Wald Test Research Articles

Tax Buoyancy in Indonesia: An Evaluation of Tax Structure and Policy Reforms

This study investigates tax buoyancies in Indonesia. It analyzes the cointegration relationship between the regional gross domestic product (RGDP), along with several control variables, and tax revenues. Focusing on personal income tax (PIT), corporate income tax (CIT), and value-added tax (VAT), it employs a dynamic analysis from 2015 to 2021. This research utilizes the Wald test to evaluate long-term buoyancies and the PMG-ARDL model to assess tax dynamics and cointegration coefficients. The results revealed tax revenues’ consistent tendency toward equilibrium in the long term, with fluctuations across Indonesian provinces. PIT displayed the highest buoyancy and adjustment speed, followed by VAT and CIT. This analysis highlights tax types’ diverse responses to underlying factors, offering crucial insights into fiscal dynamics. The research illuminates the intricate relationship between economic indicators and tax categories, providing valuable lessons for future policies, especially concerning structural changes like tax amnesty programs and tax rate modifications.

Market integration and asymmetric price transmission in selected domestic markets for major staple foods in Uganda

In this study, we examined the price transmission dynamics and market integration among domestic markets for Uganda’s major staple foods (matoke, maize, and beans) utilizing the Granger causality analysis, bounds test, Wald test for long- and short-run asymmetry, and the nonlinear ARDL model. Among the key findings, the causal order between wholesale and retail commodity prices flows unidirectionally forward from the wholesale to the retail level across all markets. Wholesale and retail prices for Uganda’s staple foods are interlinked in all markets, and spatially separated markets are also well integrated. The Wald test revealed asymmetric price transmission (APT) in speed alone for the pairs wholesale and retail prices of matoke in Kampala, and wholesale prices of matoke in Mbarara with Kampala retail prices, both APT in magnitude and APT in speed for the pairs wholesale and retail prices of beans in Kampala, wholesale and retail prices of maize in Masindi, and wholesale prices of beans in Masindi with wholesale and retail prices in Kampala. We also found that in the long run, retail prices respond more strongly to wholesale price increases than decreases, an implication of positive APT in the marketing supply chain of Uganda’s major staples. This may be linked to information asymmetry between traders and consumers, traders’ adjustment costs, production levels, inventory management, and the market power of retailers. We thus concluded that final consumers are more likely to experience an increase rather than a decrease in the prices of staples at the retail level, while retailers are more likely to benefit from price decreases at the wholesale level.

Can an online battery match in‐person cognitive testing in predicting age‐related cortical changes

AbstractBackgroundStudies into cognitive changes typically employ detailed in person cognitive testing, which is not always feasible. Therefore, we compared the relationship between brain morphology (sulcal width) and cognitive functioning, using an online and an in‐person modality and disentangled the influence of age, sex, β‐Amyloid (Aβ) and APOE‐status.Method141 healthy participants (mean age 60, range 46‐71 years, 75% female) assessed with structural MRI; cognitive batteries both, face‐to‐face and online (Cambridge Brain Systems), Aβ status (Fluorine‐18 florbetaben‐PET scan) and APOE genotype (Lupton et al., 2021); Canonical Partial Least Square method to compare cognitive modalities and Sulcal width (SW; Morphologist pipeline‐BrainVISA toolbox; Borne et al., 2020). Age effects tested with two‐sided Wald Test. Analysis of covariance to test age and sex‐interactions, amyloid and APOE status, sex‐effects (controlling for age), Aβ, and APOE (controlling for age and sex).ResultThe single robust mode for brain (SW) ‐ behaviour (cognition) covariation loaded most strongly onto memory and executive functions for both the onsite (1st mode, p = 0.013, cov = 3.55, z‐cov = 2.93, R2 = 0.18, z‐R2 = 0.95; 2nd mode, p>0.99), and the online battery (1st mode, p<0.001, cov = 2.76, z‐cov = 4.71, R2 = 0.14, z‐R2 = 1.15; 2nd mode, p = 0.99) (Fig. 1).Cognition‐related SW showed a regional pattern similar for online and in person cognitive appraisal. Significant effect of sex on SW projections in both the online and onsite conditions with larger sulcal width for men (p<0.001) and a similar effect on onsite cognitive projections with lower performance for men (p<0.001) (Fig. 2a). Cognitive performance ‐ both online (p = 0.03) and in‐person (p<0.01) – showed a significantly steeper decline with age for Aβ‐positive participants (Fig. 2b). Variance explained for the online cognitive assay (R2 = 0.15) was only slightly less than for the in‐person testing (R2 = 0.18). Brain‐behaviour z‐transformed covariance was likewise comparable across modalities.ConclusionSimilar sulcal width brain projections for both cognitive modalities, with memory and executive domains showing the strongest loadings. Aβ‐aggregation associated with a steeper cognitive projection slope for both batteries, suggesting that in our preclinical sample the early stages of Aβ accumulation accelerate cognitive ageing potentially before translation into structural brain changes. Adequate sensitivity of online cognitive tests for studying age‐related neurobiology of cognition is suggested.

