Multivariate Linear Models Research Articles

A Nonparametric Global Win Probability Approach to the Analysis and Sizing of Randomized Controlled Trials With Multiple Endpoints of Different Scales and Missing Data: Beyond O'Brien-Wei-Lachin.

Multiple primary endpoints are commonly used in randomized controlled trials to assess treatment effects. When the endpoints are measured on different scales, the O'Brien rank-sum test or the Wei-Lachin test for stochastic ordering may be used for hypothesis testing. However, the O'Brien-Wei-Lachin (OWL) approach is unable to handle missing data and adjust for baseline measurements. We present a nonparametric approach for data analysis that encompasses the OWL approach as a special case. Our approach is based on quantifying an endpoint-specific treatment effect using the probability that a participant in the treatment group has a better score than (or a win over) a participant in the control group. The average of the endpoint-specific win probabilities (WinPs), termed the global win probability (gWinP), is used to quantify the global treatment effect, with the null hypothesis gWinP = 0.50. Our approach involves converting the data for each endpoint to endpoint-specific win fractions, and modeling the win fractions using multivariate linear mixed models to obtain estimates of the endpoint-specific WinPs and the associated variance-covariance matrix. Focusing on confidence interval estimation for the gWinP, we derive sample size formulas for clinical trial design. Simulation results demonstrate that our approach performed well in terms of bias, interval coverage percentage, and assurance of achieving a pre-specified precision for the gWinP. Illustrative code for implementing the methods using SAS PROC RANK and PROC MIXED is provided.

Comparison of Outcomes for Patients Treated by Allopathic vs Osteopathic Surgeons

There are 2 degree programs for licensed physicians in the US: allopathic medical doctorate (MD) and osteopathic doctorate (DO). However, evidence is limited as to whether outcomes differ between patients treated by MD vs DO surgeons. To evaluate differences in surgical outcomes and practice patterns by surgeon medical school training (MD vs DO). This retrospective cohort study used 100% Medicare claims data from inpatient hospitals providing surgical services from January 1, 2016, to December 31, 2019 among Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of the 14 most common surgical procedures. Data analysis was performed from January 17, 2023, to August 13, 2024. Medical school degree (MD vs DO). The primary outcome was 30-day mortality, and the secondary outcomes were readmissions and length of stay. To assess differences between surgeons by medical school training, a multivariable linear probability model was used, which was adjusted for hospital fixed effects and patient, procedure, and surgeon characteristics. Of the 2 360 108 total surgical procedures analyzed, 2 154 562 (91.3%) were performed by MD surgeons, and 205 546 (8.7%) were performed by DO surgeons. Of 43 651 total surgeons, most surgeons were MDs (39 339 [90.1%]), the median (SD) age was 49.0 (9.8) years, and 6649 surgeons (15.2%) were female. The mean (SD) age of patients undergoing surgical procedures was 74.9 (6.7) years, 1 353 818 of 2 360 108 patients (57.4%) were female, and 2 110 611 patients (89.4%) self-reported as White. DO surgeons were significantly more likely to operate on older patients (DO patient mean [SD] age: 75.3 [7.1] years; MD patient mean [SD] age: 74.8 [6.6]), female patients (DO: 60.2% of patients; MD: 57.1% of patients), and Medicaid dual-eligible patients (DO: 10.3% of patients; MD: 8.6% of patients). DOs performed a lower proportion of elective operations (DO: 74.2% vs MD: 80.2%) and were more likely to work in public hospitals (DO: 10.3%; MD: 9.5%) and nonteaching hospitals (DO: 57.9%; MD: 68.1%). There was no evidence that 30-day mortality differed between MD and DO surgeons (adjusted mortality rate, DO: 1.61%; MD: 1.58%; absolute risk difference [aRD], -0.04 percentage points; 95% CI, -0.11 to 0.04; P = .37). On secondary analyses, no difference was found in 30-day readmissions or length of stay between MD and DO surgeons. In this retrospective cohort study using Medicare data, there was no evidence that patient outcomes differed between MD and DO surgeons for common operations after adjusting for patient factors and practice settings.

