Multistate Approach Research Articles

Impact of age at HBsAg seroclearance on hepatic outcomes and life expectancy in men with chronic HBV infection based on multi-state modeling of the natural history.

The effects of age at HBsAg seroclearance on clinical outcomes and survival in chronic hepatitis B (CHB) have not been adequately assessed. We evaluated the impact of age at HBsAg seroclearance on long-term outcomes, along with how coexisting factors modified risks and life expectancy in CHB patients. We used multi-state modeling approach to examine transitions through the CHB continuum in a longitudinal cohort study of male civil servants recruited in 1989-1992. Hepatic outcomes and deaths were identified by clinical evaluation and linkage with national health databases. Four sets of risk factors (CHB-related, metabolic, lifestyle, and genetic factors) were assessed. Of 2551 HBsAg carriers, with follow-up until 2021 or death, 695 achieved HBsAg seroclearance, 490 developed cirrhosis (88 decompensated), 252 developed hepatocellular carcinoma (HCC), and 652 died. The cumulative rates for HCC were 1.1% and 1.5% at 10years after HBsAg seroclearance, respectively, for patients achieving seroclearance at age 50 and 60; correspondingly, the rates for cirrhosis were 2.3% and 3.0%. Developing HBsAg seroclearance was associated with a reduced risk of cirrhosis (HR = 0.37, 95% CI 0.15-0.92) but not HCC. Patients experiencing HBsAg seroclearance lived longer years free of major liver diseases than HBsAg-persistent patients, and achieving seroclearance at age 50 (vs 60) led to a greater increase in the disease-free life expectancy. However, obesity and smoking were associated with adverse hepatic outcomes and loss of the disease-free life expectancy following HBsAg seroclearance. Our findings highlight the benefit of earlier HBsAg seroclearance for gains in disease-free life expectancy and the impact of obesity and smoking on loss of the life years free of major liver diseases following HBsAg seroclearance.

Assessing the impact of Delta and Omicron in German intensive care units: a retrospective, nationwide multistate analysis

BackgroundThe spread of several severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) variants of concern (VOCs) has repeatedly led to increasing numbers of coronavirus disease 2019 (COVID-19) patients in German intensive care units (ICUs), resulting in capacity shortages and even transfers of COVID-19 intensive care patients between federal states in late 2021. In this respect, there is scarce evidence on the impact of predominant VOCs in German ICUs at the population level.MethodsA retrospective cohort study was conducted from July 01, 2021, to May 31, 2022, using daily nationwide inpatient billing data from German hospitals on COVID-19 intensive care patients and SARS-CoV-2 sequence data from Germany. A multivariable Poisson regression analysis was performed to estimate the incidence rate ratios (IRRs) of transfer (to another hospital during inpatient care), discharge (alive) and death of COVID-19 intensive care patients associated with Delta or Omicron, adjusted for age group and sex. In addition, a multistate approach was used for the clinical trajectories of COVID-19 intensive care patients to estimate their competing risk of transfer, discharge or death associated with Delta or Omicron, specifically concerning patient age.ResultsA total of 6046 transfers, 33256 discharges, and 12114 deaths were included. Poisson regression analysis comparing Omicron versus Delta yielded an estimated adjusted IRR of 1.23 (95% CI 1.16–1.30) for transfers, 2.27 (95% CI 2.20–2.34) for discharges and 0.98 (95% CI 0.94–1.02) for deaths. For ICU deaths in particular, the estimated adjusted IRR increased from 0.14 (95% CI 0.08–0.22) for the 0–9 age group to 4.09 (95% CI 3.74–4.47) for those aged 90 and older compared to the reference group of 60-69-year-olds. Multistate analysis revealed that Omicron was associated with a higher estimated risk of discharge for COVID-19 intensive care patients across all ages, while Delta infection was associated with a higher estimated risk of transfer and death.ConclusionsRetrospective, nationwide comparisons of transfers, discharges and deaths of COVID-19 intensive care patients during Delta- and Omicron-dominated periods in Germany suggested overall less severe clinical trajectories associated with Omicron. Age was confirmed to be an important determinant of fatal clinical outcomes in COVID-19 intensive care patients, necessitating close therapeutic care for elderly people and appropriate public health control measures.

