Significant Covariates Research Articles

Correlating Groundwater Storage Change and Precipitation in Alabama, United States from 2000–2021 by Combining the Water Table Fluctuation Method and Statistical Analyses

The complexity of aquifers poses a challenge for fully comprehending the impact of climate change on groundwater. In this study, we employed a suite of hydrological and statistical methods, including the water table fluctuation (WTF) method, wavelet analysis, the Hurst exponent, and temporal trend analysis, to assess groundwater storage (GWS) changes and their correlation with precipitation in Alabama, located in the southeastern United States. These approaches were used to evaluate the temporal variability of GWS as derived from well data and large-scale model estimates that incorporated satellite observations. The results unveiled a nuanced and regionally variable relationship between GWS changes and precipitation over the past two decades. While the Mann–Kendall test did not reveal any statistically significant overarching trends in GWS changes, Sen’s slope analysis indicated subtle regional variations, including a minor decline of −0.2 mm/year for GWS in southern Alabama and modest increases of 0.5 mm/year and 0.38 mm/year in the western and northern regions, respectively, from 2000–2021. Wavelet coherence analysis showed significant co-variation between GWS and precipitation in cycles ranging from 8 to 32 months, suggesting potential cyclic or intermittent influences. Furthermore, we detected strong persistence within the groundwater system using the Hurst exponent, indicating the substantial temporal memory impact. These findings are useful for developing effective groundwater management strategies in a changing climate.

Correlates of Age at Marriage and Birth Interval in Ethiopia: A Survival Analysis

Age at first marriage has a significant effect on birth interval. This study investigates the relationship between age at marriage to birth interval and its associated factors in Ethiopia. The objective of the study is to examine the estimated age at first marriage to first birth interval and its main associated factors by age at first marriage and place of residence in Ethiopia. Data from the Ethiopia Demographic Health Survey (EDHS) 2011 were used. The Cox proportional hazard model is used to determine the significant factors contributing towards age at marriage to first birth interval in Ethiopia. The findings from the Cox proportional hazard model indicate that age at first marriage, religion, region, educational level and work status are the most important significant covariates of ‘age at first marriage to first birth interval’ in Ethiopia. Age at first marriage of women and their socio-economic factors contribute to differences in first birth interval. On the contrary, in Muslim-dominated regions such as Somali, the time of transition to motherhood is early due to their religious belief.

Vesical Imaging-Reporting and Data System use predicting the outcome of neoadjuvant pembrolizumab in muscle-invasive bladder cancer.

To evaluate the predictive capability of the pre- and post-pembrolizumab Vesical Imaging-Reporting and Data System (VI-RADS) to identify ypT0N0 or ypT≤1N0 response in muscle-invasive bladder cancer (MIBC) within the PURE-01 trial (ClinicalTrials.gov identifier: NCT02736266). Patients were staged with bladder multiparametric magnetic resonance imaging (mpMRI) before and after treatment (three cycles of pembrolizumab) prior to radical cystectomy (RC). Logistic regression models were used to analyse the pre- and post- pembrolizumab VI-RADS against ypT≤1N0 and ypT0N0 response. The VI-RADS scores were dichotomised between 0 and 3 (0 = no evidence of disease) and 4-5. Event-free survival (EFS) and overall survival (OS) analyses were performed. Comprehensive genomic profiling and transcriptome-wide expression profiling data were matched with the VI-RADS scores. In total, 110 patients underwent centrally reviewed scans (N = 220 mpMRI), treated between February 2017 and July 2020. Both pre- and post-pembrolizumab VI-RADS 0-3 scores were the only significant covariates that predicted the ypT≤1N0 endpoint in multivariable analyses, and the strongest effect was seen with post-pembrolizumab VI-RADS 0-3 predicting the ypT≤1N0 response (P < 0.001). The area under the curve for this model was 0.90. Post-pembrolizumab VI-RADS 0-3 also predicted a longer EFS (P < 0.001) and OS (P = 0.044). The scores of several gene signatures from baseline tumours differed between the pre-pembrolizumab VI-RADS 0-3 and 4-5 categories. Post-pembrolizumab VI-RADS scores are strongly associated with pathological downstaging and survival. VI-RADS scores were also characterised by distinct biomarker features. These results indicate that the VI-RADS is emerging as an important tool for designing next-generation trials for MIBC.