Stable Walking of a Biped Robot Controlled by Central Pattern Generator Using Multivariate Linear Mapping.

In order to improve the walking stability of a biped robot in multiple scenarios and reduce the complexity of the Central Pattern Generator (CPG) model, a new CPG walking controller based on multivariate linear mapping was proposed. At first, in order to establish a dynamics model, the lower limb mechanical structure of the biped robot was designed. According to the Lagrange and angular momentum conservation method, the hybrid dynamic model of the biped robot was established. The initial value of the robot's passive walking was found by means of Poincaré mapping and cell mapping methods. Then, a multivariate linear mapping model was established to form a new lightweight CPG model based on a Hopf oscillator. According to the parameter distribution of the new CPG model, a preliminary parameter-tuning idea was proposed. At last, the joint simulation of MATLAB and V-REP shows that the biped robot based on the new CPG control has a stable periodic gait in flat and uphill scenes. The proposed method could improve the stability and versatility of bipedal walking in various environments and can provide general CPG generation and a tuning method reference for robotics scholars.

Green Extraction of Bioactive Compounds from Apple Pomace from the Cider Industry.

The cider-making industry in Asturias generates between 9000 and 12,000 tons of apple pomace per year. This by-product, the remains of the apple pressing, and made up of peel, flesh, seeds and stems, is a valuable material, containing substantial amounts of antioxidant compounds associated with healthy properties. Polyphenols such as dihydrochalcones and quercetin glycosides, and triterpenic acids, among which ursolic acid is a major compound, are the main antioxidant families described in apple pomace. The simultaneous recovery of those families has been accomplished by low frequency ultrasound-assisted extraction. Working extraction conditions were optimised by response surface methodology (RSM): time, 5.1 min; extractant composition, 68% ethanol in water; solid/liquid ratio, 1/75 and ultrasonic wave amplitude, 90%. This procedure was further applied to analyse those components in the whole apple pomace (WAP), apple peel (AP) and apple flesh (AF). On average, dry WAP contained almost 1300 µg/g of flavonols, 1200 µg/g of dihydrochalcones and 4200 µg/g of ursolic acid. These figures increased in the apple peel to, respectively 2500, 1400 and 8500 µg/g dry matter. Two linear multivariate regression models allowed the antioxidant activity of apple by-products to be predicted on the basis of their bioactive composition. The results derived from this study confirm the potential of industrial cider apple pomace as a source of high-value bioactive compounds, and the feasibility of the ultrasound-assisted extraction technique to recover those components in a simple and efficient way.

Health-related quality of life and utility of maternity health states amongst post-partum Australians.

This study aimed to measure patient-reported health-related quality of life amongst post-partum women in Queensland, Australia. Patient-reported health-related quality of life data was prospectively collected from 134 post-partum women using the EQ-5D-5L at weekly intervals during the first six weeks following birth. Data across the five health domains of the EQ-5D-5L was converted to a single health utility value to represent overall health status. Linear mixed modelling and regression analysis were used to examine changes in utility over the first six weeks post-birth and determine associations between utility and clinical and demographic characteristics of post-partum women. Gestation at birth and weeks post-partum were significantly associated with utility values when considered in a multivariate linear mixed model. Mean utility values increased by 0.01 for every week increase in gestation at birth, and utility values were 0.70 at one week post-partum and increased to 0.85 at six weeks post-partum, with the largest increase occurring between one- and two-weeks post-birth. When controlling for variables that were found to predict utility values across the first six weeks post-partum, no single state of health predicted utility values at one-week post-partum. Maternity services can use our data and methods to establish norms for their own service, and researchers and maternity services can partner to conduct cost-effectiveness analysis using our more relevant utility values than what is currently available. Time since birth and gestational age of the woman's baby should be considered when selecting post-partum health state utility values for maternity services cost-effectiveness analyses.

