Pooled Data Research Articles

Spectrum of Non-Nucleoside Reverse Transcriptase Inhibitor-Associated Drug Resistance Mutations in Persons Living with HIV-1 Receiving Rilpivirine

Introduction: Few data are currently available on the nonnucleoside reverse transcriptase (RT) inhibitors (NNRTI) resistance mutations selected in persons living with HIV-1 (PLWH) who develop virological failure while receiving rilpivirine (RPV). Methods: We analyzed pooled HIV-1 RT genotypic data from 280 PLWH in the multicenter EuResist database and 115 PLWH in the Stanford HIV Drug Resistance Database (HIVDB) who received RPV as their only NNRTI. Results: Among the 395 PLWH receiving RPV, 180 (45.6%) had one or more NNRTI-associated DRMs. Overall, 44 NNRTI-associated DRMs were identified, including 26 that occurred in two or more PLWHs. Seven mutations had a prevalence ≥10% among the 180 PLWH with one or more NNRTI-associated DRM: E138K (32.2%), V90I (25.0%), K101E (17.8%), Y181C (17.2%), E138A (13.9%), H221Y (12.2%), and K103N (10.6%). Y181C was significantly more likely to co-occur with K101E, V179F, H221Y, and M230L. Ten novel non-polymorphic mutations at known NNRTI-associated mutation positions were also identified, usually in just one PLWH: L100F, V108A, T139I, P225S, M230V, Y232C, and T240A/I/M/S. Conclusions: Our analysis extends the spectrum of mutations emerging in PLWH receiving RPV. Additional phenotypic characterization of RPV-selected mutations is necessary to better understand their biological and possible clinical significance.

Inside Microfinance Matrix: Microfinance Institutions’ Characteristics and Women Credit Access

This study aims to explore the role of Microfinance Institutions’ (MFIs) organisational characteristics including ownership structure, target market, and institutional size, in shaping the lending pattern in reaching women entrepreneurs. This study employs Ordinary Least Square and Fractional Logit regression using STATA on pooled panel data of 2,330 MFIs across 116 countries. A fuzzy algorithm and Principal Component Analysis are applied to verify the consistency of the results. Findings suggest larger MFIs demonstrate greater inclusivity towards women, attributed to their extensive resources and institutional capabilities. Similarly, MFIs targeting affluent clients exhibit a higher likelihood of catering to the financial needs of women. Non-government organisations (NGOs) emerge as key drivers of women credit access, consistently prioritizing women entrepreneurs through targeted interventions. This study contributes to theoretical implications of the interplay between institutional ownership and goals related to social welfare. This finding also expands microfinance literature by emphasising how ownership influences the strategic orientation of MFIs. This study holds significance for financial regulators, and policymakers to utilise this study as a framework to evaluate the interplay between organisational scale, financial sustainability, and the fulfilment of social objectives within the microfinance sector.

Delivery Efficiency of Albuterol Pressurized Metered Dose Inhaler Through Small Size Laryngeal Mask Airways in an Infant and Child Model.

Intraoperative bronchospasm in pediatric patients supported through laryngeal mask airways (LMAs) is commonly treated with pressurized metered-dose inhaler (pMDI) albuterol. The aim of the study was to evaluate delivery of pMDI albuterol through LMAs under different conditions in a model of infant/child supported with a ventilator. We compared drug delivery efficiency of 4 actuations of albuterol pMDI (captured on a filter placed between the LMA and a test lung), drug deposition in the circuit (elbow) and in the LMA under different experimental conditions. Outcomes were expressed of percentage of nominal dose. We compared devices (valved holding chamber [VHC] and adapter), timing of administration (inspiration and expiration), tidal volumes (50 mL and 100 mL), mode of actuation (single and multiple), and LMA sizes (1, 1.5, and 2). Multiple regression analysis was used to evaluate the contribution of each to these components to the outcomes. P < .05 was considered statistically significant. Results are expressed as median (interquartile range) of pooled data. Drug delivery efficiency was 0% (0-1.1) and 6.3% (3.2-14.7) for adapter and VHC, respectively. Elbow deposition was 25.8% (19.2-63.3) and 2.9% (1.4-6.4) for adapter and VHC, respectively. LMA deposition was 2.6% (1.3-4.6) and 4.6% (2.9-6.1) for adapter and VHC, respectively. Multiple regression analysis showed that device, timing of actuation, and LMA size explained 33%, 17%, and 8% of the observed variation in delivery efficiency (R2 0.63), respectively. Multiple regression analysis showed that device and timing of actuation explained 52% and 16% of the observed variation, respectively (R2 0.70). Multiple regression analysis poorly explained factors associated with LMA deposition (R2 0.22). Using a VHC, actuating the pMDI during exhalation, and using a small LMA size increased drug delivery efficiency. The adapter was an inefficient add-on device for aerosol delivery with a pMDI through an LMA that caused significant circuit deposition.

