Maternal exposure to smoking and wheezing phenotypes in children: a cohort study of the Japan Environment and Children's Study.

BACKGROUND: Previous studies have shown that prenatal maternal smoking and maternal secondhand smoke exposure during pregnancy were associated with an increased risk of wheezing and asthma development. However, few studies have examined the influence of different sources of tobacco exposure in different perinatal timeframes (preconception, prenatal, and postnatal) on wheezing phenotypes in children. Using national survey data from Japan, we investigated the effects of exposure to tobacco smoke during pregnancy on wheezing phenotypes in children before the age of 3 years. METHODS: Pregnant women who lived in the 15 regional centers in the Japan Environment and Children's Study were recruited. We obtained information on prenatal and postnatal exposure to active and secondhand smoke (SHS) and wheeze development up to 3 years of age. Multiple logistic regression analysis was performed to determine the association between tobacco smoke exposure and wheezing phenotypes in children. RESULTS: We analyzed 73,057 singleton births and identified four longitudinal wheezing phenotypes: never wheezing; early transient wheezing (wheezing by age 1 year but not thereafter); late-onset wheezing (wheezing by age 2-3 years but not beforehand); and persistent wheezing. Maternal smoking during pregnancy was significantly associated with early transient and persistent wheezing in children compared with no maternal smoking [early transient wheezing: 1-10 cigarettes per day, adjusted odds ratio (aOR) 1.43, 95% confidence interval (CI) 1.23-1.66; ≥ 11 cigarettes per day, aOR 1.67, 95% CI 1.27-2.20; persistent wheezing: 1-10 cigarettes per day, aOR 1.64, 95% CI 1.37-1.97; ≥ 11 cigarettes per day, aOR 2.32, 95% CI 1.70-3.19]. Smoking cessation even before pregnancy was also significantly associated with increased risk of early transient wheezing, late-onset wheezing, and persistent wheezing in children. Moreover, maternal exposure to SHS during pregnancy was significantly associated with increased risk of early transient and persistent wheezing compared with no such exposure. CONCLUSIONS: Maternal smoking before and throughout pregnancy was associated with wheeze development in children up to 3 years of age. It appears that smoking is detrimental compared to never smoking, regardless of whether individuals quit smoking before or after becoming aware of the pregnancy.

Life's Essential 8 Trajectories and Risk of Stroke: A Prospective Cohort Study.

BACKGROUND: Evidence is lacking regarding long-term patterns of change in Life's Essential 8 (LE8) and their association with the risk of stroke. We aim to evaluate LE8 trajectories and examine their association with the risk of stroke in China. METHODS: This study, conducted in a workplace setting, recruited 26 719 participants (average age, 46.02±11.27 years and a male population of 73.73%) who had no history of stroke and consecutively participated in 6 surveys from 2006 to 2016. Repeated LE8 measurements were determined by taking the unweighted average of the 8 component scores ranging from 0 to 100. People with higher scores had better overall cardiovascular health. By examining the medical records of the participants, stroke cases were identified for the period from 2016 to 2020. A latent mixture model was applied to classify the trajectory clusters of LE8 from 2006 to 2016, and Cox proportional hazard models were used to analyze the data. RESULTS: Five LE8 trajectories were detected between 2006 and 2016. Four hundred ninety-eight incident strokes including 55 (11.04%) hemorrhagic and 458 (91.97%) ischemic strokes were documented. After adjusting for covariates, the hazard ratios and 95% CIs for the association between stable-low, moderate-increasing, moderate-stable, and high-stable trajectories and incident stroke, compared with the moderate-decreasing trajectory, were 1.42 (1.11-1.84), 0.73 (0.56-0.96), 0.49 (0.39-0.62), and 0.19 (0.11-0.32), respectively. Individuals with high LE8 status (LE8≥80) exhibited a significantly reduced risk of stroke compared with those with low one (LE8≤49; P-trend <0.001). A faster annual growth in LE8 was related to a lower risk of stroke. CONCLUSIONS: Maintaining high LE8 over an extended period and high baseline LE8 status were related to a decreased risk of stroke. Despite the initial low level of LE8, improvement in LE8 attenuates or even reverses the risk of stroke.

Developmental Trajectories of Transactional Sex and Age-Disparate Relationships During Adolescence: An HPTN 068 Analysis.