Plasma Proteomic Biomarkers in Alzheimer's Disease and Cardiovascular Disease: A Longitudinal Study.

The co-occurrence of Alzheimer's disease (AD) and cardiovascular diseases (CVDs) in older adults highlights the necessity for the exploration of potential shared risk factors. A total of 566 adults were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database, including 111 individuals with AD, 383 with mild cognitive impairment (MCI), and 410 with CVD. The multivariable linear mixed model (LMM) was used to investigate the associations of AD and CVD with longitudinal changes in 146 plasma proteomic biomarkers (measured at baseline and the 12-month follow-up). The LMM showed that 48 biomarkers were linked to AD and 46 to CVD (p < 0.05). Both AD and CVD were associated with longitudinal changes in 14 biomarkers (α1Micro, ApoH, β2M, BNP, complement C3, cystatin C, KIM1, NGAL, PPP, TIM1, THP, TFF3, TM, and VEGF), and both MCI and CVD were associated with 12 biomarkers (ApoD, AXL, BNP, Calcitonin, CD40, C-peptide, pM, PPP, THP, TNFR2, TTR, and VEGF), suggesting intricate connections between cognitive decline and cardiovascular health. Among these, the Tamm Horsfall Protein (THP) was associated with AD, MCI, CVD, and APOE-ε4. This study provides valuable insights into shared and distinct biological markers and mechanisms underlying AD and CVD.

Factors influencing metal concentrations in hair and nails during longitudinal follow-up of apprentice welders

ABSTRACT The aim of this study was to determine factors influencing observed increased metal biomarkers of exposure levels in a group of 116 Quebec apprentice welders during a longitudinal follow-up of exposure. Analysis of 14 metals was carried out in hair, fingernail, and toenail samples taken from participants over the course of their welding curriculum at 6 different times. Personal and socio-demographic characteristics, lifestyle habits, and other potential confounding factors were documented by questionnaire. Multivariate linear mixed-effect models were used to assess main predictors of metal concentrations in each biological matrix including increasing time of exposure throughout the curriculum (defined as the repeated measure “time” variable”). Significant associations between repeated measure “time” variable and metal levels in hair, fingernails, and toenails were found for chromium, iron, manganese and nickel. Significant associations with “time” were also noted for arsenic levels in hair and fingernails, and for barium, cobalt and vanadium levels in fingernails and toenails. The repeated measure “time” variable, hence increasing time of exposure throughout the curriculum, was the predominant predictor of elevated biological metal levels. Reduced spaces and simultaneous activities such as oxyfuel-cutting and welding in the same welding room were suspected to contribute to higher metal levels. Age, ethnicity, and annual household income exerted an effect on metal levels and considered as confounders in the models. Variations observed in metal levels between hair and nails of apprentice welders also emphasized the relevance and importance of performing multi-matrix and multi-element biomonitoring to assess temporal variations in biological metal concentrations during welding curriculum.

