Cluster-robust Standard Errors Research Articles

Unlocking the power of internal audit function (IAF) and corporate social responsibility (CSR): enhancing integrated reporting quality in Malaysian companies

Purpose This study aims to seek to answer concerns about the sufficiency of traditional corporate reporting by examining the influence of the internal audit function’s (IAF) qualities on integrated reporting quality (IRQ) and the moderating effect of corporate social responsibility committee’s (CSRC). Even though integrated reporting (IR) is becoming more significant, nothing is known about the function of IAF in this setting. Design/methodology/approach This study uses ordinary least squares regressions, integrating two-way cluster-robust standard errors (clustered by firm and year), to examine the association between the quality IAF and IRQ, as well as the moderating influence of CSRC, for companies listed in Malaysia spanning the period from 2017 to 2020. Findings Analysing data from Malaysian-listed firms (2017–2020), findings show that increased IAF investments are associated with lower IRQ, particularly in the presence of a CSRC. However, firms with in-house show a positive association with higher IRQ, which is amplified by a CSRC. This suggests a complementary relationship between CSRC and in-house IAF, potentially guiding regulatory practices regarding CSR or sustainability committees. Thus, the presence of CSRC signifies the organization’s dedication to the advancement of sustainable development principles. Originality/value This study’s implications include promoting stronger internal mechanisms such as IAFs and CSRCs, which will ultimately improve IRQ. This research contributes to understanding the combined impact of IAF and CSRC on reporting quality by focusing on them as key governance components influencing both financial and non-financial reporting. As a result, regulators and practitioners can gain insights to improve IR efficacy and stakeholder decision-making.

Associations among environmental unpredictability, changes in resting-state functional connectivity, and adolescent psychopathology in the ABCD study

Abstract Background Unpredictability is a core but understudied dimension of adversities and has been receiving increasing attention recently. The effects of unpredictability on psychopathology and the underlying neural mechanisms, however, remain unclear. It is also unknown how unpredictability interacts with other dimensions of adversities in predicting brain development and psychopathology of youth. Methods We applied cluster robust standard errors to examine how unpredictability was associated with the developmental changes in resting-state functional connectivity (rsFC) of large-scale brain networks implicated in psychopathology, as well as the moderating role of deprivation, using data from the Adolescent Brain Cognitive Development (ABCD) study, which included four measurements from baseline (mean ± s.d. age, 119.13 ± 7.51 months; 2815 females) to 3-year follow-up (N = 5885). Results After controlling for threat, unpredictability was associated with a smaller increase in rsFC within default mode network (DMN) and a smaller decrease in rsFC between cingulo-opercular network (CON) and DMN. Neighborhood educational deprivation moderated the associations between unpredictability and changes in rsFC within DMN and fronto-parietal network (FPN), as well as between CON and DMN. A smaller decrease in rsFC between CON and DMN mediated the association between unpredictability and externalizing problems. Neighborhood educational deprivation moderated the indirect pathway from unpredictability to externalizing problems via a smaller decrease in CON-DMN rsFC. Conclusions Our findings shed light on the neural mechanisms underlying the associations between unpredictability and adolescents' psychopathology and the moderating role of deprivation, highlighting the significance of providing stable environment and abundant educational opportunities to facilitate optimal development.

Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic among Swedish employees: a cohort study on the role of job instability and job insecurity