Bringing technology to market: National Heart, Lung, and Blood Institute SBIR Phase IIB projects

Abstract The National Heart, Lung, and Blood Institute (NHLBI) is the fourth largest institute in the US National Institutes of Health (NIH). Surprisingly, there is a conspicuous void of policy studies related to the research activities of NHLBI in comparison to NIH or the National Cancer Institute. This paper investigates the likelihood that a business funded through NHLBI’s Small Business Innovation Research (SBIR) program will commercialize from its Phase IIB translational support. Commercialization is one performance metric that quantifies a policy dimension of the success of the funded SBIR project. Based on an empirical analysis of sixty-one Phase IIB projects, we find that the most significant covariate with the likelihood of commercialization is the growth in human capital within the business since the Phase IIB award.

Influence of environmental factors on the power produced by photovoltaic panels artificially weathered

Solar energy is an important renewable energy source and a great option to mitigate the greenhouse gases produced by fossil fuels in electricity production. The common way to use solar energy is through photovoltaic technology. This technology converts solar photons into electricity. However, power production by photovoltaic panels (PV) is strongly related to environmental, manufactured, and maintenance factors. The present work analyzed the exposure of PV panels to environmental conditions at different stages in their lifetime (new, five, ten, 15 years, and 20 years). For this purpose, the PV panel was subjected to a simulated weathering process. A Generalized Linear Model (GLM) approach was used to evaluate the influence of environmental conditions (meteorological and air pollution) on power production, which follows a Binomial Negative distribution due to the overdispersion. The proposed method was performed in the tropical Andean during the winter season and in the presence of the El Niño Southern Oscillation (ENSO). Generally, the specific humidity and temperature were the meteorological significant covariates, while the PM2.5 was the air pollution significant covariate. Higher power production efficiencies were obtained in the presence of precipitation and wind velocity as significant covariates. The model evaluation had adequate criteria values, NSE between 0.76 and 0.96, and correlation coefficient between 0.87 and 0.98 using a new and weathered 15-year PV panel, respectively.

Assessment of a diel phosphorus pattern's potential to benefit phosphorus retention in the stormwater treatment areas

The Stormwater Treatment Areas (STAs) are constructed wetlands used to reduce the total phosphorus (TP) level in water discharged to the environmentally sensitive areas of the Everglades Protection Area. Analysis of high temporal frequency TP data reveals that TP concentrations discharged from selected STA flow-ways exhibit diel and seasonal cyclic patterns and are most affected by discharge rate and water depth. The objective of this paper is to describe the diel TP pattern and evaluate the possibility of using it to reduce TP in STA discharge. The amplitude of diel TP pattern ranged from 0.7 to 1.5 μg L−1 (3–6% deviation from daily mean) at three flow-ways, peaking in the early afternoon and reaching lowest concentrations between midnight and 4 am. To assess the possibility of further reducing TP concentration discharged from the STAs by increasing the proportion of daily flow discharged at night when diel TP is at a minimum, a General Additive Model (GAM) was created with discharge rate, water depth, year, location, day-of-year, and time-of-day as covariates. While time-of-day was a statistically significant factor in the model (p < 0.001), its average marginal effect was smaller than all other significant model covariates: discharge rate, season, and water depth. Modeling suggests that within specific ranges of discharge rate and water depth, the opportunity exists to provide additional TP reduction in STA outflow by discharging a greater proportion of the daily flow at night when TP concentrations are lower. Further research is needed to quantify the effect of increasing nighttime flow on annual flow weighted mean TP. Additionally, an evaluation of the practicality and logistical cost required to redistribute flow is needed before attempting to take advantage of this natural cyclic pattern to improve STA TP retention.

B - 08 Differences in Memory Performance between Adjustment Disorder and ADHD among Children.