Natriuretic peptides, kidney function and clinical outcomes in heart failure with mildly reduced or preserved ejection fraction: pooled data from the I-PRESERVE, TOPCAT, PARAGON and DELIVER trials

Abstract Background The prognostic utility of N-terminal pro-B-type (NT-proBNP) in patients with heart failure and chronic kidney disease (CKD) is incompletely understood since elevations in NT-proBNP could be related either to decreased clearance by the kidney or to increased severity of structural heart disease. Purpose We sought to assess the association of NT-proBNP with cardiovascular and mortality outcomes in patients with heart failure and mildly reduced or preserved ejection fraction, stratified by baseline kidney function. Methods We conducted a pooled analysis of individual participants with NT-proBNP and estimated glomerular filtration rate (eGFR) measured at baseline in the I-PRESERVE, TOPCAT (Americas region), PARAGON and DELIVER trials. We evaluated the relationship between NT-proBNP and kidney function using piecewise linear regression. Using multivariable Cox and Poisson regression models, we assessed the association of NT-proBNP with clinical outcomes across different levels of eGFR (≥60, 45-&amp;lt;60 and &amp;lt;45 mL/min/1.73m2). The primary outcome was hospitalisation for heart failure or cardiovascular death. Results Among 14,831 participants (mean age 72.1 years, 50.3% female, mean eGFR 63.3 mL/min/1.73m2 and median NT-proBNP 840 pg/mL) followed for a median 33.5 months, there were 3,092 primary outcomes, 2,184 heart failure hospitalisations, 1,465 cardiovascular and 1,049 non-cardiovascular deaths. Participants in lower eGFR categories were more likely to be older, female, and have atrial fibrillation and diabetes (all p&amp;lt;0.001). NT-proBNP levels increased by 9%, 8%, and 23% per 10 mL/min/1.73m2 lower eGFR in patients with baseline eGFR ≥60, 45-60, and &amp;lt;45 mL/min/1.73m2, respectively (P for non-linearity &amp;lt;0.001). For any given NT-proBNP concentration, participants with eGFR &amp;lt;45 mL/min/1.73m2 were at highest risk (Figure 1). Each doubling in NT-proBNP was associated with a 37% relative increase in the primary outcome (HR 1.37, 95% CI 1.34-1.41), consistent across different eGFR categories (P-interaction=0.42). Association between NT-proBNP and other clinical outcomes were also consistent across different levels of kidney function (all P-interaction&amp;gt;0.3; Figure 1). Equivalent risk for the primary outcome was apparent at NT-proBNP levels approximately 2.5- to 3.5-fold lower in patients eGFR &amp;lt;45 mL/min/1.73m2, compared to those with eGFR ≥60 mL/min/1.73m2. (Figure 2). Conclusion NTproBNP is a potent predictor of risk in patients with heart failure with mildly reduced or preserved ejection fraction across the spectrum of kidney function. However, in patients with reduced kidney function, lower NT-proBNP levels confer absolute risk of cardiovascular outcomes similar to substantially higher NT-proBNP levels in patients with normal kidney function. Accordingly, interpretation of NTproBNP levels should vary according to kidney function, particularly in those with eGFR &amp;lt;45 mL/min/1.73m2.

Heart failure risk assessment using biomarkers in patients with atrial fibrillation: analysis of 32,041 patients from the COMBINE-AF study

