Multivariable Quantile Regression Research Articles

The long-term association between exposure to wartime bombing earlier in life and post-traumatic stress later in life among today's older Vietnamese population

This analysis examines the relationship between exposure to American wartime bombardments earlier in life and later-life PTSD among current surviving Vietnamese aged 59+. It also assesses whether the relationship varies by military status during the war - formal military, informal military, or civilian - and whether associations are explained by exposure to violence and malevolent conditions. Data link survey responses from the 2018 Vietnam Health and Aging Study to provincial-wide level bombing intensity using U.S. Department of Defense records from the Theater History of Operations Vietnam database. PTSD measured using nine items from the PTSD Checklist. Analyses employ multivariate logistic quantile regression. Findings examined for a sample of 2290 Vietnamese survivors and a subsample of 736 Vietnamese that moved at least once during wartime. Results show a robust and significant positive association between province-wide bombing intensity and later-life PTSD scores. Interaction effects indicate civilians have overall lower levels of PTSD than those that were in the formal or informal military, but the association between bombing and PTSD is stronger among civilians. Much of the association is a function of exposure to violence and less is a function of exposure to malevolent conditions. Findings confirm earlier studies that have shown severe deleterious impacts of war trauma, and arial bombardments particularly, on long-term psychological health, while extending extant literature to civilian populations living in Vietnam during intense aerial bombing episodes.

Anti-spike antibody level is associated with the risk of clinical progression among subjects hospitalized with COVID-19 pneumonia: results from a retrospective cohort study.

Antibodies against SARS-CoV-2 spike (anti-S) may confer protection against symptomatic COVID-19. Whether their level predicts progression among those with COVID-19 pneumonia remains unclear. We conducted a retrospective cohort study to assess predictors of anti-S levels and whether anti-S titer is associated with death or mechanical ventilation (MV). Adults hospitalized for COVID-19 pneumonia between July 2021 and July 2022 were enrolled if anti-S had been measured within 72h of admission. Predictors of anti-S level were explored using multivariable quantile regression. The association between anti-S levels and 30-day death/MV was investigated via multivariable logistic regression. Analyses were stratified by vaccine status. The median anti-S level was 1370 BAU/ml in 328 vaccinated and 15.5 BAU/ml in 206 unvaccinated individuals. Among the vaccinated, shorter symptom duration (p = 0.001), hematological malignancies (p = 0.002), and immunosuppressive therapy (p = 0.004) were associated with lower anti-S levels. In the unvaccinated group, symptom duration was the only predictor of anti-S levels (p < 0.001). After 30days, 134 patients experienced death or MV. Among vaccinated individuals, higher anti-S levels correlated significantly with lower death/MV risk (per log2 increase, OR 0.88, 95%CI 0.81-0.97), irrespective of age and solid malignancies. Among unvaccinated, a marginally protective effect was observed (OR 0.86, 95%CI 0.73-1.01), independent of age, immunosuppressive therapy, and diabetes. Adjustment for monoclonal antibody treatment strengthened the association (OR 0.81, 95%CI 0.68-0.96). This study suggests that levels of anti-S antibodies can predict critical or fatal outcomes in COVID-19 pneumonia patients, regardless of vaccination. Whether anti-S Ab could guide risk assessment and vaccination boosting merits further evaluation.

SDG achievement through international clean energy financing and access to clean fuel and technology

Clean fuel and technology play a pivotal role in realizing sustainable development goals 9 and 12. Specifically, clean technology is essential for transitioning from fossil fuels to renewables, promoting sustainable development and fostering a cleaner environment. This study delves into the primary driving forces of ecological quality in India spanning from 2000Q1 to 2020Q4, encompassing international clean energy financing, access to clean fuel and technology, globalization and trade. To address the interdependence of explanatory variables and capture results across different quantiles, we employ the recently proposed multivariate quantile-on-quantile regression alongside multivariate quantile regression. Our study's outcomes reveal that international clean energy financing, access to clean fuel and technology, and globalization positively impact the load capacity factor, thereby enhancing ecological quality. Conversely, economic growth and trade exert a negative influence on the load capacity factor, resulting in a decline in ecological quality. Based on these findings, we propose policy recommendations for consideration.

Cardiac markers in left-sided breast cancer patients receiving adjuvant radiotherapy: a prospective study.

