Random Slope Research Articles

A default Bayes factor for testing null hypotheses about the fixed effects of linear two-level models.

Testing null hypotheses of the form "β = 0," by the use of various Null Hypothesis Significance Tests (rendering a dichotomous reject/not reject decision), is considered standard practice when evaluating the individual parameters of statistical models. Bayes factors for testing these (and other) hypotheses allow users to quantify the evidence in the data that is in favor of a hypothesis. Unfortunately, when testing equality-contained hypotheses, the Bayes factors are sensitive to the specification of prior distributions, which may be hard to specify by applied researchers. The paper proposes a default Bayes factor with clear operating characteristics when used for testing whether the fixed parameters of linear two-level models are equal to zero. This is achieved by generalizing an already existing approach for linear regression. The generalization requires: (a) the sample size for which a new estimator for the effective sample size in two-level models containing random slopes is proposed; (b) the effect size for the fixed effects for which the so-called marginal R² for the fixed effects is used. Implementing the aforementioned requirements in a small simulation study shows that the Bayes factor yields clear operating characteristics regardless of the value for sample size and the estimation method. The paper gives practical examples and access to an easy-to-use wrapper function to calculate Bayes factors for hypotheses with respect to the fixed coefficients of linear two-level models by using the R package bain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Penerapan model regresi multilevel untuk data ketepatan waktu lulus mahasiswa

Multilevel logistic regression is one of the alternatives to solving a problem that has a nested data structure like the student data in Alauddin in 2016. The data indicates that students are nested in each different study program. This condition allows the students in the same study program tend to have similar characteristics. The study aims to gain a student graduating model of punctuality using multilevel regression analysis and recognize factors that have a significant impact on student graduating time. Based on our research, we find the best model that fits the data to be the random intercepts model with a random slope of gender variable. The variables that have significant effects are gender, cumulative achievement index, educational background, and accredited program.
 Keywords: logistic regression, nested, multilevel logistic regression, graduation of studentMSC2020: 62J05

Daily Sleep-Stress Reactivity and Functional Impairment in World Trade Center Responders.

How sleep is impacted by stress ("sleep reactivity to stress") and how stress is impacted by sleep ("stress reactivity to sleep") are trait-like characteristics of individuals that predict depression, anxiety, and insomnia. However, pathways between reactivity and functional impairment (e.g., impairment in social relationships and interpersonal functioning) have not been explored, which may be a critical pathway in understanding the link between reactivity and the development of psychological disorders. We examined associations between reactivity and changes in functional impairment among a cohort of 9/11 World Trade Center responders. Data from 452 responders (Mage = 55.22 years; 89.4% male) were collected between 2014 and 2016. Four baseline sleep and stress reactivity indices (i.e., sleep duration and efficiency reactivity to stress; stress reactivity to sleep duration and efficiency) were calculated from 14 days of sleep and stress data using random slopes from multilevel models. Functional impairment was assessed approximately 1 year and 2 years after baseline via semi-structured interviews. Latent change score analyses examined associations between baseline reactivity indices and changes in functional impairment. Greater baseline sleep efficiency reactivity to stress was associated with decreases in functioning (β = -0.05, p = .039). In addition, greater stress reactivity to sleep duration (β = -0.08, p = .017) and sleep efficiency (β = -0.22, p < .001) was associated with lower functioning at timepoint one. People who are more reactive to daily fluctuations in stress and sleep have poorer interpersonal relationships and social functioning. Identifying individuals with high reactivity who could benefit from preventative treatment may foster better social integration.

Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis

Delayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran. This hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group. The DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients. A simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD.

Well-Being and Aging-Related Decline in Financial and Health Literacy in Advanced Age.