Transactional sex and sexual relationships with older partners increase HIV risk in adolescent girls and young women (AGYW), yet little is known about how these behaviors co-evolve over time. We characterize temporal patterns of transactional sex and age-disparate relationships among AGYW in South Africa. Longitudinal data are from a randomized controlled trial (HPTN 068) of school-aged, HIV-negative, AGYW who attended ≥ 3 study visits. We used group-based trajectory modeling to identify trajectories of transactional sex and age-disparate relationships (partner ≥ 5 years older) in the last year and assessed the interrelationship (conditional probability) between both trajectories. At baseline, median age was 14 years, 14.5% of girls were sexually active, and transactional sex (2.1%) and age-disparate relationships were uncommon (2.7%). We identified two trajectories for transactional sex ("low" [81.9%] and "increasing" [18.1%]) and two for age-disparate relationships ("low" [91.7%] and "increasing" [8.3%]). In a separate joint trajectory analysis, nearly a third (28%) had increasing trajectories for both transactional sex and age-disparate relationships, but most (53%) had a low trajectory of both outcomes. Baseline reporting of early sexual debut, depression, and inequitable gender norms were highest in the increasing transactional sex group. Prior pregnancy, early sexual debut, and IPV were highest among those with increasing age-disparate relationships. AGYW who engage in transactional sex or age-disparate partnerships in early adolescence are more likely to experience sustained engagement in both behaviors as they transition to adulthood, increasing HIV risk. Engaging girls early may maximize effectiveness of behavioral and biomedical HIV prevention efforts.

Military service and sociodemographic determinants of depressive symptom trajectories.

Little is known about preservice depressive symptoms, their linkages to subsequent depressive symptoms, and the role of sociodemographic factors in shaping depressive symptoms of those who serve in the military. Using data from the National Longitudinal Study of Adolescent to Adult Health (n = 18,910), we modeled depressive symptom trajectories from baseline (Mage = 15.67) through midlife and compared differences in depressive symptoms between participants who did and did not enter military service. Those who served in the military went on to develop lower levels of depressive symptoms than civilians during their prime military service years, even after accounting for sociodemographic factors that shape pathways into military service. Differences in depressive symptoms by military affiliation were no longer significant by their mid-30s. Results provided a more complete account of depressive symptom patterns associated with military service by including data on individuals before and during military service.

Body composition trajectories during childhood predict skeletal maturation at puberty: A longitudinal study.

Nutritional status significantly impacts linear bone growth. We aimed to determine the relationship between the trajectories of four body composition indicators and pubertal advanced bone age. Trajectories of body mass index z-score (BMI z-score), visceral fat area z-score (VFA z-score), fat mass index z-score (FMI z-score), and fat-free mass index z-score (FFMI z-score) were identified based on three body composition measurements conducted from October 2018 to April 2023 within a pediatric cohort (the PROC study). We assessed pubertal bone age using the Tanner-Whitehouse 3-Chinese Radius-Ulna-Short (TW3-C RUS) method among 1402 primary school children. Children with a trajectory of higher BMI z-score, VFA z-score, FMI z-score, and FFMI z-score since childhood were more likely to have advanced bone age. The risk of advanced bone age was higher in children who were consistently in the high VFA z-score group (odds ratio [OR] = 6.73) or consistently in the high BMI z-score group (OR = 5.57), as compared to those in the low VFA z-score and low BMI z-score groups. Regular monitoring and maintenance of normal VFA during childhood may reduce the risk of advanced bone age at puberty. Furthermore, BMI monitoring is optional, especially in cases where specialized body composition equipment is not available.

Suicide Risk among Chinese Left-Behind Adolescents: Developmental Trajectories and Multi-Contextual Predictors.

Suicide is prevalent among left-behind youth, a group that has yet to be thoroughly explored in terms of the developmental dynamics of their suicide risk and associated factors. This study adopted a person-centered approach to investigate the developmental trajectories of suicide risk among Chinese left-behind adolescents, along with multi-dimensional predictors. A total of 774 left-behind adolescents (Mage = 13.60, 50.1% female) completed three surveys over a year, with six-month intervals. Result of Latent Class Growth Modeling identified three subgroups with distinct developmental trajectories: High Risk-Escalating (7.6% of participants started at the highest levels with a worsening trend), Risk-Holding (21.6% maintained a stable but risk level starting above the critical threshold), and Low Risk-Diminishing (70.8% started low and continued to decrease). Gender (being a female), increased levels of childhood maltreatment, psychological pain, and depression were risk factors for High Risk-Escalating and/or Risk-Holding trajectories, while increased sense of control and regulatory emotional self-efficacy played protective roles. The findings underscore the malignant developmental patterns of suicide risk among left-behind adolescents. The predictive factors play a crucial role in distinguishing and improving these developmental trajectories.