To measure the differences in cognitive performance between a sample of children diagnosed with adjustment disorder (ad) and ADHD. Participants were selected from a de-identified child outpatient clinical database. The ad group (n = 257; Mage = 8.75, SD =2.03; Med = 3.07, SD = 1.86) had 61.5% male, 47% White, 19.2% Black, 26.3% Hispanic, and 7.2% other race. The ADHD group (n = 149; Mage = 7.85, SD = 1.84; Med = 2.23, SD = 1.74) had 75.3% male, 54.1% White, 17.6% Black, 18.8% Hispanic, and 9.4% other race. Groups differed on age and education. ANCOVAs were used to test differences between groups controlling for significant covariates. At the group level, individuals with ad performed significantly better than those with ADHD on the WISC-IV working memory index [F(1, 127) = 8.10, p = 0.01], WRAML-2 verbal memory index [F(1, 163) = 11.81, p < 0.001], visual memory index [F(1, 161) = 4.48, p = 0.04], attention and concentration index [F(1, 153) = 13.27, p < 0.001], general memory index [F(1, 161) = 12.89, p < 0.001], screening memory index [F(1, 141) = 9.35, p = 0.003], and general recognition index [F(1, 152) = 8.57, p = 0.004]. Individuals with ADHD tend to have deficits in encoding and digesting information, which can create memory-retrieval difficulties. Meanwhile, individuals with ad may experience intrusive memories that gradually fade away and do not interfere with short- or long-term memory retrieval, and may partially explain their better performance in memory tasks. Limitations of the study include the lack of premorbid measures of memory ability and lack of information about comorbidity. Future research could explore the impact of different ADHD presentations on memory ability.

Mental Health of Older Adults by Sexual Minority Status: Evidence From the 2021 National Health Interview Survey.

This study explored differences among older adults in mental health by sexual minority status. Data came from the 2021 U.S. National Health Interview Survey. The study sample included older adults (or those aged ≥50years, N = 15,559), and of those, two percent (n = 380) self-identified as lesbian, gay, or bisexual (LGB). Older LGB adults had significantly higher odds of reporting a diagnosis of depression and anxiety and experiencing serious psychological distress than older non-LGB adults. Additionally, older LGB adults reported higher odds of experiencing depression and anxiety more frequently than older non-LGB adults. Significant covariates included age, sex, housing, food security, and social support. Increased risk for mental illness may be long-term consequences of stigma and discrimination that this population has experienced over the life course. The combination of structural interventions and affirming mental healthcare that recognizes the cumulative negative experience among older LGB adults is necessary to achieve mental health equity.

Dosing recommendation of nirmatrelvir/ritonavir using an integrated population pharmacokinetic analysis.

Protease inhibitor nirmatrelvir coadministered with ritonavir as a pharmacokinetic enhancer (PAXLOVID™; Pfizer Inc) became the first orally bioavailable antiviral agent granted Emergency Use Authorization in the United States in patients ≥12 years old with mild to moderate coronavirus disease 2019 (COVID-19). This population pharmacokinetic analysis used pooled plasma nirmatrelvir concentrations from eight completed phase I and II/III studies to characterize nirmatrelvir pharmacokinetics when coadministered with ritonavir in adults with/without COVID-19. Influence of covariates (e.g., formulation, dose, COVID-19) was examined using a stepwise forward selection (α = 0.05) and backward elimination (α = 0.001) approach. Simulations with 5000 subjects for each age and weight group and renal function category were performed to support dosing recommendations of nirmatrelvir/ritonavir for adults with COVID-19 and guide dose adjustments for specific patient populations (e.g., renal insufficiency, pediatrics). The final model was a two-compartment model with first-order absorption, including allometric scaling of body weight and dose-dependent absorption (power function on relative bioavailability). Nirmatrelvir clearance (CL) increased proportionally to body surface area-normalized creatinine CL (nCLCR) up to 70 ml/min/1.73 m2 and was independent of nCLCR above the breakpoint. Significant covariates included carbamazepine or itraconazole coadministration as markers for drug interactions, COVID-19 on CL, formulation on relative bioavailability, and age on central volume of distribution. Simulation results support current dosing recommendations of nirmatrelvir/ritonavir 300/100 mg twice daily (b.i.d.) in adults with normal renal function or mild impairment and pediatrics (12 to <18 years) weighing ≥40 kg and nirmatrelvir/ritonavir 150/100 mg b.i.d. in adults with moderate renal impairment.

