Predictors Of Persistence Research Articles

Atrial fibrillation and high-grade functional mitral regurgitation - what is the chicken, what is the egg?

Abstract Background Atrial fibrillation (AF) and mitral valve regurgitation (MR) represent highly prevalent and intimately linked comorbidities with shared and interacting pathophysiological mechanisms [1]. The first-time and simultaneous occurrence of high-grade functional MR (fMR) and AF therefore often poses a chicken-or-egg dilemma, rendering clinical decision making on which of the two conditions should prioritized challenging. To date, data regarding the rationale and the timing of MR therapy in this cohort are lacking. Purpose The aim of the present study was to identify predictors of persistence of de novo high-grade fMR after rhythm control of concomitant de novo AF in order to provide guidance for the early clinical management of this relevant cohort of patients. Methods In a single center observational cohort study, consecutive patients presenting with first diagnosed MR and AF undergoing acute rhythm control of AF were identified and patients with non-high-grade MR, primary MR, simultaneous cardiogenic shock, prior mitral valve repair or replacement, endocarditis, intracardiac thrombi and/or concomitant relevant pathology of the aortic valve were excluded. Clinical and echocardiographic parameters at baseline and follow-up (FU) were assessed and predictors of persistence of high-grade fMR at FU were identified via multivariable logistic regression analyses. Results A total of 780 consecutive patients were identified between 2016 and 2022, of whom 100 patients were enrolled in the study. Acute rhythm control of AF was achieved predominantly by electrocardioversion (90%, 90/100) and in a minority by pulmonary vein isolation (10%, 10/100). After a median FU period of 318 days (IQR 849 days), 59% (59/100) patients showed mild to moderate fMR and 41% (41/100) patients presented with persisting high-grade fMR, of whom 44% (18/41) and 39% (16/41) underwent surgical or percutaneous MR therapy, respectively. The remaining 17% (7/41) were conservatively treated. AF/AT recurrence was not associated with persistent high-grade MR (Odds ratio [OR] 2.4, 95% confidence interval [CI] 0.6-4.5, p = 0.2), whereas concomitant first degree AV block (OR 1.4, 95%-CI 1.1-1.7, p=0.005), pulmonary hypertension (OR 1.3, 95%-CI 1.1-1.6, p=0.004) and NYHA functional class IV (OR 1.4, 95%-CI 1.1-1.6, p=0.02) at the time of first presentation were found to be predictors of persistent high-grade MR during FU in multivariable logistic regression. Conclusion Patients with de novo high-grade MR and AF presenting with concomitant first degree AV block, NYHA functional class IV or pulmonary hypertension are more likely to have persistent high-grade MR after early rhythm control of AF regardless of sinus rhythm stability during FU. In this constellation, early definitive therapy for MR should be prioritized. Larger, prospective studies are needed to confirm the results and to investigate the impact of early interventional rhythm control strategies on MR reversibility.

Atrial functional tricuspid regurgitation in patients undergoing transcatheter aortic valve replacement