To investigate the association between radiotherapy (RT) and cardiac biomarkers in women with left-sided breast cancer. This prospective observational study recruited patients with stage I-III left-sided breast cancer without coronary heart disease who required adjuvant RT. High-sensitivity troponin I(hsTnI), N-terminal pro-brain natriuretic peptide(NT-proBNP), and high-sensitivity C-reactive protein(hsCRP) levels were measured pre-RT, immediately after RT, and 3 months post-RT. Cardiac-sparing RT techniques were utilized (Field-in-Field IMRT/VMAT ± voluntary deep inspiration breath-hold). Statistical analyses were performed using non-parametric tests and multivariable quantile regression (QR). One hundred five patients completed the study, with 63 evaluable at three months post-RT. Pre- and post-RT biomarkers showed no significant differences. Median pre-RT and post-RT values were: hsTnI (0.012ng/mL; 0.012ng/mL), hsCRP (3.1mg/L; 2.8mg/L), and NT-proBNP (59pg/mL; 45pg/mL). Three months post-RT, hsTnI, hsCRP and NT-proBNP levels also showed no significant differences. Multivariable QR revealed no association between heart Dmean [median(IQR): 2.87Gy (2.05-3.94)] and post-RT biomarkers. Age and BMI were associated with hsCRP and NT-proBNP, respectively. hsTnI, NT-proBNP, and hsCRP are not correlated with contemporary low cardiac exposure in left-sided breast cancer patients treated with contemporary RT techniques.

Global evidence of multi-dimensional asymmetric effect of energy storage innovations on environmental quality: Delineating the role of natural resources, nuclear energy and oil consumption

The strive to lower reliance on fossil fuels and transition to clean energy sources necessitates innovations in energy storage. This study empirically investigates the effectiveness of energy storage innovations towards a greener environment on a global scale. To this end, we use quarterly frequency time series data on a global scale over the period 2000 to 2020 and the estimation techniques based on the nonparametric multivariate quantile on quantile regression (MQQR), multivariate quantile regression (MQR), and Kernel-based regularized least squares (KRLS). The empirical results reveal that energy storage innovation and nuclear energy are strongly related to a decline in carbon dioxide emissions (CO2e) but natural resources and oil consumption intensify the level of CO2e across quantiles. However, the effects of energy storage innovation, nuclear energy, natural resources, and oil consumption are heterogeneous leading to an asymmetric pattern across quantile distribution. The policy implication of this study is that, on a global scale, energy storage innovation and nuclear energy provide opportunities for attaining a greener environment and more environmentally sustainable future but natural resources and oil consumption impede policies toward a sustainable environment. Therefore, our study recommends, among other things, an aggressive boost of energy storage system and nuclear energy while decreasing reliance on fossil fuels.

Exploring the association between serum phosphate levels and mortality in patients hospitalized with infectious diseases: a nationwide study.

The purpose of this study was to examine associations of serum phosphate levels with mortality, target organ damage and length of hospital stay in adults with infectious diseases hospitalized outside of the intensive care unit. This nationwide retrospective cohort study comprised patients admitted with infections, to medical and surgical departments in eight tertiary hospitals during 2001-2020. The main exposure variable was the first serum phosphate levels at admission (up to 1 week). The analysis included multivariable logistic regression models and quantile regression. Of 126,088 patients (49% males, mean age: 69.3 years), 24,809 (19.7%) had decreased phosphate levels, 92,730 (73.5%) normal phosphate levels, and 8,549 (6.8%) elevated phosphate levels on admission. Overall- and in-hospital mortality rates were highest among those with hyperphosphatemia (74.5 and 16.4%, respectively), followed by those with normophosphatemia (57.0 and 6.6%), and lastly the hypophosphatemia group (48.7 and 5.6%); p < 0.001 for all. After adjusting for confounders, the lowest predicted mortality rate was observed in the normophosphatemia group. In the multivariable model, hyperphosphatemia conferred a higher probability of target organ damage (OR [95% CI]: 2.43 [2.06-2.86]), while moderate hypophosphatemia conferred a lower probability (OR [95% CI]: 0.73 [0.65-0.82]), compared to normal phosphate levels and extreme hypophosphatemia showed a non-significant association (OR [95% CI]: 0.87 [0.57-1.28]). The associations were independent of renal failure. In a multivariable model, hyperphosphatemia was associated with a slight increase of 0.33 days in length of stay compared to normal phosphate levels. A J-shaped relation was found between phosphate levels and prognosis in patients hospitalized with infectious diseases, regardless of their renal function.