Emerging evidence suggests that financial and health literacy deteriorates in advanced age. By contrast, well-being promotes health in aging. This study tested the hypothesis that well-being is associated with slower aging-related literacy decline. Participants were 1,099 community-based older adults without dementia at baseline. Financial and health literacy was assessed at baseline and annually thereafter via a 32-item measure. Well-being was assessed at baseline via the 18-item version of Ryff's Scales of Psychological Well-Being. During up to 12 years of annual follow-up, literacy declined about 1 percentage point per year on average (β = -0.91, standard error [SE] = 0.08, p < .001); however, there was considerable variation in change in literacy between participants (random slopes variance = 1.24, SE = 0.15, p < .001). In a linear mixed-effects model adjusted for age, sex, and education, higher well-being was associated with higher starting level of literacy (β = 2.31, SE = 0.67, p = .001) and, critically, slower literacy decline (β = 0.29, SE = 0.11, p = .01). The association of higher well-being with slower literacy decline persisted in models that additionally adjusted for income, medical conditions, depressive symptoms, and a robust measure of global cognition. This study suggests that well-being helps stave off aging-related literacy decline.

Numerical-based seismic displacement hazard analysis for earth slopes considering spatially variable soils

This paper presents a numerical-based seismic displacement analysis for slopes considering the spatial variability of soils. Two generic slope models are developed based on a finite-difference approach, and the soil parameters such as cohesion and friction angle are modelled as random fields. Dynamic analyses are conducted to estimate the slope displacements based on both deterministic and random slope cases. Dozens of scalar intensity measures (IMs) and vector-IMs are utilized for developing the 1-IM and 2-IM-based displacement models. It is found that the scalar-IMs of spectral acceleration at a degraded period of the whole slope, spectrum intensity, and peak ground velocity, and the Arias intensity (IA) or cumulative absolute velocity-containing vector-IMs such as [IA, mean period] are the most efficient scalar- and vector-IMs for developing the displacement models, respectively. In addition, compared to the deterministic cases, the median predictions by the random-based displacement models are notably larger, attributing to the existence of relatively weak zones for the random slope cases. Based on the displacement models developed, two strategies are proposed to conduct the slope displacement hazard analysis considering the spatial variability of soils. Comparative results indicate that neglecting the soil spatial variability significantly underestimates the slope displacement hazard, and the proposed strategy 1 results in slightly greater displacement hazard than strategy 2. Such difference is mainly caused by the treatment of the aleatory variability within the two strategies.

Who earns more? City hierarchy of earning returns to education among migrant workers in urban China

According to urban economic theories, workers in more developed regions should have higher educational returns. However, studies on urban workers in China have shown mixed results on whether earning returns to education are higher in regions experiencing more economic growth. Meanwhile, there is a lack of evidence on this issue among migrant populations, which have rapidly increased in number during China's economic transition. To fill this void, this study investigated how educational returns among migrant workers are related to local economic development levels and industrial structures. Specifically, we used individual-level data obtained from 286 cities through the 2018 China Migrants Dynamic Survey and city-level data to conduct a multilevel linear regression analysis with random slopes. We thus found that earning returns to education were higher in cities under two conditions, including higher development and higher shares of tertiary industry. Moreover, this association was more pronounced among high-skill migrant workers than low-skill ones. As higher income is a primary driving force in migration, we suggest that future policies should further promote industrial restructuring rather than using discriminative administrative rules to guide migration flows.

Long-Term Outcomes in IgA Nephropathy.

IgA nephropathy can progress to kidney failure, and risk assessment soon after diagnosis has advantages both for clinical management and the development of new therapeutics. We present relationships among proteinuria, eGFR slope, and lifetime risks for kidney failure. The IgA nephropathy cohort (2299 adults and 140 children) of the UK National Registry of Rare Kidney Diseases (RaDaR) was analyzed. Patients enrolled had a biopsy-proven diagnosis of IgA nephropathy plus proteinuria >0.5 g/d or eGFR <60 ml/min per 1.73 m 2 . Incident and prevalent populations and a population representative of a typical phase 3 clinical trial cohort were studied. Analyses of kidney survival were conducted using Kaplan-Meier and Cox regression. eGFR slope was estimated using linear mixed models with random intercept and slope. The median (Q1, Q3) follow-up was 5.9 (3.0, 10.5) years; 50% of patients reached kidney failure or died in the study period. The median (95% confidence interval [CI]) kidney survival was 11.4 (10.5 to 12.5) years; the mean age at kidney failure/death was 48 years, and most patients progressed to kidney failure within 10-15 years. On the basis of eGFR and age at diagnosis, almost all patients were at risk of progression to kidney failure within their expected lifetime unless a rate of eGFR loss ≤1 ml/min per 1.73 m 2 per year was maintained. Time-averaged proteinuria was significantly associated with worse kidney survival and more rapid eGFR loss in incident, prevalent, and clinical trial populations. Thirty percent of patients with time-averaged proteinuria of 0.44 to <0.88 g/g and approximately 20% of patients with time-averaged proteinuria <0.44 g/g developed kidney failure within 10 years. In the clinical trial population, each 10% decrease in time-averaged proteinuria from baseline was associated with a hazard ratio (95% CI) for kidney failure/death of 0.89 (0.87 to 0.92). Outcomes in this large IgA nephropathy cohort are generally poor with few patients expected to avoid kidney failure in their lifetime. Significantly, patients traditionally regarded as being low risk, with proteinuria <0.88 g/g (<100 mg/mmol), had high rates of kidney failure within 10 years.