Abstract Introduction Recently, a novel entity of tricuspid regurgitation (TR) – atrial functional TR, which is caused by enlargement of the right atrium – has gained in awareness. In comparison, ventricular functional TR occurs in the setting of left heart disease with pulmonary hypertension and subsequent enlargement of the right ventricle. While it could be demonstrated that in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), an improvement of moderate or severe tricuspid regurgitation (TR) can be observed in many patients, knowledge about the association between entity and improvement of TR is scarce. Purpose The aim of this study was to analyse if atrial functional TR, defined by the enlargement of the right atrium is associated with the persistence of TR after TAVR in patients with severe AS and at least moderate concomitant TR at baseline. Moreover, 3-year all-cause mortality in patients with atrial and ventricular TR was assessed. Methods We retrospectively examined 363 patients with at least moderate tricuspid regurgitation undergoing TAVR from January 2013 to December 2020 due to severe AS. Patients with primary TR, a history of tricuspid valve surgery or with TAVR due to severe aortic regurgitation were excluded. Endsystolic area of the right atrium (RA) and enddiastolic area of the right ventricle (RV) were assessed in transthoracic echocardiography and atrial TR was defined as RA/RV area ratio above the median value of 1.125. Results TR improvement of at least one grade after transcatheter aortic valve replacement was significantly less frequent in patients with atrial compared to patients with ventricular TR (29.2% vs. 60.3%, p < 0.001, Figure 1). Multivariate logistic regression analysis with adjustment for left ventricular ejection fraction, Vena contracta and CT-determined tricuspid annulus diameter confirmed that atrial functional TR was an independent predictor for absence of TR improvement after TAVR (adjusted odds ratio: 3.03, 95% CI 1.65-5.64; p<0.001). Moreover, improvement of TR was associated with a significantly lower 3-year all-cause mortality compared to patients with persistence of TR (log rank test p<0.001, Figure 2A). However, no difference could be observed regarding 3-year all-cause mortality between patients with atrial and ventricular TR (log-rank test p=0.500, Figure 2B). Conclusion In patients undergoing TAVR for severe AS and at least moderate concomitant TR, atrial functional TR is an independent predictor for TR persistence. In addition, TR persistence is associated with increased 3-year all-cause mortality.Figure 1:Development of TR after TAVRFigure 2:3-year all-cause mortality

Emergent encoding of dispersal network topologies in spatial metapopulation models.

We address a generalization of the concept of metapopulation capacity for trees and networks acting as the template for ecological interactions. The original measure had been derived from an insightful phenomenological model and is based on the leading eigenvalue of a suitable landscape matrix. It yields a versatile predictor of metapopulation persistence through a threshold value of the eigenvalue determined by ecological features of the focal species. Here, we present an analytical solution to a fundamental microscopic model that incorporates key ingredients of metapopulation dynamics and explicitly distinguishes between individuals comprising the "settled population" and "explorers" seeking colonization. Our approach accounts for general network characteristics (in particular graph-driven directional dispersal which is known to significantly constrain many ecological estimates) and yields a generalized version of the original model, to which it reduces for particular cases. Through examples, including real landscapes used as the template, we compare the predictions from our approach with those of the standard model. Results suggest that in several cases of practical interest, differences are significant. We also examine, with both models, how changes in habitat fragmentation, including removal, addition, or alteration in size, affect metapopulation persistence. The current approach demonstrates a high level of flexibility, enabling the incorporation of diverse "microscopic" elements and their impact on the resulting biodiversity landscape pattern.

Socioeconomic Characteristics Associated With Development of Chronic Pain After Pain Interference Experienced in Early Adulthood.

Predictors of pain persistence have been identified among patients undergoing treatment for chronic pain or related conditions, but correlates of pain persistence in the general population remain underexplored. We identify socioeconomic variables associated with pain onset or persistence over a 6-10 year period in a nationally representative cohort. Using panel data from the National Longitudinal Survey of Youth-1997, we examined the presence of pain interference at age 29 and chronic pain at ages 35-39. Persistent pain was defined as pain present at both interview timepoints; new onset pain was defined as pain not reported at age 29, but present at ages 35-39; and transient pain was defined as experiencing pain interference at age 29 with no report of chronic pain at ages 35-39. Based on a sample of 6,188 participants, we estimated that 4% experienced persistent pain, 11% experienced transient pain, and 7% experienced new-onset pain. Pain persistence was less likely among non-Hispanic Black respondents but more likely among formerly married respondents and those with poor health, health-related work limitation, or greater pain interference at the age 29 baseline. New onset pain was most likely among female respondents, respondents with some college education, and respondents with poor self-rated health or obesity at baseline. Development of chronic pain by mid-late 30s was common among young adults experiencing pain interference at age 29. Race/ethnicity, gender, and educational attainment exhibited different associations with persistence as compared to new onset of pain problems.

