Multilevel factor analysis models are widely used in the social sciences to account for heterogeneity in mean structures. In this paper we extend previous work on multilevel models to account for general forms of heterogeneity in confirmatory factor analysis models. We specify various models of mean and covariance heterogeneity in confirmatory factor analysis and develop Markov Chain Monte Carlo (MCMC) procedures to perform Bayesian inference, model checking, and model comparison.

We test our methodology using synthetic data and data from a consumption emotion study. The results from synthetic data show that our Bayesian model perform well in recovering the true parameters and selecting the appropriate model. More importantly, the results clearly illustrate the consequences of ignoring heterogeneity. Specifically, we find that ignoring heterogeneity can lead to sign reversals of the factor covariances, inflation of factor variances and underappreciation of uncertainty in parameter estimates. The results from the emotion study show that subjects vary both in means and covariances. Thus traditional psychometric methods cannot fully capture the heterogeneity in our data.

Ansari et al. (Psychometrika 67:49–77, 2002) applied a multilevel heterogeneous model for confirmatory factor analysis to repeated measurements on individuals. While the mean and factor loadings in this model vary across individuals, its factor structure is invariant. Allowing the individual-level residuals to be correlated is an important means to alleviate the restriction imposed by configural invariance. We relax the diagonality assumption of residual covariance matrix and estimate it using a formal Bayesian Lasso method. The approach improves goodness of fit and avoids ad hoc one-at-a-time manipulation of entries in the covariance matrix via modification indexes. We illustrate the approach using simulation studies and real data from an ecological momentary assessment.

An innovative methodological approach combining statistical typologies and stochastic frontier analysis was applied to data collected from 1840 mixed crop-livestock farms in six districts of Zimbabwe, representative of semi-arid areas of the country. The average annual cereal production was 362 kg farm–1, and the average annual livestock offtake was 0.64 ± 1.32 Tropical Livestock Units (TLU) farm–1. Our results demonstrate there is scope to increase cereal and livestock production by 90.7% and 111.9% relative to current production levels, respectively, with more efficient use of existing resources and technologies. Rainfall was found to have a strong effect on cereal production, highlighting the need for climate-smart practices. Livestock mortality (0.59 ± 1.62 TLU farm–1) was found to be in the same order of magnitude as livestock offtake (0.64 ± 1.32 TLU farm–1). Cereal production was supported by livestock, demonstrating the importance of crop-livestock interactions in these mixed farming systems. Three farm types were identified in our analysis. Crop-oriented mixed farms (31%) are likely to be the ones most responsive to crop-specific interventions e.g., crop rotation and integrated pest management. Livestock-oriented mixed farms (34%) are likely to benefit the most from livestock-specific interventions, e.g., home feed. Mixed farms dependent on off-farm activities (36% of the sample) may require nutrition-sensitive and labour-saving sustainable intensification technologies to benefit from their limited resources. Reducing cattle mortality is a priority for all three farm types. The method proposed here could be adapted to other contexts characterized by heterogeneous farming populations to target interventions.

The aim of this study is to assess nutritional status and associated factors among infants and young children aged 6–23 months in Yeka sub-city, Ethiopia, 2021. An institution-based cross-sectional study was conducted in selected health centres found in the Yeka sub-city from May 2021 to July 2021. In total, 396 systematically selected infants and young children aged 6–23 months attended the selected health centres were included in the study. Data were collected by using a structured questionnaire and anthropometric measurements. A multinomial logistic regression model was used.

The overall magnitude of undernutrition and overnutrition among infants and young children were 24.7% and 5.5%, respectively. Dietary diversity score (DDS) ((adjusted odd ratio (AOR) = 5.65; 95% CI = 2.301, 10.87; P value = 0.003), minimum meal frequency (MMF) (AOR = 5.435; 95% CI = 2.097, 11.09; P value = 0.0052), and diarrhoea (AOR = 2.52; 95% CI = 1.007, 6.310; P value = 0.002) were statistically significantly associated factors for nutritional status among infants and young children. Malnutrition (undernutrition and overnutrition) is a public health problem among infants and young children in Yeka sub-city, Ethiopia. DDS, MMF, and diarrhoeal disease were associated with higher odds of undernutrition.