Immediate Inferior Alveolar Nerve Reconstruction With Ablative Mandibular Resection Results in Functional Sensory Recovery

Ablative mandibular resection with sacrifice of the inferior alveolar nerve (IAN) results in loss of sensation and decreased quality of life. The purpose of this study is to evaluate functional sensory recovery (FSR) of immediate IAN allograft reconstruction performed during ablative mandibular resection at 1year following surgery. This is a single-center retrospective cohort study that included consecutive subjects who underwent mandibular resection with IAN discontinuity and used a nerve allograft of ≥40mm. The primary predictor variable is the use of an immediate nerve allograft in mandibular reconstruction. The main outcome variable is FSR at 1year using the Medical Research Council Scale. Covariates include subject age, sex, specific pathology, nerve gap length, and development of neuropathic pain. Statistical analysis of comparison of neurosensory outcomes was measured by bivariate statistics, weighted values, repeated measures, analysis of variance, and McNemar test. The study sample was composed of 164 subjects, of whom 55 (33.5%) underwent nerve allograft reconstruction and 30 (18.3%) did not have nerve reconstruction. Seventy-nine subjects (48.2%) did not meet the inclusion criteria. In the entire nerve allograft group of 55 subjects, FSR was achieved in 80% at 1year; however, in benign disease alone, 31 of 33 (94%) achieved FSR at 1year. In the nonallograft group (all benign disease), only 2 of 30 (7%) achieved FSR at 1year. The significant covariates were age and pathology. Benign pathologic resections were 5.2 times more likely to achieve FSR than malignancies, and all subjects ≤ 18years of age achieved FSR. After adjusting for age, sex, pathology, nerve gap length, nerve allograft was significantly associated with achieving FSR at 1year (adjusted odds ratio=5.52, 95% confidence interval= (1.03, 29.51), P value=.045<.05). Immediate long-span IAN allograft reconstruction is effective in restoration of sensation with an overall 80% of subjects achieving FSR at 1year, while benign disease resulted in 94% FSR at 1year. Immediate IAN reconstruction should be considered with mandibular resection involving the IAN, especially for children and benign disease.

Effectiveness of anthocyanin-rich foods on bone remodeling biomarkers of middle-aged and older adults at risk of osteoporosis: a systematic review, meta-analysis, and meta-regression.

Current osteoporosis pharmacological treatment has undesirable side effects. There is increasing focus on naturally derived food substances that contain phytonutrients with antioxidant effects in promoting health and regulating immune response. This review aims to systematically evaluate the effectiveness of anthocyanin-rich foods on bone remodeling biomarkers in middle-aged and older adults (≥40 y old) at risk of osteoporosis. Randomized controlled trials were searched on 8 bibliographic databases of PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Food Science and Technology Abstracts, Cochrane Library, and ProQuest. Thirteen studies were included in the meta-analysis. Receptor activator of nuclear factor kappa-B ligand (RANKL) is exhibited from osteoblastic cells that gathered osteoclasts to bone sites for bone resorption, accelerating bone loss. Anthocyanin-rich food consumption showed statistically nonsignificant effects, with no substantial heterogeneity on bone remodeling biomarkers. However, there was a significant increase in lumbar spine L1-L4 bone mineral density. Mild-to-small effects were seen to largely favor the consumption of anthocyanin-rich foods. Berries (d = -0.44) have a larger effect size of RANKL than plums (d = 0.18), with statistically significant subgroup differences. Random-effects meta-regression found body mass index, total attrition rate, total energy, and dietary carbohydrate and fat intake were significant covariates for the effect size of RANKL. All outcomes had low certainty of evidence. Anthocyanin-rich foods may improve bone health in middle-aged and older adults at risk of osteoporosis. This review contributes to the growing interest in nutrient-rich foods as a low-cost and modifiable alternative to promote human health and reduce disease burden. Future high-quality studies with larger sample sizes and longer treatment durations are required to fully understand the effect of anthocyanin-rich foods on bone health. PROSPERO registration no. CRD42022367136.

Population pharmacokinetic-pharmacodynamic modeling of clopidogrel for dose regimen optimization based on CYP2C19 phenotypes: A proof of concept study.