Nudging students' interest in learning a new language: An experimental proof of concept for an online informational-nudge

Motivating students to persist in learning they did not choose is one of the most challenging parts of being an educator. Psychological, classroom-based interventions have been popularized, but less research has explored online support outside the classroom. An experimental test of the efficacy of a programme of informational nudge videos for the support of students' interest in learning a new language during compulsory university course in Japan was conducted. First/second year students (n = 2364; F = 627), participated in the experimental study. The experimental group watched 14 engaging informational videos (mean = 56 s) twice. The control group watched 14 videos that taught a specific an English phrase for the same amount of time. Prior/post individual interest, and prior utility-value for learning English, and their prior course self-efficacy were collected. Students pre/post English knowledge and their persistence in course online learning components was collected. Following latent profile analysis based on prior variables, the full sample and each subgroup was used to test a fully-forward longitudinal Structural Equation Model which tested the impact of the experiment on students' future individual interest in learning English. The LPA reveal three latent subgroups labelled low, moderate and high motivation. SEM test indicated a small, positive experimental effect for full sample (β = .05) and a larger effect for the moderate motivation subgroup (β = .08). Post individual interest for the moderate group was a significant predictor of e-learning persistence (β = .23), which predicted future knowledge (β = 10). This pilot programme of informational nudges presented a small significant longitudinal effect for future individual interest for the full sample and moderate motivation subgroup. This was followed by subsequent mediated links to e-learning persistence and knowledge growth. The informational nudge experiment presented positive results indicating that these informational, “light-touch” nudges have the propensity to support students' interest in learning.

Predictors of symptom persistence and respiratory sequelae in respiratory symptomatics presenting to a post-COVID clinic

Predictors of symptom persistence and respiratory sequelae in respiratory symptomatics presenting to a post-COVID clinic

Predictors of persistence and adherence to deutetrabenazine among patients with Huntington disease or tardive dyskinesia.

Deutetrabenazine is approved for treatment of Huntington disease (HD)-related chorea and tardive dyskinesia (TD) in adults. Factors associated with deutetrabenazine persistence and adherence are not well understood. Claims data from the Symphony Health Solutions Integrated Dataverse (2017-2019) were analyzed to identify real-world predictors of deutetrabenazine persistence and adherence in adults with HD or TD in the United States. Predictive models for persistence and adherence that considered patient demographics, payer type, comorbidities, treatment history, and health care resource use were developed. In HD, use of anticonvulsants (HR = 2.00 [95% CI = 1.03, 3.85]; P < .05), lipid-lowering agents (2.22 [1.03, 4.76]; P < .05), and Medicaid versus Medicare insurance (2.27 [1.03, 5.00]; P < .05) predicted persistence, whereas only comorbid anxiety disorders predicted discontinuation (0.46 [0.23, 0.93]; P < .05). Of these patients, 62.5% were adherent at 6 months. Use of ≤2 treatments for chronic diseases (OR = 0.18 [95% CI = 0.04, 0.81]; P < .05) and Medicaid versus Medicare insurance (0.27 [0.09, 0.75]; P < .05) was associated with lower odds of adherence. In TD, use of lipid-lowering agents (HR = 4.76 [95% CI = 1.02, 20.00]; P < .05) predicted persistence, while comorbid schizoaffective disorder and/or schizophrenia (0.16 [0.14, 0.69]; P < .05) and sleep-wake disorders (0.18 [0.04, 0.82]; P < .05) predicted discontinuation. Of these patients, 46.7% were adherent at 6 months. Comorbid schizoaffective disorder and/or schizophrenia was associated with lower odds of adherence (OR = 0.26 [0.07, 0.91]; P < .05). Identifying factors predictive of discontinuation and/or nonadherence to deutetrabenazine may facilitate the development of personalized support programs that seek to improve outcomes in patients with HD or TD.

Reassessing growth vulnerability

SummaryThis paper replicates the results of Adrian et al. (American Economic Review, 2019) that GDP growth volatility is mainly driven by the lower quantiles of the distribution which is predicted by the financial condition. It extends their study by estimating the model with the IVX‐QR estimator of Lee (Journal of Econometrics, 2016) and double weighted estimator of Cai et al. (Journal of Econometrics, 2022) considering that the financial condition index is highly serially correlated. Both models are estimated with the smoothed estimating equation approach of Kaplan and Sun (Econometric Theory, 2017). The results show that the findings of Adrian et al. (American Economic Review, 2019) are robust to possible bias due to the existence of persistent predictors. The out‐of‐sample forecasting exercises suggest that methods that are robust to the existence of persistent predictors can improve forecasting performance at the lower quantiles of the GDP growth distribution.