Abstract Introduction Heart failure (HF) is one of the most common comorbidities in patients with AF, resulting in a clinical need for robust risk assessment. Purpose To investigate the incremental value of adding NTproBNP, high-sensitivity cardiac troponin T (hs-cTnT), and growth-differentiation factor-15 (GDF-15) to clinical predictors for HF risk stratification in patients with AF, and the individual contribution of each biomarker accounting for inter-biomarker correlation. Methods We used pooled individual patient data from 3 large RCTs investigating DOACs versus VKAs (ARISTOTLE, ENGAGE AF-TIMI 48, RE-LY) from the COMBINE-AF cohort and included all patients with available biomarkers at baseline. The composite primary endpoint was hospitalization for HF (HHF) or CV death (CVD), with HHF as secondary endpoint. We employed analyses of absolute risk and Cox-regression adjusting for clinical factors to assess the association of the individual biomarkers with both endpoints, testing incremental discrimination with the likelihood ratio test from nested models. To address the inter-biomarker correlation, weighted quantile sum (WQS) regression analysis summarizing the adjusted risk of all biomarkers (per quartile) in one index was applied, thereby exploring the individual and additive contribution of each biomarker to risk assessment. Results Data were available in 32,041 patients (median age 71 [IQR 64-77] years, 36.7% female, 23.0% with paroxysmal AF, 41.6% with established HF). Higher biomarker values were associated with a graded increase in absolute risk for HHF/CVD and HHF (Figure 1). In a model adjusting for clinical variables and all biomarkers, hs-cTnT (HR per 1-SD 1.39 [95% CI 1.33-1.44]), NT-proBNP (HR 1.67 [95% CI 1.58-1.76]), and GDF-15 (HR 1.20 [95% CI 1.15-1.25]) were associated with HHF/CVD. The c-index increased with addition of biomarkers (0.70 [0.69, 0.70] to 0.77 [0.76, 0.78]; Likelihood ratio test p&amp;lt;0.001). Results were similar for HHF alone. NTproBNP was significantly correlated with hs-cTnT (r=0.40, p&amp;lt;0.0001) and GDF-15 (r=0.36, p&amp;lt;0.001). To address this correlation, WQS regression analysis was conducted (Figure 2). NTproBNP and hs-cTnT contributed nearly equally to the risk assessment for HHF/CVD and HHF, with GDF-15 providing statistically significant but less contribution to risk assessment (Figure 2). Conclusion Hs-cTnT, NT-proBNP and GDF-15 contribute individually and additively to the risk assessment for HHF/CVD and HHF in patients with AF. Our analysis suggests that hs-cTnT is as important as NTproBNP for HF risk assessment, with significant but less contribution of GDF-15. Our findings support the possible future routine use of biomarkers to distinguish patients with AF at low or high risk for HF and could guide the introduction of therapies to mitigate the risk of HF events in this growing population.Event incidence by biomarker quartilesWeighted quantil sum regression analysis

Prevalence of anemia among coronavirus disease 2019 patients in Ethiopia: A meta-analysis

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2, impacting various systems in the human body, including the hematological and reticuloendothelial systems, which can alter blood production. Consequently, severe anemia-associated complications could occur in COVID-19 patients. At present, there is a lack of pooled prevalence data on anemia among COVID-19 patients in Ethiopia. This systematic review and meta-analysis aimed to determine the overall prevalence of anemia in this population. Following PRISMA guidelines, we conducted a literature search across PubMed/MEDLINE, Cochrane Library, Google Scholar, HINARI, and the Ethiopian Journal of Health Development for articles published before 2024. Additional manual searches were performed to identify relevant studies. Study selection, data extraction, and quality assessment were conducted independently by the authors. The I2 test statistics were used to assess heterogeneity among studies, and the overall prevalence was calculated using a random-effect restricted maximum likelihood model. Out of 860 studies obtained, 11 articles were included in the meta-analysis. The pooled prevalence of anemia among COVID-19 patients in Ethiopia was found to be 22.81% (95% CI [confidence interval]: 14.76 &amp;ndash; 30.85%). Specifically, the prevalence of anemia in Addis Ababa and Amhara was 27.13% (95% CI: 14.59 &amp;ndash; 39.66%) and 22.50% (95% CI: 11.04 &amp;ndash; 33.96%), respectively. This study indicates that anemia is a moderate public health problem among COVID-19 patients in Ethiopia. Consequently, it is imperative to implement preventative interventions and management strategies for anemia in this population.