Clopidogrel is an antiplatelet drug used to reduce the risk of acute coronary syndrome and stroke. It is converted by CYP2C19 to its active metabolite; therefore, poor metabolizers (PMs) of CYP2C19 exhibit diminished antiplatelet effects. Herein, we conducted a proof-of-concept study for using population pharmacokinetic-pharmacodynamic (PK-PD) modeling to recommend a personalized clopidogrel dosing regimen for individuals with varying CYP2C19 phenotypes and baseline P2Y12 reaction unit (PRU) levels. Data from a prospective phase I clinical trial involving 36 healthy male participants were used to develop the population PK-PD model predicting the concentrations of clopidogrel, clopidogrel H4, and clopidogrel carboxylic acid, and linking clopidogrel H4 concentrations to changes in PRU levels. A two-compartment model effectively described the PKs of both clopidogrel and clopidogrel carboxylic acid, and a one-compartment model of those of clopidogrel H4. The CYP2C19 phenotype was identified as a significant covariate influencing the metabolic conversion of the parent drug to its metabolites. A PD submodel of clopidogrel H4 that stimulated the fractional turnover rate of PRU levels showed the best performance. Monte Carlo simulations suggested that PMs require three to four times higher doses than extensive metabolizers to reach the target PRU level. Individuals within the top 20th percentile of baseline PRU levels were shown to require 2.5-3 times higher doses than those in the bottom 20th percentile. We successfully developed a population PK-PD model for clopidogrel considering the impact of CYP2C19 phenotypes and baseline PRU levels. Further studies are necessary to confirm actual dosing recommendations for clopidogrel.

Significance of Radiomics in Predicting Local Control for Patients with Malignant Liver Tumors Treated Using Stereotactic Body Radiotherapy.

We routinely deliver Stereotactic Body Radiotherapy (SBRT) in malignant liver tumors using planning computed tomography (CT) and Magnetic Resonance Images (MRI) to aid target definition. In this study, we extracted radiomic features from the MR images to predict local control (LC) post-SBRT. We retrospectively analyzed patients with either hepatocellular cancers (HCCs) or liver metastases (Mets) treated with SBRT between Aug 2014 and Aug 2020. All patients had CT simulation followed by 1.5 Tesla planning MRI in treatment position. Contrast enhanced T1 VIBE and T2 Haste MR sequences were registered with planning CT for target definition. Radiomic features were extracted from Gross Tumor Volumes (GTV) masked out of 60 seconds post contrast T1 VIBE MR images using the Radiomics calculator tool RaCaT. The output included 480 (408 textural, 50 intensity and 22 morphological) features for each target. Principal Component Analysis of the outputs obtained from all the targets yielded 20 radiomic feature clusters after computational prioritization. These clusters were correlated to LC outcomes at various time points post-SBRT. LC was defined as non-progressive disease. Accuracy of predictions was measured by area under (AUC) receiver operating characteristic curve. Cox regression analysis was done to find univariate and multivariate clinical [HCCs vs. Mets, single vs. multiple lesions, previous local therapy (yes vs. no), GTV volume (≤40 vs. >40 cc)], radiomic and dosimetric predictors (continuous) of LC. In total, 97 patients received SBRT to 122 lesions. The median dose prescribed was 45 Gy (range, 30-50 Gy). Median age was 69 years (interquartile range, IQR 61-73 yrs.). 59 patients had HCCs and 38 had Mets. 24 lesions had prior ablative therapy. 75 patients had one target, and 22 had multiple targets. Median GTV was 43.5 cc (IQR 23.4-78.6 cc). Median follow up was 16.6 months (IQR 9.7-27.2 mths). Median LC was 13.6 months (IQR 8.0-23.5 mths). On univariate analysis, histology (HCCs vs. Mets; Hazard ratio (HR) 2.9, 95% CI 1.4-6.4; p < 0.006), radiomic clusters (p < 0.006) and the max., mean, and min. doses to GTV and Planning Target Volumes correlated with improved LC (all p-values < 0.05). On multivariate analysis, histology (HCCs vs. Mets; HR 4.4, 95% CI 1.6-12.3; p = 0.004), radiomic clusters (p = 0.034) and prescription dose (p = 0.048) were significant covariates. Specifically, the 20 radiomic clusters were predictive of LC, and the accuracy of predictions showed promise with AUC values of 0.74, 0.80, and 0.81 at 12, 24, and 36 months post-SBRT, respectively. AUC values for LC in HCCs vs. Mets at 12, 24, and 36 months were 0.83, 0.77, and 0.70, and 0.66, 0.77, and 0.88, respectively. MR-based radiomics predict LC post-SBRT in patients with malignant liver tumors. Further research focused on independent validation of the model is required to explore its clinical use.

The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes.