Which Patients with Prostate Cancer and Lymph Node Uptake at Preoperative Prostate-specific Membrane Antigen Positron Emission Tomography/Computerized Tomography Scan Are at a Higher Risk of Prostate-specific Antigen Persistence After Radical Prostatectomy? Identifying Indicators of Systemic Disease by Integrating Clinical, Magnetic Resonance Imaging, and Functional Imaging Parameters

BackgroundThe role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies on prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has scarcely been explored. Limited data are available to identify men who would benefit from RP; on the contrary, those more likely to benefit already have systemic disease. ObjectiveWe aimed to assess the predictors of prostate-specific antigen (PSA) persistence in surgically managed PCa patients with lymphadenopathies on a PSMA PET/CT scan by integrating clinical, magnetic resonance imaging (MRI), and PSMA PET/CT parameters. Design, setting, and participantsWe identified 519 patients treated with RP and extended lymph node dissection, and who received preoperative PSMA PET between 2017 and 2022 in nine referral centers. Among them, we selected 88 patients with nodal uptake at preoperative PSMA PET (miTxN1M0). Outcome measurements and statistical analysisThe outcome was PSA persistence, defined as a PSA value of ≥0.1 ng/ml at the first measurement after surgery. Multivariable logistic regression models tested the predictors of PSA persistence. Covariates consisted of biopsy International Society of Urological Pathology (ISUP) grade group, clinical stage at MRI, and number of positive spots at a PET/CT scan. A regression tree analysis stratified patients into risk groups based on preoperative characteristics. Results and limitationsOverall, lymph node invasion (LNI) was detected in 63 patients (72%) and 32 (36%) experienced PSA persistence after RP. At multivariable analyses, having more than two lymph nodal positive findings at PSMA PET, seminal vesicle invasion (SVI) at MRI, and ISUP grade group >3 at biopsy were independent predictors of PSA persistence (all p < 0.05). At the regression tree analysis, patients were stratified in four risk groups according to biopsy ISUP grade, number of positive findings at PET/CT, and clinical stage at MRI. The model depicted good discrimination at internal validation (area under the curve 78%). ConclusionsOne out of three miN1M0 patients showed PSA persistence after surgery. Patients with ISUP grade 2–3, as well as patients with organ-confined disease at MRI and a single or two positive nodal findings at PET are those in whom RP may achieve the best oncological outcomes in the context of a multimodal approach. Conversely, patients with a high ISUP grade and extracapsular extension or SVI or more than two spots at PSMA PET should be considered as potentially affected by systemic disease upfront. Patient summaryOur novel and straightforward risk classification integrates currently available preoperative risk tools and should, therefore, assist physician in preoperative counseling of men candidates for radical treatment for prostate cancer with positive lymph node uptake at prostate-specific membrane antigen positron emission tomography.

Differences in mammal communities between forest fragments and restoration areas in the Atlantic Forest

AbstractThe persistence of larger mammals in fragmented forest landscapes depends not only on the protection of remaining habitats but also on ecological restoration sites. It is known that the landscape context is an important predictor of species persistence, abundance and distribution. Here we evaluate how landscape characteristics influence the recovery of larger mammals in ecological restoration sites. We assess the richness and composition of mammals in forest fragments and restoration sites using landscape metrics such as forest cover and connectivity. Forest fragments and restoration sites present the same richness (n = 26), but differ in species composition. Some seed‐dispersing mammals were absent in restoration areas, such as Alouatta guariba (brown howler monkey) and Coendou spinosus (paraguayan hairy dwarf porcupine). The percentage of forest cover in the landscape was responsible for 29.09% of the variation in species composition between the evaluated forest formations, exerting a positive or negative influence depending on the species requirements. The results demonstrate the importance of considering not only landscape metrics in an ecological restoration plan, but also the historical landscape context, such as the fauna composition before the disturbance and how these species respond to environmental changes, thus improving the success of future ecological restoration measurements and policies.