Regional multi-station real-time time transfer using an undifferenced multi-GNSS network solution

Real-time time transfer is the basis for the time synchronization and establishment and maintenance of time scales. In this contribution, we present a regional multi-station real-time time transfer approach, in which observations from multi-global navigation satellite system (GNSS) received at regional multi-station are integrated to conduct an undifferenced network solution. Consequently, the simultaneous estimation of receiver clock offsets for multiple stations becomes possible, enabling the execution of real-time time transfer. One week of observation data from five multi-GNSS Experiment (MGEX) stations located in Europe are selected to generate four links (distances from 919.7 to 2153.4 km), and four schemes are designed, i.e., GPS-only, BDS-3-only, Galileo-only, and GPS/BDS-3/Galileo (GCE) solutions, respectively. Experiment results show that the mean number of observations, time dilution of precision (TDOP) values, and standard deviation (STD) of clock offset difference time series between the Center for Orbit Determination in Europe (CODE) and the estimated solutions for four time links are 90, 76, 72, 239 and 0.34, 0.38, 0.39, 0.21 and 0.039, 0.050, 0.043, 0.036 ns for GPS-only, BDS-3-only, Galileo-only, and GCE solutions, respectively. When the averaging time is shorter than 7680 s, the frequency stability of GCE solutions shows the best performance. The mean frequency stability of four time links at 7680 s is 6.59 × 10–15,7.25 × 10–15, 6.88 × 10–15 and 5.96 × 10–15 for GPS-only, BDS-3-only, Galileo-only, and GCE solutions, respectively. The GCE solution shows the best performance among the four schemes in terms of the number of observations, TDOP, STD, and frequency stability. The experiment results demonstrate that this approach is suitable for regional multi-station real-time time transfer.

Antibiotic Prophylaxis During Allogeneic Stem Cell transplantation—A Comprehensive Single Center Retrospective Analysis

BackgroundProphylactic antibiotics are still controversial during allogeneic hematopoietic stem cell transplantation (allo-HSCT). In our transplant center, we suspended antibiotic prophylaxis during allo-HSCT in 2017. ObjectiveThe main objective of this study was the detailed analysis of the potentially beneficial impact of omittance of standard antibiotic prophylaxis during allo-HSCT in survival and Graft-versus-Host disease (GvHD) development, especially with consideration of confounding factors and competing events. Secondary objectives were the evaluation of the risk of severe infections and transplant-related mortality without antibiotic prophylaxis, the detailed assessment of bacterial and viral infections including multiresistant pathogens as well as occurrence of relapse in both groups. This study aims to support the development of future antibiotic strategies in allo-HSCT. Study DesignWe retrospectively analyzed patient outcome in the time periods before (between December 2012 and February 2017) and after suspension (between March 2017 and June 2020) of antibiotic prophylaxis during allo-HSCT. Relevant clinical outcome parameters of the patients (n = 221) were collected by chart-review in the two groups (with antibiotic prophylaxis n = 101 versus without antibiotic prophylaxis n = 120). All patients were 18 years or older. Propensity score methods were used to adjust for potentially confounding patient characteristics. To address competing events, transitions between moderate/severe acute and chronic GvHD, relapse and death were analyzed using an inverse-propensity score weighted multistate modeling approach. ResultsWhile we observed a trend towards an improved outcome in the cohort without antibiotic prophylaxis, the inverse-propensity-score-weighted analyses did not show significant differences between the two groups in overall survival (OS) (P = .811) or development of acute GvHD (aGvHD) grade 3/4 (P = .158) and chronic moderate/severe GvHD (cGvHD) (P = .686). Multistate analysis respecting competing events revealed comparable estimated probabilities without antibiotic prophylaxis versus with antibiotic prophylaxis in OS (35.0% [95% CI: 28.2%-42.7%] versus 35.3% [95% CI: 27.8%-41.1%]) as well as development of aGvHD grade 3/4 (7.7% [95% CI: 5.9%-12.2%] vs. 10.6% [95% CI: 7.7%-15.7%]) and moderate/severe cGvHD (21.0% [95% CI: 17.7%-30.0%] vs. 23.8% [95% CI: 19.6%-31.4%]). Similar analyses showed also no significant differences in relapse rate, transplant-related mortality, relapse-related mortality, or GvHD-free/relapse-free survival between the two groups. An observed increase in severe infections without antibiotic prophylaxis did not lead to a significantly higher mortality rate. Viral reactivation and detection of multiresistant bacteria were comparable, yet a higher incidence of Clostridioides difficile infections was observed in patients receiving antibiotic prophylaxis. ConclusionOur study supports previous reports of noninferiority of allo-HSCT without use of antibiotic prophylaxis with close monitoring and rapid intervention, if infection is suspected. The trend towards improved outcomes without antibiotic prophylaxis, however, might not only be due to the absence of antibiotic prophylaxis but also due to additional progresses in the field over the recent years. While the present study is too small to draw definite conclusions, these results strongly warrant further multicenter studies addressing the potential benefit of omitting antibiotic prophylaxis during allo-HSCT.