BackgroundSuicidal ideation may be a warning sign for suicide and previous work has indicated a higher prevalence of suicidal ideation during the COVID-19 pandemic. Job loss and job insecurity are potential risk factors for suicidal ideation, but their importance during the pandemic, and the role of organizational changes for suicidal ideation, is unclear. This study examined the association between various experiences associated with job loss and job insecurity during the pandemic and thoughts of suicide/self-harm in Sweden.MethodsThe study sample was drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Auxiliary data collections in February 2021 and 2022 assessed exposure to job loss/unemployment, furlough, workplace downsizing, or increased job insecurity versus stable employment and thoughts of suicide or self-harm (PHQ-9) during the pandemic. The analyses were based on 1558 individuals (2 349 observations) participating in either or both waves and who had been working before the pandemic. Logistic regression models with cluster-robust standard errors were fitted, including sociodemographic factors and prior mental health problems to control for potential confounding. Measures of personality based on a brief version of the Big-Five personality inventory were also added.ResultsThe results indicated an association between all experiences, except furlough, and thoughts of suicide/self-harm, when adjusting for sex, age, civil status, socioeconomic status and prior mental health (job loss odds ratio (OR) = 3.70, 95% confidence interval (CI) 1.79–7.63, downsizing OR = 2.41, CI 1.24–4.70, job insecurity OR = 2.77, CI 1.15–6.67). The associations for job loss and insecurity were attenuated by adjustment for personality, although it remained statistically significant for downsizing.ConclusionsThe results suggested a higher risk of suicidal ideation connected with loss of employment and survival of a downsizing, but not a forced reduction in working times/pay during the COVID-19 pandemic. The association for subjective job insecurity was less robust and may be partly explained by personality.

Tackle characteristics associated with suspected concussion in female varsity rugby union: a case-control video analysis study

ABSTRACT The tackle is the most frequent and injurious event in rugby union. Tackle-related risk factors for concussion are identified in elite men, but may differ for women. The objective of this study was to evaluate the association between tackle characteristics and suspected concussion-related vs. non-injurious tackle events in Canadian female varsity rugby. Nacsport software was used to code 325 tackle events (46 suspected-concussion, 279 non-concussion). A penalised logistic regression with cluster-robust standard errors was used to estimate odds ratios (OR) [95% confidence intervals (95% CI)]. Ball-carrier concussion was associated with a head contact intensity of 2/4 (OR 6.5, 95% CI 1.3–31.6) and 3–4/4 (OR 48.5, 95% CI 12.1–193.7), illegal tackle (OR = 13.4, 95% CI 2.9–61.0), tap tackle (OR = 6.2, 95% CI 2.0–19.7), and down pre-contact head position (OR = 4.0, 95% CI 1.1–14.8). Tackler concussion was associated with 3 tacklers in the event (OR = 7.0, 95% CI 1.4–36.1), tap tackle (OR = 15.0, 95% CI 1.6–138.3), head contact intensity of 3–4/4 (OR = 30.6, 95% CI 5.6–168.1), and away pre-contact head position (OR = 3.0, 95% CI 1.1–7.8). Interventions aiming to reduce head impacts are needed in female rugby. Future directions should evaluate sex-related tackle characteristic differences.

Smoking's impact on pocket closure after nonsurgical periodontal treatment in relation to bleeding on probing.

Our aim was to investigate the impact of smoking on pocket closure at six months after treatment of severe periodontitis, in relation to residual clinical inflammation. The clinical records of deep pockets (probing depth≥6 mm, n&#61;984) in 46 individuals with periodontitis were analyzed. Following baseline clinical assessments (plaque index, probing depth, clinical attachment level, and bleeding on probing), non-surgical periodontal treatment was performed. Clinical assessments were repeated at 2 and 24 weeks after periodontal therapy. A logistic regression model using generalised estimation equations (GEE) adapting the cluster robust standard errors was performed to investigate potential associations between bleeding on probing and pocket closure at post-treatment 24 weeks. Absence of bleeding at two weeks after non-surgical treatment related to pocket closure after six-months. Pockets that do not bleed neither at baseline nor two weeks (OR&#61;2.7; P <.005) and pockets of non-smokers (OR&#61;6.32; P <.001) and females (OR&#61;1.79; P &#61;.022) associated with pocket closure at six months. Pocket closure is associated with being a non-smoker and the absence of inflammation after non-surgical periodontal treatment, which indicates the importance of smoking cessation and inflammation control in achieving optimal clinical outcomes.