Association of baseline and changes in adiponectin, homocysteine, high-sensitivity C-reactive protein, interleukin-6, and interleukin-10 levels and metabolic syndrome incidence: Tehran lipid and glucose study

BackgroundMetabolic syndrome (MetS) is accompanied by chronic low-grade inflammation, and inflammatory markers like high-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6), and homocysteine(Hcy) contribute to inflammation, obesity, and insulin resistance. Adiponectin(AdipoQ) and interleukin-10(IL-10) are anti-inflammatory markers that play protective roles in MetS. This study aimed to investigate the association between these biochemical marker changes and MetS in a sample of the Tehranian population during six years of follow-up. MethodsIn this longitudinal study, 340 adults at baseline and after a six-year follow-up, aged ≥18 years, were selected randomly from the Tehran Lipid and Glucose Study (TLGS). MetS was defined according to the Joint Interim Statement (JIS) criteria. Individuals were categorized into four groups based on their MetS status at baseline and follow-up: 1) non-MetS: participants who did not have MetS at both baseline and follow-up; 2) incident MetS: participants who did not have MetS at baseline but developed MetS during the follow-up ; 3) recovery MetS: participants who had MetS at baseline but no longer had MetS during the follow-up; 4) persistent MetS: participants who had MetS both at baseline and follow-up. ResultsThe mean follow-up time was 6.1 years. There were 176 subjects in the non-MetS group, 35 in the incident MetS group, 41 in the recovery MetS group, and 88 in the persistent MetS group. Increases in the levels of both hs-CRP 1.40 (95% CI: 1.15, 1.71, p = 0.001) and IL-6 1.09 (95% CI: 1.03, 1.17, p = 0.004) significantly increased the odds of the incident and persistent MetS, respectively. The area under the ROC curve (AUC) was more than 0.69 (p < 0.000) for hs-CRP in predicting MetS incidence and more than 0.86 (p < 0.000) for IL-6 in predicting MetS persistence. ConclusionAfter a six-year average follow-up, hs-CRP and IL-6 levels were deemed more reliable predictors of MetS incidence and persistence, respectively.

Decipher Score predicts prostate specific antigen persistence after prostatectomy.

The aim of this study was to evaluate genomic risk of patients with persistent prostate specific antigen (PSA) using mRNA expression analysis and a validated prognostic genomic-risk classifier. Monocentric retrospective study including all patients who underwent radical prostatectomy (RP) by one surgeon and Decipher Test from October 2013 to December 2018. PSA persistent population was defined as all patients with two consecutive PSA>0.1 ng/mL at follow-up after the surgery. Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) was performed intraoperatively for research of positive surgical margins. Multivariate analysis was performed for persistent PSA (pPSA) predictors. A specific localized, organ-confined, and negative margins sub-population with PSA persistence was compared to a similar sub-population without PSA persistence for genomic differential expression analyses. A total of 564 patients were included and 61 of them had pPSA. Preoperative PSA was higher in the PSA persistent group (11.6 [6.4, 21.2] vs. 6.2 [4.7, 9.2] P=0.00010), as well as PSA density (PSAd) (0.3 [0.2, 0.5] vs. 0.2 [0.1, 0.3] P=0.0001). Postoperative characteristics, Gleason Score, and positive surgical margins were significantly higher in the PSA persistent population. 31 patients had pPSA in our specific subpopulation and were compared to 217 patients with no pPSA. On multivariate analysis, only Decipher Score (OR=5.64 [1.28; 24.89], P=0.022) and preoperative PSA (OR=1.06, [1.02; 1.09], P=0.001) were significant predictors for PSA persistence. We found two genes to be significantly upregulated with a 2.5-fold change in our specific subpopulation (SERPINB11 and PDE11A). We found unique genomic features of patients with pPSA, whilst confirming previous clinical findings that this condition behaves to a worse prognosis. Given this high genomic risk, further imaging studies should be performed to select patients for early treatment intensification.

Investigating the Role of Individual Differences in Adherence to Cognitive Training.

