Oftentimes in many fields of the social and natural sciences, data are obtained within a nested structure (e.g., students within schools). To effectively analyze data with such a structure, multilevel models are frequently employed. The present study utilizes a Monte Carlo simulation to compare several novel multilevel classification algorithms across several varied data conditions for the purpose of prediction. Among these models, the panel neural network and Bayesian generalized mixed effects model (multilevel Bayes) consistently yielded the highest prediction accuracy in test data across nearly all data conditions.

Manganese (Mn) is essential in growth and development, yet higher levels of Mn are associated with deficits in neurodevelopment. Elevated air Mn was identified near Mn alloy processing facilities in Southeast Side Chicago resulting in community concern about child exposure and health. Blood, hair, and soil samples were collected and analyzed for multiple metals for children ages 7-17 years and a parent/primary caregiver completed surveys. We used generalized estimating equations to assess associations between metals and the Adaptive Behavior Assessment System 3rd Edition (ABAS-3) scores. Sensitivity analyses were conducted to determine effect modification by child sex on associations between metals and ABAS-3 scores. Bayesian kernel machine regression was used as our principal analytic framework to assess the associations between metal mixtures and adaptive behaviors. The analyses included 108 children. Residential distance from the nearest Mn industrial source was inversely correlated with soil Mn levels and some were above the federal screening level. A significant association was found between soil Mn and lower ABAS-3 score (β: 3.78, 95 % CI: 7.31, -0.25), and between blood Mn and lower scores in females (β: 11.8, 95 % CI: 21.7, -1.87). ABAS-3 scores were negatively associated with the blood metals mixture, primarily driven by Mn. Children in Southeast Side Chicago have elevated levels of soil Mn and soil Mn was associated with poorer ABAS-3 scores. Sex-specific differences were found between metal levels and ABAS-3 scores. After considering multiple metals in mixture, Mn was the primary driver of poorer adaptive behavior.

Background: Additional therapies for hepatic encephalopathy (HE) treatment are warranted. There are data evaluating the use of zinc for HE; however, clinical outcomes, specifically in the United States, are unknown. Objective: To compare 30-day and 1-year all-cause readmission rates in patients with cirrhosis complicated by HE on lactulose and rifaximin to those on lactulose, rifaximin, and zinc. Methods: This retrospective study included patients admitted with documented cirrhosis and home medications of lactulose and rifaximin, with or without zinc. Patients were stratified into 2 groups: those receiving lactulose and rifaximin for HE (control) and those receiving lactulose, rifaximin, and zinc for HE (treatment). The primary outcomes were 30-day and 1-year all-cause readmission rates. Results: One-hundred fifty-seven patients were included (102 in control group, 55 in treatment group). Regarding 30-day and 1-year all-cause readmission rates, there was no difference between the control and treatment groups. Conclusion and Relevance: This is the first study conducted in the United States evaluating zinc for HE treatment. Zinc did not impact 30-day or 1-year all-cause readmission rates. Further studies are warranted to evaluate the potential benefit of zinc for HE, possibly in correlation with Model for End-stage Liver Disease-Sodium (MELD-Na) scores.

This explanatory mixed methods study investigated the role digital literacies play in the collaborative online learning of early childhood educators (ECEs). Through reporting quantitative survey and qualitative interview data, study results describe the attitudes and skills that contribute to ECEs’ abilities to fluently use different modes of technology to participate in collaborative online learning. Both ECEs’ and Instructors’ (higher education professionals facilitating ECE online learning courses) perceptions contribute to results on what supports and components are imperative for initial and sustained success regarding ECEs traversing and engaging with current technologies. Based on integration of databases and analysis of study results, recommendations are offered on how online learning can be used to develop the digital literacies of ECE online students.