Insulin Resistance in Hypercalciuric Calcium Kidney Stone Patients

Rational and ObjectiveDiabetes and uric acid kidney stones are strongly associated. Patients with calcium kidney stones also have higher risk of developing diabetes compared to non-kidney stone patients yet this has not been further investigated. We aimed to characterize insulin resistance in calcium kidney stone patients. Study DesignObservational Setting & PopulationThis study was performed in the University of Chicago Clinical Research Center. Kidney stone patients (N=42) were selected for having idiopathic hypercalciuria and calcium stones with no other medical conditions and controls (N=27) were healthy. ExposuresAll participants presented to the Clinical Research Center in a fasting state and at least 2 timed fasting blood and urine were collected prior to a fixed breakfast. Six additional timed blood and urine collections were performed after breakfast. OutcomesWe compared fasting and fed indices of insulin resistance between the groups. Analytic ApproachWe used t-tests and multivariable linear regression models. A sensitivity analysis removing all patients who had ever been on a thiazide diuretic was also performed. ResultsIn separate multivariable linear models, kidney stone patients had higher fasting serum insulin (24 (3 to 46pmol/L), p=0.03) and higher homeostatic model of insulin resistance (HOMA-IR) (1.0 (0.2 to 1.8), p=0.02). In separate multivariable linear models, kidney stone patients had higher fed serum glucose (10 (2 to 18mg/dL), p=0.01). Results were similar in a sensitivity analysis removing all patients who had ever been on a thiazide diuretic. There were no differences in urine composition based on HOMA-IR levels. LimitationsSingle institution. Small sample size limited subanalyses by different calcium stone types. ConclusionsCalcium kidney stone patients without diabetes or other medical conditions demonstrated signs of insulin resistance compared to healthy matched controls.

Analysis of factors influencing the dose of levothyroxine treatment in adequately controlled hypothyroid patients of different etiologies

ObjectiveThe mainstay therapy of hypothyroidism is levothyroxine (LT4). In most cases lifelong treatment is warranted, therefore, choosing adequate doses are of paramount significance. The purpose of this study was to assess several factors that have been proposed to influence LT4 therapy including etiology of hypothyroidism, gender, age, bodyweight, BMI, concomitant drug use, disease severity and time since diagnosis in patients with stable, adequately controlled hypothyroidism. MethodsIn this cross-sectional study we analysed past medical history, anthropometric data and biochemical parameters reflecting thyroid function of patients with chronic hypothyroidism who were adequately treated (TSH levels in normal range) with LT4 for at least 6 months. Potential predictors of LT4 requirement were evaluated using uni- and multivariate linear modelling. Results191 individuals were enrolled in this study, who were divided into autoimmune (n=147) and post-surgery (n=44) groups. Mean age, time since diagnosis and LT4 dose (1.3 versus 1.1 mcg/kgBW) were significantly lower in the autoimmune group. In the post-surgery group age was the only significant (p=0.016) predictor of LT4 dose. In the autoimmune group BMI (p=0.001), time since diagnosis (p=0.023), as well as their interaction (p=0.012) turned out to be significant predictors of LT4 requirement. ConclusionsOur results implicate the necessity of differentiating between etiologies of hypothyroidism when starting or changing thyroxine replacement therapy. Patient in both groups required significantly lower doses of LT4 replacement, than previous reports suggest, to maintain stable euthyroidism. Distinctly different factors predicted hormone requirement in the two study groups.

Postprostatectomy Radiotherapy Timing and Long-Term Health-Related Quality of Life

The association between radiotherapy (RT) timing after radical prostatectomy and long-term patient-reported health-related quality of life (HRQOL) in men with prostate cancer is unknown. To measure long-term HRQOL in men with prostate cancer up to 15 years after prostatectomy with or without RT and examine whether early vs late postprostatectomy RT is associated with differences in sexual, urinary, and bowel HRQOL. A prospective, multicenter, longitudinal cohort analysis using HRQOL data from the PROST-QA (2003-2006) and RP2 consortium (2010-2013) studies was conducted. Men with localized prostate cancer undergoing radical prostatectomy were included. Data were analyzed between May 8, 2023, and March 1, 2024. The study was conducted in 12 high-volume academic medical centers in the US. Men were stratified based on receipt and timing of postprostatectomy RT: prostatectomy only, early RT (<12 months), and late RT (≥12 months). Longitudinal sexual, incontinence, urinary irritation, bowel, and hormonal/vitality HRQOL were measured via the Expanded Prostate Cancer Index Composite at baseline; months 2, 6, and 12; and annually thereafter. Treatment groups were compared using multivariable linear mixed-effects models of change in longitudinal domain scores. Pad use for incontinence was measured longitudinally among men receiving postprostatectomy RT. A total of 1203 men were included in the study: prostatectomy only (n = 1082), early RT (n = 57), and late RT (n = 64). Median age for the entire cohort was 60.5 (range, 38.8-79.7) years, and 1075 men (92.0%) were White. Median follow-up was 85.6 (IQR, 35.8-117.2) months. Compared with men receiving prostatectomy alone, those receiving postprostatectomy RT had significantly greater decreases in sexual, incontinence, and urinary irritation HRQOL. However, timing of postprostatectomy RT, specifically early vs late, was not associated with a long-term decrease in any HRQOL domain. There was evidence of improved recovery of sexual, continence, and urinary irritation scores among men receiving early RT compared with those receiving late RT after prostatectomy. Before the start of postprostatectomy RT, 39.3% of men in the early RT cohort and 73.4% of men in the late RT cohort were pad-free. By the sixth visit post-RT, 67.4% in the early RT cohort and 47.6% in the late RT cohort were pad-free. In this multicenter, prospective analysis, postprostatectomy RT appeared to be negatively associated with long-term HRQOL across all domains. However, receipt of early vs late postprostatectomy RT may result in similar long-term HRQOL outcomes.