Addis Ababa initiated a universal Home-Grown School Feeding Program (HGSFP) in February 2019 to address hunger and improve the educational outcomes of schoolchildren. This study aimed to document the perceived benefits and challenges of the HGSFP in Addis Ababa, where such information was lacking. In May 2023, a qualitative phenomenological study was conducted to collect data from 20 schools participating in the HGSFP. Data were collected through key informant interviews and focus group discussions (FGDs) involving 98 purposively selected participants. The study encompassed 48 student mothers in 5 FGDs, 20 student interviews, 20 school principals, and 10 experts from the Ministry of Education, Sub-cities, and the School Feeding Agency for in-depth interviews. Data collected in the local language were transcribed, translated into English, and thematically analysed using ATLAS-TI software. The study’s findings unveiled the transformative impact of the HGSFP in Addis Ababa, Ethiopia. It demonstrated remarkable improvements in attendance, concentration, academic performance, reduced dropout rates, financial relief, enhanced behaviour, and a safer learning environment. However, urgent measures are imperative to tackle pressing challenges such as underpaid kitchen workers, operational issues, reduced reading time, rising food costs, limited market access, inadequate infrastructure, and growing dependency. To ensure the enduring sustainability of HGSFP, addressing challenges like workload reduction, kitchen infrastructure enhancement, government guideline implementation, promoting self-reliance, overcoming budget limitations, and addressing school gardening obstacles is vital.

OBJECTIVES/GOALS: The project goal was to conduct formative work using community-based participatory research (CBPR) to inform the development of a laundromat-based reproductive health literacy intervention (LI)informed by Passhe-Orlow and Wolf’s Conceptual Model. We provide insights to support the development of similar health literacy interventions. METHODS/STUDY POPULATION: In Phase I, we recruited female patrons over the age of 18 living in DC from 4 community laundromats. Participants completed a survey with validated measures to assess reproductive health knowledge, self-efficacy, and intentions to seek care. Open-ended questions assessed participants’ experiences accessing care, communication with health providers, and laundromat use. Data informed the development of a 2-3 minute reproductive health literacy intervention (LI) storyboard. In Phase II, in-depth interviews were conducted with reproductive health providers (midwives, obstetricians-gynecologists, women’s health registered nurses, women’s health nurse practitioners) working in the communities where the laundromats are located. LI acceptability and appropriateness were explored. RESULTS/ANTICIPATED RESULTS: For Phase I, we recruited 60 patrons. Participants (68.3%) expressed interest in a laundromat-based reproductive health literacy intervention (LI). Identified reproductive knowledge gaps included: unaware of fertile days (50.0%); believe prenatal care should begin after 2nd trimester of pregnancy (50.0%); unclear about pregnancy spacing (85.0%); unable to identify use for folic acid (91.7%); believe once a cesarean always a cesarean (53.3%). In Phase II, all 14 providers supported increasing community accessibility to health information: “we have to move beyond doing public health education in a provider’s office. That’s very outdated.” Providers identified the LI as an approachable, informative, and accessible way to disseminate health information. DISCUSSION/SIGNIFICANCE: Patron and provider input informed our choice of content, style, and delivery of the reproductive health literacy intervention. An essential aspect of our CBPR approach, this research will inform effective, appropriate reproductive health education despite barriers presented by access, transportation, and work schedules.

This study aimed to explore the prevalence of suicidal thoughts and potential associations (i.e., strength and direction) with caregiver characteristics or factors. A targeted survey was distributed to dementia caregivers aged 55+ years. Questions concerning psychological distress, suicidal thoughts while caregiving and antecedents of suicidal behaviours were administered. A sample of 71 French-speaking Canadian caregivers completed the survey between May and October 2019. Among them, 52.1 per cent (n = 37) reported suicidal ideation while providing care to a relative or a friend living with dementia. Caregivers who presented suicidal ideation reported more abusive behaviour toward the care recipient. Caregivers who reported suicidal thoughts were significantly more distressed than caregivers without them on measures of burden, depression, and anxiety. Suicidal thoughts in caregivers are important evaluation targets, primarily for the prevention of suicide, but also because caregivers who report suicidal thoughts also present a heightened risk for abusing the care recipient.

