categorized into low, medium and high segregation groups (SG), according to clinician segregation index (SI). SI can range from 0-1 (0: the ratio of Black to White patients is the same for all clinicians; 1: each clinician treats only Black or only White patients). Outcomes were analysed using generalized linear mixed effect models. Among 8649 patients [median age 75 (67-82), 45.4% female, 16.1% Black, 83.9% White], odds of care from a cardiologist did not vary across race for all SGs [Low SG adjusted odds ratio (aOR): 0.79 (95% CI: 0.58-1.08), P=0.14; Medium SG aOR: 0.86 (95% CI: 0.60-1.25), P=0.43; High SG aOR: 1.07 (95% CI: 0.68-1.69), P=0.76]. Among those that received care from a cardiologist, there was no difference in the 30-day readmission between Black and White patients across SGs [Low SG aOR: 1.05 (95% CI: 0.83-1.31), P=0.70; Medium SG aOR: 1.22 (95% CI: 0.92-1.61), P=0.17; High SG aOR: 0.81 (95% CI: 0.57-1.17), P=0.27]. Among patients that did not receive care from a cardiologist, Black patients in low SG had higher odds of 30-day readmission compared to White patients [aOR: 2.74 (95%CI:1.38-5.43), P<0.01]. Odds of 1-year survival were similar across race for all SG irrespective of receipt of care from a cardiologist [seen by a cardiologist: Low SG aOR: 1.13 (95% CI: 0.86-1.48), P=0.38; Medium SG aOR: 0.83 (95% CI: 0.59-1.17), P=0.29; High SG aOR: 1.01 (95% CI: 0.66-1.52), P=0.98; not seen by a cardiologist: Low SG aOR: 0.56 (95% CI: 0.23-1.34), P=0.19; Medium SG aOR: 0.81 (95% CI: 0.28-2.37), P=0.70; High SG aOR: 0.63 (95% CI: 0.23-1.74), P=0.37]. Among an insured population, race was not associated with care by a cardiologist for VHD or survival. Black patients not seen by cardiologists had higher odds of 30-day readmission in low clinician SG.

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders

BackgroundDespite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.MethodsAdolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.ResultsResults suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.ConclusionsData from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

Contrasting topologies of synchronous and asynchronous functional brain networks

ABSTRACT We generated asynchronous functional networks (aFNs) using a novel method called optimal causation entropy and compared aFN topology with the correlation-based synchronous functional networks (sFNs), which are commonly used in network neuroscience studies. Functional magnetic resonance imaging (fMRI) time series from 212 participants of the National Consortium on Alcohol and Neurodevelopment in Adolescence study were used to generate aFNs and sFNs. As a demonstration of how aFNs and sFNs can be used in tandem, we used multivariate mixed effects models to determine whether age interacted with node efficiency to influence connection probabilities in the two networks. After adjusting for differences in network density, aFNs had higher global efficiency but lower local efficiency than the sFNs. In the aFNs, nodes with the highest outgoing global efficiency tended to be in the brainstem and orbitofrontal cortex. aFN nodes with the highest incoming global efficiency tended to be members of the default mode network in sFNs. Age interacted with node global efficiency in aFNs and node local efficiency in sFNs to influence connection probability. We conclude that the sFN and aFN both offer information about functional brain connectivity, which the other type of network does not.

A Remote Behaviorally Designed Intervention to Promote Physical Activity in Patients With Knee Osteoarthritis: Results of a Pilot Randomized Clinical Trial.

We evaluated a behaviorally designed intervention utilizing gamification and social support to improve physical activity and reduce symptoms in patients with osteoarthritis of the knee (KOA). Veterans with KOA, aged 40-80 years, were enrolled in this randomized controlled trial. Participants received a Fitbit and completed a 2- to 4-week baseline period. A Web-based platform administered biweekly surveys after randomization and tracked physical activity. Participants selected a daily step goal that was 33%, 40%, or 50% above their baseline. The intervention arm received game playing aspects and a social support partner to advance weekly step performance while the control arm only received weekly updates. The primary outcome was the change in steps per day averaged over 2-week intervals. We used mixed effects regression, adjusting for baseline step count. Secondary outcomes assessed the change in KOOS (Knee Injury and Osteoarthritis Outcome Score) over 32 weeks. Thirty-one participants were included in the final analysis. Most participants were male (90.3%), Black (70.96%), had a mean (SD) age of 60 (13) years, and body mass index of 33.7 (5.9) kg/m2. Participants that received the intervention walked a total of 1119 (95% confidence interval: -562, 2799) more steps per day (p = 0.19). The effect was greatest in the first 6 months (1491 [-272, 3254], p = 0.10). Compared with controls, those that received the intervention had improvement over time in total KOOS (mean 2-week change +0.62 [0.031, 1.20] vs -0.38 [-1.04, 0.28], p = 0.02) and several subscales. This intervention demonstrated promise for promoting greater physical activity and improving symptoms in patients with KOA.