Influence of Impaired Diffusing Capacity and Sleep-disordered Breathing on Nocturnal Hypoxemia and Health Outcomes in Men with and without HIV.

Nocturnal hypoxemia is common in sleep-disordered breathing (SDB) and is associated with increased morbidity and mortality. Although impaired diffusing capacity of the lungs for carbon monoxide (DLCO) is associated with daytime hypoxemia, its influence on SDB-related nocturnal hypoxemia is not known. To characterize the effects of DLCO impairment on SDB-related nocturnal hypoxemia and associated health outcomes. Data from a multi-center cohort of men with and without HIV, with concomitant measures of DLCO and home-based polysomnography (N=544), were analyzed. Multivariable quantile regression models characterized associations between DLCO and several measures of SDB-related hypoxemia (e.g., total sleep time with oxygen saturation [SpO2]<90% [T90]). Structural equation models assessed associations between impaired DLCO and SDB-related hypoxemia measures with prevalent hypertension and type 2 diabetes. DLCO impairment (<80% predicted) was associated with sleep-related hypoxemia. Participants with severe SDB (apnea-hypopnea index≥30 events/hr) and impaired DLCO had a higher T90 (median difference: 15.0%; [95% CI: 10.3,19.7]) and average SDB-related desaturation (median difference: 1.0; [0.5, 1.5]), and lower nadir SpO2 (median difference: -8.2%; [-11.4, -4.9]) and average SpO2 during sleep (median difference: -1.1%; [-2.1, -0.01]), than those with severe SDB and preserved DLCO. A higher T90 was associated with higher adjusted odds of prevalent hypertension (OR 1.39; [1.14,1.70]) and type 2 diabetes (OR 1.25; [1.07,1.46]). DLCO impairment in severe SDB was associated with sleep-related hypoxemia, prevalent hypertension and type 2 diabetes. Assessment of SDB should be considered in those with impaired DLCO to guide testing and risk-stratification strategies.

Establishing Normative Values for Performance-Based Tests in Older Thai Adults: A Nationwide Cross-Sectional Study

ObjectiveTo determine normative values and identify contributing factors for physical performance tests in older, Thai, community-dwelling adults. DesignNationwide cross-sectional study. SettingThai older community-dwelling adults. ParticipantsThai older community-dwelling adults aged ≥60 years who had no major health problems (N=1430) between March 2021 and August 2022. InterventionsNot applicable. Main Outcome MeasuresNormative values for the timed Up and Go (TUG) test, gait speed test, and 5-times sit-to-stand (5TSTS) test were determined for sex and age groups. Multivariable quantile regression analysis was employed to evaluate the participants, considering factors that may influence physical performance, such as height, and Charlson comorbidity index (CCI). ResultsThe study included 1430 eligible participants. Their mean age was 68.4±5.8 years, and 58.5% were women. Men demonstrated superior physical performance in the medians (p50) of the TUG (10.0 s vs 11.0 s), gait speed (0.98 m/s vs 0.91 m/s), and 5TSTS (14.0 s vs 16.1 s) tests compared with women. These differences were consistently observed across age groups. Moreover, age, sex, and height were significantly associated with poor physical performance. ConclusionThis study observed variations in the normative values of TUG, gait speed, and 5TSTS tests among different age groups of older, Thai, community-dwelling adults. Additionally, our findings identified age, sex, and height as significant contributing factors to physical performance in this population.