Constructing a temperature transferable coarse-grained model of cis-1,4-polyisoprene with the structural and thermodynamic consistency aided by machine learning

Polyisoprene (PI) is a widely used polymer and constructing a systematic coarse-grained (CG) PI model with the structural and thermodynamic consistency with the underlying atomic model over a wide range of thermodynamic conditions is very important for the predictive capability of CG model on overall properties of PI polymer materials and the establishment of their structure-property relationship. However, as the number of tunable CG potential parameters and target properties grows, traditional parameter tuning methods become impractical. In this work, we present a novel approach for determining the optimal CGPI non-bonded potential parameters by employing Particle Swarm Optimization as the calibrator with machine learning-based models trained using molecular dynamics data. The resulting CG model is further augmented with temperature factors through a multistate parameterization approach. This enhancement ensures the model's temperature transferability of structure and thermodynamics in a wide temperature of 150K∼750K.

Family trajectories among immigrants and their descendants in three European countries: A multistate approach in comparative research

This study investigates partnership changes and childbearing among immigrants and their descendants in the UK, France, and Germany. Our analysis of longitudinal data shows, first, significant diversity in family trajectories among immigrants and their descendants in Europe. Immigrants from other European countries and their descendants tend to cohabit prior to marriage, and their fertility in unions is often similar to that of the native population. In contrast, South Asians and Turkish populations exhibit marriage-centred family behaviour with elevated third-birth rates. Individuals of sub-Saharan African or Caribbean origin display higher rates of non-marital family transitions. Second, we observe some changes in partnership and childbearing patterns across migrant generations; these are stronger for fertility than for partnership patterns. Third, migration background is particularly associated with partnership patterns, whereas the destination country context influences childbearing patterns. We expect some patterns to persist across future migrant generations (e.g. preference for marriage vs cohabitation), whereas others are likely to vanish (e.g. large families).

A multi-analytical approach for the identification of pollutant sources on black crust samples: Stable isotope ratio of carbon, sulphur, and oxygen

This study is focused on the identification of pollutant sources on black crust (BC) samples from the Monumental Cemetery of Milan (Italy), through a multi-analytical approach based on the determination of stable isotope ratios of carbon, sulphur, and oxygen. Six black crust samples, mainly developed on marble sculptures over a time span of 100–150 years, were analysed.For the first time, δ13C was measured for BC samples: δ13C values of the pulverized samples (from −1.2 to +1.3 ‰) are very close to the values obtained from the carbonate matrix, whereas after the removal of the matrix through acidification, δ13C values of BC samples from Milan range from −27.2 to −22.1 ‰, with no significant variation between samples with different ratios of organic carbon to elemental carbon. In sum, the δ13C values obtained for all BC samples fall within the range of anthropogenic emissions such as vehicle traffic, coal combustion and industrial emissions.δ34S and δ18O values of sulphate from BC samples range from −6.3 to +7.0 ‰ and from +7.6 to +10.5 ‰, respectively. Coupling the analysis of the oxygen isotope ratio with that of sulphur enables a more precise identification of the origin of sulphates: the observed isotopic composition falls in the range typical for anthropogenic emission of sulphur dioxide.Overall, in this study, C, S and O isotopes were combined for the first time to assess pollutant sources on black crust samples: this multi-stable isotope approach allowed to show that the BC formation on monuments from the Monumental Cemetery of Milan mostly results from anthropogenic emissions from fossil fuels combustion by road vehicles and factories, as well as domestic heating.