Oral anticoagulation (OAC) prevents stroke in atrial fibrillation, yet a residual stroke risk remains. In this single-center retrospective analysis of acute ischemic stroke patients despite OAC, suboptimal OAC treatment is common (30%: inappropriate dosing (17%); patient non-adherence (13%)). Other causes of stroke included OAC interruption (14.5%), a competing stroke mechanism (11.0%), and undetermined breakthrough stroke in 44.5%. Overall, easily modifiable causes of ischemic stroke despite OAC are common. Accordingly, strategies to improve treatment compliance, including appropriate dosing along with guideline-based risk factor and periprocedural OAC management, should be emphasized to improve secondary stroke prevention in this patient population.

Background: Socioeconomic barriers or divergent implementation of prevention measures may impact risk of healthcare-associated infections by racial groups. We utilized a previously studied cohort of patients to quantify disparities in central-line–associated bloodstream infection (CLABSI) risk by race accounting for inherent differences in risk related to device utilization. Methods: In a retrospective cohort of adult patients at 4 hospitals (range, 110–733 beds) from 2012 to 2017, we linked central-line data to patient encounter data: race, age, comorbidities, total parenteral nutrition (TPN), chemotherapy, CLABSI. Analysis was limited to patients with >2 central-line days and <3 concurrent central lines. Patient exposures were calculated for each central-line episode (defined by insertion and removal dates); analysis of central-line episode-specific risk of CLABSI among Black versus White patients adjusted for clinical factors, duration of central-line episode, and central-line risk category (ie, low: single port, dialysis or PICC; medium: single temporary or nontunneled; or high: any concurrent central-lines) in Cox proportional hazards regression of time to CLABSI. Results: In total, 526 CLABSIs occurred a median of 14 days after insertion among 57,642 central-line episodes in 32,925 patients. CLABSIs occurred in similar frequency across racial groups: 217 (1.7%) among Black patients, 256 (1.6%) among White patients, and 11 (1.6%) among Hispanic patients (also 42 among unknown or other race). Duration of central-line episode was similar between racial groups (median, 5 days). Black patients were less likely to have medium-risk central lines (34%) compared to white patients (RR, 0.82; 95% CI, 0.79–0.84), but they had a similar frequency of high-risk central lines (21%; RR, 1.0; 95% CI, 1.0–1.1). Compared with low-risk central lines, risk of CLABSI was increased among medium-risk central lines (RR, 1.3; 95% CI, 1.0–1.7) and high-risk central lines (RR, 2.2; 95% CI, 1.8–2.7). CLABSIs were more likely in TPN central lines (RR, 2.3; 95% CI, 1.9–2.7) than others, but they were not more likely among Black patients than White patients (RR, 0.9; 95% CI, 0.1–1.1). In survival analysis, there were 24,700 central-line episodes among Black patients compared to 26,648 episodes among White patients; adjusting for central-line risk and TPN, the risk of CLABSI was similar during the first 21 days of central-line use (adjusted hazard ratio, 1.08; 95% CI, 0.88–01.32) (Fig. 1). Conclusions: After accounting for central-line configuration, Black patients did not have a higher risk of CLABSI within 21 central-line days. Further evaluation is warranted to assess racial disparities in risks of other healthcare-associated infections and to determine whether a lack of CLABSI-specific racial disparities can be replicated in other regions and healthcare systems.

Disclosures: None

Anthropogenic nutrient loading from land use, especially agriculture, is a major threat to waterbodies worldwide. Efforts to govern nutrient pollution are increasingly based on simulation modeling for research, evaluation, and regulation. This study develops a novel approach to simulate nutrient losses from agriculture applied to the Lake Champlain basin in the US state of Vermont. The Vermont Phosphorus-Index—a farm-based empirical model regularly used for site evaluation—is scaled up to the basin level with high-resolution geographic data and probabilistic estimation of unknown parameters and management practices. Results are comparable with analyses using more data and computationally intensive tools. Important insights into basin-wide management include: (1) nutrient-management planning can significantly reduce P losses in a livestock-agriculture-dominated watershed by re-distributing manure applications from areas of high loss to low loss; (2) hotspot identification from geographic data alone may be deeply complicated by high underlying heterogeneity of soil phosphorus; and (3) probabilistic modeling using simple, field-scale models is a potentially useful complement to complex watershed process models. Findings suggest that currently available best-management practices will likely be insufficient to reach reduction targets in the most impaired sub-watersheds. Reductions of agricultural land use and herd size, particularly in intensive dairy operations, may be necessary.