Adverse Childhood Experiences: Associations with a Blunted Cortisol Stress Response During Pregnancy.

Adverse Childhood Experiences (ACEs) are associated with a range of negative physical and mental health outcomes, yet there is limited research focused on the effect of ACEs on stress responses during pregnancy. Expectant mothers experience an increase in cortisol levels as pregnancy progresses, with this increase having important implications for fetal and early infant development. Little is known about the impact of ACEs on maternal cortisol levels. This study explored the relationship between maternal ACEs and cortisol response among expectant mothers nearing or in the third trimester of pregnancy. 39 expectant mothers were exposed to a Baby Cry Protocol via an infant simulator, with salivary cortisol collected at five points in time (N = 181). Stepwise, multilevel model creation resulted in a random intercept and random slope model with an interaction term for total number of ACEs and week of pregnancy. The repeated measures data showed that cortisol levels decreased across collection times, from arrival at the lab, through the Baby Cry Protocol, to recovery. Predictive margins for the interaction term showed that while exposure to a greater number of ACEs was associated with higher cortisol levels early in the third trimester, the expected increase in cortisol late in pregnancy was blunted for expectant mothers who were exposed to a greater number of ACEs. These findings findings suggest the importance of ACEs screening and intervention efforts as part of prenatal care.

Frequency of Visual Fields Needed to Detect Glaucoma Progression: A Computer Simulation Using Linear Mixed Effects Model.

Irregular visual field test frequency at relatively short intervals initially and longer intervals later on in the disease provided acceptable results in detecting glaucoma progression. It is challenging to maintain a balance between the frequency of visual field testing and the long-term costs that may result from insufficient treatment of glaucoma patients. This study aims to simulate real-world circumstances of visual field data to determine the optimum follow-up scheme for the timely detection of glaucoma progression using a linear mixed effects model (LMM). An LMM with random intercept and slope was used to simulate the series of mean deviation sensitivities over time. A cohort study including 277 glaucoma eyes that were followed for 9.0±1.2 years was used to derive residuals. Data were generated from patients with early-stage glaucoma having various regular and irregular follow-up scenarios and different rates of visual field loss. For each condition, 10,000 series of eyes were simulated, and one confirmatory test was conducted to identify progression. By doing one confirmatory test, the percentage of incorrect progression detection decreased considerably. The time to detect progression was shorter for eyes with an evenly spaced 4-monthly schedule, particularly in the first 2 years. From then onward, results from twice-a-year testing were similar to results from examinations scheduled 3 times per year. Irregular visual field test frequency at relatively short intervals initially and longer intervals later on in the disease provided acceptable results in detecting glaucoma progression. This approach could be considered for improving glaucoma monitoring. Moreover, simulating data using LMM may provide a better estimate of the disease progression time.

Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older

Food insecurity has a known association with prevalent impaired cognition. However, it is unknown whether food insecurity has a longitudinal association with cognitive decline among older adults. To determine whether food insecurity is associated with a faster decline in cognitive function among community-dwelling older adults. This retrospective cohort study used data from a nationally representative sample of Medicare beneficiaries 65 years and older recruited for the National Health and Aging Trends Study (NHATS). Community-dwelling NHATS participants were followed up for a maximum of 7 years (mean [SD] follow-up duration, 5.4 [1.1] years). Data were collected from January 1, 2012, to December 31, 2020, and analyzed from December 23, 2021, to December 6, 2022. Self-reported food insecurity assessed from 2012 to 2019. Primary outcomes were immediate memory, delayed memory, and executive function collected from 2013 to 2020. Immediate and delayed recall were assessed by a 10-item word-list memory task (range, 0-10, with higher scores indicating more words recalled). Executive function was measured by the clock drawing test (range, 0-5, with higher scores indicating more accurate depiction of a clock). Each year's cognitive functions were linked to the prior year's food insecurity data. Linear mixed-effects models with random slopes and intercepts were used to examine the association between food insecurity and cognitive decline. Analytic weights in each year were applied to represent community-dwelling Medicare beneficiaries 65 years and older in 2011. Of 3037 participants, a weighted 57.8% (raw count, 1345) were younger than 75 years, 56.2% (raw count, 1777) were women, and most (84.9% [raw count, 2268]) were White. Over 7 years, 417 (weighted proportion, 12.1%) experienced food insecurity at least once. Food insecurity was associated with a faster decline in executive function in a fully adjusted model: the mean difference of annual change in executive function score between people exposed to and not exposed to food insecurity was -0.04 (95% CI, -0.09 to -0.003) points. However, food insecurity was not associated with changes in immediate and delayed memory (0.01 [95% CI, -0.05 to 0.08] and -0.01 [95% CI, -0.08 to 0.06], respectively). Among community-dwelling older adults, food insecurity was prevalent and associated with a decline in executive function. Interventions and policies aiming to increase healthy food access or reduce food insecurity should be assessed for their impact on older adults' cognitive outcome.

Alcohol Consumption and a Decline in Glomerular Filtration Rate: The Japan Specific Health Checkups Study.

Previous studies have reported conflicting results on the clinical impact of alcohol consumption on the glomerular filtration rate (GFR). This retrospective cohort study aimed to assess the dose-dependent association between alcohol consumption and the slope of the estimated GFR (eGFR) in 304,929 participants aged 40-74 years who underwent annual health checkups in Japan between April 2008 and March 2011. The association between the baseline alcohol consumption and eGFR slope during the median observational period of 1.9 years was assessed using linear mixed-effects models with the random intercept and random slope of time adjusting for clinically relevant factors. In men, rare drinkers and daily drinkers with alcohol consumptions of ≥60 g/day had a significantly larger decline in eGFR than occasional drinkers (difference in multivariable-adjusted eGFR slope with 95% confidence interval (mL/min/1.73 m2/year) of rare, occasional, and daily drinkers with ≤19, 20-39, 40-59, and ≥60 g/day: -0.33 [-0.57, -0.09], 0.00 [reference], -0.06 [-0.39, 0.26], -0.16 [-0.43, 0.12], -0.08 [-0.47, 0.30], and -0.79 [-1.40, -0.17], respectively). In women, only rare drinkers were associated with lower eGFR slopes than occasional drinkers. In conclusion, alcohol consumption was associated with the eGFR slope in an inverse U-shaped fashion in men but not in women.

Dairy Cows Are Limited in Their Ability to Increase Glucose Availability for Immune Function during Disease.

Shortages of energy and glucose have been hypothesized to play a key role in the development of and responses to production diseases in dairy cows during early lactation. Given the importance of glucose for immune functions, we used a recently established method for the estimation of glucose balance (GB) to evaluate glucose availability during disease phases. A dataset comprising ration analyses as well as individual daily milk yields (MY), dry matter intake (DMI), body weights, and health records of 417 lactations (298 cows) was used to calculate individual daily GB and energy balance (EB). The magnitude and dynamics of MY, DMI, GB, and EB were evaluated in the weeks before, at, and after diagnoses of inflammatory diseases in different stages of early lactation from week in milk 1 to 15. Diagnoses were categorized as mastitis, claw and leg diseases, and other inflammatory diseases. Mixed linear models with a random intercept and slope term for each lactation were used to evaluate the effect of diagnosis on MY, DMI, GB, and EB while accounting for the background effects of week in milk, parity, season, and year. When unaffected by disease, in general, the GB of cows was close to zero in the first weeks of lactation and increased as lactation progressed. Weekly means of EB were negative throughout all lactation stages investigated. Disease decreased both the input of glucose precursors due to a reduced DMI as well as the output of glucose via milk due to a reduced MY. On average, the decrease in DMI was -1.5 (-1.9 to -1.1) kg and was proportionally higher than the decrease in MY, which averaged -1.0 (-1.4 to -0.6) kg. Mastitis reduced yield less than claw and leg disease or other diseases. On average, GB and EB were reduced by -3.8 (-5.6 to -2.1) mol C and -7.5 (-10.2 to -4.9) MJ in the week of diagnosis. This indicates the need to investigate strategies to increase the availability of glucogenic carbon for immune function during disease in dairy cows.