Factors associated with modern contraceptive utilization among reproductive age women in Cambodia; evidenced by the recent Cambodia demographic and health survey

IntroductionCambodia is a low-income country with limited access to family planning (FP) in terms of modern contraceptive utilization. Despite several FP programs designed to make contraceptives accessible, adoption of contraceptives has been difficult in Cambodia, which has high rates of fertility and maternal mortality. This gap in essential care can put women and adolescent girls at greater risk of adverse outcomes such as stillbirth, spontaneous abortion, unwanted pregnancy, or even maternal death. One of the goals set by the government to decrease both maternal and child mortality and morbidity was increasing the modern contraceptives utilization. So, the main objective of this study was to evaluate spatial variations in modern contraceptives utilization and its contributing factors among women.MethodsData from the Cambodia 2021–22 Demographic and Health Survey datasets were used for secondary data analysis. A total of 19,496 women of reproductive age participated in the study. A spatial and multilevel mixed effects analysis was done on the factors affecting modern contraceptives utilization among Cambodian women. Finally, the percentage, odd ratio, together with their 95% confidence intervals and the results of the spatial analysis were provided.ResultThe prevalence of modern contraceptive use was 31.2% in Cambodia. Living in an urban area [AOR = 1.224; 95% CI = (1.126.1.330); P = 0.0001]; being married [AOR = 34.131; 95% CI= (12.673, 91.921); P = 0.0001]; and having a history of terminated pregnancy [AOR = 1.137; 95% CI= (1.055, 1.225); P = 0.0001] were found to be positively associated with modern contraceptive utilization. In contrast to this, being between the age range of 46–49 [AOR = 0.421; 95% CI = (0.364, 0.487); P = 0.0001]; being a female-headed household [AOR = 0.784; 95% CI = (0.723, 0.850); P = 0.0001]; and current breast feeding [AOR = 0.84; 95% CI = (0.75, 0.93); P = 0.010] were found to be negatively associated with modern contraceptive utilization. Additionally, the spatial analysis of modern contraceptive utilization showed that a higher proportion was utilized in the southern and southwest regions of Cambodia.ConclusionIn this study, living in urban area, being married and having history of terminated pregnancy were found positively associated with modern contraceptive utilization. In contrast to this, being old age, being female headed household and being currently breast-feeding women were found negatively associated with modern contraceptive utilization. In addition to this, there were geographic (spatial) variations in modern contraceptive utilization among Cambodian’s women across the country.

Early childhood family threat and longitudinal amygdala-mPFC circuit development: Examining cortical thickness and gray matter-white matter contrast

Early threat-associated cortical thinning may be interpreted as accelerated cortical development. However, non-adaptive processes may show similar macrostructural changes. Examining cortical thickness (CT) together with grey/white-matter contrast (GWC), a proxy for intracortical myelination, may enhance the interpretation of CT findings. In this prospective study, we examined associations between early life family-related threat (harsh parenting, family conflict, and neighborhood safety) and CT and GWC development from late childhood to middle adolescence. MRI was acquired from 4200 children (2069 boys) from the Generation R study at ages 8, 10 and 14 years (in total 6114 scans), of whom 1697 children had >1 scans. Linear mixed effect models were used to examine family factor-by-age interactions on amygdala volume, caudal and rostral anterior cingulate (ACC) and medial orbitofrontal cortex (mOFC) CT and GWC. A neighborhood safety-by-age-interaction was found for rostral ACC GWC, suggesting less developmental change in children from unsafe neighborhoods. Moreover, after more stringent correction for motion, family conflict was associated with greater developmental change in CT but less developmental change in GWC. Results suggest that early threat may blunt ACC GWC development. Our results, therefore, do not provide evidence for accelerated threat-associated structural development of the amygdala-mPFC circuit between ages 8–14 years.

