Applying Propensity Score Matching Research Articles

#1254 SGLT-2 inhibitors in patients with type 2 diabetes with acute kidney disease

Abstract Background and Aims Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been observed to exhibit correlative relationships with favorable impacts on renal and cardiovascular outcomes among individuals diagnosed with type 2 diabetes. Nonetheless, the extent of the influence of SGLT-2 inhibitors on patients with type 2 diabetes concomitant with acute kidney disease (AKD) remains enigmatic. Method This investigation leveraged expansive global healthcare data from TriNetX, spanning the timeframe from September 2002 to September 2022. Propensity score matching was systematically applied to meticulously curate a patient cohort, with a subsequent follow-up period extending over 5 years or until the manifestation of a defined outcome or mortality. The underlying research design took the form of an observational cohort study. The primary objective of this study was to scrutinize the enduring associations of Sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients afflicted with type 2 diabetes and concurrent acute kidney disease (AKD). Particular emphasis was directed towards evaluating the impact on mortality rates, major adverse kidney events (MAKEs), and major adverse cardiovascular events (MACEs) over the specified temporal continuum. The primary outcomes measured were mortality, MAKEs, and MACEs. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were calculated to compare the risks between SGLT-2 inhibitor users and non-users, representing the average treatment effect among the treated. Results A total cohort of 230, 366 individuals diagnosed with AKD, boasting a mean age of 67.1 years and a male representation of 53.1%, formed the basis of this study. Within this cohort, 5 319 subjects (constituting 2.3%) were identified as users of SGLT-2 inhibitors. The incidence rates for mortality, MAKEs, and MACEs among non-users were recorded at 18.7%, 21.0%, and 25.8%, respectively. Following the meticulous application of propensity score matching, absolute differences in the incidence rates of mortality, MAKEs, and MACEs between SGLT-2 inhibitor users and non-users were calculated at 9.7%, 11.5%, and 12.3%, respectively. In the treated population, SGLT-2 inhibitor users exhibited a notably lower risk of mortality (adjusted Hazard Ratio [aHR]: 0.69, 95% Confidence Interval [CI]: 0.62-0.77), MAKEs (aHR: 0.62, 95% CI: 0.56-0.69), and MACEs (aHR: 0.75, 95% CI: 0.65-0.88) in comparison to their non-using counterparts. The robustness of these observed benefits was validated externally using a multicenter cohort dataset comprising 1, 233 AKD patients who were SGLT-2 inhibitor users, thereby affirming the positive outcomes. Importantly, the risk reduction associated with SGLT-2 inhibitors persisted significantly even among subpopulations devoid of hypertension, those with advanced chronic kidney disease, and individuals not concurrently receiving other oral hypoglycemic agents. Conclusion In this meticulously conducted cohort study involving individuals diagnosed with type 2 diabetes and AKD receiving treatment with SGLT-2 inhibitors, our findings suggest a potential association with diminished rates of mortality, MAKEs, and MACEs. These results underscore the imperative for subsequent and more in-depth investigations into the precise associations of SGLT-2 inhibitors within this distinctively treated population.

Battery Electric Vehicles: Travel Characteristics of Early Adopters

Do U.S. households with battery electric vehicles (BEVs) drive less or more than U.S. households with internal combustion engine vehicles (ICEVs)? Answering this question is important to policymakers and transportation planners concerned with reducing vehicle miles traveled and the emissions of greenhouse gases from transportation. So far, this question has not been answered satisfactorily, possibly because of the relatively low number of EVs in the U.S. until recently, but also because of methodological issues. In this paper, we aim to fill this gap by analyzing data from the 2017 National Household Travel Survey (NHTS). We apply propensity score matching (PSM), a quasi-experimental method, to examine the differences in self-reported annual mileage and calculated daily mileage for various trip purposes among households with only BEVs (BEV-only), households with both BEVs and ICEVs (BEV+), and households without BEVs (non-BEV households). Our findings indicate that households with BEVs drive fewer annual miles than non-BEV households, but typically travel no less than they do for daily activities. This apparent discrepancy is likely due to taking fewer longer trips because the public charging infrastructure was still in its infancy in 2017, and its reliability was questionable. As technological progress is helping to overcome current battery limitations, policymakers may consider measures for fostering fast charging technologies while pondering new measures to fund both the charging infrastructure and the road network.