Consistent with research across several domains, intervention adherence is associated with desired outcomes. Our study investigates adherence, defined by participants' commitment to, persistence with, and compliance with an intervention's regimen, as a key mechanism underlying cognitive training effectiveness. We examine this relationship in a large and diverse sample comprising 4,775 adults between the ages of 18 and 93. We test the predictive validity of individual difference factors, such as age, gender, cognitive capability (i.e., fluid reasoning and working memory), grit, ambition, personality, self-perceived cognitive failures, socioeconomic status, exercise, and education on commitment to and persistence with a 20-session cognitive training regimen, as measured by the number of sessions completed. Additionally, we test the relationship between compliance measures: (i) spacing between training sessions, as measured by the average time between training sessions, and (ii) consistency in the training schedule, as measured by the variance in time between training sessions, with performance trajectories on the training task. Our data suggest that none of these factors reliably predict commitment to, persistence with, or compliance with cognitive training. Nevertheless, the lack of evidence from the large and representative sample extends the knowledge from previous research exploring limited, heterogenous samples, characterized by older adult populations. The absence of reliable predictors for commitment, persistence, and compliance in cognitive training suggests that nomothetic factors may affect program adherence. Future research will be well served to examine diverse approaches to increasing motivation in cognitive training to improve program evaluation and reconcile the inconsistency in findings across the field.

Predictors of immune persistence induced by two-dose BBIBP-CorV vaccine in high-risk occupational population

BackgroundThe immune protection from infection may wane over time as neutralizing antibody levels decline. We aimed to develop a nomogram to predict long-term immune persistence induced by two-dose BBIBP-CorV vaccine and calculate the neutralizing antibody decline probability of individuals. MethodsIn the initial study, a total of 809 participants were recruited and randomly allocated (1:1:1) to vaccination group with three two-dose schedules on days 0 and 14, 0 and 21, or 0 and 28. The participants with neutralizing antibody titers of 16 or above on day 28 after the second dose were followed up at month 3, 6 and 10. Multivariable Cox proportional hazards regression model and nomogram model were used to identify predictors associated with maintaining of neutralizing antibody levels during 10 months after the second dose. ResultsA total of 744 participants followed up at day 28 after the second dose. The participants with age ≥ 50 (aHR = 3.556, 95 %CI: 1.141–4.884, P = 0.028) were associated with a high risk of response loss (titers < 16). The participants who were in 0–28 d group (aHR = 0.403, 95 %CI: 0.177–0.919, P = 0.031), had an influenza vaccination history (aHR = 0.468, 95 %CI: 0.267–0.921, P = 0.033) or were female (aHR = 0.542, 95 %CI: 0.269–0.935, P = 0.035) tended to maintain immune persistence during 10 months after the second dose. The nomogram was constructed and showed moderate discrimination[C-index:0.711 (95 %CI: 0.652–0.770); AUC: 0.731 (95 %CI: 0.663–0.792)] and good calibration. ConclusionsFrom 28 days to 10 months after receipt of the second dose of the BBIBP-CorV vaccine, neutralizing antibody levels were substantially decreased, especially among men, among persons 50 years of age or older, among persons with the 0–14 d group, and among persons without history of influenza vaccination.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100041705, ChiCTR2100041706.

Identifying Predictors of First-Line Subcutaneous TNF-Inhibitor Persistence in Patients with Inflammatory Arthritis: A Decision Tree Analysis by Indication.

