The effects of a quality improvement project to reduce caesarean sections in selected private hospitals in Brazil.

BACKGROUND: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called "Adequate Childbirth Project (PPA)" was conceived to reduce CS in the private sector. This project consisted of four primary components: "Governance", "Participation of Women", "Reorganization of Care" and "Monitoring". This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery. METHODS: A sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1-4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA. RESULTS: The probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was "Reorganization of Care", leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations. CONCLUSION: PPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals.

INTRODUCTION: Brazil boasts one of the highest rates of caesarean sections (CS) globally, with nearly 90% of births in private facilities being delivered via CS. In response, the 'Adequate Childbirth Project ­ PPA' was launched as a quality improvement initiative aimed at curbing CS rates in private healthcare. Its goal is to improve the quality of childbirth and reduce the number of CS in private healthcare. The project has four main parts: 'Governance', 'Participation of Women', 'Reorganization of Care', and 'Monitoring'. METHOD: an evaluative study was conducted across 12 private hospitals involved in the PPA, involving 2473 women who were categorized into PPA participants and non-participants. They used a method called a cause-effect network to see which parts of the PPA helped more women have vaginal deliveries. RESULTS: They found that women in the PPA were 37.7% more likely to have a vaginal delivery. Giving women access to good practices during labor and birth was really important. Also, 'Reorganization of Care' was the most important part of the project. It led to a 73% chance of vaginal delivery for women in labor. CONCLUSION: The PPA is effective in helping more women in private hospitals have vaginal deliveries. This means it's a good program for improving childbirth in Brazil's private hospitals.

Bayesian analysis of psychological capital in peruvian university students: Differences by sex and age.

Psychological capital (PsyCap) constitutes a positive personal resource that enhances better well-being and academic performance in university students. Initially addressed in the organizational realm and recently in the academic one. This study aimed to establish the differences in PsyCap according to gender and age in Peruvian university students. A quantitative, comparative, non-experimental, and cross-sectional study was conducted with 708 students (77.4 % women and 22.6 % men), aged between 18 and 61 years (M = 22.1; SD = 5.95), selected in a non-probabilistic manner, who completed the Psychological Capital Questionnaire (PCQ-12). The results indicate very strong evidence supporting the existence of significant differences between different age groups, suggesting that the observed variations are not due to chance but reflect real differences between ages. Regarding gender, the data do not provide enough information to confidently assert whether there are significant differences between men and women in relation to psychological capital (PsyCap) and its dimensions. This implies that we cannot confirm whether gender influences these variables. These findings highlight the need to consider age when assessing and intervening in PsyCap in university students.

Bayesian Modeling and Estimation of Spatial Risk for Hospitalization and Mortality from Ischemic Heart Disease in Paraná, Brazil.

Objective: Despite significant advancements in understanding risk factors and treatment strategies, ischemic heart disease (IHD) remains the leading cause of mortality worldwide, particularly within specific regions in Brazil, where the disease is a burden. Therefore, the aim of this study was to estimate the risk of hospitalization and mortality from IHD in the state of Paraná (Brazil), using spatial analysis to identify areas with higher risk based on socioeconomic, demographic and health variables. Methods: This is an ecological study based on secondary and retrospective IHD hospitalization and mortality data obtained from the Brazilian Hospitalization and Mortality Information Systems during the 2010-2021 period. Data were analyzed for 399 municipalities and 22 health regions in the state of Paraná. To assess the spatial patterns of the disease and identify relative risk (RR) areas, we constructed a risk model by Bayesian inference using the R-INLA and SpatialEpi packages in R software. Results: A total of 333,229 hospitalizations and 73,221 deaths occurred in the analyzed period, and elevated RR of hospitalization (RR = 27.412, CI 21.801; 34.466) and mortality (RR = 15.673, CI 2.148; 114.319) from IHD occurred in small-sized municipalities. In addition, medium-sized municipalities also presented elevated RR of hospitalization (RR = 6.533, CI 1.748; 2.006) and mortality (RR = 6.092, CI 1.451; 2.163) from IHD. Hospitalization and mortality rates were higher in white men aged 40-59 years. A negative association was found between Municipal Performance Index (IPDM) and IHD hospitalization and mortality. Conclusion: Areas with increased risk of hospitalization and mortality from IHD were found in small and medium-sized municipalities in the state of Paraná, Brazil. These results suggest a deficit in health care attention for IHD cases in these areas, potentially due to a low distribution of health care resources.