Comparing random effects models, ordinary least squares, or fixed effects with cluster robust standard errors for cross-classified data.

Cross-classified random effects modeling (CCREM) is a common approach for analyzing cross-classified data in psychology, education research, and other fields. However, when the focus of a study is on the regression coefficients at Level 1 rather than on the random effects, ordinary least squares regression with cluster robust variance estimators (OLS-CRVE) or fixed effects regression with CRVE (FE-CRVE) could be appropriate approaches. These alternative methods are potentially advantageous because they rely on weaker assumptions than those required by CCREM. We conducted a Monte Carlo Simulation study to compare the performance of CCREM, OLS-CRVE, and FE-CRVE in models, including conditions where homoscedasticity assumptions and exogeneity assumptions held and conditions where they were violated, as well as conditions with unmodeled random slopes. We found that CCREM out-performed the alternative approaches when its assumptions are all met. However, when homoscedasticity assumptions are violated, OLS-CRVE and FE-CRVE provided similar or better performance than CCREM. When the exogeneity assumption is violated, only FE-CRVE provided adequate performance. Further, OLS-CRVE and FE-CRVE provided more accurate inferences than CCREM in the presence of unmodeled random slopes. Thus, we recommend two-way FE-CRVE as a good alternative to CCREM, particularly if the homoscedasticity or exogeneity assumptions of the CCREM might be in doubt. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Back-analysis of a rainfall-induced landslide case history using deterministic and random limit equilibrium methods

Because recurrent rainfall-induced landslide episodes mimic prior failures, this study builds a back-analysis approach to identify those prior failure events and assess the prospective slope performance going forward. Engineers use the results of this approach to project the slope performance based on the quantity of rainfall accumulation during the anticipated rainfall event. A landslide case that occurred in 2004, as a result of a typhoon event, was selected for the back-analysis procedure. Four typhon events were chosen to simulate the pore water pressure conditions, which may have caused damage of varying severity (including landslide failure) to the slope. The numerical model was initially analyzed via the deterministic limit equilibrium slope stability approach to evaluate the most critical failure surface. By adopting the Monte Carlo simulation approach, the following step assessed the random limit equilibrium slope stability on the most critical failure surfaces. The probabilistic distributions of the safety factor were then generated for each typhoon event. Subsequently, the simulation outcomes provide safety indicator values incorporating the mean safety factor, failure probability, and reliability index. From the failure probability and reliability index, a zonation approach with various site-specific performance levels were established by using the corresponding accumulated rainfall to define the exceedance threshold values for each zone. In order to confirm the site-specific performance, we compared the normalized error values acquired from the analysis technique to those measured under two recent typhoon occurrences. An acceptable consistency was attained, validating the procedure's appropriateness for future rainfall events.

Workers’ whole day workload and next day cognitive performance

Workload experienced over the whole day, not just work periods, may impact worker cognitive performance. We hypothesized that experiencing greater than typical whole day workload would be associated with lower visual processing speed and lower sustained attention ability, on the next day. To test this, we used dynamic structural equation modeling to analyze data from 56 workers with type 1 diabetes. For a two-week period, on smartphones they answered questions about whole day workload at the end of each day, and completed cognitive tests 5 or 6 times throughout each day. Repeated smartphone cognitive tests were used, instead of traditional one- time cognitive assessment in the laboratory, to increase the ecological validity of the cognitive tests. Examples of reported occupations in our sample included housekeeper, teacher, physician, and cashier. On workdays, the mean number of work hours reported was 6.58 (SD 3.5). At the within-person level, greater whole day workload predicted decreased mean processing speed the next day (standardized estimate=-0.10, 95% CI -0.18 to -0.01) using a random intercept model; the relationship was not significant and only demonstrated a tendency toward the expected effect (standardized estimate= -0.07, 95% CI -0.15 to 0.01) in a model with a random intercept and a random regression slope. Whole day workload was not found to be associated with next-day mean sustained attention ability. Study results suggested that just one day of greater than average workload could impact next day processing speed, but future studies with larger sample sizes are needed to corroborate this finding.