Examination of Genetic Risk Factors for Alzheimer’s Disease in a Cohort of Familial Longevity: the Long Life Family Study

AbstractBackgroundGenetic risk factors have been explored extensively for late onset Alzheimer’s Disease (LOAD). The largest meta‐analysis GWAS studies to date (Bellenguez et al., 2022) identified 83 single nucleotide polymorphisms (SNPs) associated with LOAD in the general population. The Long Life Family Study (LLFS) is aimed to identify factors associated with familial longevity and healthy aging by examining US and Danish families. Our earlier studies have shown that LLFS families are at lower risk of several age‐related diseases, including LOAD. Here, we will: (1) compare allele frequencies and effect sizes of the identified meta‐GWAS variants against those in LLFS; and (2) assess whether a polygenic risk score (PRS) based on meta‐GWAS variants differs between LOAD vs. cognitively healthy in LLFS.MethodWe examined LLFS participants who were Non‐Hispanic Whites, had available cognitive and whole genome sequencing (WGS) (n = 4,220). Allele frequencies were estimated based on founders only. Association analyses were performed via logistic regression using Wald test and adjusting for sex, age, site, education, first principal components, and the genetic relationship matrix. PRS was calculated using a weighted formula, and to account for family structure, means for each status per family were obtained.ResultIndependent of LOAD status, 13 SNPs had significantly different allele frequencies between the two studies. Minor allele frequencies of 10 of the SNPs were lower in LLFS when compared with Bellenguez et al. When examining the relations between LOAD and the 77 available SNPs, only five variants appeared to be associated in LLFS. The direction of association differed for two of the SNPs. Lastly, estimated PRS scores did not differ by LOAD status (affected vs unaffected: ‐0.059 vs. ‐0.054, respectively).ConclusionHere we show that variants associated with LOAD in the general population were not necessarily associated with LOAD in in the LLFS cohort, a cohort ascertained for familial healthy aging. When estimating disease risk using genetic markers, as expected, ascertainment needs to be taken into consideration.

Individual Participant Data Meta-Analysis of LR-5 in LI-RADS Version 2018 versus Revised LI-RADS for Hepatocellular Carcinoma Diagnosis.