Bidirectional relationship between kidney disease progression and cardiovascular events in type 2 diabetes: new Insights from the CANVAS Program and CREDENCE trial

Abstract Background The extent to which chronic kidney disease (CKD) progression increases cardiovascular risk, and whether different types of cardiovascular events affect risk of CKD progression, is incompletely understood. Purpose We sought to explore risk of cardiovascular events before and after CKD progression, and CKD progression before and after different cardiovascular events in patients with type 2 diabetes. Methods We conducted a pooled individual participant data analysis of the CANVAS Program and CREDENCE trial. Using Poisson regression, we assessed the incidence of major adverse cardiovascular events ([MACE] stroke, myocardial infarction, or cardiovascular death) and hospitalised heart failure (HHF) or cardiovascular death before and after CKD progression (defined as 40% decline in estimated glomerular filtration rate [eGFR] or kidney failure), and CKD progression before and after nonfatal cardiovascular events, with no adjustment for confounding related to subgroups defined by post-randomization variables. We estimated the cumulative incidence of all-cause mortality after different nonfatal cardiovascular and kidney outcomes, including different thresholds of CKD progression (kidney failure, 40% or 50% decline in eGFR or doubling of serum creatine) using Cox regression models. Results Among 14,464 participants (mean age 63.7 years, 35.3% female, mean eGFR 55mL/min/1.73m2 and median urinary albumin:creatinine ratio 34mg/g) over a median follow-up of 2.5 years, 1,482, 1,076 and 1,020 experienced MACE, HHF or cardiovascular death, and CKD progression, respectively. After (vs. before) CKD progression, there was an approximate 3-fold increase in incidence of MACE (30.2 vs. 93.8 per 1000-patient-years) and 4-fold increase in HHF or cardiovascular death (21.0 vs. 79.3 per 1000-patient-years). Conversely, the incidence of CKD progression was approximately 1.5-fold higher after (vs. before) nonfatal myocardial infarction or stroke (21.7 vs. 34.1 per 1000-patient-years) and 5-fold higher after HHF (21.2 vs. 108.2 per 1000-patient-years). These patterns were consistent in both treatment arms, with unadjusted incidence rates for clinical events appearing numerically lower in canagliflozin compared to placebo-treated participants (Figure 1). Of all non-fatal cardio-kidney outcomes, HHF and doubling of serum creatine or kidney failure conferred the highest risk of death (Figure 2). Conclusion Atherosclerotic and heart failure risk increases substantially after CKD progression. CKD progression was accelerated after cardiovascular events, particularly HHF. Treatment with canagliflozin was associated with lower event rates before and after a serious cardio-kidney outcome, suggesting continued use of canagliflozin may be beneficial even after cardiovascular events and CKD progression.Figure 1.Figure 2.

Blood pressure control and cardiovascular risk assessment in patients with hypertension: a pooled analysis of 6 countries in Eastern and Southern Europe (SNAPSHOT study)

Abstract Background Recent guidelines of the European Society of Cardiology (ESC) introduced stricter recommendations regarding blood pressure (BP) control, based on recommended levels following an assessment of cardiovascular (CV) risk. However, data are lacking on perception and actual BP control, and CV risk assessment. Purpose To assess BP control and CV risk assessment in patients with hypertension. Methods This is a cross-sectional multicentre study (SNAPSHOT) including pooled data from 6 countries in Europe. 9466 patients with hypertension were included from 513 participating investigators (69.6% general practitioners [GPs], 17.4% cardiologists, 6.2% endocrinologists). BP control and CV risk were assessed by investigators and compared to the re-assessment based on current ESC guidelines (SCORE1 and SCORE2&amp;2-OP). Results 9443 patients with complete data (65.6±10.7 years, 57.0% female) were analysed from Bulgaria (35.6%), Romania (26.8%), Croatia (13.8%), Serbia (12.5%), Georgia (6.4%), and Spain (4.9%). Most patients had additional risk factors, such as overweight/obesity (81.6%), dyslipidaemia (80.8%), type 2 diabetes (32.8%) or current/former smoking (29.5%). Two or more risk factors (male gender, age ≥65 years, obesity, smoking) were more frequent in patients with very high calculated CV risk (60.9% by SCORE1, 57.7% by SCORE2&amp;2-OP). Systolic and diastolic BPs were 139.3±17.3 mmHg and 82.3±10.9 mmHg, respectively. Almost all patients (98.5%) had their hypertension treated, 54.5% taking a single-pill combination (SPC). The most used drug classes were diuretics (59.6%), angiotensin-converting enzyme inhibitors (59.4%), and beta-blockers (57.0%). Combination therapy of 2 or 3 drug classes (SPC or not) was used in 33.2% and 34.4% of patients, respectively. According to investigators, BP was considered controlled in 75.0% of patients, whereas 48.0% of patients had BP &amp;lt;140/90 mmHg, and only 24.4% of patients were controlled at BP target according to guidelines (Figure 1). CV risk was estimated by investigators as low, moderate, high or very high for 10.1%, 34.9%, 32.0% and 23.0% of patients, respectively, whereas calculated CV risk was very high in most patients (59.1% by SCORE1, 86.8% by SCORE2&amp;2-OP). CV risk estimated by investigators varied by country and by speciality, being high (29.4%, 35.0% and 32.0%) and very high (32.4%, 49.8% and 18.6%) for cardiologists, endocrinologists and GPs, respectively. Compared to calculated CV risk, CV risk estimated by investigators was frequently underestimated (54.4% by SCORE1, 67.6% by SCORE2&amp;2-OP), varying between 30.8% in Spain and 68.2% in Bulgaria for SCORE1, and between 42.1% in Spain and 84.8% in Serbia for SCORE2&amp;2-OP (Figure 2). Conclusion Physicians across 6 European countries tended to overestimate control of BP and underestimate CV risk in patients with hypertension. Our findings highlight the need for better assessment and management of patients according to the latest ESC guidelines.