Total knee arthroplasty (TKA) procedures are expected to grow exponentially in the upcoming years, highlighting the importance of identifying preoperative risk factors that predispose patients to poor outcomes. The present study sought to determine if preoperative healthcare events (PHEs) influenced outcomes following TKA. This was a retrospective review of all patients who underwent TKA at a single institution from June 2011 to April 2022. Patients who had a PHE within 90 days of surgery, defined as an emergency department visit or hospital admission, were compared to patients with no history of PHE. Patients who underwent revision, nonelective, and/or bilateral TKA were excluded. Chi-squared analysis and independent sample t-tests were used to determine significant differences between demographic variables. All significant covariates were included in binary logistic regressions used to predict discharge disposition, 90-day readmission, and 1-year revision. Of the 10,869 patients who underwent TKA, 265 had ≥1 PHE. Patients who had a PHE were significantly more likely to require facility discharge (odds ratio [OR]: 1.662; P= .001) than patients who did not have a PHE. Any PHE predisposed patients to significantly higher 90-day readmission rates (OR: 2.173; P= .002). Patients with ≥2 PHEs were at a significantly higher risk of 1-year revision (OR: 5.870; P= .004) compared to patients without a PHE. Our results demonstrate that PHEs put patients at significantly greater risk of facility discharge, 90-day readmission, and 1-year revision. Moving forward, consideration of elective surgery scheduling in the context of a recent PHE may lead to improved postoperative outcomes. Retrospective Cohort Study.

GWAS Meta-Analysis of Suicide Attempt: Identification of 12 Genome-Wide Significant Loci and Implication of Genetic Risks for Specific Health Factors.

Suicidal behavior is heritable and is a major cause of death worldwide. Two large-scale genome-wide association studies (GWASs) recently discovered and cross-validated genome-wide significant (GWS) loci for suicide attempt (SA). The present study leveraged the genetic cohorts from both studies to conduct the largest GWAS meta-analysis of SA to date. Multi-ancestry and admixture-specific meta-analyses were conducted within groups of significant African, East Asian, and European ancestry admixtures. This study comprised 22 cohorts, including 43,871 SA cases and 915,025 ancestry-matched controls. Analytical methods across multi-ancestry and individual ancestry admixtures included inverse variance-weighted fixed-effects meta-analyses, followed by gene, gene-set, tissue-set, and drug-target enrichment, as well as summary-data-based Mendelian randomization with brain expression quantitative trait loci data, phenome-wide genetic correlation, and genetic causal proportion analyses. Multi-ancestry and European ancestry admixture GWAS meta-analyses identified 12 risk loci at p values <5×10-8. These loci were mostly intergenic and implicated DRD2, SLC6A9, FURIN, NLGN1, SOX5, PDE4B, and CACNG2. The multi-ancestry SNP-based heritability estimate of SA was 5.7% on the liability scale (SE=0.003, p=5.7×10-80). Significant brain tissue gene expression and drug set enrichment were observed. There was shared genetic variation of SA with attention deficit hyperactivity disorder, smoking, and risk tolerance after conditioning SA on both major depressive disorder and posttraumatic stress disorder. Genetic causal proportion analyses implicated shared genetic risk for specific health factors. This multi-ancestry analysis of suicide attempt identified several loci contributing to risk and establishes significant shared genetic covariation with clinical phenotypes. These findings provide insight into genetic factors associated with suicide attempt across ancestry admixture populations, in veteran and civilian populations, and in attempt versus death.

The Association of Nutrition and Exercise Behaviors of Women with Diabetes in Pregnancy with Infant Breastfeeding Practices.