Background A simplification of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 (v2018), revised LI-RADS (rLI-RADS), has been proposed for imaging-based diagnosis of hepatocellular carcinoma (HCC). Single-site data suggest that rLI-RADS category 5 (rLR-5) improves sensitivity while maintaining positive predictive value (PPV) of the LI-RADS v2018 category 5 (LR-5), which indicates definite HCC. Purpose To compare the diagnostic performance of LI-RADS v2018 and rLI-RADS in a multicenter data set of patients at risk for HCC by performing an individual patient data meta-analysis. Materials and Methods Multiple databases were searched for studies published from January 2014 to January 2022 that evaluated the diagnostic performance of any version of LI-RADS at CT or MRI for diagnosing HCC. An individual patient data meta-analysis method was applied to observations from the identified studies. Quality Assessment of Diagnostic Accuracy Studies version 2 was applied to determine study risk of bias. Observations were categorized according to major features and either LI-RADS v2018 or rLI-RADS assignments. Diagnostic accuracies of category 5 for each system were calculated using generalized linear mixed models and compared using the likelihood ratio test for sensitivity and the Wald test for PPV. Results Twenty-four studies, including 3840 patients and 4727 observations, were analyzed. The median observation size was 19 mm (IQR, 11-30 mm). rLR-5 showed higher sensitivity compared with LR-5 (70.6% [95% CI: 60.7, 78.9] vs 61.3% [95% CI: 45.9, 74.7]; P < .001), with similar PPV (90.7% vs 92.3%; P = .55). In studies with low risk of bias (n = 4; 1031 observations), rLR-5 also achieved a higher sensitivity than LR-5 (72.3% [95% CI: 63.9, 80.1] vs 66.9% [95% CI: 58.2, 74.5]; P = .02), with similar PPV (83.1% vs 88.7%; P = .47). Conclusion rLR-5 achieved a higher sensitivity for identifying HCC than LR-5 while maintaining a comparable PPV at 90% or more, matching the results presented in the original rLI-RADS study. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Sirlin and Chernyak in this issue.

Comparative Performance of 2018 LI-RADS versus Modified LIRADS (mLI-RADS): An Individual Participant Data Meta-Analysis.

LI-RADS version 2018 (v2018) is used for non-invasive diagnosis of hepatocellular carcinoma (HCC). A recently proposed modification (known as mLI-RADS) demonstrated improved sensitivity while maintaining specificity and positive predictive value (PPV) of LI-RADS category 5 (definite HCC) for HCC. However, mLI-RADS requires multicenter validation. To evaluate the performance of v2018 and mLI-RADS for liver lesions in a large, heterogeneous, multi-national cohort of patients at risk for HCC. Systematic review and meta-analysis using individual participant data (IPD) [Study Protocol: https://osf.io/duys4]. 2223 observations from 1817 patients (includes all LI-RADS categories; females = 448, males = 1361, not reported = 8) at elevated risk for developing HCC (based on LI-RADS population criteria) from 12 retrospective studies. 1.5T and 3T; complete liver MRI with gadoxetate disodium, including axial T2w images and dynamic axial fat-suppressed T1w images precontrast and in the arterial, portal venous, transitional, and hepatobiliary phases. Diffusion-weighted imaging was used when available. Liver observations were categorized using v2018 and mLI-RADS. The diagnostic performance of each system's category 5 (LR-5 and mLR-5) for HCC were compared. The Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2 was applied to determine risk of bias and applicability. Diagnostic performances were assessed using the likelihood ratio test for sensitivity and specificity and the Wald test for PPV. The significance level was P < 0.05. 17% (2/12) of the studies were considered low risk of bias (244 liver observations; 164 patients). When compared to v2018, mLR-5 demonstrated higher sensitivity (61.3% vs. 46.5%, P < 0.001), similar PPV (85.3% vs. 86.3%, P = 0.89), and similar specificity (85.8% vs. 90.8%, P = 0.16) for HCC. This study confirms mLR-5 has higher sensitivity than LR-5 for HCC identification, while maintaining similar PPV and specificity, validating the mLI-RADS proposal in a heterogeneous, international cohort. 3 TECHNICAL EFFICACY: Stage 2.