Importance of Quality of Maternal and Newborn Care in Childbirth: Findings Over Time of the Imagine Euro Study on 40 WHO Standard-Based Quality Measures During the COVID-19 Pandemic in Latvia

Abstract The objectives of the study were to investigate the quality of maternal and newborn care (QMNC) from the view of mothers who gave birth in a healthcare facility during the COVID-19 pandemic in Latvia. An online questionnaire survey was conducted in Latvia from 1 March 2020 to 28 October 2021, which was based on 40 World Health Organisation (WHO) Standard-based Quality measures. In addition, descriptive and multivariate quantile regression analyses were performed to compare the years 2020 and 2021. A total of 2079 women participated in the study, of whom 833 gave birth in 2020 — of them, 648 had a vaginal delivery, and 185 had a cesarean section, and 1205 women gave birth in 2021, 979 with a vaginal delivery, and 226 with a cesarean section. A lower QMNC during the COVID-19 pandemic was reported by 29.8% and 24.5% of respondents in 2020 and 2021. The total QMNC Index was notably higher in 2021 compared to 2020. This study showed essential gaps in the QMNC in Latvia perceived by mothers, while observing a slight increase in quality in 2021. Therefore, strategies to improve mothers’ and newborns’ health care should be introduced as soon as possible.

Association between early postoperative hypoalbuminaemia and outcome after orthotopic heart transplantation.

In patients undergoing heart transplantation (HTX), preoperative liver impairment and consecutive hypoalbuminaemia are associated with increased mortality. The role of early postoperative hypoalbuminaemia after HTX is unclear. This study investigated the association between early postoperative hypoalbuminaemia and 1-year mortality as well as 'days alive and out of hospital' (DAOH) after HTX. This retrospective cohort study included patients who underwent HTX at the University Hospital Duesseldorf, Germany, between 2010 and 2022. The main exposure was serum albumin concentration at intensive care unit (ICU) arrival. The primary endpoints were mortality and DAOH within 1 year after surgery. Receiver operating characteristic (ROC) curve analysis was performed and logistic and quantile regression models with adjustment for 13 a priori defined clinical risk factors were conducted. Out of 241 patients screened, 229 were included in the analysis (mean age 55 ± 11 years, 73% male). ROC analysis showed moderate discrimination for 1-year mortality by postoperative serum albumin after HTX [AUC = 0.74; 95% confidence interval (CI): 0.66-0.83]. The cutoff for serum albumin at ICU arrival was 3.0 g/dl. According to multivariate logistic and quantile regression, there were independent associations between hypoalbuminaemia and mortality/DAOH [odds ratio of 4.76 (95% CI: 1.94-11.67) and regression coefficient of -46.97 (95% CI: -83.81 to -10.13)]. Postoperative hypoalbuminaemia <3.0 g/dl is associated with 1-year mortality and reduced DAOH after HTX and therefore might be used for early postoperative risk re-assessment in clinical practice.

Factors associated with late initiation of antiretroviral therapy in Iran’s HIV/AIDS surveillance data

Early initiation of Antiretroviral Treatment (ART) in HIV patients is essential for effectively suppressing the viral load and prognosis. This study utilized National HIV/AIDS Surveillance Data in Iran to identify factors associated factors with the duration to initiate ART. This hybrid cross-sectional historical cohort study was conducted on Iran’s National HIV/AIDS Surveillance Data from 2001 to 2019. Sociodemographic characteristics, route of transmission, HIV diagnosis date, and ART initiation date were collected. Multivariable linear and quantile regression models were employed to analyze the duration to initiate ART by considering predictor variables. This study included 17,062 patients (mean age 34.14 ± 10.77 years, 69.49% males). Multivariate quantile regression coefficients varied across different distributions of the dependent variable (i.e., duration to initiate ART) for several independent variables. Generally, male gender, injecting drug use (IDU), and having an HIV-positive spouse were significantly associated with an increased duration to initiate ART (p < 0.05). However, a significant decrease was observed in older patients, those with a university level education, men who had sex with men (MSM), and patients diagnosed after 2016 (p < 0.05). Despite improvements in the duration to initiate ART after implementing the WHO’s 2016 program in Iran, various sociodemographic groups were still vulnerable to delayed ART initiation in the region. Therefore, programs including early testing, early ART initiation, active care, educational and cultural interventions, and appropriate incentives are required for these groups.

Three approaches to assessing dietary quality in Mexican adolescents from 2006 to 2018 with data from national health and nutrition surveys.