Development and Validation of the Teachers’ Perceptions of Classroom Climate Scale for the Portuguese Population

To improve learning outcomes, evidence-based processes suggest that classroom climate is a means of creating more sustainable schools committed to improving the quality of teaching and learning. Therefore, valid measures of classroom climate are necessary to enable comparative studies focused on teachers' perceptions, including important dimensions such as cooperation. As no validated instruments exist for the Portuguese context, we developed and validated the Teachers' Perception of Classroom Climate (TPCC), consisting of five dimensions: teacher support, peer support, academic competence, satisfaction with the school, and cooperation. Following a quantitative research approach, the construct validity was analyzed using Confirmatory Factor Analysis, internal consistency was evaluated using Cronbach’s Alpha coefficient, and test-retest reliability was assessed using univariate and multivariate General Linear Models and Spearman’s rho correlations. The study supported the five-factor structure of the TPCC and demonstrated good psychometric properties. These results support the use of the TPCC to evaluate teacher perceptions of classroom climate.

Y-Balance Test after ACL Reconstruction: The relationship with knee and hip muscle strength, ankle dorsiflexion range of motion and postural stability

BackgroundY-Balance Test (YBT) assesses postural stability. When is applied to patients after anterior cruciate ligament reconstruction (ACLR), it is not clear which variables influence its result. ObjectiveTo connect YBT and postural stability, quadriceps, hamstring, and gluteus complex muscle strength, ankle dorsiflexion range of motion (ADFROM). Study designCross-sectional. MethodsFifty-nine participants (52 males and 7 females) with ACLR ≥6 months were evaluated. YBT anterior, posterolateral, posteromedial, and composite, isokinetic peak torque of the knee, strength of the gluteal complex with Hip Stability Isometric Test, ADFROM with Weight-Bearing Lunge Test, postural stability with Stability Index of Biodex Balance System® were applied. ResultsIn the ACLR limb, the multivariate regression linear models pointed out an association between the quadriceps muscle strength and ADFRM with anterior, posteromedial and composite reaches (R2 = 0.30; 0.23; 0.26). Hamstring muscle strength and ADFRM with posterolateral (R2 = 0.13). In the uninjured limb, overall stability index and ADFRM with anterior reach (R2 = 0.25), strength of gluteal complex with posteromedial (R2 = 0.31), hamstring muscle strength, Overall and lateromedial stability indexes with posterolateral (R2 = 0.20), hamstring muscle strength, Overall stability index, ADFRM and strength of gluteal complex with composite (R2 = 0.32). ConclusionsThe quadriceps muscle strength and ADFRM are important variables for YBT performance in the ACLR limb. In the uninjured limb, ADFROM, the strength of the gluteal complex and hamstring, overall and lateromedial stability indexes are associated with YBT performance. We question the utility of the YBT to measure postural stability given the lack of association with other postural stability measures.