Abstract B114: Population differences in the associations between chromosomal abnormalities and overall survival among Blacks and Whites with multiple myeloma

Abstract Background: Several primary and secondary cytogenetic abnormalities (e.g., translocation t(4;14) and 1q copy number changes) are associated with poor prognosis and worse survival of multiple myeloma (MM). Some of the aberrations (e.g., t(11;14), t(14;16), and t(14;20)) have been suggested, albeit inconclusively, to be enriched in Blacks. However, whether the associations between chromosomal abnormalities and overall survival (OS) of MM differ by race/ethnicity remains largely unknown. Methods: We prospectively enrolled 586 patients with newly diagnosed MM between 2010-2019 at the University of Chicago Medical Center. Of the 561 subjects identified as Black or White, 181 had chromosomal abnormalities determined by fluorescence in situ hybridization (FISH), which used CD138+ plasma cells enriched from bone marrow aspirates collected within 180 days of diagnosis. We analyzed data for 19 aberrations, including IGH/FGFR3 fusion [t(4;14)(p16,q32)]; IGH/CCND1 fusion [t(11;14)(q13,q32)]; IGH/MAF [t(14;16)(q32,q23)]; IGH/MAFB [t(14;20)(q32,q12)]; trisomies of chromosome 3, 7, 9, and 12; chromosome 13 deletion; loss of ATM [11q22.3]; gain of ATM; loss of TP53 [17p13.1]; gain of TP53; loss of CDKN2C [1p32.3]; gain of CKS1B [1q21]; IGH translocation with uncommon chromosome partners; IGH locus rearrangement; loss of IGH; and tetraploidy. Vital status was ascertained using the National Death Index. Baseline clinical and laboratory data were retrieved from electronic medical records. We used proportions and Chi-square tests to compare the distributions of cytogenetic abnormalities in Blacks and Whites. In each population, we evaluated the associations between cytogenetic abnormalities and OS using hazard ratios (HRs) and 95% confidence interval (CIs) from Cox proportional hazards models, adjusting for prognostic factors including age, international staging system, elevated lactate dehydrogenase, and estimated glomerular filtration rate. We used the Wald test of the cross-product terms to assess potential heterogeneity of effect in the HRs by race. Results: Of the 181 MM patients, 55 (30.39%) were Black and 126 (69.61%) were White. The median follow-up was 69 months. The frequencies of the 19 cytogenetic abnormalities did not differ between Blacks and Whites. However, we observed population differences in the associations between two chromosomal abnormalities and OS: the presence of t(4;14) was associated with worse OS in Blacks (HR=14.34 [2.17-94.58]; N=38) but not Whites (HR=2.04 [0.70-5.88]; N=99, p-heterogeneity = 0.08), whereas gain of 1q was associated with poorer OS in Whites (HR: 3.38, 95% CI: [1.25- 9.09], N=77), but not Blacks (HR=1.32 [0.31-5.68]; N=32; p-heterogeneity=0.02). Conclusions: Although we found similar frequencies of primary and secondary chromosomal abnormalities between Blacks and Whites, our data show population differences in the associations between two established high-risk cytogenetic abnormalities and the OS of MM. Our findings suggest that cytogenetic features may have varying impacts on the OS of MM based on race. Citation Format: Bei Wang, Benjamin A. Derman, Jason Cheung, Wei Zhang, Andrzej Jakubowiak, Brian C. Chiu. Population differences in the associations between chromosomal abnormalities and overall survival among Blacks and Whites with multiple myeloma [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B114.

Digital Cognitive Assessment Leveraging the Boston Process Approach Can Flag Emergent Cognitive Decline in Individuals with Subtle and Mild Functional Disability