Comparison of two propensity score-based methods for balancing covariates: the overlap weighting and fine stratification methods in real-world claims data

BackgroundTwo propensity score (PS) based balancing covariate methods, the overlap weighting method (OW) and the fine stratification method (FS), produce superb covariate balance. OW has been compared with various weighting methods while FS has been compared with the traditional stratification method and various matching methods. However, no study has yet compared OW and FS. In addition, OW has not yet been evaluated in large claims data with low prevalence exposure and with low frequency outcomes, a context in which optimal use of balancing methods is critical. In the study, we aimed to compare OW and FS using real-world data and simulations with low prevalence exposure and with low frequency outcomes.MethodsWe used the Texas State Medicaid claims data on adult beneficiaries with diabetes in 2012 as an empirical example (N = 42,628). Based on its real-world research question, we estimated an average treatment effect of health center vs. non-health center attendance in the total population. We also performed simulations to evaluate their relative performance. To preserve associations between covariates, we used the plasmode approach to simulate outcomes and/or exposures with N = 4,000. We simulated both homogeneous and heterogeneous treatment effects with various outcome risks (1-30% or observed: 27.75%) and/or exposure prevalence (2.5-30% or observed:10.55%). We used a weighted generalized linear model to estimate the exposure effect and the cluster-robust standard error (SE) method to estimate its SE.ResultsIn the empirical example, we found that OW had smaller standardized mean differences in all covariates (range: OW: 0.0–0.02 vs. FS: 0.22–3.26) and Mahalanobis balance distance (MB) (< 0.001 vs. > 0.049) than FS. In simulations, OW also achieved smaller MB (homogeneity: <0.04 vs. > 0.04; heterogeneity: 0.0-0.11 vs. 0.07–0.29), relative bias (homogeneity: 4.04–56.20 vs. 20–61.63; heterogeneity: 7.85–57.6 vs. 15.0-60.4), square root of mean squared error (homogeneity: 0.332–1.308 vs. 0.385–1.365; heterogeneity: 0.263-0.526 vs 0.313-0.620), and coverage probability (homogeneity: 0.0–80.4% vs. 0.0-69.8%; heterogeneity: 0.0-97.6% vs. 0.0-92.8%), than FS, in most cases.ConclusionsThese findings suggest that OW can yield nearly perfect covariate balance and therefore enhance the accuracy of average treatment effect estimation in the total population.

Relationships between elementary teachers' enjoyment and students' engagement across content areas and among student groups.

We explored associations among teachers' self-reported enjoyment for teaching mathematics, science, and English language arts and their students' self-reported behavioral engagement in each content area, and how these associations varied depending on student sex and socioeconomic status. Participants included 33 fourth-grade teachers and 443 students from 14 schools in the Southwestern United States. Multiple regression models with cluster robust standard errors was used. Models regressed students' content-area engagement on teachers' content-area enjoyment, controlling for students' initial engagement in that content area and other relevant covariates. Teachers' English language arts and mathematics enjoyment were each positively associated with students' engagement in each content area, and an interaction effect was detected in mathematics whereby lower socioeconomic status students with low-mathematics-enjoyment teachers reported lower mathematics engagement. Findings extend recent research highlighting teachers' emotions, and more specifically positive emotions, as factors that can be leveraged to support student learning, as well as provide more nuanced information about the contexts and student groups for whom these processes may be most relevant. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Investigating the Black Birth Experience: A Race-Stratified Analysis of Preterm Birth Risk and Exposure to Metropolitan Statistical Area-Level Police-Related Deaths, US 2018–2019

Police-related violence may be a source of chronic stress underlying entrenched racial inequities in reproductive health in the USA. Using publicly available data on police-related fatalities, we estimated total and victim race-specific rates of police-related fatalities (deaths per 100,000 population) in 2018–2019 for Metropolitan Statistical Areas (MSA) and counties within MSAs in the USA. Rates were linked to data on live births by maternal MSA and county of residence. We fit adjusted log-Poisson models with generalized estimating equations and cluster-robust standard errors to estimate the relative risk of preterm birth associated with the middle and highest tertiles of police-related fatalities compared to the lowest tertile. We included a test for heterogeneity by maternal race/ethnicity and additionally fit race/ethnicity-stratified models for associations with victim race/ethnicity-specific police-related fatality rates. Fully adjusted models indicated significant adverse associations between police-related fatality rates and relative risk of preterm birth for the total population, non-Hispanic Black, and non-Hispanic White groups separately. Results confirm the role of fatal police violence as a social determinant of population health outcomes and inequities, including preterm birth.