The correlation between frailty trajectories and adverse outcomes in older patients: A systematic review.

INTRODUCTION: Frailty is a geriatric syndrome that is highly susceptible to adverse health outcomes and is a major burden that exacerbates society's medical care. By investigating the frailty trajectory within the older demographic and initially recognizing its clinical outcomes, we will have more tactics to manage the at-risk population. METHODS: We executed a systematic review of trajectory studies elucidating the connection between frailty and adverse outcomes among older individuals (≥ 65 years) and explored articles published in English and Chinese from the inception of the database until Jun 30, 2024, in PubMed, Web of Science, Embase, The Cochrane Library, CINAHL, Scopus, CNKI, China Online Journals, VIP Information, and SinoMed. RESULTS: The database survey unearthed 3522 articles, of which 21 were deemed eligible. The majority incorporated distinct assessment tools and statistical methodologies to classify frailty trajectories into three groups. Although these frailty trajectories produced inconsistent clinical outcomes, they did reveal trends in the frailty status of older adults. CONCLUSION: The link between frailty trajectories and adverse outcome is a multifaceted and complex process that is currently understudied. More comprehensive and in-depth longitudinal studies should be conducted to explore the mechanism of interaction between the two to obstruct the progression of the frailty trajectory and bolster support for interventions.

Re-analyzing and confirming a differential use of redintegration in students with mild and borderline intellectual disabilities.

While numerous studies on verbal working memory have investigated the capacity of the phonological loop and the effectiveness of rehearsal as one core process for maintaining the memory trace, the reconstruction of the memory trace from long-term memory, called redintegration, has been studied less thoroughly. This holds particularly for the population of students with special educational learning needs and mild and borderline intellectual disabilities (MBID). In a previous study, we found a differential developmental relation between the effectiveness of redintegration and vocabulary size, counter-intuitively suggesting that students with MBID tend to show less effective redintegration with higher vocabulary size. However, differential item functioning (DIF) in the picture naming task may have biased the result. Therefore, the current study is a re-analysis of this interaction controlling for DIF in the vocabulary measure. To this end, the items of the picture naming task (k = 95) were analyzed through a Rasch model, and k = 29 biased items were excluded. The resulting corrected vocabulary score was used to predict the redintegration effectiveness, comparing students with and without MBID. The interaction remains significant, supporting the original finding that students with MBID have a differential developmental pattern and are less able to make adequate use of a growing vocabulary when reconstructing traces in their working memory. Implications of this result for the understanding of MBID and further research directions are discussed.

Bone Accrual Trajectories in Children and Adolescents with Perinatal HIV Infection.

CONTEXT: Low bone mineral density (BMD) has been reported in children and adolescents living with perinatally-acquired HIV (PHIV). Little is known about their bone accrual through puberty compared to an uninfected healthy cohort. OBJECTIVE: To compare bone accrual in PHIV and healthy children. DESIGN: PHIV children aged 7-16 years had dual energy X-ray absorptiometry (DXA) at entry, 2 years, and then at least 2 years later. Bone accrual was compared to healthy children from the Bone Mineral Density in Childhood Study (BMDCS). SETTING: United States academic clinical research centers. PATIENTS: 172 PHIV; 1321 BMDCS. ANALYSIS: We calculated height-adjusted whole-body and spine BMD and bone mineral content (BMC) Z-scores in PHIV using BMDCS reference curves. We fit piecewise weighted linear mixed effects models with change points at 11 and 15 years, adjusted for age, sex, race, height Z-score, and Tanner stage, to compare BMD and BMC Z-scores across actual age by cohort.Main Outcome Measure: BMD/BMC Z-scores. RESULTS: Height-adjusted whole-body BMD and BMC Z-scores in PHIV were lower across age compared to BMDCS children. Spine BMD Z-score across age was higher in PHIV after height adjustment. Whole-body and spine bone area tended to be lower in PHIV. PHIV had slower accrual in whole-body and spine bone area before 14 years. After 15 years, bone area accruals were similar, as were height-adjusted spine BMC Z-scores, across age. CONCLUSIONS: PHIV had persistent deficits in all measures except height-adjusted spine BMD and BMC Z-scores. Data are needed on PHIV followed to adulthood.