AbstractBackgroundEarly detection of Mild Cognitive Impairment (MCI) and Alzheimer’s Disease and Related Dementias (ADRD) is key to optimal management. Digital tests allow for the reliable capture of meaningful, process‐based neuropsychological test parameters that traditional paper/pencil measures fail to detect, thus enabling earlier detection. We assessed how subtle functional decline relates to process features extracted from the digital Clock Drawing Test (dCDT) and the digital Trail Making Test‐Part B (dTrB).Methods629 community dwelling participants (58.5% female) were assessed with the Functional Assessment Questionnaire (FAQ), the MMSE, the digital clock drawing test (dCDT) and the digital Trail Making Test‐Part B (dTrB). Three FAQ groups were constructed: FAQ = 0‐2 (minimal functional disability, n = 490); FAQ = 3‐5 (subtle functional disability, n = 90); FAQ = 6‐8 (mild functional disability, n = 49).ResultsParticipants with minimal functional disability were younger (p = 0.027) and scored better on the MMSE (p = 0.001) than other groups. Groups were equated for education. dCDT command/copy component placement was more accurate among participants with minimal functional disability compared to other groups (command dCDT p = 0.001 versus mild functional disability; copy dCDT p = 0.006 versus both subtle and mild functional disability). On the dTrB, participants with minimal disability drew faster than those with subtle or mild disability (mean stroke velocity, p = 0.001). Analyses for percent pen lift time found no difference between participants with minimal versus subtle disability; however, both groups differed from participants with mild disability (p = 0.001). Optimal group classification using stepwise nominal regression with the minimal functional disability group as the reference was achieved using dCDT copy component placement and dTrB mean stroke velocity (X 2 = 28.37, p = 0.001), where dTrB mean velocity entered first (X 2 = 17.73, p = 0.001) followed by dCDT copy component placement (X 2 = 11.19, p = 0.004). Both variables contributed comparably to group classification (Wald statistic range 5.82‐8.88, p = 0.012, respectively).ConclusionsThe digital assessment described above, targeting executive, scanning, visuoconstructional and motor domains, captures highly nuanced, discrete behaviors with precision/ operationalism heretofore unattainable. Consequently, it is reasonable to posit that digital cognitive assessments leveraging the Boston Process Approach can both objectively detect emergent cognitive impairment and infer its likely impact on functional activities, critical for practical assessment in clinical care.

Is There an Adequate Therapeutic Approach to Thyroid Pathology in Patients with Down Syndrome?

Thyroid dysfunction stands as the most prevalent endocrine disorder in individuals with Down syndrome, particularly showcasing both clinical and subclinical hypothyroidism. TSH and FT4 blood values serve as common diagnostic and treatment adjustment markers. In Down syndrome (DS), hormone values may deviate from those observed in the general population, which may lead to overdiagnosis and consequent iatrogenesis of subclinical hypothyroidism. The objective of this study was to analyze the appropriateness of the replacement therapeutic approach by identifying the TSH and FT4 values that can be considered normal in these patients. Methods: A cross-sectional study was conducted in 503 subjects with DS of both sexes and without age limit drawn from the Health Program for individuals with DS in Valencia (Spain) from February 1993 to November 2021. The exclusion criteria included hyperthyroidism, nodules, tumors, or individuals under treatment with drugs influencing iodine metabolism. The normality of data distribution was assessed using the Shapiro–Wilk test. Outliers were detected using the Reed’s criterion. Hormone values were estimated using quantile regression models for the 2.5th and 97.5th percentiles. Results: The normal values identified were 0.88–11.25 mIU/L for TSH and 0.71–1.63 ng/dL for FT4. The Wald test indicated no significant differences in the reference intervals based on age or sex. Conclusion: The establishment of these values, which, in people with DS, can be considered unique, is of great importance, allowing a watchful waiting attitude to be maintained before starting replacement therapy that is unnecessarily or adjusting medication in diagnosed cases.

Robust moving target detection for FDA-MIMO radar with steering vector mismatches

This paper studies a robust moving target detection problem for frequency diverse array multiple-input multiple-output (FDA-MIMO) radar with a target embedded in Gaussian clutter with an unknown covariance matrix. We focus on the case of signal mismatch where the errors exist in the transmit-receive vector and Doppler steering vector. To solve the above detection problem, we adopt the subspace approach, where the true and nominal transmit-receive and Doppler steering vectors are assumed to lie in four-dimensional and two-dimensional subspaces, respectively, for the special framework for FDA-MIMO radar. At the detector design stage, we propose three robust adaptive detectors based on the one-step generalized likelihood ratio test (GLRT), two-step GLRT, and Wald test, respectively, with the training data free. The proposed detectors own the constant false alarm rate (CFAR) property against the clutter covariance matrix. The numerical examples validate the effectiveness of the proposed detectors.