Longitudinal method comparison: modeling polygenic risk for post-traumatic stress disorder over time in individuals of African and European ancestry.

Cross-sectional data allow the investigation of how genetics influence health at a single time point, but to understand how the genome impacts phenotype development, one must use repeated measures data. Ignoring the dependency inherent in repeated measures can exacerbate false positives and requires the utilization of methods other than general or generalized linear models. Many methods can accommodate longitudinal data, including the commonly used linear mixed model and generalized estimating equation, as well as the less popular fixed-effects model, cluster-robust standard error adjustment, and aggregate regression. We simulated longitudinal data and applied these five methods alongside naïve linear regression, which ignored the dependency and served as a baseline, to compare their power, false positive rate, estimation accuracy, and precision. The results showed that the naïve linear regression and fixed-effects models incurred high false positive rates when analyzing a predictor that is fixed over time, making them unviable for studying time-invariant genetic effects. The linear mixed models maintained low false positive rates and unbiased estimation. The generalized estimating equation was similar to the former in terms of power and estimation, but it had increased false positives when the sample size was low, as did cluster-robust standard error adjustment. Aggregate regression produced biased estimates when predictor effects varied over time. To show how the method choice affects downstream results, we performed longitudinal analyses in an adolescent cohort of African and European ancestry. We examined how developing post-traumatic stress symptoms were predicted by polygenic risk, traumatic events, exposure to sexual abuse, and income using four approaches-linear mixed models, generalized estimating equations, cluster-robust standard error adjustment, and aggregate regression. While the directions of effect were generally consistent, coefficient magnitudes and statistical significance differed across methods. Our in-depth comparison of longitudinal methods showed that linear mixed models and generalized estimating equations were applicable in most scenarios requiring longitudinal modeling, but no approach produced identical results even if fit to the same data. Since result discrepancies can result from methodological choices, it is crucial that researchers determine their model a priori, refrain from testing multiple approaches to obtain favorable results, and utilize as similar as possible methods when seeking to replicate results.

Drought risk and audit pricing: a mixed-methods study

PurposeClimate change has led to a rise in the frequency, intensity and scope of droughts, posing significant implications for businesses. This study examines the impact of local community drought levels on audit pricing. Additionally, it explores the moderating effects of high-tech industries, auditor busyness and the level of local community concern regarding the drought crisis.Design/methodology/approachThis study employs a mixed-methods approach to rigorously test the research hypotheses. The quantitative phase of the study utilizes a sample of 1,278 firm-year observations from Iran’s capital market. For the analysis of the quantitative data, ordinary least squares regression with clustered robust standard errors is used. Additionally, this research supplements its quantitative findings with qualitative evidence obtained through semi-structured interviews with 19 Iranian audit partners.FindingsThe results suggest that firms operating in provinces facing severe droughts experience notably higher audit fees. Furthermore, the positive relationship between drought and audit fees is weakened when auditors are busy, local community concern regarding the drought crisis is high or the firm operates within high-tech industries. These findings are supported by a range of robustness checks and qualitative evidence gathered from the field.Originality/valueThis research contributes to the growing literature on climate change by examining the influence of local community drought levels on audit pricing within an Iranian context. Additionally, our study sheds light on how high-tech industries, auditor workload and the level of local community concern regarding the drought crisis moderate the relationship between drought and audit fees. Importantly, our study pioneers in providing mixed-methods evidence of the association between drought severity and audit fees.