Treatment persistence is a proxy for efficacy, safety and patient satisfaction, and a switch in treatment or treatment discontinuation has been associated with increased indirect and direct costs in inflammatory arthritis (IA). Hence, there are both clinical and economic incentives for the identification of factors associated with treatment persistence. Until now, studies have mainly leveraged traditional regression analysis, but it has been suggested that novel approaches, such as statistical learning techniques, may improve our understanding of factors related to treatment persistence. Therefore, we set up a study using nationwide Swedish high-coverage administrative register data with the objective to identify patient groups with distinct persistence of subcutaneous tumor necrosis factor inhibitor (SC-TNFi) treatment in IA, using recursive partitioning, a statistical learning algorithm. IA was defined as a diagnosis of rheumatic arthritis (RA), ankylosing spondylitis/unspecified spondyloarthritis (AS/uSpA) or psoriatic arthritis (PsA). Adult swedish biologic-naïve patients with IA initiating biologic treatment with a SC-TNFi (adalimumab, etanercept, certolizumab or golimumab) between May 6, 2010, and December 31, 2017. Treatment persistence of SC-TNFi was derived based on prescription data and a defined standard daily dose. Patient characteristics, including age, sex, number of health care contacts, comorbidities and treatment, were collected at treatment initiation and 12months before treatment initiation. Based on these characteristics, we used recursive partitioning in a conditional inference framework to identify patient groups with distinct SC-TNFi treatment persistence by IA diagnosis. A total of 13,913 patients were included. Approximately 50% had RA, while 27% and 23% had AS/uSpA and PsA, respectively. The recursive partitioning algorithm identified sex and treatment as factors associated with SC-TNFi treatment persistence in PsA and AS/uSpA. Time on treatment in the groups with the lowest treatment persistence was similar across all three indications (9.5-11.3months), whereas there was more variation in time on treatment across the groups with the highest treatment persistence (18.4-48.9months). Women have low SC-TNFi treatment persistence in PsA and AS/uSpA whereas male sex and golimumab are associated with high treatment persistence in these indications. The factors associated with treatment persistence in RA were less distinct but may comprise disease activity and concurrent conventional systemic disease-modifying anti-rheumatic drug (DMARD) treatment.

Persistence of antibody responses to COVID-19 vaccines among participants in the COVID-19 Community Research Partnership

IntroductionHigh levels of immunity to SARS-CoV-2 in the community correlate with protection from COVID-19 illness. Measuring COVID-19 antibody seroprevalence and persistence may elucidate the level and length of protection afforded by vaccination and infection within a population. MethodsWe measured the duration of detectable anti-spike antibodies following COVID-19 vaccination in a multistate, longitudinal cohort study of almost 13,000 adults who completed daily surveys and submitted monthly dried blood spots collected at home. ResultsOverall, anti-spike antibodies persisted up to 284 days of follow-up with seroreversion occurring in only 2.4% of the study population. In adjusted analyses, risk of seroreversion increased with age (adults aged 55–64: adjusted hazard ratio [aHR] 2.19 [95% confidence interval (CI): 1.22, 3.92] and adults aged > 65: aHR 3.59 [95% CI: 2.07, 6.20] compared to adults aged 18–39). Adults with diabetes had a higher risk of seroreversion versus nondiabetics (aHR 1.77 [95% CI: 1.29, 2.44]). Decreased risk of seroreversion was shown for non-Hispanic Black versus non-Hispanic White (aHR 0.32 [95% CI: 0.13, 0.79]); college degree earners versus no college degree (aHR 0.61 [95% CI: 0.46, 0.81]); and those who received Moderna mRNA-1273 vaccine versus Pfizer-BioNTech BNT162b2 (aHR 0.35 [95% CI: 0.26, 0.47]). An interaction between healthcare worker occupation and sex was detected, with seroreversion increased among male, non-healthcare workers. ConclusionWe established that a remote, longitudinal, multi-site study can reliably detect antibody durability following COVID-19 vaccination. The survey platform and measurement of antibody response using at-home collection at convenient intervals allowed us to explore sociodemographic factors and comorbidities and identify predictors of antibody persistence, which has been demonstrated to correlate with protection against disease. Our findings may help inform public health interventions and policies to protect those at highest risk for severe illness and assist in determining the optimal timing of booster doses.Clinical trials registry: NCT04342884.