Postoperative lenvatinib + PD-1 blockade reduces early tumor recurrence in hepatocellular carcinoma with microvascular invasion (Barcelona Clinic Liver Cancer stage 0 or A): a propensity score matching analysis

PurposeThis research seeks to determine the effectiveness of post-operative adjuvant lenvatinib plus PD-1 blockade for early-stage HCC patients with microvascular invasion (MVI). Methods393 HCC patients (Barcelona Clinic Liver Cancer stage 0-A) who underwent curative hepatectomy with histopathologically proven MVI were enrolled according to inclusion and exclusion criteria and assigned to two groups: surgery alone (Surgery-alone) and surgery with lenvatinib and PD-1 blockade (Surgery+Len+PD-1) to compare recurrence-free survival (RFS), overall survival (OS), recurrence type, and annual recurrence rate following the application of propensity score matching (PSM). The Cox proportional hazards model was utilized for univariate and multivariate analysis. Results99 matched pairs were selected using PSM. Patients in the Surgery+Len+PD-1 group had significantly higher three-year RFS (76.8%, 65.7%, and 53.5%) compared to patients in the Surgery-alone group (60.6%, 45.5%, and 37.4%) (P=0.012). The two groups showed no significant differences in recurrence types and OS. Surgery-alone, MVI-M2, and AFP≥200ng/mL were independent risk factors for RFS (P<0.05), and history of alcoholism was an independent risk factor for OS (P=0.022). ConclusionsPostoperative lenvatinib plus PD-1 blockade improved the RFS in HCC patients with MVI and was particularly beneficial for specific individuals.

Cross-regional integration of renewable energy and corporate carbon emissions: Evidence from China's cross-regional surplus renewable energy spot trading pilot

Using data from A-share listed renewable energy enterprises, this study constructs a quasi-natural experiment with China's Cross-regional Surplus Renewable Energy Spot Trading Pilot policies as the shock and explores its impact on corporate carbon emissions from 2014 to 2021 using the staggered difference-in-differences (DID) model. The results indicate that the Cross-regional Surplus Renewable Energy Spot Trading Pilot can significantly reduce the carbon emissions of renewable energy enterprises in pilot regions during the sample period, demonstrating heterogeneity in regional location, ownership, and corporate social responsibility. The positive effect of the pilot is more pronounced for enterprises in the central region, state-owned enterprises, and enterprises with a high sense of social responsibility. The results remained robust when we applied propensity score matching DID, difference-in-differences-in-differences (DDD), placebo tests, alternative measures and 2SLS instrumental variable tests to further eliminate the interference from other factors. Moreover, in terms of mechanisms, the Cross-regional Surplus Renewable Energy Spot Trading Pilot can reduce corporate carbon emissions by promoting renewable energy consumption and corporate energy efficiency. This study enhances understanding of cross-regional renewable energy integration, expanding discussions on selecting trajectories for energy efficiency and emissions reduction goals in the energy sector. Our findings offer practical examples of how different regions and countries promote the integration of renewable energy markets, thereby contributing to research on renewable energy integration.

Clinical Characteristics, Treatment, and Prognosis of Osteoarticular Brucellosis: A Retrospective Real-World Study in Shenyang, China, 2014-2019.

This study aimed to assess the clinical characteristics, treatment, and prognosis of osteoarticular brucellosis. We conducted a retrospective study enrolling brucellosis patients from the Sixth People's Hospital of Shenyang between September 2014 and June 2019. A total of 1917 participants were admitted during this period. After applying propensity score matching, we retrospectively analyzed 429 patients with osteoarthritis and 429 patients without osteoarthritis. The primary outcome was treatment completion. The secondary outcome was symptom disappearance and seroconversion. Brucellosis patients with osteoarthritis had longer treatment course (160 [134.3-185.7] vs. 120 [102.3-137.7] d, p = 0.008) than those without osteoarthritis. The most common involved site was lumbar vertebrae (290 [67.6%]) in brucellosis patients with osteoarthritis. Longer symptom duration (90 [83.0-97.0] vs. 42 [40.2-43.8], p < 0.001) along with no significant difference in seroconversion (180 [178.8-181.2] vs. 180 [135.1-224.9], p = 0.212) was observed in osteoarthritis patients with treatment course >90 d. Peripheral joint involvement (adjusted hazard ratio [95% confidence interval] 1.485 [1.103-1.999]; p = 0.009) had a shorter symptom duration compared with shaft joint involvement. No significant differences were observed in treatment therapy between doxycycline plus rifampin (DR) or plus cephalosporins (DRC) in treatment course (p = 0.190), symptom persistence (p = 0.294), and seroconversion (p = 0.086). Lumbar vertebra was the most commonly involved site. Even if all symptoms disappeared, Serum agglutination test potentially remained positive in some patients. Compared with peripheral arthritis, shaft arthritis was the high-risk factor for longer symptom duration. The therapeutic effects were similar between DR and DRC. In summary, our study provided important insights into the clinical characteristics, treatment, and outcomes of osteoarticular brucellosis. Clinical Trial Registration number: NCT04020536.

Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study

BackgroundSepsis and acute kidney injury (AKI) are common severe diseases in the intensive care unit (ICU). This study aimed to estimate the attributable mortality of AKI among critically ill patients with sepsis and to assess whether AKI was an independent risk factor for 30-day mortality.MethodsThe information we used was derived from a multicenter prospective cohort study conducted in 18 Chinese ICUs, focusing on septic patients post ICU admission. The patients were categorized into two groups: those who developed AKI (AKI group) within seven days following a sepsis diagnosis and those who did not develop AKI (non-AKI group). Using propensity score matching (PSM), patients were matched 1:1 as AKI and non-AKI groups. We then calculated the mortality rate attributable to AKI in septic patients. Furthermore, a survival analysis was conducted comparing the matched AKI and non-AKI septic patients. The primary outcome of interest was the 30-day mortality rate following the diagnosis of sepsis.ResultsOut of the 2175 eligible septic patients, 61.7% developed AKI. After the application of PSM, a total of 784 septic patients who developed AKI were matched in a 1:1 ratio with 784 septic patients who did not develop AKI. The overall 30-day attributable mortality of AKI was 6.6% (95% CI 2.3 ∼ 10.9%, p = 0.002). A subgroup analysis revealed that the 30-day attributable mortality rates for stage 1, stage 2, and stage 3 AKI were 0.6% (95% CI −5.9 ∼ 7.2%, p = 0.846), 4.7% (95% CI −3.1 ∼ 12.4%, p = 0.221) and 16.8% (95% CI 8.1 ∼ 25.2%, p < 0.001), respectively. Particularly noteworthy was that stage 3 AKI emerged as an independent risk factor for 30-day mortality, possessing an adjusted hazard ratio of 1.80 (95% CI 1.31 ∼ 2.47, p < 0.001).ConclusionsThe overall 30-day attributable mortality of AKI among critically ill patients with sepsis was 6.6%. Stage 3 AKI had the most significant contribution to 30-day mortality, while stage 1 and stage 2 AKI did not increase excess mortality.

Does dam-based irrigation affect the sustainability of natural capital ?: A doubly robust analysis

This study assesses the impact of dam-based irrigation on the adoption of management practices for sustaining the natural capital of a region, with a focus on soil and water resources, using survey data from 1020 farmlands in northwestern Tunisia. Because treatment effect estimates are frequently prone to misspecification in either the treatment or outcome models, we use the doubly-robust inverse probability weighted regression adjustment estimator on four soil and water sustaining agricultural practices. As a robustness check, we also apply propensity score matching, with both methods consistently indicating a positive impact of dam irrigation on the adoption of these practices. Overall, these findings emphasize the indirect positive ecological effects of dams on a region's natural capital sustainability.

Does environmental credit affect bank loans? Evidence from Chinese A‐share listed firms

AbstractWe investigate the effect of government‐initiated enterprise environmental credit ratings on firms' bank loans. While prior research indicates that companies with superior environmental performance tend to secure more bank loans, it is crucial to acknowledge that these performance metrics predominantly rely on voluntary corporate social responsibility or environmental, social, and governance disclosures made by the firms themselves or evaluated by third‐party agencies. Consequently, the evaluation results could be biased due to incomplete information disclosure, methodologies, or systems, raising concerns among scholars about potential “greenwashing” or symbolic environmental actions. In contrast, we employ a dataset comprising 27,388 observations from 2009 to 2021, applying propensity score matching and a time‐varying difference‐in‐difference model to better discern the relationship between firms' environmental credit ratings and their ability to obtain bank loans. Our findings highlight that firms participating in environmental credit evaluation can secure more bank loans compared to non‐participating firms. This effect is especially pronounced in regions with advanced green finance development. Further analysis shows that non‐state‐owned enterprises with excellent or good environmental credit ratings receive more loans, thus mitigating ownership bias in loan distribution. Overall, our results demonstrate that mandatory government environmental credit ratings mitigate information asymmetry by enabling lenders to better understand firms' environmental information.

Evaluating the Practicality of Causal Inference From Non-randomized Observational Data in Small-Scale Clinical Settings: A Study on the Effects of Ninjin'yoeito.