Background: Although breastfeeding confers significant benefits to infants, women with diabetes in pregnancy experience unique nutrition and health challenges, which may influence infant feeding practice. This study aimed to determine the association between nutrition and exercise behaviors of women with diabetes in pregnancy and breastfeeding at birth and 6 months. Methods: A secondary data analysis of a longitudinal study on maternal pregestational diabetes mellitus (DM) and gestational diabetes (GDM) and infant development was conducted. Women self-reported engaging in nutrition behaviors, such as using meal plans, and exercise health behaviors. Primary outcomes were exclusive breastfeeding at birth and any breastfeeding at 6 months. Logistic regression models adjusted for significant maternal-infant covariates. Results: Of n = 48 women with diabetes in pregnancy, 94% had GDM and 6% had pregestational type 1 or type 2 DM. Forty percent of women exclusively breastfed at birth and 68% partially or exclusively breastfed at 6 months (of n = 34 with complete 6-month data). Women who cooked their own meals had two times greater adjusted odds of exclusive breastfeeding at birth (adjusted odds ratio [AOR] = 1.94, 95% confidence interval [CI] = 1.12-5.11), and women who exercised during pregnancy had seven times greater adjusted odds of any breastfeeding at 6 months (AOR = 7.2, 95% CI = 1.10-42.8). Conclusion: Nutrition and exercise behaviors were associated with exclusive breastfeeding at birth and any breastfeeding at 6 months. Health behaviors to effectively manage diabetes during pregnancy may inform efforts to improve breastfeeding initiation and duration, and future studies in a larger sample are needed.

Exploring Depression and Nutritional Covariates Amongst US Adults using Shapely Additive Explanations.

Depression affects personal and public well-being and identification of natural therapeutics such as nutrition is necessary to help alleviate this public health concern. The study aimed to identify feature importance in a machine learning model using solely nutrition covariates. A retrospective analysis was conducted using a modern, nationally representative cohort, the National Health and Nutrition Examination Surveys (NHANES 2017-2020). Depressive symptoms were evaluated using the validated 9-item Patient Health Questionnaire (PHQ-9), and all adult patients (total of 7929 individuals) who completed the PHQ-9 and total nutritional intake questionnaire were included in the study. Univariable regression was used to identify significant nutritional covariates to be included in a machine learning model and feature importance was reported. The acquisition and analysis of the data were authorized by the National Center for Health Statistics Ethics Review Board. 7929 patients met the inclusion criteria in this study. The machine learning model had 24 out of a total of 60 features that were found to be significant on univariate analysis (p < 0.01 used). In the XGBoost model the model had an Area Under the Receiver Operator Characteristic Curve (AUROC) = 0.603, Sensitivity = 0.943, Specificity = 0.163. The top four highest ranked features by gain, a measure of the percentage contribution of the covariate to the overall model prediction, were Potassium Intake (Gain = 6.8%), Vitamin E Intake (Gain = 5.7%), Number of Foods and Beverages Reported (Gain = 5.7%), and Vitamin K Intake (Gain 5.6%). Machine learning models with feature importance can be utilized to identify nutritional covariates for further study in patients with clinical symptoms of depression.

Reduced-Intensity Compared to Nonmyeloablative Conditioning in Patients with Non-Hodgkin Lymphoma Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Reduced-intensity conditioning (RIC) and nonmyeloablative (NMA) conditioning are preferred for patients with non-Hodgkin lymphoma (NHL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT). Although prior studies have suggested that higher-intensity regimens in RIC-NMA conditioning are associated with inferior outcomes in patients with NHL, the optimal conditioning regimen remains unknown. We performed a retrospective single-center analysis to determine outcomes of adult patients with B cell and T cell NHL who underwent allo-HCT and received either RIC or NMA conditioning between March 2008 and December 2019. RIC regimens included fludarabine-cyclophosphamide-thiotepa-4 Gy-total body irradiation (Flu-Cy-TT-4Gy-TBI), fludarabine-melphalan (Flu-Mel), fludarabine-cyclophosphamide-4 Gy-total body irradiation (Flu-Cy-4Gy-TBI), and fludarabine-busulfan-4 (Flu-Bu-4). The NMA regimen comprised fludarabine-cyclophosphamide-2 Gy-total body irradiation (Flu-Cy-2Gy-TBI). The primary outcome was overall survival (OS); secondary outcomes included progression-free survival (PFS), nonrelapse mortality (NRM), and the incidence of acute and chronic graft-versus-host-disease (GVHD). Of 279 transplants recipients (median age, 58 years), 110 received RIC (55% Flu-Mel, 38% Flu-Cy-TT-4Gy-TBI, 6% Flu-Bu-4, 1% Flu-Cy-4Gy-TBI) and 169 received NMA conditioning with Flu-Cy-2Gy-TBI. With a median of 64 months of follow-up post-allo-HCT, there was no significant difference in OS between the NMA and RIC groups (median, not reached [NR] versus 103 months; P=.1), and this was maintained on multivariable analysis. Similarly, after adjustment for all independently significant covariates (age, Karnofsky Performance Status [KPS], Hematopoietic Cell Transplantation Comorbidity Index [HCT-CI], and disease histology), the regression analysis showed no significant difference in PFS with RIC compared to NMA conditioning (hazard ratio [HR] 1.38; 95% confidence interval [CI], .92 to 2.09; P=.24). On univariable analysis, there was no significant difference in NRM between the RIC and NMA arms (100-day estimate, 10.0% versus 1.8%; P=.5). After adjustment for age, ethnicity, KPS, HCT-CI, GVHD prophylaxis, and donor source, RIC conditioning was associated with a significantly higher incidence of NRM compared to NMA conditioning (HR, 2.61; 95% CI, 1.04 to 6.52; P=.039). On multivariable analysis, compared with the NMA arm, the RIC arm had higher rates of grade II-IV (HR, 2.25; 95% CI, 1.31 to 3.86; P=.002) and grade III-IV acute GVHD (HR, 5.62; 95% CI, 2.03 to 15.6; P < .001). The findings of this study suggest that NMA conditioning with Flu-Cy-TBI-2Gy may be considered over more intensive RIC regimens for patients with NHL undergoing allo-HCT.