Syringe reuse among people who inject drugs in rural Appalachian Kentucky

BackgroundPersonal syringe reuse (i.e., reuse of one's own syringes) can place people who inject drugs at increased risk for infectious disease but has received relatively little attention in published literature. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs in rural Kentucky. MethodsParticipants (n = 238) completed interviewer-administered questionnaires on syringe reuse and demographic, behavioral, and service access characteristics. Unadjusted negative binomial regression with cluster-robust standard errors was used to model the associations with a logged offset for number of injections in the past 30 days. ResultsThe average age of the sample was 35 and 59.7 % were male. Most participants (77.7 %) reused syringes at least once in the past 30 days, using each syringe a median of three times. Reuse was higher among those who were older and reported a higher street price for syringes. Syringe reuse was lower among people who were within walking distance to a syringe service program (SSP) and who obtained most of their syringes from SSPs or pharmacies. ConclusionSyringe reuse among people who inject drugs in rural Kentucky is common. However, these data suggest that increased access to syringes from SSPs and pharmacies, as well as policy-level interventions that reduce street syringe price, might reduce syringe reuse and related harms.

Multiple Dimensions of Gender Ideologies: How They Relate to Normative Judgments of the Gender Division of Parental Leave

Abstract Previous research has found that gender ideologies are multidimensional. Additionally, their influence on work–care practices depends on the context, including the life stage, presence of children, and partners’ resources, which has received less attention. This study contributes to the understanding of the conditionality of gender ideologies by examining how dimensions of gender ideologies relate to more specific normative judgments regarding the division of parental leave and testing whether the association depends on partners’ relative earnings. I draw on data from a vignette experiment implemented in the representative German GESIS Panel and apply ordinary least squares (OLS) regression models with cluster-robust standard errors to 8,185 vignette evaluations of 2,249 respondents. More egalitarian ideologies regarding the division of employment and housework and less essentialist ideologies are associated with less traditional judgments of the division of parental leave. Support for individual choice is only associated with less traditional judgments on the condition that the mother earns more.

Get advanced or retreat: well-informed board and bank risk-taking

PurposeThis paper aims to examine the relationship between board structure and risk-taking, exploring how this association is influenced by advanced technologies in the banking sector.Design/methodology/approachThis study uses a panel sample of 22 Pakistani banks from 2011 to 2018. To test the authors’ hypothesis, the authors use regression analysis with two-way cluster robust standard errors. Further, the authors also check the robustness of the authors’ findings using alternate proxies of board structure and bank risk-taking behavior. To address endogeneity concerns, the authors use the two-stage least square technique.FindingsIn the era of the Fourth Industrial Revolution, Pakistani banks’ digitalization is modeled by the presence of Temenos-T24/Oracle as their core banking system (software providing end-to-end operational integration). Its interactional effect with corporate governance is evaluated to implicate informed risk-taking by the board as a result of improved information access and analysis. The authors find that board size has a positive association with risk-taking, and the use of modern technology reshapes this association in the banking sector.Originality/valueThe contribution of this paper is twofold. First, the impact of board structure on bank risk-taking has not been extensively researched in Pakistan – a highly volatile and unpredictable economy. Second, the evaluation of the role of technology on bank risk is being researched for the very first time – a uniqueness of this paper.

Dental implant failures in Utah and US veteran cohorts.

Approximately, 5.5 million dental implants are estimated to be surgically placed in the United States yearly, with an anticipated long-term failure rate ranging from 3% to 10%. At the Salt Lake City Dental Clinic within the Department of Veterans Affairs (VHA), specific protocols have been established to mandate that clinicians present every dental implant case for review by a committee. To understand the effectiveness of this approach, a comparative data analysis was undertaken to compare local dental implant failure data against national VHA data. Leveraging electronic health records of veterans spanning from 2000 to 2021, we gathered procedural records related to dental implant placement or failure, demographic information, and medical history for individuals who received dental care at various dental clinics within the nationwide VHA network. Subsequently, statistical analyses were conducted using mixed-effects Poisson regression models with cluster-robust standard errors. Incident rate ratios (IRRs) for Utah-specific and nationwide cohorts were ascertained. The Utah VHA dental clinical data showed that there was a slightly lower prevalence of implant failure at 6.7% compared to the national cohort, which had a rate of 6.9%. The implant level failure rates were also low, with 4.20 (confidence interval [CI]: 3.68, 4.81) per 1000 implant placements per year for Utah cohorts. The adjusted IRR indicated a relative 16% reduction in risk among Utah Veterans (IRR 0.84, 95% CI [0.76-0.92]; p < 0.001). The stringent protocols in place at Salt Lake City, which integrate evidence-based practices and expert opinion for evaluating patient suitability for dental implant placement and subsequent care, contributed to the reduced risk among Utah Dental Clinic veterans pool compared to veterans of other states.