Objective The primary goal of this study was to demonstrate the practical application of causal inference using non-randomized observational data, adapting this approach to smaller populations, such as those in hospitals or community healthcare. This adaptation seeks a more effective and practical research method than randomized controlled trials (RCTs), with the goal of revealing novel insights unexplored by traditional research and enhancing understanding within the realm of causal inference. Methods This study evaluated the effects of Ninjin'yoeito (NYT), a traditional Japanese Kampo medicine, on Overactive Bladder Symptom Score (OABSS) and the frailty scores. Employing new statistical methods, this study sought to illustrate the efficacy of estimating causal relationships from non-randomized data in a clinical setting. The database included 985 women aged 65-90 years who visited a clinic between November 2016 and November 2022. By utilizing various statistical techniques, including regression analysis, inverse probability of treatment weighting (IPTW), instrumental variable (IV), and difference-in-differences (DiD) analysis, this study aimed to provide insights beyond traditional methods, attempting to bridge the gap between theory and practice in causal inference. Results After applying propensity score matching, the NYT treatment group (220 participants) and non-treatment group (182 participants) were each adjusted to two groups of 159 individuals. NYT significantly improved OABSSand frailty scores. IPTW analysis highlighted that on average, the NYT treatment group showed an improvement of 0.8671 points in OABSS and 0.1339 points in the frailty scores, surpassing the non-treatment group (p<0.05). IV analysis indicated that NYT treatment is predicted to increase ΔOABSS by an average of approximately 4.86 points, highlighting its significant positive impact on OABSS improvement. The DiD analysis showed that the NYT treatment group demonstrated an average improvement of 0.5457 points in OABSS, which was significantly higher than that of the control group.The adjusted R² value for the model is 0.025. Conclusion This study successfully implemented a practical application of causal inference using non-randomized observational data in a relatively small population. NYT showed a significant improvement in OABSS and vulnerability, and this result was confirmed using a new statistical method. The relatively low adjusted R² of the model suggests the existence of other unmeasured variables that influence OABSS and vulnerability improvement. In particular, the use of diverse statistical techniques, including IPTW, IV, and DiD analysis, is an important step toward revealing the effectiveness of inferring causal relationships from non-randomized data and narrowing the gap between theory and practice. This study provides a valid and practical alternative to RCTs and reveals new insights that have not been explored in traditional research.

Student-to-Teacher Victimization and Its Negative Impact on Teaching Approaches: Applying Propensity Score Matching.

The negative impact of student-to-teacher victimization on teachers' perceptions of the work environment and their well-being is supported by growing empirical literature. For instance, violence in the classroom can have a negative impact on teachers themselves and hinder teachers from playing crucial roles in students' classroom experiences, resulting in adverse effects on student performance. However, the research field is limited in understanding the adverse effects on teachers' perceptions more directly related to student learning, such as teacher neglect. To fill the gap in the literature, the current study analyzes data from a nationwide sample of 1,054 middle and high school teachers in South Korea where teachers are generally treated with high regard and social status, often exerting a strong influence and authority over students in both an educational and parental way. Specifically, we conduct propensity score matching to investigate potential influences that student-to-teacher victimization can have on the following three outcome variables: teacher neglect, commitment, and pride. Results of mean comparisons after accounting for other confounding factors show that when compared with nonvictims, victims of student-to-teacher victimization are more likely to neglect their students; these victims also tend to exhibit less pride as teachers. Yet, the results also showed no significant statistical difference in teacher commitment. The current findings highlight the importance of developing programs to prevent and intervene in students' aggressive behaviors toward teachers. Particularly, administrators are recommended to consider providing training for teachers, specific to understanding student-to-teacher victimization in order to promote a more positive school environment and better student-to-teacher relationships in classrooms, including improving teachers' job performance.

Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study

BackgroundBoth sepsis and acute respiratory distress syndrome (ARDS) are common severe diseases in the intensive care unit (ICU). There is no large-scale multicenter study to clarify the attributable mortality of ARDS among septic patients. This study aimed to evaluate the excess mortality of ARDS in critically ill patients with sepsis.MethodsThe data were obtained from a multicenter, prospective cohort study in 18 Chinese ICUs between January 2014 and August 2015. The study population was septic patients after ICU admission. The patients were categorized into two groups: those who developed ARDS (ARDS group) within seven days following a sepsis diagnosis and those who did not develop ARDS (non-ARDS group). Applying propensity score matching (PSM), patients were matched 1:1 as ARDS and non-ARDS groups. Mortality attributed to ARDS was calculated. Subsequently, we conducted a survival analysis to estimate the impact of ARDS on mortality. The primary endpoint was 30-day mortality after sepsis diagnosis.Results2323 septic patients were eligible, 67.8% developed ARDS. After PSM, 737 patients with ARDS were matched 1:1 with 737 non-ARDS patients. ARDS’s overall 30-day attributable mortality was 11.9% (95% CI 7.5–16.3%, p < 0.001). Subgroup analysis showed that the 30-day attributable mortality of mild, moderate, and severe ARDS was 10.5% (95% CI 4.0-16.8%, p < 0.001), 11.6% (95% CI 4.7–18.4%, p < 0.001) and 18.1% (95% CI 4.5–30.9%, p = 0.006), respectively. ARDS was an independent risk factor for 30-day mortality, with adjusted hazard ratios of 1.30 (95% CI 1.03–1.64, p = 0.027), 1.49 (95% CI 1.20–1.85, p < 0.001), and 1.95 (95% CI 1.51–2.52, p < 0.001) for mild, moderate, and severe ARDS, respectively.ConclusionsThe overall 30-day attributable mortality of ARDS among critically ill patients with sepsis was 11.9%. Compared with mild and moderate ARDS, severe ARDS contributed more to death. ARDS was significantly associated with an increase in the 30-day mortality.