Long-term effects of patisiran on survival and cardiac parameters in patients with transthyretin-mediated cardiac amyloidosis: post hoc analysis of APOLLO-B and cardiac subpopulation of APOLLO OLE

Abstract Introduction Transthyretin-mediated (ATTR) amyloidosis is a progressive, fatal disease in which the most serious manifestations are polyneuropathy and cardiomyopathy. Patients with hereditary ATTR (ATTRv; v for variant) amyloidosis commonly develop a mixed phenotype, and patients with wild-type ATTR amyloidosis predominantly have cardiomyopathy, although polyneuropathy may coexist. Patisiran, an RNAi therapeutic that rapidly knocks down TTR, has shown long-term benefit on measures of polyneuropathy in the APOLLO open-label extension (OLE) study in patients with ATTRv amyloidosis. Purpose To evaluate the long-term benefit of patisiran on survival, hospitalisations and cardiac parameters in a pooled cohort of patients with ATTR amyloidosis and evidence of cardiac involvement, across the patisiran clinical programme (Phase [Ph] 2 launched in 2012). Methods Post hoc analysis of pooled data from cardiac subpopulations of patients with ATTRv amyloidosis and polyneuropathy from 5-year Global OLE (Ph 2 OLE and Ph 3 APOLLO; patients with baseline left ventricular [LV] wall thickness ≥13 mm; absence of history of aortic valve disease or hypertension), and Ph 3 APOLLO-B (patients with wild-type or ATTRv cardiac amyloidosis). Patients received patisiran or placebo every 3 weeks for 18 months in APOLLO and 12 months in APOLLO-B; all patients received patisiran thereafter. Analyses included Kaplan-Meier estimates and Cox regression of survival and all-cause hospitalisations, and summary statistics of cardiac biomarkers and echocardiographic parameters by initial treatment arm. Results Pooled analysis included 496 patients (initial arm placebo, n=214; initial arm patisiran, n=282). Compared with placebo, patients initially receiving patisiran had better long-term survival and fewer hospitalisations (hazard ratio [95% confidence interval] over 84 months for all-cause mortality and all-cause hospitalisations: 0.59 [0.37–0.93] [Figure 1] and 0.77 [0.60–0.99], respectively). At baseline, NT-proBNP and troponin I levels, peak longitudinal strain and LV wall thickness were comparable between patisiran vs placebo-treated patients. Placebo-treated patients showed worsening of all these parameters whilst on placebo; the rates of worsening decreased once the patients initiated patisiran. In contrast, patients who initially received patisiran demonstrated relative stability over 84 months in the Global OLE and significant benefit compared with those initially treated with placebo. Conclusion Long-term benefit of patisiran in patients with cardiomyopathy was observed on survival, hospitalisations, cardiac biomarkers and echocardiographic parameters. Outcomes were significantly more favourable for those initially randomised to patisiran than placebo, highlighting the impact of initiating treatment early in the course of disease.

Political trust and economic development in European regions

AbstractThis paper examines the complex relationship between political and social trust, government quality, and economic development across 208 regions in the European Union (EU). We use a pooled data generalized structural equation model (GSEM) to show that political trust serves as a fundamental driver of regional economic development in the EU. Political trust is, in turn, influenced by both social trust and government quality. Social trust and government quality have quadratic effects on political trust, showing diminishing returns, while the effect of political trust on economic development is linear. Political trust mediates the relationship between social trust and economic development entirely, while government quality retains a direct relationship with economic development. These findings underscore the fundamental role that political trust plays as a mechanism through which both formal and informal institutions shape regional development.