Social Risk Factors, Health Insurance Coverage, and Inequities in Access to Care.

Social risk factors are associated with worse access to care. This study measured the prevalence of social risk factors among low-income adults, assessed the relationship between number of social risk factors and access to care, and examined heterogeneity by health insurance type. Using 2022 Behavioral Risk Factor Surveillance Survey data from 39 states, the association between number of SRFs (0, 1, 2-3, 4, or more) and three access to care measures (having a personal doctor, having a routine checkup, and inability to see doctor because of cost) were measured using multivariable linear probability models. The analysis was stratified by health insurance coverage type (private, Medicare, Medicaid, or uninsured) to assess whether effects were differential. Analyses were conducted in 2024. Among 90,208 low-income adults, 46.6% reported at least one SRF. Compared to people who reported no SRFs, those who reported four or more were more likely to report being unable to afford care (28.21 percentage points [PP], p<0.001) and less likely to have a personal doctor (-4.98 PP, p<0.001) or routine checkup in the last two years (-4.29 PP, p<0.001). The magnitude of disparity by number of SRFs in inability to afford care was larger among privately insured and uninsured people compared to those with Medicare or Medicaid coverage. Higher levels of SRFs were associated with worse access to care among low-income adults. Policies that minimize cost-related barriers to care, coupled with care delivery reforms and social policies that address SRFs, may improve access to care.

Anatomical compensation of retinal nerve fiber layer improves the detection of glaucoma between ethnicities.

The study aimed to evaluate the impact of compensating retinal nerve fiber layer (RNFL) thickness for demographic and anatomical factors on glaucoma detection in Chinese and Indian adults. A population-based study included 1995 healthy participants (1076 Chinese and 919 Indians) to construct a multivariable linear regression compensation model. This model was applied to 357 Chinese glaucoma patients, 357 healthy Chinese, and 357 healthy Indians using Cirrus spectral-domain optical coherence tomography (OCT). The compensated RNFL thickness considered age, refractive error, optic disc parameters, and retinal vessel density. Results showed that although the average RNFL thickness was significantly higher in Chinese participants compared to Indians, the compensation model reduced this difference to nonsignificance. Moreover, the compensation model significantly improved the area under the receiver operating characteristic curve (0.90 vs. 0.78; p<0.001), sensitivity (75% vs. 51%), and specificity (67% vs. 32%) in distinguishing Chinese glaucoma patients from healthy Indian individuals. The compensation model significantly enhanced the diagnostic accuracy of RNFL thickness in distinguishing glaucoma in the Chinese ethnic group compared to the OCT instrument's default values. These results suggest that modifying RNFL measurements based on individual characteristics can yield substantial benefits for glaucoma detection across ethnicities.

Spillover effects of Medicaid expansion on insurance coverage among low-income older individuals newly diagnosed with cancer.