A hierarchical Bayesian analysis for bivariate Weibull distribution under left-censoring scheme.

This paper presents a novel approach for analyzing bivariate positive data, taking into account a covariate vector and left-censored observations, by introducing a hierarchical Bayesian analysis. The proposed method assumes marginal Weibull distributions and employs either a usual Weibull likelihood or Weibull-Tobit likelihood approaches. A latent variable or frailty is included in the model to capture the possible correlation between the bivariate responses for the same sampling unit. The posterior summaries of interest are obtained through Markov Chain Monte Carlo methods. To demonstrate the effectiveness of the proposed methodology, we apply it to a bivariate data set from stellar astronomy that includes left-censored observations and covariates. Our results indicate that the new bivariate model approach, which incorporates the latent factor to capture the potential dependence between the two responses of interest, produces accurate inference results. We also compare the two models using the different likelihood approaches (Weibull or Weibull-Tobit likelihoods) in the application. Overall, our findings suggest that the proposed hierarchical Bayesian analysis is a promising approach for analyzing bivariate positive data with left-censored observations and covariate information.

An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals.

BACKGROUND: Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. METHOD: Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA-"Participation of women" and "Reorganization of care" - among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". RESULTS: PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 - 0.32) and "Participation of Women" (0.21 - 0.34). The combined implementation score was 0.39-0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. CONCLUSION: The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.

Conductas de salud en estudiantes universitarios: un análisis bayesiano / Health behaviors in college students: a Bayesian analysis / Comportamentos de saúde em estudantes universitários: uma análise bayesiana

En la actualidad, diversos estudios han explorado las diferencias de las conductas de salud en los estudiantes universitarios de acuerdo con características como edad, sexo y ciclo de estudio, no obstante, estos se han centrado en un enfoque frecuentista basado en la prueba de significancia de la hipótesis nula (NHST). Objetivo. Explorar las diferencias de las conductas de salud de acuerdo con el sexo, edad y ciclo académico, así como establecer la relación entre estas y la percepción de salud general en estudiantes universitarios peruanos, desde un enfoque bayesiano. Materiales y métodos. Se ejecutó un estudio cuantitativo, comparativo, correlacional y transversal, en una muestra de 708 universitarios seleccionados de manera intencional. Se utilizó el cuestionario de conductas de salud (CEJUV-R) y una ficha de datos sociodemográficos. Resultados. Los hallazgos muestran que los hombres tienen mejores hábitos de actividad y condición física y organización del sueño, con respecto a las mujeres. Asimismo, se observa una evidencia moderada a favor de la hipótesis alternativa del autocuidado en función de la edad y el ciclo académico. Finalmente, la actividad física, la organización del descanso, el autocuidado y la organización del sueño presentan evidencias muy fuertes (BF>100) de su relación con la percepción general de salud. Conclusión. El análisis bayesiano mostró evidencia a favor de la hipótesis alterna en algunas de las conductas de salud en función del sexo, edad y ciclo académico, lo que resaltan la importancia de promover conductas más saludables entre los estudiantes universitarios peruanos atendiendo a sus características personales.

Currently, several studies have explored the differences in health behaviors in university students according to characteristics such as age, sex and study cycle; however, these have focused on a frequentist approach based on the null hypothesis significance test (NHST). Objective. To explore the differences in health behaviors according to sex, age and academic cycle, as well as to establish the relationship between these and the perception of general health in Peruvian university students, from a Bayesian approach. Materials and methods. A quantitative, comparative, correlational and cross-sectional study was carried out in a sample of 708 intentionally selected university students. The health behaviors questionnaire (CEJUV-R) and a sociodemographic data sheet were used. Results. The findings show that men have better habits of activity and physical condition and sleep organization, with respect to women. Likewise, there is moderate evidence in favor of the alternative hypothesis of self-care as a function of age and academic cycle. Finally, physical activity, rest organization, self-care and sleep organization present very strong evidence (BF>100) of their relationship with the general perception of health. Conclusion. The Bayesian analysis showed evidence in favor of the alternative hypothesis in some of the health behaviors as a function of sex, age and academic cycle, which highlights the importance of promoting healthier behaviors among Peruvian university students according to their personal characteristics.