Differential Association of Preadolescent Risk Factors Across Developmental Patterns of Adolescent Concurrent Gambling Participation and Substance Use.

Early risk factors for gambling participation (GP) and substance use (SU) in adolescents have usually been studied separately, although these disorders were integrated into the same clinical category over a decade ago. This exploratory study aimed to investigate the early individual, parental, familial and social risk factors associated with developmental patterns of adolescent GP and SU in a population-representative cohort (N = 1594, 51.2% boys). Using a person-centered strategy and multiple assessments from age 12 to 17, six developmental patterns describing joint GP and SU courses were revealed. Non-substance users/non-gamblers served as the reference class in an integrated longitudinal-multivariate analysis framework examining 15 distinct risk factors. Results showed that a core of risk factors were common to all trajectory-classes of substance users with or without GP. For a similar level of SU, most of the risk factors associated with non-gambling users also affected their gambling peers. However, additional risk factors were specifically related to GP. Thus, substance users who also gamble were affected by a greater number of risk factors than non-gambling substance users. Findings are consistent with a developmental syndrome of addiction, which posits a shared etiology between different expressions of addiction as well as differences in risk factors that lead to distinct trajectories of addictive behaviors. They highlight the importance of considering both GP and SU for a comprehensive assessment of adolescents' level of risk with regard to addictive behaviors.

Dietary pattern trajectories in early childhood and their associations with patterns of maternal feeding practices in a multi-ethnic Asian cohort.

BACKGROUND: Maternal feeding practices play a major role in children's dietary intakes. However, there is limited data on the associations between trajectories of dietary patterns (DPs) and patterns of maternal feeding practices during early childhood. METHODS: Using data from a multi-ethnic Asian cohort study, namely the Growing Up in Singapore Towards healthy Outcomes (GUSTO), dietary intakes were measured using Food Frequency Questionnaires in children at 18 months, 5 and 7 years of age. Maternal feeding practices were assessed using validated questionnaires at 15 months, 3 and 5 years of age. Principal component analysis was used to derive 2 major DPs at all time-points as well as patterns of maternal feeding practices. Group-based trajectory modelling was used to identify trajectory groups for the derived DPs. Multivariable logistic regression examined associations between patterns of maternal feeding practices and DP trajectory groups. RESULTS: Two DPs, namely the 'healthy' and 'less healthy' were consistently derived at 18 months, 5 and 7 years of age. From each DP, 2 stable DP trajectory groups were further identified between 18 months and 7 years of age. For the 'healthy' DP trajectory, majority of the children (Group 1) formed a consistent average adherence trajectory group (91.8%) while the remaining children (Group 2) showed a higher but decreasing adherence (8.2%) to this DP. For the 'less healthy' DP trajectory, most children (Group 1) formed a consistent average adherence trajectory (95.5%), while the remainder (Group 2) showed consistent higher adherence to this 'less healthy' DP (4.5%). Two patterns of maternal feeding practices were derived and labelled as 'structured with autonomy support' and 'coercive control', respectively, at ages 15 months, 3 and 5 years. Children whose mothers showed high adherence to the structured with autonomy support feeding practices at age 5 years were significantly more likely to be associated with the higher but decreasing 'healthy' DP trajectory group [OR = 3.62 (95% CI: 1.64, 7.99)]. CONCLUSIONS: A small number of children in this multi-ethnic study showed high adherence to the 'healthy' or 'less healthy' DP trajectory groups, respectively, while the majority showed average adherence to either of these trajectories. The positive association between structured with autonomy support maternal feeding practices and higher z-scores for the healthy DP trajectory highlights the importance of guiding parents on appropriate feeding practices.

Trajectories of cognitive function development and predictive factors in disabled middle-aged and older adults.

Objective: To explore the trajectories of cognitive function development and predictive factors in disabled middle-aged and older adults. Methods: Utilizing data from 983 disabled middle-aged and older adults in the China Health and Retirement Longitudinal Study (CHARLS) from 2013 to 2020, latent growth mixture models were constructed to analyze the categories of cognitive function development trajectories and their predictive factors. Results: The cognitive function trajectories of the disabled middle-aged and older adults were classified into three categories: rapid decline (32.6%), Slow decline (36.1%), and Stable (31.2%). Multinomial logistic regression analysis identified age, gender, residence, education, marital status, household income, sleep duration, depression, hearing ability, and social participation as predictors of these trajectories. Conclusion: There is heterogeneity in the cognitive function development trajectories among disabled middle-aged and older adults. Healthcare professionals can implement targeted health management based on the characteristics of different groups to prevent the deterioration of cognitive function in this population.