Retention in care and antiretroviral therapy adherence among Medicaid beneficiaries with HIV, 2001–2015

ABSTRACT Disparities in HIV care by socioeconomic status, place of residence, and race/ethnicity prevent progress toward epidemic control. No study has comprehensively characterized the HIV care cascade among people with HIV enrolled in Medicaid – an insurance source for low-income individuals in the US. We analyzed data from 246,127 people with HIV enrolled in Medicaid 2001–2015, aged 18–64, living in 14 US states. We estimated the monthly prevalence of four steps of the care cascade: retained in care/adherent to ART; retained/not adherent; not retained/adherent; not retained/not adherent. Beneficiaries were retained in care if they had an outpatient care encounter every six months. Adherence was based on medication possession ratio. We estimated prevalence using a non-parametric multi-state approach, accounting for death as a competing event and for Medicaid disenrollment using inverse probability of censoring weights. Across 2001–2015, the proportion of beneficiaries with HIV who were retained/ART adherent increased, overall and in all subgroups. By 2015, approximately half of beneficiaries were retained in care, and 42% of beneficiaries were ART adherent. We saw meaningful differences by race/ethnicity and region. Our work highlights an important disparity in the HIV care cascade by insurance status during this time period.

Using a multistate mapping approach to surface hopping to predict the ultrafast electron diffraction signal of gas-phase cyclobutanone.

Using the recently developed multistate mapping approach to surface hopping (multistate MASH) method combined with SA(3)-CASSCF(12,12)/aug-cc-pVDZ electronic structure calculations, the gas-phase isotropic ultrafast electron diffraction (UED) of cyclobutanone is predicted and analyzed. After excitation into the n-3s Rydberg state (S2), cyclobutanone can relax through two S2/S1 conical intersections, one characterized by compression of the CO bond and the other by dissociation of the α-CC bond. Subsequent transfer into the ground state (S0) is then achieved via two additional S1/S0 conical intersections that lead to three reaction pathways: α ring-opening, ethene/ketene production, and CO liberation. The isotropic gas-phase UED signal is predicted from the multistate MASH simulations, allowing for a direct comparison to the experimental data. This work, which is a contribution to the cyclobutanone prediction challenge, facilitates the identification of the main photoproducts in the UED signal and thereby emphasizes the importance of dynamics simulations for the interpretation of ultrafast experiments.

Quantifying intraspecific variation in host resistance and tolerance to a lethal pathogen.

Testing for intraspecific variation for host tolerance or resistance in wild populations is important for informing conservation decisions about captive breeding, translocation, and disease treatment. Here, we test the importance of tolerance and resistance in multiple populations of boreal toads (Anaxyrus boreas boreas) against Batrachochytrium dendrobatidis (Bd), the amphibian fungal pathogen responsible for the greatest host biodiversity loss due to disease. Boreal toads have severely declined in Colorado (CO) due to Bd, but toad populations challenged with Bd in western Wyoming (WY) appear to be less affected. We used a common garden infection experiment to expose post-metamorphic toads sourced from four populations (2 in CO and 2 in WY) to Bd and monitored changes in mass, pathogen burden and survival for 8 weeks. We used a multi-state modelling approach to estimate weekly survival and transition probabilities between infected and cleared states, reflecting a dynamic infection process that traditional approaches fail to capture. We found that WY boreal toads are more tolerant to Bd infection with higher survival probabilities than those in CO when infected with identical pathogen burdens. WY toads also appeared more resistant to Bd with a higher probability of infection clearance and an average of 5 days longer to reach peak infection burdens. Our results demonstrate strong intraspecific differences in tolerance and resistance that likely contribute to why population declines vary regionally across this species. Our multi-state framework allowed us to gain inference on typically hidden disease processes when testing for host tolerance or resistance. Our findings demonstrate that describing an entire host species as 'tolerant' or 'resistant' (or lack thereof) is unwise without testing for intraspecific variation.

Childhood Transitions Between Weight Status Categories: Evidence from the UK Millennium Cohort Study.