Sex-Specific Association of Ambient Temperature With Urine Biomarkers in Southwest Coastal Bangladesh

IntroductionMen are vulnerable to ambient heat-related kidney disease burden, but limited evidence exists on how vulnerable women are when exposed to high ambient heat. We evaluated the sex-specific association between ambient temperature and urine electrolytes (concentration and 24-hour excretion), and 24-hour urine total protein, and volume. MethodsWe pooled a longitudinal data of 1,175 participants' concentration and 24-hour excretion of urine electrolytes and other biomarkers (24-hour urine total protein and volume) (5624 person-visits) collected in southwest coastal Bangladesh (Khulna, Satkhira, and Mongla districts) during November 2016 - April 2017. We then spatiotemporally linked ambient temperature data from local weather stations to participants' health outcomes. For evaluating the relationships between average ambient temperature and urine electrolytes and other biomarkers, we plotted confounder-adjusted restricted cubic spline (RCS) plots using participant-, household-, and community-level random intercepts. We then used piece-wise linear mixed-effects models for different ambient temperature segments determined by inflection points in RCS plots and reported the maximum likelihood estimates and cluster robust standard errors. By applying interaction terms for sex and ambient temperature, we determined the overall significance using the Wald test. Bonferroni correction was used for multiple comparisons. ResultsThe RCS plots demonstrated non-linear associations between ambient heat and urine biomarkers for males and females. Piecewise linear mixed-effects models suggested sex did not modify the relationship of ambient temperature with any of the urine parameters after Bonferroni correction (p-value <0.004). ConclusionOur findings suggest that women are as susceptible to the effects of high ambient temperature exposure as men.

Adolescent Mental Health and Resilience Before and During the COVID-19 Pandemic

PurposeWe aimed to assess levels of depression, anxiety, and resilience factors before and during the COVID-19 pandemic in a school sample of adolescents. We also aimed to examine the compensatory and protective effects of individual, family, and school resilience factors on adolescent mental health. MethodsWe used fall 2019 and fall 2020 survey responses from a cluster randomized controlled trial implemented in 20 schools in a Midwestern county. The sample consisted of 3,085 responses from students in grades 5 and 6. Multilevel mixed-effects models with cluster robust standard errors were used to investigate the associations between exposure to the COVID-19 pandemic, mental health (anxiety, depression), and resilience factors (future orientation, family engagement, and having a caring school adult). ResultsAnxiety, but not depression, was higher in fall 2020 compared to fall 2019. Family engagement increased during the pandemic, while future orientation of the student body was lower during that time and the prevalence of having a caring adult at school was unchanged. A positive future orientation was associated with lower levels of anxiety and depression, while having a caring school adult was associated with lower depression. Adolescents with less positive future orientations, low family engagement, and no caring school adults experienced the greatest increases in anxiety. DiscussionPositive future orientations, family engagement, and supportive nonparental adult relationships had compensatory and protective effects on adolescent mental health during the COVID-19 pandemic. Adding these measures to the inventory of modifiable resilience factors during natural disasters may promote healthy adaptation among adolescents.

The Added Value of MRI-Based Targeted Biopsy in Biopsy-Naïve Patients: A Propensity-Score Matched Comparison.