Atualmente, vários estudos exploraram as diferenças nos comportamentos de saúde em estudantes universitários de acordo com características como idade, gênero e ciclo de estudos; no entanto, eles se concentraram em uma abordagem frequentista baseada no teste de significância da hipótese nula (NHST). Objetivo. Explorar as diferenças nos comportamentos de saúde de acordo com o sexo, a idade e o ciclo acadêmico, bem como estabelecer a relação entre eles e a percepção da saúde geral em estudantes universitários peruanos, a partir de uma abordagem bayesiana. Materiais e métodos. Foi realizado um estudo quantitativo, comparativo, correlacional e transversal em uma amostra de 708 estudantes universitários selecionados intencionalmente. Foram utilizados o questionário de comportamento de saúde (CEJUV-R) e uma planilha de dados sociodemográficos. Resultados. Os achados mostram que os homens têm melhores hábitos de atividade física, condicionamento físico e organização do sono do que as mulheres. Também há evidências moderadas a favor da hipótese alternativa de autocuidado em função da idade e do ciclo acadêmico. Por fim, a atividade física, a organização do descanso, o autocuidado e a organização do sono mostram evidências muito fortes (BF>100) de sua relação com a percepção geral da saúde. Conclusão. A análise bayesiana mostrou evidências a favor da hipótese alternativa em alguns dos comportamentos de saúde em função do sexo, da idade e do ciclo acadêmico, destacando a importância de promover comportamentos mais saudáveis entre os estudantes universitários peruanos de acordo com suas características pessoais.

Emergence and dissemination of equine-like G3P[8] rotavirus A in Brazil between 2015 and 2021.

Rotavirus A (RVA) is a major cause of acute gastroenteritis globally that is classically genotyped by its two immunodominant outer capsid proteins, VP7 (G-) and VP4 (P-). Recent evidence suggests that the reassortant equine-like G3P[8] strain played a substantial role in RVA transmission in Brazil since 2015. To understand its global emergence and dissemination in Brazilian territory, stool samples collected from 11 Brazilian states (n = 919) were genotyped by RT-qPCR and proceeded to sequence the VP7 gene (n = 102, 79 being newly generated) of the G3P[8] samples with pronounced viral loads. Our phylogenetic genotyping showed that G3P[8] became the dominant strain in Brazil between 2017 and 2020, with equine-like variants representing 75%-100% of VP7 samples in this period. A Bayesian discrete phylogeographic analysis strongly suggests that the equine-like G3P[8] strain originated in Asia during the early 2010s and subsequently spread to Europe, the Caribbean, and South America. Multiple introductions were detected in Brazil between 2014 and 2017, resulting in five national clusters. The reconstruction of the effective population size of the largest Brazilian cluster showed an expansion until 2017, followed by a plateau phase until 2019 and subsequent contraction. Our study also supports that most mutations fixed during equine-like G3P[8] evolution were synonymous, suggesting that adaptive evolution was not an important driving force during viral dissemination in humans, potentially increasing its susceptibility to acquired immunity. This research emphasizes the need for comprehensive rotavirus genomic surveillance that allows close monitoring of its ever-shifting composition and informs more effective public health policies.IMPORTANCEOur original article demonstrated the origin and spread in a short time of equine-like G3P[8] in Brazil and the world. Due to its segmented genome, it allows numerous mechanisms including genetic drift and reassortment contribute substantially to the genetic diversity of rotavirus. Although the effectiveness and increasing implementation of vaccination have not been questioned, a matter of concern is its impact on the emergence of escape mutants or even the spread of unusual strains of zoonotic transmission that could drive epidemic patterns worldwide. This research emphasizes the need for comprehensive rotavirus genomic surveillance, which could facilitate the formulation of public policies aimed at preventing and mitigating its transmission.