Exposure-Response Analysis of Tofacitinib in Active Psoriatic Arthritis: Results from Two Phase 3 Studies.

Tofacitinib is an oral Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA). These post hoc exposure-response (E-R) analyses of pooled data from two Phase 3 studies (NCT01877668 and NCT01882439) characterized the relationships between tofacitinib exposure and efficacy (American College of Rheumatology [ACR] criteria), and changes in hemoglobin (Hgb) in patients with PsA. Efficacy data for the proportion of patients receiving tofacitinib 5 or 10 mg twice daily, or placebo, achieving ACR ≥20%, ≥50%, or ≥70% response criteria (ACR20, ACR50, and ACR70, respectively) at Month 3, were modeled jointly using a four-category ordered categorical exposure-response model (ACR20 non-responder, ACR20 responder but not ACR50 responder, ACR50 responder but not ACR70 responder, and ACR70 responder). A maximum drug effect (Emax) model (using average concentrations of tofacitinib at steady state [Cavg]) adequately described the exposure-ACR response rate relationship. Model-predicted response rates for tofacitinib 5 and 10 mg twice daily were 51% and 58%, respectively, for ACR20; 29% and 36% for ACR50; and 15% and 20% for ACR70. The E-R relationship between tofacitinib exposure and changes in Hgb was assessed using an indirect response model, which generally predicted Hgb concentration-time profiles across treatments well. The proportions of patients experiencing a decrease in Hgb of >2 g/dL were similar with tofacitinib 5 mg twice daily or placebo. These results were generally consistent with previous analyses in rheumatoid arthritis and psoriasis, and support the use of tofacitinib 5 mg twice daily for active PsA.

Suicidal ideation and mental illnesses during the COVID-19 pandemic in Canada

Abstract Background The presence of a mental illness is a known risk factor for suicide mortality and other suicide-related behaviours, including suicidal ideation. We examined prevalence of mental illnesses among adults with and without suicidal ideation in Canada during the pandemic. Data and methods We used pooled data from the 2020, 2021, &amp; 2023 Survey on COVID-19 and Mental Health to estimate the prevalence of moderate to severe symptoms of generalized anxiety disorder, major depressive disorder, and posttraumatic stress disorder among adults who reported suicidal ideation, compared to those who did not report suicidal ideation. We also conducted the analyses across sociodemographic factors and COVID-19 pandemic-related experiences. Results Among adults in Canada who reported suicidal ideation, 83.0% also screened positive for at least one of the three mental illnesses. The prevalence of mental illnesses did not differ significantly across sociodemographic factors or pandemic-related experiences. In contrast, the prevalence of at least one mental illness among adults without suicidal ideation was much lower (21.2%), and this prevalence differed by sociodemographic factors and pandemic-related experiences. Interpretation During the COVID-19 pandemic, most adults in Canada with suicidal ideation had moderate to severe symptoms of mental illness.

Who dominates? Multiple constructions of women's subjective social status and their cohort dynamics in transitional China

The way women construct their subjective social status has garnered significant attention. However, the roles of husbands and fathers in this process have been underexplored, with even less focus on how these roles have evolved across generations. This study aims to answer two important questions against the backdrop: First, which is the most dominant factor in shaping married women's subjective social status, their own objective class or those of their husband or father? Answers to this question reveal the impacts of assortative mating and intergenerational mobility. Second, how does the construction pattern change across birth cohorts? Cohort dynamics help reflect the evolution of gender roles and family values in China. Using pooled data from the Chinese General Social Survey in 2010–2017 and the diagonal reference model, our study finds that Chinese married women previously tended to construct their own social status based on the objective class of their husbands. However, this trend is reversed for younger cohorts. Father's objective class status carries roughly the same weight as women's own, but its impact becomes moderately stronger in younger cohorts. Taken together, the above findings reveal a unique pathway of family modernization in transitional China. Married women, although increasingly independent of their spouses, still remain closely connected with their natal families.

Experimental evaluation of effectiveness of genomic selection for resistance to northern corn leaf blight in maize.