Safety and effectiveness of stent-assisted coiling with adjunctive techniques in ruptured acute aneurysms: a propensity score-matched cohort study.

The use of stent-assisted coiling (SAC) in acute subarachnoid hemorrhage cases is associated with higher incidence rates of bleeding and ischemic complications. The aim of this study was to evaluate the safety and efficacy of the SAC technique in the treatment of ruptured intracranial aneurysms (RIAs). A retrospective analysis was conducted on patients with RIAs treated with SAC or coiling alone (CA). Univariate analysis compared clinical information between the two groups. Propensity score matching was used to select patients for comparison and analyze surgical complications, prognosis, and imaging outcomes in both groups. A total of 394 aneurysms were included, and 272 aneurysms remained after application of propensity score matching, with an equal distribution of 136 cases in both the SAC and CA groups. There was no statistically significant difference in the immediate postoperative outcomes between the two groups (63.2% of SAC patients achieved class 1 on the Raymond-Roy occlusion classification scale vs 58.8% of CA patients, difference [95% CI] 4.4% [-0.076 to 0.163]; 33.1% achieved class 2 vs 38.2%, 5.1% [-0.065 to 0.170]; 3.7% achieved class 3 vs 2.9%, 0.8% [-0.047 to 0.062], p = 0.506). At the 1-year follow-up, the SAC group exhibited higher rates of complete occlusion (59.5% vs 42.4%, 17.1% [0.040-0.294]) and stability (24.0% vs 19.2%, 4.8% [-0.061 to 0.156]), while experiencing lower rates of improvement (12.4% vs 22.4%, 10.0% [0.001-0.201]) and recanalization (4.1% vs 16.0%, 11.9% [0.036-0.120]), with statistically significant differences in these outcomes (p < 0.001). No significant disparities were observed in clinical outcomes in terms of modified Rankin Scale (mRS) scores at discharge (76.5% vs 77.2% had mRS score 0-2, 0.7% [-0.098 to 0.113]; 23.5% vs 22.8% had mRS score 3-6, 0.7% [-0.098 to 0.113], p = 0.886) and 1-year follow-up (90.8% vs 92.2% had mRS score 0-2, 1.4% [-0.063 to 0.091]; 9.2% vs 7.8% had mRS score 3-6, 1.4% [-0.063 to 0.091], p = 0.683). Intraoperative rupture occurred more frequently in the SAC group compared with the CA group, although the difference was not statistically significant (5.1% vs 2.9%, 2.2% [-0.035 to 0.081], p = 0.356). The SAC group demonstrated a higher incidence of intraoperative thrombosis, but the difference was not statistically significant (8.1% vs 2.9%, 5.2% [-0.010 to 0.117], p = 0.063). Postoperative thrombosis in the SAC group was 3 times higher, but this difference was not statistically significant (6.6% vs 2.2%, 4.4% [-0.013, 0.106], p = 0.076). The surgery-related mortality rates did not differ significantly between the two groups (4.4% vs 5.9%, 1.5% [-0.048 to 0.077], p = 0.583). Although stent treatment for RIA results in some incidents of complications, it is safe and effective. Besides, the SAC group showed better vascular imaging results compared with the CA group.

Impact of Sex on Thrombectomy Outcomes in Ischemic Stroke: A Propensity Score‐Matched Study, Systematic Review, and Meta‐Analysis