Chronic disease prevalence in a population with structural hemoglobin disorders undergoing diabetes diagnosis: A bayesian approach.

Background: Structural disorders of hemoglobin are a group of rare and fatal genetic diseases that disrupt the transport and exchange of oxygen in the blood, causing tissue damage and ultimately leading to chronic conditions. The hemoglobin (Hb) S variant predominantly impacts individuals of Afro-descendant heritage. A significant concentration of the Afro-descendant population in Colombia, notably 12.5 %, is found in the city of Cali. Previous research has identified this city's structural hemoglobin disorders prevalence rate of 3.78 %. The aim of this study was to determine the prevalence of HbC, HbS, HbF, and HbA2 variants within a population who underwent HbA1c testing, as well as the prevalence of chronic diseases among patients with these hemoglobin alterations, at a high-complexity hospital in the city of Cali from 2015 to 2019. Methods: A descriptive observational study was conducted, involving a study population that comprised patients with both suspected and monitored diagnoses of diabetes. The cohort was selected from a high-complexity hospital in Cali. A total of 15,608 patients were included in the analysis, all of whom underwent HbA1C measurement through capillary electrophoresis, which also offers an indirect diagnosis of certain structural disorders of hemoglobin. Bayesian methods were employed for frequency analysis. Results: Among the 15,608 patients assessed, 63.6 % (n = 9920) were women. The overall prevalence of structural hemoglobin disorders was 1.98 % (n = 287, 95 % CI = 1.77 %-2.21 %). The co-occurrence of diabetes and kidney disease emerged as the most prevalent combination of pathologies observed in individuals with HbC, for both men and women across various age groups: 18-42 (58.3 % and 50.0 % respectively), 43-55 (50.0 % for both), 56-65 (50.0 % and 37.5 % respectively), and >65 years (66.7 % and 57.1 % respectively). Conclusions: The observed prevalence of the studied variants exceeded 1 %, a threshold underscored by the World Health Organization (WHO) as epidemiologically significant. Among HbC and HbS-positive patients, the elevated prevalence of diabetes and kidney disease is a guiding factor in developing proactive prevention strategies.

Unraveling the socio-environmental drivers during the early COVID-19 pandemic in China.

The effect of environmental and socioeconomic conditions on the global pandemic of COVID-19 had been widely studied, yet their influence during the early outbreak remains less explored. Unraveling these relationships represents a key knowledge to prevent potential outbreaks of similar pathogens in the future. This study aims to determine the influence of socioeconomic, infrastructure, air pollution, and weather variables on the relative risk of infection in the initial phase of the COVID-19 pandemic in China. A spatio-temporal Bayesian zero-inflated Poisson model is used to test for the effect of 13 socioeconomic, urban infrastructure, air pollution, and weather variables on the relative risk of COVID-19 disease in 122 cities of China. The results show that socioeconomic and urban infrastructure variables did not have a significant effect on the relative risk of COVID-19. Meanwhile, COVID-19 relative risk was negatively associated with temperature, wind speed, and carbon monoxide, while nitrous dioxide and the human modification index presented a positive effect. Pollution gases presented a marked variability during the study period, showing a decrease of CO. These findings suggest that controlling and monitoring urban emissions of pollutant gases is a key factor for the reduction of risk derived from COVID-19.

Molecular phylogeny of Psychodopygina (Diptera, Psychodidae) supporting morphological systematics of this group of vectors of New World tegumentary leishmaniasis.

New World sandflies are vectors of leishmaniasis, bartonellosis, and some arboviruses. A classification based on 88 morphological characters was proposed 27 years ago when the New World phlebotomines were organized into two tribes Hertigiini and Phlebotomini. The latter was structured into four subtribes (Brumptomyiina, Sergentomyiina, Lutzomyiina, and Psychodopygina) and 20 genera. The subtribe Psychodopygina, including most of the American vectors of tegumentary Leishmania comprises seven genera from which no molecular work has been produced to support this classification. Here, we carried out a molecular phylogeny based on combined sequences (1,334 bp) of two genes: partial 28S rDNA and mtDNA cytochrome b from 47 taxa belonging to the Psychodopygina. The Bayesian phylogenetic reconstruction agreed with the classification based on morphological characters, supporting the monophyly of the genera Psychodopygus and Psathyromyia, whereas Nyssomyia and Trichophoromyia seemed to be paraphyletic. The paraphylies of the two latter groups were exclusively caused by the doubtful position of the species Ny. richardwardi. Our molecular analysis provides additional support to adopt the morphologic classification of Psychodopygina.