Ethnic differences in the prevalence of amyloid positivity and cognitive trajectories.

INTRODUCTION: We investigated the prevalence of amyloid beta (Aß) positivity (+) and cognitive trajectories in Koreans and non-Hispanic Whites (NHWs). METHODS: We included 5121 Koreans from multiple centers across South Korea and 929 NHWs from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Participants underwent Aß positron emission tomography and were categorized into cognitively unimpaired (CU), mild cognitive impairment (MCI), and dementia stages. Age, sex, education, and apolipoprotein E. genotype were adjusted using multivariable logistic regression and stabilized inverse probability of treatment weights based on the propensity scores to mitigate imbalances in these variables. RESULTS: The prevalence of Aß+ was lower in CU Koreans than in CU NHWs (adjusted odds ratio 0.60). Aß+ Koreans showed a faster cognitive decline than Aß+ NHWs in the CU (B = -0.314, p = .004) and MCI stages (B = -0.385, p < .001). DISCUSSION: Ethnic characteristics of Aß biomarkers should be considered in research and clinical application of Aß-targeted therapies in diverse populations. HIGHLIGHTS: Koreans have a lower prevalence of Aß positivity compared to NHWs in the CU stage. The effects of Alzheimer's risk factors on Aß positivity differ between Koreans and NHWs. Aß-positive (Aß+) Koreans show faster cognitive decline than Aß+ NHWs in the CU and MCI stages.

Air pollutant exposure is associated with visual trajectories and visual impairment in children.

Air pollution is associated with vision loss in children, but the relationship with vision trajectories has not been explored. The study was conducted as a prospective cohort in 16 districts of Shanghai from 2021 to 2023, involving 5612 children with complete survey data. Each child underwent 3-4 eye tests, including unaided visual acuity and computerized refraction. Children's air pollutant exposure levels (PM2.5, PM10, O3, SO2, NO2, and CO) were assessed using school addresses and examination dates. Latent class mixture modeling was used to identify the trajectories of changes in vision-related measurements in children. Multinomial logistic regression and Cox proportional hazards regression were used to examine the association of air pollutant exposure and visual trajectories, as well as visual impairment outcomes. The study identified three trajectory categories for children's unaided visual acuity, spherical equivalent, and four trajectory categories for axial length. Increased levels of PM2.5, PM10, O3, and SO2 exposure are associated with an increased risk of categorizing vision-related measurements into the "poor" category trajectory in children. Increased exposure to PM2.5, O3, and NO2 was associated with an increased risk of visual impairment outcomes in children with normal vision at baseline, and the effect was more significant in female and older children.

Trajectories of hookah use among young adult college students in Texas, 2014-2019.

The purpose of the study was to examine trajectories in hookah use behaviors across young adulthood and socio-demographic correlates of the trajectories. Data were drawn from Project M-PACT for the years 2014-2019. Participants were 5,220 college students aged 18 to 25 years at baseline. Growth curve models with an accelerated design were fit to examine four hookah use trajectories across ages 18 to 30, adjusted for covariates. Prevalence of current hookah use decreased between 2014 and 2019, from 17% to 7% and the frequency of use decreased by almost one day a month. Trajectories of hookah use alone and concurrent with cigarettes or with e-cigarettes also decreased as students increased in age. Current hookah users were likely to be young, male, racial/ethnic minority, and attending a four-year college. Observed disparities among hookah users have implications, in particular regarding the role of social context, race, and ethnicity, in tailoring smoking interventions.

Multiscale spatio-temporal dynamics of UBE3A gene in brain physiology and neurodevelopmental disorders.

The UBE3A gene, located in the chromosomal region 15q11-13, is subject to neuron-specific genomic imprinting and it plays a critical role in brain development. Genetic defects of UBE3A cause severe neurodevelopmental disorders, namely the Angelman syndrome (AS) and the 15q11.2-q13.3 duplication syndrome (Dup15q). In the last two decades, the development of in vitro and in vivo models of AS and Dup15q were fundamental to improve the understanding of UBE3A function in the brain. However, the pathogenic mechanisms of these diseases remain elusive and effective treatments are lacking. Recent evidence suggests that UBE3A functions are both spatially and temporally specific, varying across subcellular compartments, brain regions, and neuronal circuits. In the present review, we summarize current knowledge on the role of UBE3A in neuronal pathophysiology under this spatio-temporal perspective. Additionally, we propose key research questions that will be instrumental to better understand the pathogenic mechanisms underpinning AS and Dup15q disorders and provide the rationale to develop novel therapies.