To assess trends in the dietary quality of Mexican adolescents from 2006 to 2018, both overall and by sociodemographic indicators, using adaptations of the EAT-Lancet Planetary Health (PH) recommendations, optimal intake estimated by the Global Burden of Disease (GBD) and 2015 Mexican Dietary Guidelines (MDG) in nationally representative samples. Using dietary data from a semi-quantitative FFQ, dietary quality indexes were constructed as adaptations of three dietary intake recommendations. Trends in adherence to recommendations were evaluated with multivariate quantile regression models with survey year as the main independent variable and adjusted for age, sex, energy intake, dwelling area, geographical region, household assets condition, and student/non-student status. P values and CI were Bonferroni-corrected. Mexico. Non-pregnant or lactating adolescents aged 12-19 years (n 16 520). Adherence to the PH index was about 40 %, GBD was nearly 35 % and MDG was about 37 %. The lowest adherences were for added sugars, sugar-sweetened beverages, nuts and seeds, red meats, processed meats, and legumes (<28 %). No 2006-2018 trends in total adherence were found in any index. Nevertheless, negative adherence trends were identified for poultry (β = -2·4), and saturated fats (β = -0·93), and positive for unsaturated oils (β = 1·23), in the PH. In MDG, relevant trends were found for plain water (β = 1·63) and foods rich in fats (β = -1·24). Mexican adolescents have demonstrated poor dietary quality by these three approaches. Therefore, this population has a high-risk profile for diet-associated chronic diseases. Further research and appropriate public policies are needed.

Cash critical care time prices vary substantially by region and hospital ownership: A cross-sectional study

ObjectivesEmergency department (ED) patients may be billed for critical care time (current procedural terminology codes 99291 and 99292) if they receive at least 30 min of critical care services. We sought to determine the median cash (self-pay) prices for critical care time performed in the ED in the United States and assess for associations between hospital characteristics and prices. MethodsWe performed a cross-sectional analysis of hospital cash prices for critical care time performed in the ED using the first 25 alphabetical states. For each hospital, we recorded hospital characteristics including state, control (nonprofit, governmental, or for-profit), size, teaching status, and system. We then searched for each hospital's cash prices for 99291 and 99292 using Turquoise and hospital websites. We determined the median price for 99291 nationally, regionally, and for large hospital systems. We performed multivariable quantile regression to assess for associations between hospital characteristics and prices for 99291. ResultsOf the 2629 eligible hospitals, 2245 (85.4%) and 1893 (72.0%) reported cash prices for 99291 and 99292, respectively. For 99291, the cash price ranged from $45 to $84,775 with a median of $1816 (IQR: $1039-3237). For 99292, the median price was $567 (IQR: $298–1008). On multivariable analysis, hospitals had higher cash prices for 99291 if they were located in the West, for-profit, or part of a large system. In particular, hospitals owned by Tenet Healthcare charged the most for 99291 (median $28,244). ConclusionThe cash prices for critical care time vary substantially based on hospital characteristics. In particular, for-profit hospitals and those in the West tend to charge the most. Given that patients who require critical care are unlikely to be able to choose the hospital to which they present, standardization of critical care time fees should be considered.

Confounding-adjustment methods for the causal difference in medians

BackgroundWith continuous outcomes, the average causal effect is typically defined using a contrast of expected potential outcomes. However, in the presence of skewed outcome data, the expectation (population mean) may no longer be meaningful. In practice the typical approach is to continue defining the estimand this way or transform the outcome to obtain a more symmetric distribution, although neither approach may be entirely satisfactory. Alternatively the causal effect can be redefined as a contrast of median potential outcomes, yet discussion of confounding-adjustment methods to estimate the causal difference in medians is limited. In this study we described and compared confounding-adjustment methods to address this gap.MethodsThe methods considered were multivariable quantile regression, an inverse probability weighted (IPW) estimator, weighted quantile regression (another form of IPW) and two little-known implementations of g-computation for this problem. Methods were evaluated within a simulation study under varying degrees of skewness in the outcome and applied to an empirical study using data from the Longitudinal Study of Australian Children.ResultsSimulation results indicated the IPW estimator, weighted quantile regression and g-computation implementations minimised bias across all settings when the relevant models were correctly specified, with g-computation additionally minimising the variance. Multivariable quantile regression, which relies on a constant-effect assumption, consistently yielded biased results. Application to the empirical study illustrated the practical value of these methods.ConclusionThe presented methods provide appealing avenues for estimating the causal difference in medians.