Multiparametric Magnetic Resonance Imaging (mpMRI)-based targeted biopsy has shown to be beneficial in detecting Clinically Significant Prostate Cancer (csPCa) and avoiding diagnosis of Non-csPCa (ncsPCa); however, its role in the treatment of biopsy-naïve patients is still under discussion. After identifying predictors for the diagnosis of csPCa via Multivariate Logistic Regression Analysis (MLRA), a propensity-score (1:1 nearest neighbor) matched comparison was performed between a Systematic-Only Biopsy (SOB) cohort and a mpMRI-based Combined (systematic + targeted) Biopsy (CB) cohort from two tertiary urologic centers (SOB: Department of Urology, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Crete, Greece; CB: LKH Hall in Tirol, Austria). Only biopsy-naïve patients were included in the study. The study period for the included patients was from February 2018 to July 2023 for the SOB group and from July 2017 to June 2023 for the CB group. The primary outcome was the diagnosis of csPCa (≥ISUP 2); secondary outcomes were overall cancer detection, the added value of targeted biopsy in csPCa detection, and the reduction in ncsPCa diagnosis with CB compared to SOB. To estimate the Average Treatment effect of the Treated groups (ATT), cluster-robust standard errors were used to perform g-computation in the matched sample. p-values < 0.05 with a two-sided 95% confidence interval were considered statistically significant. Matching achieved well-balanced groups (each n = 140 for CB and SOB). In the CB group, 65/140 (46.4%) patients were diagnosed with csPCa compared to 44/140 (31.4%) in the SOB group (RR 1.48, 95%-CI: 1.09-2.0, p = 0.01). In the CB group, 4.3% (6/140) and 1.4% (2/140) of csPCa cases were detected with targeted-only and systematic-only biopsy cores, respectively. In the CB group, 22/140 (15.7%) patients were diagnosed with ncsPCa compared to 33/140 (23.6%) in the SOB group (RR = 0.67, 95% CI: 0.41-1.08, p = 0.1). When comparing SOB to CB (ATT), the marginal OR was 0.56 (95% CI: 0.38-0.82, p = 0.003) for the diagnosis of csPCa and 0.75 (95% CI: 0.47-1.05, p = 0.085) for the diagnosis of overall cancer (≥ISUP 1). The CB approach was superior to the SOB approach in detecting csPCa, while no additional detection of ncsPCa was seen. Our results support the application of mpMRI for biopsy-naïve patients with suspicions of prostate cancer.

Effect of on-pump vs. off-pump coronary artery bypass grafting in patients with non-dialysis-dependent severe renal impairment: propensity-matched analysis from the UK registry dataset.

On-pump coronary artery bypass (ONCABG) grafting in patients with a pre-existing poor renal reserve is known to carry significant morbidity and mortality. There is limited controversial evidence on the benefit of off-pump coronary artery bypass (OPCABG) grafting in these high-risk groups of patients. We compared early clinical outcomes in propensity-matched cohorts of patients with non-dialysis-dependent pre-operative severe renal impairment undergoing OPCABG vs. ONCABG, captured in a large national registry dataset. All data for patients with a pre-operative creatinine clearance of less than 50 mL/min who underwent elective or urgent isolated OPCABG or ONCABG from 1996 to 2019 were extracted from the UK National Adult Cardiac Surgery Audit (NACSA) database. Propensity score matching was performed using 1:1 nearest neighbor matching without replacement using several baseline characteristics. We investigated the effect of ONCABG vs. OPCABG in the matched cohort using cluster-robust standard error regression. We identified 8,628 patients with severe renal impairment undergoing isolated CABG, of whom 1,142 (13.23%) underwent OPCABG during the study period. We compared 1,141 propensity-matched pairs of patients undergoing OPCABG vs. ONCABG. The median age of the matched population was 78 years in both groups, with no significant imbalance post-matching in the rest of the variables. There was no difference between OPCABG and ONCABG in in-hospital mortality rates, post-operative dialysis, and stroke rates. However, the return to theatre for bleeding or tamponade was higher in ONCABG vs. OPCABG (P > 0.02); however, OPCABG reduced the total length of stay in the hospital by 1 day (P = 0.008). After double adjustment in the matched population using cluster-robust standard regression, ONCABG did not increase mortality compared to OPCABG (OR, 1.05, P = 0.78), postoperative stroke (OR, 1.7, P = 0.12), and dialysis (OR, 0.7, P = 0.09); however, ONCABG was associated with an increased risk of bleeding (OR, 1.53, P = 0.03). In this propensity analysis of a large national registry dataset, we found no difference in early mortality and stroke in patients with pre-operative severe renal impairment undergoing OPCABG or ONCABG surgery; however, ONCABG was associated with an increased risk of return to theatre for bleeding and an increased length of hospital stay.