Clinician response to the 2021 USPSTF recommendation for colorectal cancer screening in average risk adults aged 45-49 years

IntroductionIn 2021, the USPSTF lowered the recommended age of colorectal cancer (CRC) screening initiation from 50 to 45 years. We assessed clinician response to the updated guideline in a major health system. MethodsThis was a retrospective cohort study of average-risk, CRC screening-naïve adults aged 45-50 years with a primary care appointment between July 2018 and February 2023. We defined the pre-guideline change period as July 2018-February 2020 (pre-period) and the post-guideline change period as July 2021-February 2023 (post-period). Clinician ordering of any CRC screening type was assessed. Mixed effects Poisson regression was used to model the incidence rate ratio (IRR) of a patient receiving a screening order, including an interaction between age (45-49 years versus 50 years) and time-period (pre- versus post-guideline change.) Variation in screening orders were also described by calendar quarter and clinician. ResultsThere were 28,114 patients in the pre-period and 22,509 in the post-period. Compared to patients aged 40-49 years in the pre-period, those in the post-period were more likely to have screening ordered (IRR:12.1; 95%CI:11.3-13.0). The screening ordering rate increased for 50-year-olds from the pre- to the post-period (IRR:1.08;95%CI:1.01-1.16) and was slightly higher than that of 45-49-year-olds in the post-period (IRR:1.08; 95%CI:1.02-1.14). All clinicians increased their ordering rate for patients aged 45-49 years. Within five months of the guideline change, the ordering rate for 45-49-year-olds and 50-year-olds was nearly the same. ConclusionsRapidly following the guideline change, clinicians increased their screening ordering rate for 45-49-year-olds, indicating almost complete uptake of the recommendation.

Longitudinal Changes in Estimated Glomerular Filtration Rate Following Repeat Heart Transplant in Children and Young Adults.

Chronic kidney disease (CKD) is common after heart transplantation (HT). There are scarce studies looking at longitudinal changes in estimated glomerular filtration rate (eGFR) after repeat HT (RT) and risk factors for the presence of CKD3 post-RT. First-time HT recipients (FT) were matched with RT, based on age at transplant, sex, race, and transplant era. eGFR was derived from CKiD-U25 formula using creatinine. Changes in eGFR were measured within and between patients using a mixed effects model. Logistic regression and survival analysis were performed to identify significant risk factors for CKD3 presence post-RT. The unmatched cohort included 393 HT recipients and 47 RT. 29 patients in both groups with at least 2 years of follow-up data underwent matching. Over 6 years, the mean eGFR for FT and RT did not significantly change overtime. For those with CKD3 or higher prior to RT, 73% improved to CKD2 or lower at 2 years post-RT. Risk factors for CKD3 post-RT included female sex (OR 17.5 [1.7-181.9], p = 0.017) and greater than two acute kidney injuries (AKI) between FT and RT (OR 1.77 [1.06-2.95], p = 0.03). Approximately 50% of females and those with greater than two AKIs maintained or developed CKD3 at 7.5 and 3 years, respectively. This study provides data on longitudinal changes in eGFR over 6 years and finds that female sex and repeat HT recipients with greater 2 AKIs between transplants are at greatest risk for CKD3 presence post-RT.

Investigating the Effect of Blurring and Focusing Current in Cochlear Implant Users with the Panoramic ECAP Method.

For some cochlear implants (CIs), it is possible to focus electrical stimulation by partially returning current from the active electrode to nearby, intra-cochlear electrodes (partial tripolar (pTP) stimulation). Another method achieves the opposite: "blurring" by stimulating multiple electrodes simultaneously. The Panoramic ECAP (PECAP) method provides a platform to investigate their effects in detail by measuring electrically evoked compound action potentials and estimating current spread and neural responsiveness along the length of the CI electrode array. We investigate how sharpening and broadening the electrical current spread are reflected in PECAP estimates. PECAP measurements were recorded at most comfortable level in 12 ears of Advanced Bionics CI users. Focused thresholds were also determined. For the electrodes with the highest and lowest focused thresholds, additional PECAP measurements were recorded while stimulating in pTP mode and in "blurred" mode with 3 or 5 adjacent electrodes simultaneously stimulated. Current spread and neural responsiveness were then estimated along the electrode array using PECAP. PECAP revealed increased current spread estimates across participants for blurred stimulation of the targeted electrodes towards the apex of the cochlea. Variable results for pTP stimulation were found, with two of eight ears appearing to drive a small group-level effect of increased current spread. When stimulating multiple electrodes simultaneously, PECAP detected localized increases in current spread towards the apex (but not the base) of the cochlea. pTP stimulation showed mixed effects on PECAP current spread estimates. These findings are in line with behavioral speech perception studies and have implications for cochlear implant optimization.