168 Background: Medicaid expansion is associated with increased insurance coverage and improved health outcomes among patients diagnosed with cancer &lt; 65 years. Although not the target population, individuals ≥65 years may benefit from Medicaid expansion through “welcome mat” effects – the indirect increase in enrollment, particularly those with low income eligible for both Medicaid and Medicare (dual-eligible). This study aims to examine the associations of Medicaid expansion with Medicaid coverage, including both dual-eligible and Medicaid-only, among individuals diagnosed with cancer. Methods: Using the National Cancer Database, we identified patients ≥65 years newly diagnosed with cancer between 2010-2019 with income below 138% federal poverty level. We applied a quasi-experimental design, the difference-in-difference approach, with multivariable linear probability models to compare the changes in the percentage of dual-eligible or Medicaid-only coverage post (vs. pre) Medicaid expansion in expansion v. non-expansion states. Analyses were also stratified by key demographic characteristics. Results: A total of 256,997 patients with cancer were identified, with 136,373 patients from expansion states and 120,624 patients from non-expansion states. After adjusting for sociodemographic characteristics, the percentage of patients with dual or Medicaid-only coverage increased from 16.84 to 18.09 in expansion states and decreased from 14.14 to 12.62 in non-expansion states, resulting in a net increase of 2.11 percentage points (ppt, 95% confidence interval: 1.55, 2.67) associated with Medicaid expansion. Differences were more pronounced among patients diagnosed with stage III-IV cancers (DD: 2.53 ppt, 95%CI: 1.58, 3.48), racialized as non-Hispanic Black (DD: 3.71 ppt, 95%CI: 2.70, 4.73), residing in metropolitan areas (DD: 2.77 ppt, 95%CI: 2.08, 3.47), with two or more comorbidities (DD: 4.14 ppt, 95%CI: 2.47, 5.80), and treated in comprehensive (DD: 2.98 ppt, 95%CI: 2.02, 3.94) or academic cancer centers (DD: 3.31 ppt, 95%CI: 2.14, 4.49). Conclusions: Medicaid expansion was associated with an increase in Medicaid enrollment among patients diagnosed with cancer at 65 or older, suggesting spillover benefits of Medicaid expansion in supporting low-income elderly populations with cancer.

Differential correlations of changes in in vivo neuroimaging markers of hippocampal volume and arteriolosclerosis with declining financial and health literacy in old age.

Financial and health literacy is essential for older adults to navigate complex decision processes in late life. However, the neurobiological basis of age-related decline in financial and health literacy is poorly understood. This study aimed to characterize progression of neurodegenerative and vascular conditions over time, and to assess how these changes coincide with declining financial and health literacy in old age. Data came from 319 community-living older adults who were free of dementia at baseline, and underwent annual literacy assessments, as well as biennial 3-Tesla neuroimaging scans. Financial and health literacy was assessed using a battery of 32 items. Two in vivo neuroimaging markers of neurodegenerative and cerebrovascular conditions were used, i.e., hippocampal volume and the ARTS marker of arteriolosclerosis. A multivariate linear mixed effects model estimated the simultaneous changes in financial and health literacy, hippocampal volume, and the ARTS score. Over a mean of 7 years of follow-up, these older adults experienced a significant decline in financial and health literacy, a significant reduction in hippocampal volume, and a significant progression in ARTS score. Individuals with faster hippocampal atrophy had faster decline in literacy. Similarly, those with faster progression in ARTS also had faster decline in literacy. The correlation between the rates of hippocampal atrophy and declining literacy, however, was stronger than the correlation between the progression of ARTS with declining literacy. These findings suggest that neurodegeneration and, to a lesser extent, cerebrovascular conditions are correlated with declining financial and health literacy in old age.

Прогнозирование региональной экономики на основе взаимосвязи человеческого капитала и инновационной деятельности

The most important condition for ensuring the competitiveness of the regional economy of a post-industrial society and its transition to an innovative development path is human capital. The authors proposed a method for forecasting the regional economy based on the relationship between human capital and innovation activity. This forecast was based on multivariate linear models. Unlike other methods of forecasting the regional economy, the author's method takes into account the synergistic effect from the possible cooperation of the leading regions. This technique has been tested on the example of forecasting the regional economies of the leaders of the Volga Federal District (the Republic of Tatarstan, the Republic of Bashkortostan, the Nizhny Novgorod region) for 2022–2027.