Relationship satisfaction, feelings of closeness and annoyance, and linkage in electrodermal activity.

Physiological linkage refers to moment-to-moment, time-linked coordination in physiological responses among people in close relationships. Although people in romantic relationships have been shown to evidence linkage in their physiological responses over time, it is still unclear how patterns of covariation relate to in-the-moment, as well as general levels of, relationship functioning. In the present study with data collected between 2014 and 2017, we capture linkage in electrodermal activity (EDA) in a diverse sample of young-adult couples, generally representative and generalizable to the Los Angeles community from which we sampled. We test how naturally occurring, shifting feelings of closeness with and annoyance toward one's partner relate to concurrent changes in levels of physiological linkage over the course of 1 day. Additionally, we examine how linkage relates to overall relationship satisfaction. Results showed that couples evidenced significant covariation in their levels of physiological arousal in daily life. Further, physiological linkage increased during hours that participants felt close to their romantic partners but not during hours that participants felt annoyed with their partners. Finally, those participants with overall higher levels of relationship satisfaction showed lower levels of linkage over the day of data collection. These findings highlight how individuals respond in sync with their romantic partners and how this process ebbs and flows in conjunction with the shifting emotional tone of their relationships. The discussion focuses on how linkage might enhance closeness or, alternatively, contribute to conflict escalation and the potential of linkage processes to promote positive interpersonal relationships. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring the efficacy of metabarcoding and non-target screening for detecting treated wastewater

Wastewater treatment processes can eliminate many pollutants, yet remainder pollutants contain organic compounds and microorganisms released into ecosystems. These remainder pollutants have the potential to adversely impact downstream ecosystem processes, but their presence is currently not being monitored. This study was set out with the aim of investigating the effectiveness and sensitivity of non-target screening of chemical compounds, 18S V9 rRNA gene, and full-length 16S rRNA gene metabarcoding techniques for detecting treated wastewater in receiving waters. We aimed at assessing the impact of introducing 33 % treated wastewater into a triplicated large-scale mesocosm setup during a 10-day exposure period. Discharge of treated wastewater significantly altered the chemical signature as well as the microeukaryotic and prokaryotic diversity of the mesocosms. Non-target screening, 18S V9 rRNA gene, and full-length 16S rRNA gene metabarcoding detected these changes with significant covariation of the detected pattern between methods.The 18S V9 rRNA gene metabarcoding exhibited superior sensitivity immediately following the introduction of treated wastewater and remained one of the top-performing methods throughout the study. Full-length 16S rRNA gene metabarcoding demonstrated sensitivity only in the initial hour, but became insignificant thereafter. The non-target screening approach was effective throughout the experiment and in contrast to the metabarcoding methods the signal to noise ratio remained similar during the experiment resulting in an increasing relative strength of this method. Based on our findings, we conclude that all methods employed for monitoring environmental disturbances from various sources are suitable. The distinguishing factor of these methods is their ability to detect unknown pollutants and organisms, which sets them apart from previously utilized approaches and allows for a more comprehensive perspective. Given their diverse strengths, particularly in terms of temporal resolution, these methods are best suited as complementary approaches.