Title: La phylogénie moléculaire des Psychodopygina (Diptera, Psychodidae) soutient la systématique morphologique de ce groupe de vecteurs de leishmaniose cutanée du Nouveau Monde. Abstract: Les phlébotomes du nouveau monde sont des vecteurs de leishmaniose, de bartonellose et de certains arbovirus. Une classification basée sur 88 caractères morphologiques a été proposée il y a 27 ans lorsque les phlébotomes du nouveau monde ont été organisés en deux tribus Hertigiini et Phlebotomini. Cette dernière était structurée en quatre sous-tribus (Brumptomyiina, Sergentomyiina, Lutzomyiina et Psychodopygina) et 20 genres. La sous-tribu des Psychodopygina, qui inclut la plupart des vecteurs américains de la leishmaniose cutanée, comprend sept genres mais aucun travail moléculaire n'a été produit pour soutenir cette classification. Dans cet article, nous avons réalisé une phylogénie moléculaire basée sur des séquences combinées (1334 pb) de deux gènes : ADNr 28S partiel et cytochrome b (ADNmt) chez 47 taxons appartenant aux Psychodopygina. La reconstruction phylogénique bayésienne est en accord avec la classification basée sur les caractères morphologiques, soutenant la monophylie des genres Psychodopygus et Psathyromyia, alors que Nyssomyia et Trichophoromyia semblent être paraphylétiques. Les paraphylies des deux derniers groupes sont exclusivement causées par la position douteuse de la seule espèce Ny. richardwardi. Notre analyse moléculaire fournit une raison supplémentaire pour adopter la classification morphologique des Psychodopygina.

"Does a Respiratory Virus Have an Ecological Niche, and If So, Can It Be Mapped?" Yes and Yes.

Although the utility of Ecological Niche Models (ENM) and Species Distribution Models (SDM) has been demonstrated in many ecological applications, their suitability for modelling epidemics or pandemics, such as SARS-Cov-2, has been questioned. In this paper, contrary to this viewpoint, we show that ENMs and SDMs can be created that can describe the evolution of pandemics, both in space and time. As an illustrative use case, we create models for predicting confirmed cases of COVID-19, viewed as our target "species", in Mexico through 2020 and 2021, showing that the models are predictive in both space and time. In order to achieve this, we extend a recently developed Bayesian framework for niche modelling, to include: (i) dynamic, non-equilibrium "species" distributions; (ii) a wider set of habitat variables, including behavioural, socio-economic and socio-demographic variables, as well as standard climatic variables; (iii) distinct models and associated niches for different species characteristics, showing how the niche, as deduced through presence-absence data, can differ from that deduced from abundance data. We show that the niche associated with those places with the highest abundance of cases has been highly conserved throughout the pandemic, while the inferred niche associated with presence of cases has been changing. Finally, we show how causal chains can be inferred and confounding identified by showing that behavioural and social factors are much more predictive than climate and that, further, the latter is confounded by the former.

Modeling spatial pattern of anemia and malnutrition co-occurrence among under-five children in Ethiopia: A Bayesian geostatistical approach.

Anemia and malnutrition among under-five children are some of the challenges to public health in Ethiopia. This study aims to determine the socio-economic, demographic, and geographical risk factors that increase the prevalence of the co-occurrence of anemia and malnutrition among under-five children in Ethiopia. The Ethiopia Demographic and Health Survey data for the survey years 2011 and 2016 were used. A Bayesian hierarchical mixed model with a stochastic partial differential equation was adopted to understand the spatial patterns of co-occurrence of these ailments in Ethiopia. The significant risk factors are gender, maternal education, birth order, preceding births, contraceptive use, vaccination, marital status, distance to a health facility, and birth weight. Findings revealed more vulnerability among children less than twenty months and existing geographical disparity with a higher burden of the prevalence of the co-occurrences of anemia and malnutrition in the North-East regions. For cost-effective intervention, policies and programs that improve individual-level risk factors of parents are a more promising approach to tackle these ailments in high-prevalent regions than the ones on the children and should be of utmost priority in the North-East region of the country.