Northern corn leaf blight (NLB) caused by Setosphaeria turcica (Luttrell) Leonard & Suggs is a severe foliar disease in maize. Resistance to NLB is complexly inherited and controlled by several quantitative trait loci (QTL) distributed across the genome. Phenotype and DNA marker-based selection for resistance to NLB is expected to be effective. Hence, an investigation was carried out to predict the genetic value of selection candidates for resistance to NLB and compare the accuracies of genomic prediction in two F2:3 populations of two crosses (CM212 × MAI172; CM202 × SKV50) derived from contrasting parents. Linkage analysis using 297 polymorphic SNPs in population-1 and 290 polymorphic SNPs in population-2 revealed ten linkage groups spanning 3623.88cM and 4261.92cM with an average distance of 12.40cM and 14.9cM in population-1 and population-2, respectively. Location-wise and pooled data across locations identified common QTLs on linkage groups 1 and 6 in population-1 and 3 and 8 in population-2. The prediction accuracy of the QTL mapping (9.92 and 9.10 for population-1 and population-2, respectively) was based on only a few markers, which explained higher percent phenotypic variation. The prediction accuracies of the genomic estimated breeding values in the present investigation were relatively low in population-1 (0.24 to 0.26) and population-2 (0.29-0.32) compared to the expected accuracies. This could be due to fewer polymorphic markers and a small training/population size. Though the GS prediction accuracies were relatively low, they were significantly higher than QTL mapping, which promises better genetic gain per cycle. The resistant progenies from both populations were advanced to derive inbred lines and crossed with four different testers in line × tester mating design to test for their combining ability and effectiveness of genomic selection. High overall general combining ability was exhibited by 21 inbred lines. Among F1s, 48% were assigned high overall specific combining ability status. Out of the 136 single crosses, seven recorded significant positive standard heterosis over the best check for grain yield. Twenty-five inbreds with high GEBVs were crossed with four testers to obtain 100 F1s and evaluated for their response to NLB. The majority of hybrids displayed moderate to resistant reaction to NLB either in combination with susceptible or resistant testers indicating the effectiveness of selection based on high GEBVs.

Stenting for symptomatic intracranial arterial stenosis with different qualifying arteries: a preplanned pooled individual patient data analysis

BackgroundThe efficacy of percutaneous transluminal angioplasty and stenting (PTAS) relative to medical management in treating symptomatic intracranial arterial stenosis (ICAS) varies based on the qualifying artery. This study aims to...

Causal inference in multi-cohort studies using the target trial framework to identify and minimize sources of bias.

Longitudinal cohort studies, which follow a group of individuals over time, provide the opportunity to examine causal effects of complex exposures on long-term health outcomes. Utilizing data from multiple cohorts has the potential to add further benefit by improving precision of estimates through data pooling and by allowing examination of effect heterogeneity through replication of analyses across cohorts. However, the interpretation of findings can be complicated by biases that may be compounded when pooling data, or, contribute to discrepant findings when analyses are replicated. The "target trial" is a powerful tool for guiding causal inference in single-cohort studies. Here we extend this conceptual framework to address the specific challenges that can arise in the multi-cohort setting. By representing a clear definition of the target estimand, the target trial provides a central point of reference against which biases arising in each cohort and from data pooling can be systematically assessed. Consequently, analyses can be designed to reduce these biases and the resulting findings appropriately interpreted in light of potential remaining biases. We use a case study to demonstrate the framework and its potential to strengthen causal inference in multi-cohort studies through improved analysis design and clarity in the interpretation of findings. Special Collection: N/A.

Do immigrant women spend more time on unpaid labor? Generational differences by race, ethnicity, and household composition in household work within the United States

ABSTRACT Despite relative progress, it is an overt fact that women still take on the heavier burden of unpaid work in the household compared to men in the United States. Our study expands the horizons of previous studies by looking at women specifically and analyzes how women’s performance of unpaid labor differentiates based on various contexts such as generational status, household composition, race, and ethnicity. Using the pooled cross-sectional data from the 2011-2021 American Time Use Survey (ATUS), we test hypotheses derived from an absolute resources perspective and a structural perspective to examine migrant generational differences among married, cohabiting, and single women as well as investigate the intra-group differences of racial and ethnic groups. From our descriptive analysis and ordinary least squares (OLS) regression analyses, we find support for the structural perspective for housework, as the generational differences remain even after controlling for socioeconomic factors, but only for first-generation married women. However, socioeconomic factors account for the differences between cohabiting or single first-generation women, which is supported by the absolute resources perspective. Our intra-group analysis by racial and ethnic groups yielded similar findings but found that Hispanic and Asian first-generation women take on a larger proportion of housework, relative to later-generation women.