Impacts of Local and Remote SST Warming on Summer Circulation Changes in the Western North Pacific

Abstract This study explores how future SST warming in remote ocean basins may affect the western North Pacific (WNP) wet season climate by applying a high-resolution atmospheric general circulation model to conduct a series of numerical experiments. A marked precipitation and tropical cyclone (TC) activity reduction, as well as enhanced anticyclonic circulation, in the WNP is projected in AMIP experiments forced by SST change in a future warming scenario. The sensitivity experiments reveal that various SST warming phenomena (e.g., in the global SST warming pattern, the tropical ocean belt, the Indian Ocean, the tropical Atlantic, and the subtropical northeast Pacific) and the increase in greenhouse gas concentration could weaken the precipitation, TC activity, and circulation. By contrast, the SST warming in the WNP and eastern equatorial Pacific has opposite and mixed effects, respectively, and tends to weakly offset the dominant influences of remote ocean warming. These results indicate that the WNP, being the epicenter of the global teleconnection of divergent and rotational flow, is susceptible to the influence of the SST warming in remote ocean basins. The remote forcing as projected in future scenarios would overwhelm the enhancing effect of local SST warming and weaken the circulation, convection, and TC activity in the WNP. These findings further the understanding of how the decreased precipitation and enhanced subtropical high in the WNP may be easily triggered by remote SST warming as revealed in the AMIP-type simulations. How this effect would be affected by air–sea coupling needs further investigation.

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.

Functional connectivity in resting-state networks relates to short-term global cognitive functioning in cardiac arrest survivors.

Long-term cognitive impairment is common in cardiac arrest survivors. Screening to identify patients at risk is recommended. Functional magnetic resonance brain imaging (fMRI) holds potential to contribute to prediction of cognitive outcomes. In this study, we investigated the possible value of early changes in resting-state networks for predicting short and long-term cognitive functioning of cardiac arrest survivors. We performed a prospective multicenter cohort study in cardiac arrest survivors in three Dutch hospitals. Resting-state fMRI scans were acquired within a month after cardiac arrest. We primarily focused on functional connectivity within the default-mode network (DMN) and salience network (SN), and additionally explored functional connectivity in seven other networks. Cognitive outcome was measured using the Montreal Cognitive Assessment (MoCA) during hospital admission and at 3 and 12 months, and by neuropsychological examination (NPE) at 12 months. We tested mixed effects models to evaluate the value of connectivity within the networks for predicting global cognitive outcomes at the three time points, and long-term cognitive outcomes in the memory, attention, and executive functioning domains. We included 80 patients (age 60 ± 11 years, 72 (90%) male). MoCA scores increased significantly between hospital admission and 3 months (ΔMoCAhospital-3M = 2.89, p < 0.01), but not between 3 and 12 months (ΔMoCA3M-12M = 0.38, p = 0.52). Connectivity within the DMN, SN, and dorsal attention network (DAN) was positively related to global cognitive functioning during hospital admission (βDMN = 0.85, p = 0.03; βSN = 1.48, p < 0.01; βDAN = 0.96, p = 0.01), but not at 3 and 12 months. Network connectivity was also unrelated to long-term memory, attention, or executive functioning. Resting-state functional connectivity in the DMN, SN, and DAN measured in the first month after cardiac arrest is related to short-term global, but not long-term global or domain-specific cognitive performance of survivors. These results do not support the value of functional connectivity within these RSNs for prediction of long-term cognitive performance after cardiac arrest.

Refractive error and ocular alignment in school-aged children from low-income areas of São Paulo, Brazil

BackgroundUncorrected refractive errors and amblyopia are reported as the two main causes of childhood visual impairment and blindness worldwide. Our purpose was to evaluate refractive status, ocular alignment and effective refractive error coverage (eREC) of school-aged children from low-income areas of Sao Paulo city, Brazil.MethodsData from the “Ver na Escola” Project were used for the current study. Children enrolled in the selected schools had an ophthalmic exam including eye alignment assessed by cover test, automatized and subjective dynamic and static refraction. The associations of demographic variables with occurrence and magnitude of refractive errors and eREC were investigated by multiple logistic regressions and multilevel mixed effect models.ResultsA total of 17,973 children (51.12% females) with mean ± sd age 8.24 ± 3.54 years old examined from July 2018 to July 2019, were included in the study. Most of the participants (73%) showed orthoposition of the visual axis for both distance and near. Heterophoria was found in about 25% of participants (N = 4,498), with 71.7% of them (N= 3,222) classified as exophoria. Less than 2% (N = 232) showed strabismus, most of them (N = 160) esotropia. Overall, 1,370 (7.70%) of participants had myopia and 577 (3.24%) had hyperopia. Age was found to be significantly associated with increasing static subjective refraction spherical equivalent (Coefficient: -0.18; 95% Confidence Interval (CI): -0.21 to -0.16; p < 0.001). Female sex (Odds Ratio (OR) = 1.13; 95%CI: 1.01–1.27; p = 0.027) and older age (OR = 1.17; 95%CI: 1.16–1.19; p < 0,001) were significantly associated with myopia diagnosis. Older age decreased the odds of hyperopia (OR = 0.95; 95%CI: 0.93–0.98; p < 0.001). The overall effective refractive coverage was 51.76% and was significantly associated with age group, ranging from 32.25% in children aged 3 to 7 years to 61.35% in children aged 8 to 12 years.ConclusionsMost children have shown eye alignment for both distance and near assessments and no refractive error. Myopia was observed in 7.70% of the population and it was associated with older age and female sex. Hyperopia was observed in 3.24% and was associated with younger age. The overall eREC was 51.76%, significantly associated with age.