Characterizing Interhospital Variability in Neurosurgical Interventions for Patients with Mild Traumatic Brain Injury and Intracranial Hemorrhage.

The objective of this study was to quantify nation-wide interhospital variation in neurosurgical intervention risk by intracranial hemorrhage (ICH) type in the setting of mild traumatic brain injury (mTBI). This was a retrospective cohort study of adult (≥18 years) trauma patients included in the National Trauma Data Bank from 2007 to 2019 with an emergency department Glasgow Coma Scale score 13-15, diagnosed ICH, no skull fracture. The primary outcome was neurosurgical intervention. Interhospital variation was assessed by examining the best linear unbiased predictors (BLUPs) obtained from mixed-effects logistic regression with random slopes and intercepts for hospitals and covariates for time and 14 demographic, injury, and hospital characteristics; one model per ICH type. Intercept BLUPs are estimates of how different each hospital is from the average hospital (after covariate adjustment). The study population included 49,220 (7%) neurosurgical interventions among 666,842 patients in 1060 hospitals. In 2019, after adjusting for patient case-mix and hospital characteristics, the percentage of hospitals with hemorrhage-specific neurosurgical intervention risk significantly different from the average hospital was as follows: isolated unspecified hemorrhage (0% of 995 hospitals); isolated contusion/laceration (0.54% of 929); isolated epidural hemorrhage (0.39% of 778); isolated subarachnoid hemorrhage (0.10% of 1002); multiple hemorrhages (2.49% of 963); and isolated subdural hemorrhage (16.25% of 1028). In the setting of mTBI, isolated subdural hemorrhages were the only ICH type to have considerable interhospital variability. Causes for this significant variation should be elucidated and might include changing hemorrhage characteristics and practice patterns over time.

Significant National Declines in Neurosurgical Intervention for Mild Traumatic Brain Injury with Intracranial Hemorrhage: A 13-Year Review of the National Trauma Data Bank.

There have been large changes over the past several decades to patient demographics in those presenting with mild traumatic brain injury (mTBI) with intracranial hemorrhage (ICH; complicated mTBI) with the potential to affect the use of neurosurgical interventions. The objective of this study was to characterize long-term trends of neurosurgical interventions in patients with complicated mTBI using 13 years of the National Trauma Data Bank (NTDB). This was a retrospective cohort study of adult (≥18 years) trauma patients included in the NTDB from 2007 to 2019 who had an emergency department Glasgow Coma Scale score 13-15, an intracranial hemorrhage (ICH), and no skull fracture. Neurosurgical intervention time trends were quantified for each ICH type using mixed-effects logistic regression with random slopes and intercepts for hospitals, as well as covariates for time and 14 demographic, injury, and hospital characteristics. In total, 666,842 ICH patients across 1060 hospitals were included. The four most common hemorrhages were isolated subdural hemorrhage (36%), isolated subarachnoid hemorrhage (24%), multiple hemorrhage types (24%), and isolated unspecified hemorrhages (9%). Overall, 49,220 (7%) patients received a neurosurgical intervention. After adjustment, the odds of neurosurgical intervention significantly decreased every 10 years by the following odds ratios (odds ratio [95% confidence interval]): 0.85 [0.78, 0.93] for isolated subdural, 0.63 [0.51, 0.77] for isolated subarachnoid, 0.50 [0.41, 0.62] for isolated unspecified, and 0.79 [0.73, 0.86] for multiple hemorrhages. There were no significant temporal trends in neurosurgical intervention odds for isolated epidural hemorrhages (0.87 [0.68, 1.12]) or isolated contusions/lacerations (1.03 [0.75, 1.41]). In the setting of complicated mTBI, the four most common ICH types were associated with significant declines in the odds of neurosurgical intervention over the past decade. It remains unclear whether changing hemorrhage characteristics or practice patterns drove these trends.