Assessing the cost-effectiveness of interventions targeting childhood excess weight requires estimates of the hazards of transitioning between weight status categories. Current estimates are based on studies characterized by insufficient sample sizes, a lack of national representativeness, and untested assumptions. We sought to (1) estimate transition probabilities and hazard ratios for transitioning between childhood weight status categories, (2) test the validity of the underlying assumption in the literature that transitions between childhood bodyweight categories are time-homogeneous, (3) account for complex sampling procedures when deriving nationally representative transition estimates, and (4) explore the impact of child, maternal, and sociodemographic characteristics. We applied a multistate transition modeling approach accounting for complex survey design to UK Millennium Cohort Study (MCS) data to predict transition probabilities and hazard ratios for weight status movements for children aged 3-17. Surveys were conducted at ages 3 (wave 2 in 2004), 5 (wave 3 in 2006), 7 (wave 4 in 2008), 11 (wave 5 in 2012), 14 (wave 6 in 2015), and 17 (wave 7 in 2018) years. We derived datasets that included repeated body mass index measurements across waves after excluding multiple births and children with missing or implausible bodyweight records. To account for the stratified cluster sample design of the MCS, we incorporated survey weights and jackknife replicates of survey weights. Using a validation dataset from the MCS, we tested the validity of our models. Finally, we estimated the relationships between state transitions and child, maternal, and sociodemographic factors. The datasets for our primary analysis consisted of 10,399 children for waves 2-3, 10,729 for waves 3-4, 9685 for waves 4-5, 8593 for waves 5-6, and 7085 for waves 6-7. All datasets consisted of roughly equal splits of boys and girls. Under the assumption of time-heterogeneous transition rates (our base-case model), younger children (ages 3-5 and 5-7 years) had significantly higher annual transition probabilities of moving from healthy weight to overweight (0.033, 95% confidence interval [CI] 0.026-0.041, and 0.027, 95% CI 0.021-0.033, respectively) compared to older children (0.015, 95% CI 0.012-0.018, at ages 7-11; 0.018, 95% CI 0.013-0.023, at ages 11-14; and 0.018, 95% CI 0.013-0.025 at ages 14-17 years). However, the resolution of unhealthy weight was more strongly age-dependent than transitions from healthy weight to non-healthy weight states. Transition hazards differed by child, maternal, and sociodemographic factors. Our models generated estimates of bodyweight status transitions in a representative UK childhood population. Compared to our scenario models (i.e., time-homogeneous transition rates), our base-case model fits the observed data best, indicating a non-time-homogeneous pattern in transitions between bodyweight categories during childhood. Transition hazards varied significantly by age and across subpopulations, suggesting that conducting subgroup-specific cost-effectiveness analyses of childhood weight management interventions will optimize decision-making.

Estimating the Sex Gap in Depression-Free Life Expectancy Among Widowed Americans Aged 50 and Older: An Application Using the Interpolated Markov Chain Approach.

Using Interpolated Markov Chain software, we compare the length of life with and without depression among married individuals and widowers, and the related sex differences. We applied a multi-state life table approach to estimate depression-free life expectancy among recent cohorts of older married and widowed women and men in the United States, using data from the Health and Retirement Study over a 7-year period (2012-2018). The study revealed that the difference in life expectancy between sexes widens in the context of widowhood. At age 50, the sex gap in depression-free life expectancy is 0.8years among married people, whereas the gap almost doubles to 1.7years among widowed people. By quantifying disparities in the duration of life affected by depression between married and widowed women and men, policymakers could properly allocate resources specifically to address the mental health needs of these groups.

Premorbid personality traits as predictors for incident predementia syndromes: a multistate model approach.

Associations have been found between five-factor model (FFM) personality traits and risk of developing specific predementia syndromes such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). The aims of this study were to: 1) Compare baseline FFM traits between participants who transitioned from healthy cognition or SCD to amnestic MCI (aMCI) versus non-amnestic MCI (naMCI); and 2) Determine the relationship between FFM traits and risk of transition between predementia cognitive states. Participants were 562 older adults from the Einstein Aging Study, 378 of which had at least one follow-up assessment. Baseline data collected included levels of FFM personality traits, anxiety and depressive symptoms, medical history, performance on a cognitive battery, and demographics. Follow-up cognitive diagnoses were also recorded. Mann-Whitney U tests revealed no differences in baseline levels of FFM personality traits between participants who developed aMCI compared to those who developed naMCI. A four-state multistate Markov model revealed that higher levels of conscientiousness were protective against developing SCD while higher levels of neuroticism resulted in an increased risk of developing SCD. Further, higher levels of extraversion were protective against developing naMCI. FFM personality traits may be useful in improving predictions of who is at greatest risk for developing specific predementia syndromes. Information on these personality traits could enrich clinical trials by permitting trials to target individuals who are at greatest risk for developing specific forms of cognitive impairment. These results should be replicated in future studies with larger sample sizes and younger participants.