ВЗАЄМОЗВ’ЯЗОК КІБЕРБЕЗПЕКИ ТА ІННОВАЦІЙНОГО ПОТЕНЦІАЛУ КРАЇНИ ПІД ЧАС ТРАНСФЕРУ ТА ВПРОВАДЖЕННЯ ІННОВАЦІЙ

The article is devoted to the investigation of the relationship between innovation and cyber security in the context of forecasting and reducing risks related to cyber security during the implementation of innovations. The purpose of the study is to confirm and model the interconnection between the levels of innovation development and cyber security of the country. The work describes the concept of innovation risk and the importance of cyber security in the modern world as one of the important factors in overcoming innovation risks. The current state of cyber security was analysed based on various indices, and the impact of cyber threats on innovation processes was investigated based on a sample from 26 countries of the world. This made it possible to identify leaders and outsiders in this field, as well as trends in the development of cyber security in dynamics. It is well-founded that cyber security is a key factor for the development and implementation of innovations. To confirm the existing relationship between cyber security and innovation, the multiple correlation coefficient was calculated, and an econometric model was built using the built-in functions of MS Excel (the estimation of the model parameters was carried out using the method of least squares using the built-in "Data Analysis" package of the MS spreadsheet editor Excel for a multivariable linear model). The significance of the model was confirmed by the coefficient of determination, Fisher's test, and the level of significance of the p-value. The results of the study can be used to develop effective cyber defence strategies and contribute to the stable development of technologies in the face of growing cyber threats.

Diet quality and blood lead levels in Uruguayan first graders

ObjectiveFoods are a potential source of lead but also contain nutrients that counteract the intestinal absorption of lead. Translatable evidence is needed to better understand the relationship between whole diets and blood lead levels (BLLs) in children. In this cross-sectional study we investigated the association between dietary variety, adequacy, moderation, and overall diet quality with children's BLLs. MethodsFirst graders (~ 7 years) from Montevideo, Uruguay were evaluated in years 2009–13 (Phase I, n = 303) and 2015–19 (Phase II, n = 443). Lead was measured in fasting blood via atomic absorption spectrometry and primary caregivers completed two non-consecutive 24-h recalls. Indices of dietary variety (maximum score of 20), adequacy (maximum 40), moderation (maximum 30), and overall diet quality were calculated from food and nutrient intakes averaged over two recall days. The indices were adapted from the Diet Quality Index-International based on dietary recommendations for children. Missing covariate data were imputed. The associations between diet quality measures and BLLs were modeled separately in Phase I and II with multivariable linear models, testing for sex differences via interaction terms and stratified models. ResultsThe median[IQR] BLLs were 3.8[2.6, 4.9] and 1.3[0.7, 3.6] μg/dL in study Phases I and II, respectively. All diet quality scores were <60 % of the maximum values and daily intakes of key food groups fell below recommended levels. There was little evidence of an association between measures of diet quality and children's BLLs overall. On the other hand, higher diet variety, adequacy, and overall diet quality were associated with slightly higher BLLs among girls in Phase I only. ConclusionsIn the context of low lead exposure and food consumption patterns that fall short of recommended levels, the relation of diet quality to children's BLLs may depend on lead exposure levels.

Functional brain connectivity changes associated with day-to-day fluctuations in affective states

Affective neuroscience has traditionally relied on cross-sectional studies to uncover the brain correlates of affects, emotions, and moods. Such findings obfuscate intraindividual variability that may reveal meaningful changing affect states. The few functional magnetic resonance imaging longitudinal studies that have linked changes in brain function to the ebbs and flows of affective states over time have mostly investigated a single individual. In this study, we explored how the functional connectivity of brain areas associated with affective processes can explain within-person fluctuations in self-reported positive and negative affects across several subjects. To do so, we leveraged the Day2day dataset that includes 40 to 50 resting-state functional magnetic resonance imaging scans along self-reported positive and negative affectivity from a sample of six healthy participants. Sparse multivariate mixed-effect linear models could explain 15% and 11% of the within-person variation in positive and negative affective states, respectively. Evaluation of these models’ generalizability to new data demonstrated the ability to predict approximately 5% and 2% of positive and negative affect variation. The functional connectivity of limbic areas, such as the amygdala, hippocampus, and insula, appeared most important to explain the temporal dynamics of affects over days, weeks, and months.