Abstract P655: Childhood and Lifecourse Socioeconomic Position and Cardiovascular Health in Hispanic/Latino Adults of the Hispanic Community Health Study/Study of Latinos

Introduction: The Hispanic/Latino population experiences extensive socioeconomic adversity across the lifespan. Yet little is known about the role of lifecourse socioeconomic position (SEP) on cardiovascular health (CVH) in this population. Hypothesis: Childhood and adulthood SEP as well as socioeconomic mobility are associated with changes in CVH over time in Hispanic/Latino adults. Methods: We used longitudinal data (N = 14,604) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a population-based cohort study conducted in four major U.S cities. We determined childhood SEP using participant-reported parental education classified as No schooling; Elementary, middle, or high school; and more than high school (HS). Adulthood SEP was determined through an index with a score ranging from 0 to 9 combining participants’ education, occupation, annual household income, and assets, and classified as low (0), middle (1-4), and high SEP (5-9). Using childhood and adulthood SEP, we classified participants into socioeconomic mobility categories (e.g., persisting low, downward, or upward mobility, etc.). Using the four-health metrics of the American Heart Association “Life’s Essential 8” (i.e., body mass index, non-HDL cholesterol, fasting blood glucose or HbA1c, and blood pressure) we built a score of ideal CVH ranging from 0 to 100. CVH was assessed at baseline and at the 6-year follow-up. Since changes in CVH over time differed by CVH at baseline, we conducted linear mixed effects models stratifying by CVH at baseline, with random intercept and slope, adjusting for age, sex, Hispanic/Latino background, study center, U.S or foreign-born, years in the U.S, as well as baseline health insurance, diet, physical activity, hours of sleep per night, smoking, alcohol consumption, and antihypertensive and cholesterol medication use. Results: 8% of parents did not have any formal education, 11% of the population had low SEP in adulthood, and 37% showed upward socioeconomic mobility. Among those with low (CVH score &lt;50) and moderate to high (CVH score 50-100) baseline CVH, there was no association between childhood SEP and CVH at baseline. However, among those with moderate to high baseline CVH, high childhood SEP was associated with greater CVH over time (Coefficient for &gt;HS: 0.24, 95% CI: 0.00, 0.47). There was no longitudinal association among those with low baseline CVH. High adulthood SEP was associated with greater CVH at baseline for those with low (Coefficient: 2.55 95% CI: 1.25, 3.85) and moderate to high CVH (Coefficient: 1.36 95% CI: 0.09, 2.62). However, it was not associated with changes in CVH. Socioeconomic mobility was associated with greater baseline CVH as well as with improvements in CVH over time. Conclusion: Among Hispanic/Latino population with high initial CVH, high childhood SEP and socioeconomic mobility were associated with better CVH over time.

An Ultrasound Investigation of Tongue Dorsum Raising in Children with Cleft Palate +/- Cleft Lip.

This study aimed to determine whether increased raising of the back of the tongue is evident in children with repaired cleft palate with or without cleft lip (CP+/-CL). We hypothesized that children with CP+/-CL would show increased raising of the tongue dorsum, a compensatory pattern. Secondary data analysis of mid-sagittal ultrasound tongue imaging data from 31 children with CP+/-CL and 29 typically developing children were used. We annotated the consonants /ʃ, t, s, k/ at the point of maximum constriction in an /aCa/ environment. Children with CP+/-CL said the tokens 10 times, typically developing children said them once. We automatically fitted splines to the tongue contour and extracted the Dorsum Excursion Index (DEI) for each consonant. This metric measures the relative use of the tongue dorsum, with more posterior consonants having higher values. We compared DEI values across groups and consonants using a linear mixed effects model. DEI was predicted by the interaction of consonant (baseline: /ʃ/) and speaker type (baseline: TD), including by-speaker random slopes for consonant and random intercepts for speaker. Overall DEI was not higher in children with CP+/-CL compared to typically developing children. Between groups the only significant difference was the position of /k/ relative to /ʃ/, where the difference between these two consonants was smaller in the children with CP+/-CL. There was no support for the hypothesis that increased raising of the tongue dorsum is a common characteristic in children with repaired CP+/-CL. However, individual children may present with this pattern.