Evaluating two small-sample corrections for fixed-effects standard errors and inferences in multilevel models with heteroscedastic, unbalanced, clustered data

Multilevel modeling (MLM) is commonly used in psychological research to model clustered data. However, data in applied research usually violate one of the essential assumptions of MLM—homogeneity of variance. While the fixed-effect estimates produced by the maximum likelihood method remain unbiased, the standard errors for the fixed effects are misestimated, resulting in inaccurate inferences and inflated or deflated type I error rates. To correct the bias in fixed effects standard errors and provide valid inferences, small-sample corrections such as the Kenward-Roger (KR) adjustment and the adjusted cluster-robust standard errors (CR-SEs) with the Satterthwaite approximation for t tests have been used. The current study compares KR with random slope (RS) models and the adjusted CR-SEs with ordinary least squares (OLS), random intercept (RI) and RS models to analyze small, heteroscedastic, clustered data using a Monte Carlo simulation. Results show the KR procedure with RS models has large biases and inflated type I error rates for between-cluster effects in the presence of level 2 heteroscedasticity. In contrast, the adjusted CR-SEs generally yield results with acceptable biases and maintain type I error rates close to the nominal level for all examined models. Thus, when the interest is only in within-cluster effect, any model with the adjusted CR-SEs could be used. However, when the interest is to make accurate inferences of the between-cluster effect, researchers should use the adjusted CR-SEs with RS to have higher power and guard against unmodeled heterogeneity. We reanalyzed an example in Snijders & Bosker (2012) to demonstrate the use of the adjusted CR-SEs with different models.

Social Disconnectedness, Perceived Loneliness, and Cognitive Functioning: The Role of Neighborhood Environment.

Social disconnectedness and loneliness pose significant challenges for older Chinese immigrants. Yet, it remains unclear whether they are associated with an increased risk of cognitive decline in this population. This study aimed to investigate the association of social disconnectedness and loneliness with cognitive functioning and examine the moderation role of neighborhood contexts. This longitudinal analysis examined a sample of individuals aged 60 years and older from the Population Study of Chinese Elderly in Chicago (N = 2,044). Global cognition was assessed using the averaged z-scores of cognitive performance tests. Social disconnectedness was constructed using 5 indicators about structural aspects of social relationships. Loneliness was assessed with the R-UCLA loneliness scale. Neighborhood socioeconomic status (NSES) and neighborhood segregation index were constructed using 2010-2014 American Community Survey data at the census tract level. Individual perceptions about neighborhood environments were used to construct neighborhood cohesion index and neighborhood disorder index (NDI). Latent growth curve models with adjusted cluster robust standard errors were estimated. More loneliness was associated with a higher level of initial cognitive functioning (B = 0.030, p < .01), but also with a faster decline rate over time (B = -0.007, p < .01) after adjusting for covariates. High NSES and less neighborhood segregation buffered the negative effects of loneliness on cognitive decline, respectively. High NDI amplified the positive relationship between loneliness and initial functioning, but accelerated the rate of cognitive decline associated with loneliness. The study revealed that perceived loneliness, but not social disconnectedness, is a risk factor for cognitive decline among older Chinese immigrants. Living in a neighborhood with low socioeconomic status, more segregation, and high disorder elevated the detrimental effect of loneliness on long-term cognitive decline. Further research needs to investigate the complex interplay between social relationships, neighborhood environment, and cognition.