General joint hypermobility in temporomandibular joint disease; clinical characteristics, biomarkers, and surgical aspects

ObjectivesThis study aimed at identifying biomarkers in the temporomandibular joint (TMJ) synovial tissue analysing 28 extra cellular matrix proteins in TMJ diseased patients, classified with either general joint hypermobility (GJH) or normal joint mobility (NJM), and to compile clinical and protein characterisation to reveal potential surgical predictive factors. Study designA prospective observational cohort study including 97 consecutive patients scheduled for TMJ surgery was performed. Joint mobility and several other predefined clinical variables were recorded. Synovial tissue was harvested during surgery followed by examination using multi-analytic profiling. A multivariate quantile regression model was used for analysis purposes. ResultsThe GJH/NJM ratio was 2:5. The GJH cohort were younger (P = 0.001) and more likely to be women (P = 0.026) compared to the NJM cohort. None of the protein concentrations could be correlated to joint mobility in the multivariate regression model, but often to the variable TMJ diagnosis. The surgical outcome after the six-month follow-up were equal between GJH and NJM patients. ConclusionsGJH was more common in the study cohort compared to general population frequencies, but GJH was not a negative factor for surgical outcome. Young age and female gender correlated to GJH. No TMJ biomarkers were GJH specific, and the results suggested that TMJ diagnosis more strongly correlated to the protein profile compared to GJH and the other investigated variables.

Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana: an Ecological Time-Series Analysis, 2018-2021.

Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs' targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.

Abstract 16482: Proteomic Measures Associated With Leisure-Time Physical Activity and Heart Failure Risk in Late-Life - The Atherosclerosis Risk in Communities Study

Introduction: Leisure-time physical activity (LTPA) is associated with lower heart failure (HF) risk. However, the underlying molecular mechanisms by which LTPA impacts HF risk is unclear. Methods: We evaluated participants at Atherosclerosis Risk in Communities study visits 3 (1993-95) and 5 (2011-13) with plasma proteomics data (Somascan v4) and without HF or stroke. LTPA was assessed by the Baecke questionnaire as metabolic equivalent (MET)-minutes/week. We performed cross-sectional associations of 4,955 proteins with LTPA at visit 3 and then at visit 5 LTPA using multivariable quantile regression models at Bonferroni-corrected significance (p&lt;1e-5, p&lt;0.0004, respectively). We related these proteins to incident HF after visit 3 and then visit 5 using multivariable Cox regression models at Bonferroni-corrected significance (p&lt;0.00086, p&lt;0.003, respectively). Results: Thirty-nine proteins were associated with LTPA at visit 3 (n=10,402; age 60±6 yrs, 54% women; mean 688.6 MET-minutes/week, 773 incident HF events) and visit 5 (n=4,135; 75±5 yrs, 58% women; mean 834.8 MET-minutes/week, 362 events), of which 5 proteins were also associated with incident HF at both visits. Higher levels of THBS2, GABARAP, and BAGE2 were associated with lower LTPA and higher HF risk while higher levels of ART3 associated with higher LTPA and lower risk of incident HF (Figure). PTK7 demonstrated discordant associations with LTPA and HF risk. Levels of THBS2, GABARAP, BAGE2, and ART3 accounted for a significant proportion of the LTPA-HF association (p&lt;0.05). Conclusion: Large-scale proteomics can identify novel biomarkers potentially linking LTPA to HF risk. Further study is needed of THBS2, GABARAP, BAGE2, and ART3, which may link the association of LTPA on HF.

“Help, I Need Somebody, Help…”: Supporting Doctoral Candidates In Different Fields Of Research

This study examines the perceived support of doctoral candidates within the academic environment in Germany, with regard to their academic progress and the probability of dropout intentions from their study programs. Based on Becher (1987), we investigated doctoral candidates in five different research fields with divergent research cultures, namely physics, mechanical engineering, German studies &amp; history, economics, psychology &amp; educational sciences. Perceived support was assessed on four sub-dimensions: professional, emotional, network integration and career planning, as developed by Vogel, Brandt, and Jaksztat (2017). We used data from the German 2019 National Academics Panel Study (NACAPS) comprising 28,368 respondents, the largest survey of doctoral candidates in Germany (Adrian et al., 2020). To investigate the effect of perceived support on students’ doctoral status, we used multivariate quantile regressions to compare doctoral candidates at similar stages of the doctoral process. To investigate the effect on the probability of dropout intentions, we performed linear probability regressions. We found that strong support of all types was associated with an advanced doctoral status and a decreasing likelihood of intentions to drop out. However, differences between candidates from different research fields were found.