Background Women are underrepresented in stroke thrombectomy trials, and the impact of sex differences in outcomes after stroke thrombectomy is unclear. We performed a multicenter propensity matching study to define sex‐related differences in outcome after endovascular thrombectomy and integrated results in a meta‐analysis. Methods We included patients with anterior circulation large vessel occlusion consecutively treated with thrombectomy at 2 Comprehensive Stroke Centres (2016–2023). Selection criteria reflected international guidelines. Through systematic review we selected all studies reporting endovascular thrombectomy outcomes in anterior circulation large vessel occlusion stroke, applying propensity score matching. MEDLINE, EMBASE, and Cochrane CENTRAL were searched up to August 15, 2023 according to predefined protocol (OSF.io/je3da). Data were extracted by 2 independent raters, pooled estimates calculated according to random‐effect modeling meta‐analysis and reported as odds ratio (OR) and standard 95% CI. Outcomes were good functional outcome, defined as modified Rankin Scale score 0–2 at 90 days after stroke, and symptomatic intracranial hemorrhage, adjudicated according to European Cooperative Acute Stroke Study II criteria. Results After matching, 698 patients (349 women versus 349 men) had similar cardiovascular risk factors, baseline features, and treatment approach. No significant differences were found for good functional outcome (OR = 0.89, 95% CI = 0.66–1.2) and symptomatic intracranial hemorrhage (OR = 1.00, 95% CI = 0.44–2.26) in the cohort study by sex. Systematic review identified 3 studies (n = 3706), all of high quality. No differences emerged in rates of good functional outcome (OR = 1.00, 95% CI = 0.79–1.21) or symptomatic intracranial hemorrhage (OR = 0.85, 95% CI = 0.60–1.19) depending on sex. Conclusion Women receiving endovascular thrombectomy for anterior circulation large vessel occlusion related stroke have similar rates of good functional outcome and symptomatic intracranial hemorrhage compared to men.

Participation in village savings and lending associations and rice profitability in Tanzania: Application of propensity score matching and endogenous switching regression

We assess the contribution of participation in bundled service-bundled VSLAs on rice productivity and profit among smallholder rice farmers in Mvomero District, Tanzania. The study propensity score matching (PSM) and endogenous switching regression (ESR) models, and found that participation in VSLA has a positive and significant contribution to rice productivity and profit for smallholder rice farmers. Participation in VSLAs increases farmers' ability to regenerate income for investing in improving productivity and profitability and enhancing rice sector development. VSLAs prove as a tool for building financial capital through savings and easy access to credit in rural areas. This study improves on existing research and offers new insights into the effects of VSLA as one of the financial inclusion tools on the economic activities of agricultural households in Tanzania.

Early Changes in LIPI Score Predict Immune-Related Adverse Events: A Propensity Score Matched Analysis in Advanced Non-Small Cell Lung Cancer Patients on Immune Checkpoint Blockade.

In advanced cancer patients undergoing immune checkpoint blockade, the burden of immune-related adverse events (irAEs) is high. The need for reliable biomarkers for irAEs remains unfulfilled in this expanding therapeutic field. The lung immune prognostic index (LIPI) is a noninvasive measure of systemic inflammation that has consistently shown a correlation with survival in various cancer types when assessed at baseline. This study sought to determine whether early changes in the LIPI score could discriminate the risk of irAEs and different survival outcomes in advanced non-small cell lung cancer (NSCLC) patients receiving PD-(L)1 blockade-based therapies. We included consecutive patients diagnosed with metastatic NSCLC who received pembrolizumab, nivolumab, or atezolizumab as second-line therapy following platinum-based chemotherapy, or first-line pembrolizumab either alone or in combination with platinum-based chemotherapy. The LIPI score relied on the combined values of derived neutrophil/lymphocyte ratio (dNLR) and lactate dehydrogenase. Their assessment at baseline and after two cycles of treatment allowed us to categorize the population into three subgroups with good (LIPI-0), intermediate (LIPI-1), and poor (LIPI-2) prognosis. Between April 2016 and May 2023, we enrolled a total of 345 eligible patients, 165 (47.8%) and 180 (52.2%) of whom were treated as first- and second-line at our facility, respectively. After applying propensity score matching, we considered 83 relevant patients in each cohort with a homogeneous distribution of all characteristics across the baseline LIPI subgroups. There was a noticeable change in the distribution of LIPI categories due to a significant decrease in dNLR values during treatment. Although no patients shifted to a worse prognosis category, 20 (24.1%) transitioned from LIPI-1 to LIPI-0, and 7 (8.4%) moved from LIPI-2 to LIPI-1 (p < 0.001). Throughout a median observation period of 7.3 (IQR 3.9-15.1) months, a total of 158 irAEs (63.5%) were documented, with 121 (48.6%) and 39 (15.7%) patients experiencing mild to moderate and severe adverse events, respectively. Multivariate logistic regression analysis showed that the classification and changes in the LIPI score while on treatment were independent predictors of irAEs. The LIPI-0 group was found to have significantly increased odds of experiencing irAEs. Following a median follow-up period of 21.1 (95% CI 17.9-25.8) months, the multivariable Cox model confirmed LIPI categorization at any given time point as a significant covariate with influence on overall survival, irrespective of the treatment line. These findings suggest that reassessing the LIPI score after two cycles of treatment could help pinpoint patients particularly prone to immune-related toxicities. Those who maintain a good LIPI score or move from the intermediate to good category would be more likely to develop irAEs. The continuous assessment of LIPI provides prognostic insights and could be useful for predicting the benefit of PD-(L)1 checkpoint inhibitors.