Commercial milk formula marketing entry points: setting the course of infant and young child feeding trajectories.

BACKGROUND: There is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF. METHODS: Women of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels. RESULTS: Hospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding. CONCLUSIONS: The cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford.

Early emotion regulation developmental trajectories and ADHD, internalizing, and conduct problems symptoms in childhood.

Emotion dysregulation is considered a transdiagnostic factor with importance for a range of neurodevelopmental and mental health issues, including attention deficit hyperactivity disorder (ADHD) symptoms, internalizing problems, and conduct problems. Emotion regulation skills are acquired from early in life and are thought to strengthen gradually over childhood. Children, however, acquire these skills at different rates and slower acquisition may serve as a marker for neurodevelopmental and mental health issues. The current study uses the UK Millennium Cohort Study, a large longitudinal study to evaluate whether developmental trajectories of emotion regulation across ages 3, 5, and 7 predict levels of ADHD symptoms, internalizing problems, and conduct problems at age 7. Both higher initial levels of and slower reductions in emotion dysregulation across ages 3, 5, and 7 predicted higher ADHD symptoms, conduct problems, and internalizing problems at age 7 in both male and female children. Our findings suggest that monitoring trajectories of emotion regulation over development could help flag at-risk children. Additionally, supporting the acquisition of emotion regulation skills in this critical period could be a promising transdiagnostic preventive intervention.

Latent trajectories of cerebral perfusion pressure and risk prediction models among patients with traumatic brain injury: based on an interpretable artificial neural network.

OBJECTIVE: This study aimed to characterize long-term cerebral perfusion pressure (CPP) trajectory in traumatic brain injury (TBI) patients and construct an interpretable prediction model to assess the risk of unfavorable CPP evolution patterns. METHODS: TBI patients with CPP records were identified from the Medical Information Mart for the Intensive Care (MIMIC)-IV 2.1, eICU Collaborative Research Database (eICU-CRD) 2.0 and HiRID dataset 1.1.1. The research process consisted of two stages. First, group-based trajectory modeling (GBTM) was used to identify different CPP trajectories. Second, different ANN algorithms were employed to predict the trajectories of CPP. RESULTS: A total of 331 eligible patients' records from MIMIC-IV 2.1 and eICU-CRD 2.0 were used for trajectory analysis and model development. Additionally, 310 patients' data from HiRID were used for external validation. The GBTM identified 5 CPP trajectory groups, group 1 and group 5 were merged into class 1 based on unfavorable in-hospital mortality. The best 6 predictors were invasive systolic blood pressure coefficient of variation (ISBPCV), venous blood chloride ion concentration, PaCO2, PT (Prothrombin Time), CPP coefficient of variation (CPPCV), and mean CPP. Compared with other algorithms, Scaled Conjugate Gradient (SCG) performed relatively better in identifying class 1. CONCLUSION: This study identified 2 CPP trajectory groups associated with elevated risk and 3 with reduced risk. PaCO2 might be a strong predictor for the unfavorable CPP class. The ANN model achieved the primary goal of risk stratification, which is conducive to early intervention and individualized treatment.

Modelling patient trajectories in emergency department simulations using retrospective patient cohorts.

Computer simulations of emergency departments (EDs) are tools that can support managing and optimising ED operations. A core component of ED simulation models is patient trajectories, defined as the series of activities patients undergo in the ED from arrival to discharge. The combined duration of these activities, and waiting times between them, determines a patient's length of stay (LOS). Patient trajectories are often calibrated and validated solely based on the estimated acuity of patients assigned upon arrival. However, acuity is a prospective patient indicator that inconsistently reflects patients' actual urgency and resource usage as seen retrospectively upon discharge. Here, we propose a data-driven ED simulation model in which patient trajectories are modelled based on both acuity and retrospective patient indicators. We show that including retrospective patient indicators recovers the observed LOS distributions more accurately than when using acuity alone. We also demonstrate how the use of retrospective patient indicators leads to more plausible estimates of the impact of increased stress in the ED on patients' LOS. Our work exemplifies how we can better utilise ED data to make the development and evaluation of ED simulation models more accurate and robust, enabling them to provide more reliable and useful operational insights.