Assessing the relative performance of fast molecular dating methods for phylogenomic data.

Advances in genome sequencing techniques produced a significant growth of phylogenomic datasets. This massive amount of data represents a computational challenge for molecular dating with Bayesian approaches. Rapid molecular dating methods have been proposed over the last few decades to overcome these issues. However, a comparative evaluation of their relative performance on empirical data sets is lacking. We analyzed 23 empirical phylogenomic datasets to investigate the performance of two commonly employed fast dating methodologies: penalized likelihood (PL), implemented in treePL, and the relative rate framework (RRF), implemented in RelTime. They were compared to Bayesian analyses using the closest possible substitution models and calibration settings. We found that RRF was computationally faster and generally provided node age estimates statistically equivalent to Bayesian divergence times. PL time estimates consistently exhibited low levels of uncertainty. Overall, to approximate Bayesian approaches, RelTime is an efficient method with significantly lower computational demand, being more than 100 times faster than treePL. Thus, to alleviate the computational burden of Bayesian divergence time inference in the era of massive genomic data, molecular dating can be facilitated using the RRF, allowing evolutionary hypotheses to be tested more quickly and efficiently.

Development and Validation of a Novel Waist Girth-Based Equation to Estimate Fat Mass in Young Colombian Elite Athletes (F20CA Equation): A STROSA-Based Study.

The estimation of body fat percentage (%BF) from anthropometry-related data requires population-specific equations to avoid incorrect interpretations in young athletes. Waist girth (WG) has been described as potential predictor of fat mass (FM) in several populations; however, there are no valid WG-based equations to estimate body composition in young Colombian athletes. The aim of this STandardisierte BerichtsROutine für Sekundärdaten Analysen STROSA-based study was twofold: i) to validate the relative fat mass (RFM) and its pediatric version (RFMp) compared to dual-energy x-ray absorptiometry (DXA) and ii) to develop a new equation (F20CA) to estimate the fat mass in Colombian children and adolescent elite athletes. A total of 114 young athletes that belong to the 'Team Medellín' program (58F, 56M; 51 children, 63 adolescents; 14.85 [2.38] years; 55.09 [12.16] kg; 162.38 [11.53] cm) participated in this cross-sectional study. The statistical analysis revealed a poor correlation, agreement and concordance of RFMp and RFM estimations with DXA measurements. After model specification using both Ordinary Least Square method and Bayesian analysis, the regression output revealed that sex, body mass-to-waist ratio, and waist-to-stature ratio were the statistically significant predictor variables that account for variability in FM. The new F20CA equation is expressed as FM (kg) = 5.46 ∗ (Sex) + 0.21 ∗ (BM/W [kg/m]) + 81.7 ∗ (W/Stature [cm/cm]) - 41.8 (R2 = 0.683; SEE = 2.468 kg), where sex is 0 for males and 1 for females. A moderate-to-high correlation and agreement of the F20CA was confirmed within the internal validation data set (R2 = 0.689; ICC [95%CI] = 0.805 [0.615, 0.904]; RMSE = 2.613 kg). The Bland-Altman analysis corroborated the high concordance between the reference method (DXA) and the F20CA-estimated FM (bias [95% LoA] = 1.02 [-3.77, 5.81] kg), indicating the two methods could be considered interchangeable. Even though external validation is needed, practitioners are advised to use the F20CA in young Colombian athletes with similar characteristics to those who participated in this study.

Partial Least Squares Enhances Genomic Prediction of New Environments.