Evaluating the mobility and environmental effects of light-rail transit developments using a multi-state supernetwork approach

Mass light-rail transit (LRT) has been promoted as an effective solution toward sustainable transportation in urban areas. This paper presents a micro-simulation framework combining the multi-state supernetwork (MSN) approach and a mobility-related emission module to evaluate the mobility and environmental effects of LRT developments. The evaluation framework considers individuals’ mode choice of LRT and particularly the trip chaining with their private vehicles to conduct daily activity programs. As complementary policies to LRT developments, parking pricing and park & ride (P + R) developments are also integrated. The output of daily travel patterns from the MSN approach can be used congruently to calculate the air pollutant emissions. The framework is applied to the extended Metropolitan area of Eindhoven (the Netherlands), where new LRT developments and additional parking policies are considered to improve accessibility and reduce environmental effects. The micro-simulation concerns a synthetic population of approximately 110,000 individuals and seven LRT scenarios. The simulation results show a decrease in overall vehicle kilometers traveled and travel time, an increase in public transport use, a decrease in total air pollutant emissions, and an increase in activities in areas around public transport stops and P + R locations. It appears that the inclusion of parking measures in the simulations strengthens the effects, confirming the effectiveness of policy combinations.

The cost-effectiveness of germline BRCA testing-guided olaparib treatment in metastatic castration resistant prostate cancer.

Olaparib targets the DNA repair pathways and has revolutionized the management of metastatic castration resistant prostate cancer (mCRPC). Treatment with the drug should be guided by genetic testing; however, published economic evaluations did not consider olaparib and genetic testing as codependent technologies. This study aims to assess the cost-effectiveness of BRCA germline testing to inform olaparib treatment in mCRPC. We conducted a cost-utility analysis of germline BRCA testing-guided olaparib treatment compared to standard care without testing from an Australian health payer perspective. The analysis applied a decision tree to indicate the germline testing or no testing strategy. A Markov multi-state transition approach was used for patients within each strategy. The model had a time horizon of 5years. Costs and outcomes were discounted at an annual rate of 5 percent. Decision uncertainty was characterized using probabilistic and scenario analyses. Compared to standard care, BRCA testing-guided olaparib treatment was associated with an incremental cost of AU$7,841 and a gain of 0.06 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was AU$143,613 per QALY. The probability of BRCA testing-guided treatment being cost effective at a willingness-to-pay threshold of AU$100,000 per QALY was around 2 percent; however, the likelihood for cost-effectiveness increased to 66 percent if the price of olaparib was reduced by 30 percent. This is the first study to evaluate germline genetic testing and olaparib treatment as codependent technologies in mCRPC. Genetic testing-guided olaparib treatment may be cost-effective with significant discounts on olaparib pricing.

Building a multistate model from electronic health records data for modeling long-term diabetes complications

Abstract Objective: The progression of long-term diabetes complications has led to a decreased quality of life. Our objective was to evaluate the adverse outcomes associated with diabetes based on a patient’s clinical profile by utilizing a multistate modeling approach. Methods: This was a retrospective study of diabetes patients seen in primary care practices from 2013 to 2017. We implemented a five-state model to examine the progression of patients transitioning from one complication to having multiple complications. Our model incorporated high dimensional covariates from multisource data to investigate the possible effects of different types of factors that are associated with the progression of diabetes. Results: The cohort consisted of 10,596 patients diagnosed with diabetes and no previous complications associated with the disease. Most of the patients in our study were female, White, and had type 2 diabetes. During our study period, 5928 did not develop complications, 3323 developed microvascular complications, 1313 developed macrovascular complications, and 1129 developed both micro- and macrovascular complications. From our model, we determined that patients had a 0.1334 [0.1284, .1386] rate of developing a microvascular complication compared to 0.0508 [0.0479, .0540] rate of developing a macrovascular complication. The area deprivation index score we incorporated as a proxy for socioeconomic information indicated that patients who reside in more disadvantaged areas have a higher rate of developing a complication compared to those who reside in least disadvantaged areas. Conclusions: Our work demonstrates how a multistate modeling framework is a comprehensive approach to analyzing the progression of long-term complications associated with diabetes.

Exciton dynamics from the mapping approach to surface hopping: comparison with Förster and Redfield theories.

