A Bayesian joint model for zero-inflated integers and left-truncated event times with a time-varying association: Applications to senior health care.

Population aging in most industrialized societies has led to a dramatic increase in emergency medical demand among the elderly. In the context of private health care, an optimal allocation of the medical resources for seniors is commonly done by forecasting their life spans. Accounting for each subject's particularities is therefore indispensable, so the available data must be processed at an individual level. We use a large and unique dataset of insured parties aged 65 and older to appropriately relate the emergency care usage with mortality risk. Longitudinal and time-to-event processes are jointly modeled, and their underlying relationship can therefore be assessed. Such an application, however, requires some special features to also be considered. First, longitudinal demand for emergency services exhibits a nonnegative integer response with an excess of zeros due to the very nature of the data. These subject-specific responses are handled by a zero-inflated version of the hierarchical negative binomial model. Second, event times must account for the left truncation derived from the fact that policyholders must reach the age of 65 before they may begin to be observed. Consequently, a delayed entry bias arises for those individuals entering the study after this age threshold. Third, and as the main challenge of our analysis, the association parameter between both processes is expected to be age-dependent, with an unspecified association structure. This is well-approximated through a flexible functional specification provided by penalized B-splines. The parameter estimation of the joint model is derived under a Bayesian scheme.

Juvenile Wels Catfish (Silurus glanis) Display Age-Related Mortality to European Catfish Virus (ECV) under Experimental Conditions.

We have limited knowledge about the course of the European catfish virus (ECV) infection in different age groups of wels catfish (Silurus glanis). The results of this study demonstrate that an ECV strain isolated from the brown bullhead (Ameiurus nebulosus) in Hungary could cause devastating losses among juvenile wels catfish. Furthermore, the age-related mortality rate following ECV infection was investigated in three virus challenge experiments at two different virus dosages. Eight-week-old (ca. 3 g), ten-week-old (ca. 8 g), and sixteen-week-old (ca. 55 g) catfish were infected with ECV at 21°C. In the youngest age group, 96% (at a 106 TCID50/mL dosage) and 100% (at 105 TCID50/mL) mortality rates were observed, while these rates were reduced to 56% and 68% in the ten-week-old groups, respectively. The mortality was significantly higher in the virus-exposed groups than in the control ones. In the sixteen-week-old group, 23% mortality was detected at a 105 TCID50/mL concentration of ECV. Here, a significant difference was not found between the exposed and control groups. The performed experiments show that different age groups of wels catfish may have various susceptibility to ECV. These findings draw attention to the importance of the prevention of/protection against virus infections in juvenile (up to 3-month-old) wels catfish in aquaculture.