In plant breeding, the need to improve the prediction of future seasons or new locations and/or environments, also denoted as "leave one environment out," is of paramount importance to increase the genetic gain in breeding programs and contribute to food and nutrition security worldwide. Genomic selection (GS) has the potential to increase the accuracy of future seasons or new locations because it is a predictive methodology. However, most statistical machine learning methods used for the task of predicting a new environment or season struggle to produce moderate or high prediction accuracies. For this reason, in this study we explore the use of the partial least squares (PLS) regression methodology for this specific task, and we benchmark its performance with the Bayesian Genomic Best Linear Unbiased Predictor (GBLUP) method. The benchmarking process was done with 14 real datasets. We found that in all datasets the PLS method outperformed the popular GBLUP method by margins between 0% (in the Indica data) and 228.28% (in the Disease data) across traits, environments, and types of predictors. Our results show great empirical evidence of the power of the PLS methodology for the prediction of future seasons or new environments.

Phylogeography of Rotavirus G8P[8] Detected in Argentina: Evidence of Transpacific Dissemination.

Rotavirus is one of the leading causes of diarrhea in children. In 2018, G8P[8], an unusual association of genotypes, was detected with moderate frequency in symptomatic children in Argen-tina, unlike a previous sporadic identification in 2016. The aim of this study was to analyze the dissemination pattern of the G8P[8]-lineage IV strains detected in Argentina. Nucleotide sequences of the VP7 gene of Argentine G8P[8] strains (2016, 2018 and 2019) were studied by discrete phylodynamic analyses, together with other worldwide relevant G8-lineage IV strains. Bayes Factor (BF) was used to assess the strength of the epidemiological association between countries. Phylodynamic analyses determined an evolutionary rate of 3.7 × 10-3 (HDP95%: 1.4 × 10-3-8.2 × 10-3) substitutions/site/year. Likewise, the most recent common ancestor was 32.2 years old, dating back to 1986 (HDP95% = 1984-1988). The spatiotemporal dynamics analysis revealed South Korea as being the country of origin of the Argentine strains (posterior probability of the ancestral state: 0.8471), which was also evidenced by a significant rate of diffusion from South Korea to Argentina (BF: 55.1). The detection of G8 in South America in 2016-2017 was not related to the cases detected in 2018-2019, revealing a new G8 introduction to the region and supporting a transpacific dissemination.

Seroprevalence of pathogenic Leptospira spp. in domestic dogs from southern Chile and risk factors associated with different environments.

Leptospirosis is a neglected and severe zoonotic bacterial disease that affects canine populations worldwide, and it is present in animals from different settings, such as urban and rural environments. Therefore, a cross-sectional study was conducted on owned domestic dogs from urban and rural origins in southern Chile. The study aimed: 1) to estimate the true prevalence of pathogenic Leptospira in dogs from urban and rural environments in southern Chile, 2) to determine the serovars circulating in an endemic area of Chile, 3) to assess potential risk factors associated with seropositivity in dogs from urban and rural environments. Blood samples from 706 canines were collected, and the serum was tested with Micro-Agglutination-Test (MAT), using a panel of 13 serovars. A Bayesian approach was applied to estimate True prevalence (TP). In addition, dog owners answered a questionnaire that had prompts regarding dog characteristics and potential risk factors. The effect of these factors on the risk of being infected was analysed using a logistic regression model. The TP for urban dogs was 9.4% and 9.1% for rural animals. However, seroprevalence was higher in dogs with different individual, lifestyle, and habitat characteristics regarding their origin. For example, in urban animals, those living in places with rodents roaming near houses and dogs with rodent hunting habits had decreased risk for the seropositivity in MAT. On the other hand, in rural dogs, those of a recognized breed, with contact with cattle and sheep, living with more than one cat at home and living in places close to natural water sources have more risk to seropositivity in MAT. The presence of anti-Leptospira antibodies is widespread in pet dogs in urban and rural environments in southern Chile, and individual, lifestyle and habitat characteristics of the animals, according to the origin, are associated with the seropositivity in MAT. Therefore, the adoption of preventive measures is urgent, in addition to increase the awareness either in public health institutions, practitioners and companion animals' owners, considering the zoonotic potential of Leptospira infection and the close contact between people and their pets.

Assessment of diagnostic capacity and decision-making based on the 2015 American Thyroid Association ultrasound classification system.