Tuberculosis risk factors in South Africa, 2008 to 2017: A Generalised Estimating Equations approach

&#x0D; Background: Although, death due to tuberculosis has been on the decline. In 2016, 124 000 people died of tuberculosis in South Africa and the disease was declared the leading cause of death by Statistics South Africa. Continued efforts to use research to create a nation free of tuberculosis are underway. &#x0D; Methods: A repeated measures investigation was performed with the aim of identifying the persistent predictors and the long-term patterns of tuberculosis infection in South Africa for the period 2008 to 2017. The most suitable Generalised Estimating Equations that describe the population average probability of infection over time were applied to a sample of respondents taken from the National Income Dynamics Survey data, wave 1 to wave 5. The response variable was binary with the outcome of interest being the respondents that self-reported to have been diagnosed with tuberculosis. To improve estimation efficiency, the best working correlation matrix for this data was selected. &#x0D; Results: We used a sample of 8510 individuals followed for five waves, of these, 3.7%, 2.54%, 4.15%, 5.72% and 5.99% for waves 1, 2, 3, 4 and 5 respectively, reported to have been diagnosed with tuberculosis. Findings revealed that the independent working correlation matrix with the model-based standard error estimates gave the most robust results for the repeated measures tuberculosis data in South Africa. Furthermore, over the years, the average probability of being diagnosed with tuberculosis was positively associated with being single, male, middle-aged (30- 59 years), black African, unemployed, smoking, lower education levels, lack of regular exercise, asthma, suffering from other diseases, lack of access to improved sanitation, lower household income and expenditure. &#x0D; Conclusion: The probabilities of tuberculosis infection are independent within individuals over time. The inequalities in socioeconomic status in South Africa caused the poor to be more at risk of tuberculosis over time from 2008 to 2017. &#x0D;

The GRE as a predictor of persistence to a PhD

The GRE as a predictor of persistence to a PhD

HLA-DQA1*05 and upstream variants of PPARGC1B are associated with infliximab persistence in Japanese Crohn's disease patients.

Recently, the HLA-DQA1*05 (rs2097432) genetic variation has been reported to be linked to early infliximab (IFX) treatment failure in the Caucasian Crohn's disease (CD) population, but that evidence is scarce in the Asian population. This study aimed to investigate the relationship between rs2097432 and the cumulative discontinuation-free time of IFX (IFX persistence) in 189 Japanese biologics-naive CD patients. We also performed a genome-wide association study (GWAS) to discover novel genetic predictors for IFX persistence. The C allele of rs2097432 significantly increased the risk of early discontinuation of IFX [Hazard ratio (HR) = 2.23 and P-value = 0.026]. In GWAS, one locus tagged by rs73277969, located upstream of PPARGC1B which attenuates macrophage-mediated inflammation, reached genome-wide significance (HR = 6.04 and P-value = 7.93E-9). Pathway analysis suggested association of signaling by PDGF and FCGR activation signaling with IFX persistence (P-value = 8.56E-5 and 5.80E-4, respectively).

Improved tests for stock return predictability

– Predictive regression methods are widely used to examine the predictability of (excess) stock returns by lagged financial variables characterized by unknown degrees of persistence and endogeneity. We develop a new hybrid test for predictability in these circumstances based on simple regression t-statistics. Where the predictor is endogenous, the optimal, but infeasible, test for predictability is based on the t-statistic on the lagged predictor in the basic predictive regression augmented with the current period innovation driving the predictor. We propose a feasible version of this augmented test, designed for the case where the predictor is an endogenous near-unit root process, using a GLS-based estimate of the innovation used in the infeasible test regression. The limiting null distribution of this statistic depends on both the endogeneity correlation parameter and the local-to-unity parameter characterizing the predictor. A method for obtaining asymptotic critical values is discussed and response surfaces are provided. We compare the asymptotic power properties of the feasible augmented test with those of a (non augmented) t-test recently considered in Harvey et al. and show that the augmented test is more powerful in the strongly persistent predictor case. We then propose using a weighted combination of the augmented statistic and the t-statistic of Harvey et al., where the weights are obtained using the p-values from a unit root test on the predictor. We find this can further improve asymptotic power in cases where the predictor has persistence at or close to that of a unit root process. Our final hybrid testing procedure then embeds the weighted statistic within a switching-based procedure which makes use of a standard predictive regression t-test, compared with standard normal critical values, when there is evidence for the predictor being weakly persistent. Monte Carlo simulations suggest that overall our new hybrid test displays superior finite sample performance to comparable extant tests.