Assessing the Impact of Covid-19 in Mozambique in 2020

AbstractTaking advantage of the 2019/2020 Mozambican household budget survey, in the field both before and during the first phases of the Covid-19 pandemic, we assess the impact of Covid-19 on welfare in 2020, aiming to disentangle this impact from the effect of other shocks. Comparing a number of welfare metrics, and applying propensity score matching and inverse probability weighted regression adjustment approaches, we find that consumption levels are significantly lower and poverty rates substantially higher during the first phases of Covid-19 than in the pre-Covid-19 period. Moreover, the impact was greater in urban areas and accordingly in the more urbanised southern region. Non-food expenditures suffered relatively more than food expenditures, likely a coping strategy, while the impact on consumption levels was greater for people working in the secondary and tertiary sectors than for workers in the primary sector, mainly agriculture. Stunting among under-5 children also suffered. Only a limited number of countries have actual, collected in-person, survey data that span across the initial phases of the Covid-19 pandemic. Thus, the present analysis adds value to our understanding of the welfare consequences of Covid-19 in a low-income context, where automatic social safety nets were not in place during the early phases of the pandemic. More specifically, it helps in assessing the results of previous welfare impact simulations, compared to real data. Even though our main findings are broadly in line with existing estimates based on simulations or phone surveys, important differences between the predictions and the actual results emerge. We conclude that it is critically important for Mozambique and its development partners to develop stronger and more targeted policies and tools to respond to temporary shocks.

Influence of labor migration on rural household food waste in China: Application of propensity score matching (PSM)

Food waste has emerged as a critical global concern, with households identified as major contributors to this pressing issue. As the world grapples with sustainability challenges, addressing food waste in the context of rural labor migration is crucial for achieving broader sustainable development goals. However, there is still limited research regarding the relationship between labor migration and food waste. We utilized propensity score matching to analyze cross-sectional data collected from 1270 rural households in China. Labor migration led to significant increases of 37% in overall food waste and 35% in plant-based food waste, respectively. Furthermore, households with labor migration exhibited 29%, 31%, and 30 % higher energy, protein, and carbohydrate waste, respectively, compared to non-migration households. Regarding micronutrients, migration led to a 39% increase in iron waste, a 42% increase in zinc waste, and a 47% increase in selenium waste. The results of the categorical analysis indicate variations in the impact of labor migration on food wastage within rural households. Food wastage in rural households with chronic illness patients responds differently to labor migration. Moreover, labor migration predominantly affects households without courier services in villages, where dietary diversity plays a significant role. Understanding these variations is essential for crafting targeted interventions and policies to address food waste in different rural contexts. The policy implications of our study are crucial for addressing food waste and advancing sustainable development in rural China, where labor migration plays a significant role.

Effects of fodder production on smallholder farmers’ household income in Homa Bay County, Kenya: An application of propensity score matching

Effects of fodder production on smallholder farmers’ household income in Homa Bay County, Kenya: An application of propensity score matching

Comparison of Autologous, Matched Sibling, and Alternative Donor Stem Cell Transplant Outcomes for Acute Myeloid Leukemia Patients in First Remission: A Propensity Score Matching Study