BACKGROUND: This study evaluates the American Thyroid Association (ATA) ultrasound (US) classification system for the initial assessment of thyroid nodules to determine if it indeed facilitates clinical decision-making. AIM: To perform a systematic review and meta-analysis of the diagnostic value of the ATA US classification system for the initial assessment of thyroid nodules. METHODS: In accordance with the PRISMA statement for diagnostic test accuracy, we selected articles that evaluated the 2015 ATA US pattern guidelines using a diagnostic gold standard. We analyzed these cases using traditional diagnostic parameters, as well as the threshold approach to clinical decision-making and decision curve analysis. RESULTS: We reviewed 13 articles with 8445 thyroid nodules, which were classified according to 2015 ATA patterns. Of these, 46.62% were malignant. No cancer was found in any of the ATA benign pattern nodules. The Bayesian analysis post-test probability for cancer in each classification was: (1) Very-low suspicion, 0.85%; (2) Low, 2.6%; (3) Intermediate, 6.7%; and (4) High, 40.9%. The net benefit (NB), expressed as avoided interventions, indicated that the highest capacity to avoid unnecessary fine needle aspiration biopsy (FNAB) in the patterns that we studied was 42, 31, 35, and 43 of every 100 FNABs. The NB calculation for a probability threshold of 11% for each of the ATA suspicion patterns studied is less than that of performing FNAB on all nodules. CONCLUSION: These three types of analysis have shown that only the ATA high-suspicion diagnostic pattern is clinically useful, in which case, FNAB should be performed. However, the curve decision analysis has demonstrated that using the ATA US risk patterns to decide which patients need FNAB does not provide a greater benefit than performing FNAB on all thyroid nodules. Therefore, it is likely that a better way to approach the assessment of thyroid nodules would be to perform FNAB on all non-cystic nodules, as the present analysis has shown the ATA risk patterns do not provide an adequate clinical decision-making framework.

Effectiveness of a health technician-delivered brief intervention for alcohol: a Bayesian reanalysis of a clinical trial.

OBJECTIVE: To reanalyze a clinical trial on the effectiveness of a Brief Intervention (BI) delivered by non-professionals to reduce risky alcohol drinking. Our previous null-hypothesis test of the effects of the BI yielded a 'non-significant' p-value, yet remained uninformative. Here we use the Bayesian paradigm which allows for expressing the probability of different effect sizes to better inform public policy decisions. RESULTS: The posterior probability of the odds of risky drinking at follow-up favored a marked effect of the BI, with 96% of the probability mass being less than OR = 1, and 84% being less than OR = 0.8. Our findings show that there is a high probability that the BI delivered by health technicians lowered risky alcohol use. The posterior distributions of the BI's effects are presented to help contextualize the evidence for policy making in Chile.

Association between densities of adult and immature stages of Aedes aegypti mosquitoes in space and time: implications for vector surveillance.

BACKGROUND: Mosquito control is currently the main tool available to contain the spread of several arboviruses in Brazil. We have evaluated the association between entomological surveys of female adult Aedes aegypti and the Breteau index (BI) in space and time in a hyperendemic area, and compared the human resources costs required to measure each of these indicators. METHODS: Entomological surveys were conducted between 2016 and 2019 in Vila Toninho, a neighborhood in the city of São José do Rio Preto, Brazil. Monthly records of collected mosquito specimens were made and then grouped by season. RESULTS: Our findings showed that adult and immature mosquitoes are more related in time than in space, possibly due to differences in their habitats or in climate variables. Bayesian temporal modeling revealed that an increase in 1 standard deviation in the BI was associated with a 27% increase in the number of adult female mosquitoes when adjusted for climatic conditions. The cost of entomological surveys of adult mosquitoes was found to be 83% lower than the cost of determining the BI when covering the same geographic area. CONCLUSIONS: For fine-scale assessments, a simple measure of adult Ae. aegypti abundance may be more realistic than aquatic indicators, but the adult indices are not necessarily the only reliable measure. Surveying adult female mosquitoes has significant potential for optimizing vector control strategies because, unlike the BI, this tool provides an effective indicator for micro-areas within an urban region. It should be noted that the results of the present study may be due to specific features of of the study area, and future studies should analyze whether the patterns found in the study neighborhood are also found in other regions.