There is an emerging need in clinical research to accurately predict patients' disease status and disease progression by optimally integrating multivariate clinical information. Clinical data are often collected over time for multiple biomarkers of different types (e.g. continuous, binary and counts). In this paper, we present a flexible and dynamic (time-dependent) discriminant analysis approach in which multiple biomarkers of various types are jointly modelled for classification purposes by the multivariate generalized linear mixed model. We propose a mixture of normal distributions for the random effects to allow additional flexibility when modelling the complex correlation between longitudinal biomarkers and to robustify the model and the classification procedure against misspecification of the random effects distribution. These longitudinal models are subsequently used in a multivariate time-dependent discriminant scheme to predict, at any time point, the probability of belonging to a particular risk group. The methodology is illustrated using clinical data from patients with epilepsy, where the aim is to identify patients who will not achieve remission of seizures within a five-year follow-up period.

• Keywords
• Discriminant analysis, mixture distributions, multivariate generalized linear mixed model, multivariate longitudinal data, random effects,
• MeSH
• Algorithms MeSH
• Biomarkers * MeSH
• Discriminant Analysis * MeSH
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Adolescent MeSH
• Young Adult MeSH
• Child, Preschool MeSH
• Disease Progression * MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Child, Preschool MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Biomarkers * MeSH

OBJECTIVE: To examine whether changes in memory over a 10-year period could predict a change in C-reactive protein (CRP) levels. METHOD: A mixed model analysis was first conducted to obtain the estimates for change in memory over the 10-year period using data from the Health and Retirement Study. Then a multivariate regression to determine whether a change in episodic memory could predict subsequent CRP levels was conducted. Furthermore, a general linear model was conducted to determine differences in CRP levels among different rates of change in episodic memory. RESULTS: Greater declines in episodic memory were associated with higher levels of subsequent CRP (Estimate = -0.32, SE = 0.12, β = -.03, p = .008). The general linear model revealed that those with greater memory declines were more likely to have higher levels of CRP, F = 26.50, p < .001. DISCUSSION: These results highlight the notion that memory decline and inflammation may be intertwined, and we discuss various avenues that warrant further investigation.

• Keywords
• biomarkers, cognitive function, cognitive status,
• MeSH
• Biomarkers analysis   MeSH
• C-Reactive Protein analysis   MeSH
• Memory, Episodic MeSH
• Cognition MeSH
• Humans MeSH
• Memory Disorders * blood   diagnosis   MeSH
• Predictive Value of Tests MeSH
• Aged MeSH
• Inflammation * blood   psychology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Biomarkers MeSH
• C-Reactive Protein MeSH

Climbing, a sport with increasing popularity, poses diverse risks and injury patterns across its various disciplines. This study evaluates the incidence and nature of climbing-related injuries, focusing on how different disciplines and climbers' personal characteristics affect these injuries. Data on injury incidence, severity, and consequences, as well as climbers' personal attributes, were collected through a questionnaire and analyzed using generalized linear models and generalized linear mixed models, Cochran-Armitage tests, and multivariate analysis. Our findings indicate a direct correlation between time spent on bouldering and lead climbing and increased injury frequency, while injury incidence decreases with time in traditional climbing. Interestingly, personal characteristics showed no significant impact on injury incidence or severity. However, distinct patterns emerged in individual disciplines regarding the recent injuries in which age and weight of climbers play a role. While the phase of occurrence and duration of consequences show no significant variation across disciplines, the intensity of the required treatment and causes of injury differ. This research provides insights into climbing injuries' complex nature, highlighting the need for tailored preventive strategies across climbing disciplines. It underscores the necessity for further investigation into the factors contributing to climbing injuries, advocating for more targeted injury prevention and safety measures in this evolving sport.

• Keywords
• bouldering, climbing phase, indoor climbing, injury severity, risk factors, rock climbing, sport injuries,
• Publication type
• Journal Article MeSH

RATIONALE & OBJECTIVE: Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017. PREDICTOR: Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. OUTCOME: Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. ANALYTICAL APPROACH: Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. RESULTS: During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P<0.001). LIMITATIONS: Clinical rather than population-based data. CONCLUSIONS: CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices.

• Keywords
• Pediatric dialysis, access dysfunction, access infection, access revision, adolescents, arteriovenous fistula (AVF), arteriovenous graft (AVG), central venous catheter (CVC), children, end-stage renal disease (ESRD), long-term hemodialysis, registry data, vascular access,
• MeSH
• Arteriovenous Shunt, Surgical * adverse effects   MeSH
• Blood Vessel Prosthesis * adverse effects   MeSH
• Renal Dialysis adverse effects   methods   MeSH
• Child MeSH
• Internationality MeSH
• Catheterization, Central Venous * adverse effects   MeSH
• Clinical Decision-Making MeSH
• Humans MeSH
• Adolescent MeSH
• Prospective Studies MeSH
• Registries MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH

The effects of hormonal contraception in non-human primates have been studied predominantly in relation to reproductive physiology. To date, no study has investigated how hormonal contraception affects vocal patterns in non-human primates. As part of our long-term research into the vocal behavior of southern yellow-cheeked gibbons (Nomascus gabriellae) in zoos, we have managed to obtain vocal datasets from four adult contracepted (Nexplanon® and Depo-Provera®) females of this species. In addition, we also recorded coda vocalizations (i.e., male calls added after the completion of the great call) from three paired males who are partners of three of the four females studied. We quantified 11 acoustic features in the female great calls and five acoustic features in the male coda vocalizations, for which we applied a Principal Component Analysis (PCA) and subsequently components were tested using multivariate Generalized Linear Mixed Models (GLMM). Our study revealed that hormonal contraception did indeed affect the vocal structure of great call in southern yellow-cheeked gibbon females. In contrast, our study did not reveal any flexible adjustment of the structure of the coda vocalization in direct response to changes in the females' song. In female great call, we found that the Group 1 call component and Group 2 call component were not affected by the hormonal contraceptive (Depo-Provera®) in the during-application period. However, it was noteworthy that once the effects of contraception had worn off (post-application period), the values of components did not return to pre-application periods but continued to change. Conversely, although the values of the Group 1 call component and Group 2 call component were most greatly affected by the contraceptive Nexplanon® (during-application period). The values of both components tended to return to pre-treatment levels once the effects had waned. There was a change in the values of the Group 3 call component only after application of the contraceptive Nexplanon®. These values remained significantly higher than the values at the pre-application level once the effects waned. This study provides the first evidence of changes in the stable vocal patterns of female southern yellow-cheeked gibbons as a consequence of the application of hormonal contraception.

• Keywords
• Nomascus, breeding programs, gibbon, vocalization, zoo,
• Publication type
• Journal Article MeSH