The Effects of Different Nursing Positions During Preterm Infants Feeding on Gastric Residual Volume and Emptying Rate: A Systematic Review and Network Meta-Analysis.

Preterm infants need nutritional support due to their premature digestive system, undeveloped anatomy and functional limitations. Neonatal positioning in the proper position is one of the nurses' main principles that affect the residual volume. We performed our systematic review and network meta-analysis to determine the best feeding position for preterm infants in reducing gastric residual volume and increasing the rate of gastric emptying. We systematically searched PubMed, Cochrane, CINHAL, Scopus and Web of Science from their inception to August 2023. We included studies that assess the effect of different feeding positions for preterm infants on gastric residuals. The Cochrane risk of bias tool (ROB2) appraised the included clinical trials. Cohort studies were assessed by the NIH tool and quasi-experimental studies by the relevant items from (Downs and Black) checklist. RevMan Version 5.4 was used for analysing the pooled data. Our study included a frequentist network meta-analysis of the aggregate data to obtain network estimates for the outcomes of interest. Network meta-analysis was done using R software. We included 16 studies with 1139 premature infants, comparing six preterm feeding positions. The pooled MD and 95% CI for GRV at 30 min for right lateral, prone, right anterior oblique and left lateral compared to supine position were as follows: (-12.08 [-20.09, -4.07]), (-11.14 [-18.26, -4.01]), (-9.02 [-21.66, 3.61]) and (-0.18 [-7.87, 7.5]), respectively. Moreover, the pooled MD and 95% CI for GRV at 180 min for right lateral, prone and left lateral compared to supine position were as follows: (-0.69 [-1.29, -0.09]), (-0.56 [-1.22, 0.1]) and (0.09 [-0.63, 0.81]), respectively. Nevertheless, the pooled MD and 95% CI for GRV at 120 min for right anterior oblique, prone, right lateral and left lateral compared to supine position were as follows: (-6.09 [-11.33, -0.86]), (-5.07 [-7.71, -2.43]), (-3.08 [-5.89, -0.27]) and (-0.44 [-3.41, 2.53]), respectively. We concluded that the best nursing position after preterm infants feeding for lower gastric residuals and higher gastric emptying rate is the right lateral position after 30 and 180 min post-feeding. Also, the right anterior oblique was the best after 120 min. Although the prone position can lower the GRV better than the left lateral and supine positions, it is not advisable to use this position because it raises the SIDS risk. Our results could help healthcare professionals to provide the appropriate positioning of preterm infants.

Olokizumab plus methotrexate: safety and efficacy over 106 weeks of treatment

ObjectiveTo report long-term safety and tolerability of olokizumab (OKZ) in combination with methotrexate (MTX) in subjects with active rheumatoid arthritis (RA), using pooled data from three randomised clinical trials (RCT)...

Effectiveness of Acupuncture in Improving Quality of Life for Patients with Advanced Cancer: A Systematic Review and Meta-Analysis.

To investigate the effect of acupuncture on advanced cancer patients by meta-analysis. Nine databases (the Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science, Embase, China National Knowledge Infrastructure, the Cumulative Index to Nursing and Allied Health Literature, Chinese Biomedical Literature Database, China Science and Technology Journal Database, and WanFang Data) were searched for randomized controlled trials (RCTs) on acupuncture in advanced cancer patients published from inception to February 13, 2023 and updated to June 1, 2023. Primary outcomes were quality of life (QOL), while secondary outcomes were pain, fatigue, and adverse events (side effects). Data synthesis was performed using RevMan V.5.3 to calculate pooled effect sizes. RoB-2 was used for the risk of bias, and the quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Totally 17 RCTs involving 1,178 participants were included, 15 of which were pooled for meta-analysis. Most studies demonstrated some concern for the overall risk of bias. The pooled data indicated that acupuncture was associated with improved QOL [mean difference (MD)=6.67, 95% confidence interval (CI): 5.09 to 8.26], pain (MD=-1.18, 95% CI -2.28 to -0.08), and adverse events (risk ratio=0.30, 95% CI: 0.26 to 0.57) compared with control groups. Fatigue outcome was not included. Heterogeneity was substantial, and GRADE evidence was very low for both QOL and pain. Acupuncture could benefit patients with advanced cancer and is considered safe compared with usual care. However, the evidence regarding QOL and pain outcomes requires further validation. It is crucial to encourage the development of high-quality studies to strengthen this evidence. (Registry No. CRD42023423539).