Introduction Autologous hematopoietic stem cell transplantation (auto-HSCT), matched sibling donor HSCT (MSD-HSCT), and alternative donor HSCT (AD-HSCT) are viable post-remission treatment options for acute myeloid leukemia (AML). Auto-HSCT is more commonly administered in favorable- and intermediate-risk AML with good remission, while MSD-HSCT and AD-HSCT are suggested for patients with high-risk factors. In the present study, we aim to retrospectively compared auto-HSCT with MSD-HSCT and AD-HSCT in de novo AML patients who are in first complete remission (CR1) with favorable or intermediate risk, according to 2022 ELN criteria. Methods We conducted a single-center retrospective comparative analysis, comparing auto-HSCT and allo-HSCT for favorable and intermediate-risk de novo AML in CR1. Patients with secondary AML, acute promyelocytic leukemia, poor-risk AML, those receiving syngeneic HSCT, those not in CR1 before HSCT, or those who achieved CR1 with ≥ 3 cycles of induction chemotherapy were excluded from the study. A total of 283 de novo favorable- and intermediate-risk AML patients, based on the ELN 2022 criteria, in first complete remission were initially included for propensity score matching. Persistent undetectable MRD (uMRD) was defined as uMRD after one course of chemotherapy without recurrent positive MRD before HSCT, while non-persistent uMRD was characterized by the presence of detectable MRD at least once before HSCT. The variables used for propensity score matching included induction chemotherapy cycles, consolidation chemotherapy cycles, and measurable residual disease (MRD) measurement by flow cytometer before HSCT. A caliper width of 0.2 was used. Following the matching process, 126 patients were selected for further analysis, with 42 patients in each of the auto-HSCT, MSD-HSCT, and AD-HSCT groups. Results After applying propensity score matching, a final cohort of 126 patients was available for analysis. This cohort consisted of 42 patients in each group: auto-HSCT, MSD-HSCT, and AD-HSCT. Among the AD-HSCT group, 38 of 42 (90.5%) patients received haploidentical HSCT (haplo-HSCT). All patients received myeloablative conditioning regimen. There were no significant differences observed in the 3-year overall survival (OS) and disease-free survival (DFS) among the auto-HSCT, MSD-HSCT, and AD-HSCT groups [3-year OS: 79.5% (95% CI, 67.8-93.3%), 83.0% (95% CI, 72.2-95.3%), and 65.7% (95% CI, 50.5-85.5%), respectively; P=0.21. 3-year DFS: 72.6% (95% CI, 59.9-87.9%), 83.0% (95% CI, 72.2-95.3%), and 67.5% (95% CI, 54.2-84.1%), respectively; P=0.32]. The cumulative incidence of 3-year NRM was 2.7% (95% CI, 2.0-12.5%), 7.3% (95% CI, 1.8-17.9%), and 21.9% (95% CI, 10.7-35.6%), respectively (P=0.008). The 1-year probability of OS after relapse was higher in the auto-HSCT group (44.4%; 95% CI, 21.4-92.3%) compared with MSD-HSCT (0.0%) and AD-HSCT (37.5%; 95% CI, 8.4-99.9%) (P=0.0017). The MRD status before HSCT had an impact on DFS (persistent uMRD versus non-persistent uMRD: HR=0.29; 95% CI 0.09-0.94, P=0.04) and relapse (persistent uMRD versus non-persistent uMRD: HR=0.17; 95% CI 0.05-0.66, P=0.01) following auto-HSCT. The subgroup analysis was then performed based on MRD status before HSCT. In patients with uMRD before transplant (n=83), OS was similar across the groups. However, auto-HSCT showed a trend of increased DFS compared to AD-HSCT (HR 2.85, P=0.09), resulting in a 3-year DFS and OS of 79.1% and 82.8%, respectively. In the non-persistent uMRD group (n=38), auto-HSCT exhibited a tendency to increase the risk of relapse, particularly when compared to AD-HSCT (HR 0.24, P=0.07), but this did not result in inferior OS. The monthly direct medical cost per patient within the first two years after HSCT was significantly lower in auto-HSCT compared to MSD-HSCT (P=0.015) and AD-HSCT (P&amp;lt;0.001). Conclusions Our results provide evidence for the use of auto-HSCT as a viable therapeutic option for favorable- and intermediate-risk de novo AML patients in first complete remission with persistent uMRD. Additionally, our findings demonstrated a notable cost advantage associated with auto-HSCT compared to MSD-HSCT and AD-HSCT.

Feasibility and safety of specimen extraction via an enlarged (U-Plus) skin bridge loop ileostomy: a single-center retrospective comparative study.

To investigate the feasibility and safety of specimen extraction via an enlarged (U-Plus) skin bridge loop ileostomy. A retrospective analysis of 95 patients with rectal cancer who underwent laparoscopic low anterior rectal resection and skin bridge loop ileostomy between August 2018 and August 2022, including 44 patients with specimen extraction via an enlarged (U-Plus) skin bridge loop ileostomy (experimental group) and 51 patients with specimen extraction via an abdominal incision (control group). Following the application of propensity score matching (PSM), 34 pairs of data were successfully matched. Subsequently, a comparative analysis was conducted on the clinical data of the two groups. The experimental group exhibited significantly better outcomes than the control group in various aspects. Specifically, the experimental group had lower values for average operative time (P < 0.001), estimated blood loss (P < 0.001), median length of visible incision after surgery (P < 0.001), median VAS pain score on the first day after surgery (P = 0.015), and average postoperative hospitalization (P = 0.001). There was no statistical significance observed in the incidence of stoma-related complications in both groups (P > 0.05). Within each group, the stoma-QOL scores before stoma closure surgery were significantly higher than those at one month and two months after the surgery, with statistical significance (P < 0.05). Specimen extraction via a U-Plus skin bridge loop ileostomy is a safe and feasible method that shortens operation time and postoperative visual incision length, decreases estimated blood loss, and reduces patient postoperative pain compared with specimen extraction via an abdominal incision.