Development of an epigenetic age predictor for costal cartilage with a simultaneous somatic tissue differentiation system

Age prediction from DNA has been a topic of interest in recent years due to the promising results obtained when using epigenetic markers. Since DNA methylation gradually changes across the individual’s lifetime, prediction models have been developed accordingly for age estimation. The tissue-dependence for this biomarker usually necessitates the development of tissue-specific age prediction models, in this way, multiple models for age inference have been constructed for the most commonly encountered forensic tissues (blood, oral mucosa, semen). The analysis of skeletal remains has also been attempted and prediction models for bone have now been reported. Recently, the VISAGE Enhanced Tool was developed for the simultaneous DNA methylation analysis of 8 age-correlated loci using targeted high-throughput sequencing. It has been shown that this method is compatible with epigenetic age estimation models for blood, buccal cells, and bone. Since when dealing with decomposed cadavers or postmortem samples, cartilage samples are also an important biological source, an age prediction model for cartilage has been generated in the present study based on methylation data collected using the VISAGE Enhanced Tool. In this way, we have developed a forensic cartilage age prediction model using a training set composed of 109 samples (19–74 age range) based on DNA methylation levels from three CpGs in FHL2, TRIM59 and KLF14, using multivariate quantile regression which provides a mean absolute error (MAE) of ± 4.41 years. An independent testing set composed of 72 samples (19–75 age range) was also analyzed and provided an MAE of ± 4.26 years. In addition, we demonstrate that the 8 VISAGE markers, comprising EDARADD, TRIM59, ELOVL2, MIR29B2CHG, PDE4C, ASPA, FHL2 and KLF14, can be used as tissue prediction markers which provide reliable blood, buccal cells, bone, and cartilage differentiation using a developed multinomial logistic regression model. A training set composed of 392 samples (n = 87 blood, n = 86 buccal cells, n = 110 bone and n = 109 cartilage) was used for building the model (correct classifications: 98.72%, sensitivity: 0.988, specificity: 0.996) and validation was performed using a testing set composed of 192 samples (n = 38 blood, n = 36 buccal cells, n = 46 bone and n = 72 cartilage) showing similar predictive success to the training set (correct classifications: 97.4%, sensitivity: 0.968, specificity: 0.991). By developing both a new cartilage age model and a tissue differentiation model, our study significantly expands the use of the VISAGE Enhanced Tool while increasing the amount of DNA methylation-based information obtained from a single sample and a single forensic laboratory analysis. Both models have been placed in the open-access Snipper forensic classification website.

A longitudinal study of distress symptoms and work impairment in immune-mediated inflammatory diseases

ObjectiveWe investigated the association between distress symptoms (pain, fatigue, depression, anxiety) and work impairment in four patient populations: multiple sclerosis (N = 107), rheumatoid arthritis (N = 40), inflammatory bowel disease (N = 136) and psychiatric disorders (N = 167). MethodsFour waves of data collection were completed over three years. The relationship between distress symptoms and overall work impairment was evaluated with univariate and multivariable quantile logistic regression at the 25th, 50th and 75th percentiles. Models were fit to participant average scores and change scores on distress symptom measures. Covariates included sociodemographic factors, comorbidity, physical disability and cognitive function. ResultsIn the primary univariate analyses of overall work impairment at the 50th percentile, greater severity of distress symptoms was associated with greater work impairment: pain (average β = 0.27, p < 0.001; change β = 0.08, p < 0.001), fatigue (average β = 0.21, p < 0.001; change β = 0.09, p < 0.001) depression (average, β = 0.35, p < 0.001; change, β = 0.16, p < 0.001), anxiety (average, β = 0.24, p < 0.001; change, β = 0.08, p < 0 0.01). Findings were similar in multivariable analyses. ConclusionPain, fatigue, depression, and anxiety symptoms are important determinants of work impairment in persons with immune-mediated diseases and persons with psychiatric disorders. Successful clinical management of these symptoms has potential to improve work-related outcomes across IMIDs.