We compare the recently introduced multi-state mapping approach to surface hopping (MASH) with the Förster and Redfield theories of excitation energy transfer. Whereas Förster theory relies on weak coupling between chromophores, and Redfield theory assumes the electronic excitations to be weakly coupled to fast chromophore vibrations, MASH is free from any perturbative or Markovian approximations. We illustrate this with an example application to the rate of energy transfer in a Frenkel-exciton dimer, showing that MASH interpolates correctly between the opposing regimes in which the Förster and Redfield results are reliable. We then compare the three methods for a realistic model of the Fenna-Matthews-Olson complex with a structured vibrational spectral density and static disorder in the excitation energies. In this case there are no exact results for comparison so we use MASH to assess the validity of Förster and Redfield theories. We find that Förster theory is the more accurate of the two on the picosecond timescale, as has been shown previously for a simpler model of this particular light-harvesting complex. We also explore various ways to sample the initial electronic state in MASH and find that they all give very similar results for exciton dynamics.

Multistate modeling for estimating clinical outcomes of Covid-19 patients

The severity of COVID-19 is often associated with severe pneumonia requiring intensive care unit (ICU) without Ventilation and ICU with ventilation. Clinical outcomes depend on the length of the ICU and the duration of the states. It is difficult to estimate how many people will experience each of these outcomes (discharge, death) due to the time dependence of the data and the potential for multiple events. Because of their time dependence, potential multiple events, and competing, terminal events of discharge, alive and death, estimating these quantities statistically is challenging. The main objective of this paper is to study the time-dependent progress of COVID-19 patients through the multistate approach with hazard rates and transition probabilities. The methodology allows for the analysis of active instances by accommodating censoring and the probability plots offer comprehensive information in a straightforward manner that can be easily shared with decision-makers in healthcare capacity planning

HAPPY LIFE EXPECTANCY AND REGIONAL AND GROUP HETEROGENEITY AMONG CHINESE OLDER ADULTS

Abstract A long, healthy and happy life is the aspiration of most people and an essential part of human well-being. However, longer life expectancy does not mean a higher quality of life. The measure of quality of life includes both objective and subjective indicators. Similar to healthy life expectancy, happy life expectancy is a measure that combines life expectancy with happiness indicators and can reflect both life length and quality of life. But at present, there is relatively little research on happy life expectancy. In China, there have been no studies using panel data to calculate happy life expectancy. We obtained longitudinal data from the Chinese Longitudinal Health Longevity Survey (CLHLS). We used the multistate life table approach to calculate the happy life expectancy of Chinese older adults, and analyzed the regional and group heterogeneity. A total of 13,807 participants aged 65 and older were included in this study. We found that the proportion of happy life expectancy to remaining life of Chinese older adults increased with age, which confirmed the “compression of unhappiness” hypothesis. In addition, older adults with more education had a higher proportion of happy life expectancy than those with less education. Finally, in terms of region, older adults in the more economically developed areas of eastern China have a higher proportion of happy life expectancy. Our findings provide a more comprehensive understanding of the quality of life of Chinese older adults and highlight the importance of education for the happiness of older adults in later life.

Dealing with time-dependent exposures and confounding when defining and estimating attributable fractions-Revisiting estimands and estimators.

The population-attributable fraction (PAF) is commonly interpreted as the proportion of events that can be ascribed to a certain exposure in a certain population. Its estimation is sensitive to common forms of time-dependent bias in the face of a time-dependent exposure. Predominant estimation approaches based on multistate modeling fail to fully eliminate such bias and, as a result, do not permit a causal interpretation, even in the absence of confounding. While recently proposed multistate modeling approaches can successfully eliminate residual time-dependent bias, and moreover succeed to adjust for time-dependent confounding by means of inverse probability of censoring weighting, inadequate application, and misinterpretation prevails in the medical literature. In this paper, we therefore revisit recent work on previously proposed PAF estimands and estimators in settings with time-dependent exposures and competing events and extend this work in several ways. First, we critically revisit the interpretation and applied terminology of these estimands. Second, we further formalize the assumptions under which a causally interpretable PAF estimand can be identified and provide analogous weighting-based representations of the identifying functionals of other proposed estimands. This representation aims to enhance the applied statistician's understanding of different sources of bias that may arise when the aim is to obtain a valid estimate of a causally interpretable PAF. To illustrate and compare these representations, we present a real-life application to observational data from the Ghent University Hospital ICUs to estimate the fraction of ICU deaths attributable to hospital-acquired infections.