Energy of functional brain states correlates with cognition in adolescent-onset schizophrenia and healthy persons.

Adolescent-onset schizophrenia (AOS) is rare, under-studied, and associated with more severe cognitive impairments and poorer outcomes than adult-onset schizophrenia. Neuroimaging has shown altered regional activations (first-order effects) and functional connectivity (second-order effects) in AOS compared to controls. The pairwise maximum entropy model (MEM) integrates first- and second-order factors into a single quantity called energy, which is inversely related to probability of occurrence of brain activity patterns. We take a combinatorial approach to study multiple brain-wide MEMs of task-associated components; hundreds of independent MEMs for various sub-systems are fit to 7 Tesla functional MRI scans. Acquisitions were collected from 23 AOS individuals and 53 healthy controls while performing the Penn Conditional Exclusion Test (PCET) for executive function, which is known to be impaired in AOS. Accuracy of PCET performance was significantly reduced among AOS compared to controls. A majority of the models showed significant negative correlation between PCET scores and the total energy attained over the fMRI. Across all instantiations, the AOS group was associated with significantly more frequent occurrence of states of higher energy, assessed with a mixed effects model. An example MEM instance was investigated further using energy landscapes, which visualize high and low energy states on a low-dimensional plane, and trajectory analysis, which quantify the evolution of brain states throughout this landscape. Both supported patient-control differences in the energy profiles. Severity of psychopathology was correlated positively with energy. The MEM integrated representation of energy in task-associated systems can help characterize pathophysiology of AOS, cognitive impairments, and psychopathology.

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.

Improving the efficiency of aerial surveys for monitoring North American beaver population dynamics

Context The North American beaver (Castor canadensis) was extirpated from much of its range in the US in the 1800s due to fur trapping and change in land use. However, the species has recolonised much of its former range, including the US state of Ohio. Since 2013, the Ohio Division of Wildlife (ODOW) has monitored trends in beaver colony density via aerial surveys of 40 km × 40 km plots classified as low, medium, or high suitability based on the amount of wetland. Nonetheless, the current classification system may miss important correlates of beaver colony density. Aims Our study aimed to (1) identify predictors of beaver colony density (number of colonies inferred from aerial counts of lodges) across Ohio, and (2) develop a model-based classification system to improve the efficacy of monitoring efforts. Methods To predict beaver colony density in Ohio we used an aerial survey dataset of 54 plots (40 km × 40 km) collected by ODOW annually between 2013 and 2020, along with a suite of environmental, anthropogenic, and climate variables in a mixed effects modelling framework. Key results Beaver colony density was positively associated with wetland and reclaimed surface mine areas and inversely associated with the proportion of agricultural lands. There was a negative interaction between wetland and surface mines; in general, beaver colony density increased with wetland and surface mine area. However, in plots with wetland area &gt;1000 ha, beaver colony density was weakly negatively associated with surface mine area. Using median and interquartile ranges of model-averaged predicted beaver colony density, we developed a new classification of low, moderate and high suitability for both the survey plots and the entire state of Ohio. We found that eastern Ohio had high suitability, while the central and western parts of the state had lower suitability for C. canadensis. Conclusions Our approach to identifying predictors for beaver colony density at broad spatial scales highlights the importance of reclaimed surface mines and wetlands for beaver populations, while the model-based habitat classification provides ODOW additional information for monitoring and beaver management decisions. Implications Improved C. canadensis monitoring at the landscape scale using habitat classifications that consider local conditions can both improve annual survey cost-effectiveness and facilitate the sustainable management of this recovering species.

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.