Background: The late-onset cerebellar ataxias (LOCAs) have until recently resisted molecular diagnosis. Contributing to this diagnostic gap is that non-coding structural variations, such as repeat expansions, are not fully accessible to standard short-read sequencing analysis. Methods: We combined bioinformatics analysis of whole-genome sequencing and long-read sequencing to search for repeat expansions in patients with LOCA. We enrolled 66 French-Canadian, 228 German, 20 Australian and 31 Indian patients. Pathogenic mechanisms were studied in post-mortem cerebellum and induced pluripotent stem cell (iPSC)-derived motor neurons from 2 patients. Results: We identified 128 patients who carried an autosomal dominant GAA repeat expansion in the first intron of the FGF14 gene. The expansion was present in 61%, 18%, 15% and 10% of patients in the French-Canadian, German, Australian and Indian cohorts, respectively. The pathogenic threshold was determined to be (GAA)≥250, although incomplete penetrance was observed in the (GAA)250-300 range. Patients developed a slowly progressive cerebellar syndrome at an average age of 59 years. Patient-derived post-mortem cerebellum and induced motor neurons both showed reduction in FGF14 RNA and protein expression compared to controls. Conclusions: This intronic, dominantly inherited GAA repeat expansion in FGF14 represents one of the most common genetic causes of LOCA uncovered to date.

Background: Nursing home (NH) residents and staff were at high risk for COVID-19 early in the pandemic; several studies estimated seroprevalence of infection in NH staff to be 3-fold higher among CNAs and nurses compared to other staff. Risk mitigation added in Fall 2020 included systematic testing of residents and staff (and furlough if positive) to reduce transmission risk. We estimated risks for SARS-CoV-2 infection among NH staff during the first winter surge before widespread vaccination. Methods: Between February and May 2021, voluntary serologic testing was performed on NH staff who were seronegative for SARS-CoV-2 in late Fall 2020 (during a previous serology study at 14 Georgia NHs). An exposure assessment at the second time point covered prior 3 months of job activities, community exposures, and self-reported COVID-19 vaccination, including very recent vaccination (≤4 weeks). Risk factors for seroconversion were estimated by job type using multivariable logistic regression, accounting for interval community-incidence and interval change in resident infections per bed. Results: Among 203 eligible staff, 72 (35.5%) had evidence of interval seroconversion (Fig. 1). Among 80 unvaccinated staff, interval infection was significantly higher among CNAs and nurses (aOR, 4.9; 95% CI, 1.4–20.7) than other staff, after adjusting for race and interval community incidence and facility infections. This risk persisted but was attenuated when utilizing the full study cohort including those with very recent vaccination (aOR, 1.8; 95% CI, 0.9–3.7). Conclusions: Midway through the first year of the pandemic, NH staff with close or common resident contact continued to be at increased risk for infection despite enhanced infection prevention efforts. Mitigation strategies, prior to vaccination, did not eliminate occupational risk for infection. Vaccine utilization is critical to eliminate occupational risk among frontline healthcare providers.

Funding: None

Disclosures: None

This article investigates the change in relations between Parisian haute couture and the French textile industry in the 1950s and 1960s. This study is grounded in the multiple changes that occurred between the two decades with the end of a state-sponsored and textile-backed aid to couture plan in 1960, the dematerialization of fashion in the 1960s and the advent of brands and licenses, and the waning of couture’s influence throughout the period. It cross-references archives from multi-stakeholder meetings between the state, couture, and textile representatives with the couturiers’ trade association archives and diplomatic archives to show how the changing fashion landscape impacted their interactions. This study shows that while the couture and textile industries drifted apart, the government’s interest in couture grew. This reframes the narrative on couture’s alleged influence as the spearhead of the textile industry while illustrating its wider prestige influence and its relevance to the state.

This article analyses how emergency regulations protected persons living in urban poverty, particularly unlawful occupiers, from eviction during the COVID-19 pandemic in South Africa. It is set against the socio-economic and environmental effects of unlawful occupiers being forced onto the streets through evictions. It examines the judicial interpretation and application of the COVID-19 regulations on the prohibition of the eviction of unlawful occupiers, together with remedies for compensation for demolished dwellings. Ultimately, the article shows that the regulatory and judicial responses to the pandemic were pro-poor and sought to protect human dignity, the right to life, and the right to an environment that is not detrimental to human health and well-being. The responses safeguarded access to housing at a time when many vulnerable people could have been rendered homeless by eviction and the demolition of their dwellings.