Diagnostic Performance of Cerebrospinal Fluid Neurofilament Light Chain and Soluble Amyloid-β Protein Precursor β in the Subcortical Small Vessel Type of Dementia.

The subcortical small vessel type of dementia (SSVD) is a common subtype of vascular dementia, but there is a lack of disease-specific cerebrospinal fluid (CSF) biomarkers. We investigated whether CSF concentrations of neurofilament light chain (NFL), soluble amyloid-β protein precursor α (sAβPPα), sAβPPβ, and CSF/serum albumin ratio could separate SSVD from healthy controls, Alzheimer's disease (AD), and mixed dementia (combined AD and SSVD). This was a mono-center study of patients with SSVD (n = 38), AD (n = 121), mixed dementia (n = 62), and controls (n = 96). The CSF biomarkers were measured using immunoassays, and their independent contribution to the separation between groups were evaluated using the Wald test. Then, the area under the receiver operating characteristics curve (AUROC) and 95% confidence intervals (CIs) were calculated. Elevated neurofilament light chain (NFL) and decreased sAβPPβ independently separated SSVD from controls, and sAβPPβ also distinguished SSVD from AD and mixed dementia. The combination of NFL and sAβPPβ discriminated SSVD from controls with high accuracy (AUROC 0.903, 95% CI: 0.834-0.972). Additionally, sAβPPβ combined with the core AD biomarkers (amyloid-β42, total tau, and phosphorylated tau181) had a high ability to separate SSVD from AD (AUROC 0.886, 95% CI: 0.830-0.942) and mixed dementia (AUROC 0.903, 95% CI: 0.838-0.968). The high accuracy of NFL and sAβPPβ to separate SSVD from controls supports that SSVD is a specific diagnostic entity. Moreover, SSVD was distinguished from AD and mixed dementia using sAβPPβ in combination with the core AD biomarkers.

High-dose chemotherapy with transplantation of autologous hematopoietic stem cells in the first line of follicular lymphoma therapy

Introduction. The follicular lymphoma (FL) is the most common indolent lymphatic tumor with high sensitivity to immunochemotherapy un most cases. Although overall survival (OS) is generally long, the disease is characterized by multiple relapses. High-dose chemotherapy (HDCT) with transplantation of autologous hematopoietic stem cells (auto-HSCT) is used for recurrent FL. Aim: to evaluate the efficacy and safety of HDCT with aHSCT in the first line of FL therapy; identify risk factors for disease progression and refractoriness. Material and methods. A prospective single-center study (conducted from May 2015 to January 2023) included 35 patients aged 18–65 years (median 43) with PL 1–3A grade t(14;18)+ with stages III–IV or stage II with bulky, having at least one criterion for the need to start therapy (according to GELF). Patients were treated according to the FL-2015 protocol: 4 R-CHOP, 2 R-DHAP and BeEAM with auto-HSCT. The primary endpoint was the rate of overall response (OR) and/or complete remission (CR) at the end of chemotherapy. Secondary end points were 3-year survival rates: OS, relapse-free survival (RFS), progression-free survival (PFS), and event-free survival (EFS). Minimal residual disease (MRD) in blood and/or bone marrow was assessed by PCR based on immunoglobulin heavy chain (IGH) gene rearrangements and/or BCL2::IGH rearrangements. Statistical analysis (by intent to treat) was performed on January 12, 2023. Results. 86 % of patients had stage IV tumor and 79 % had 3–5 FLIPI factors. After the end of treatment, OR and PR were 90 % and 90 %, the incidence of POD24 was 3 %. After the end of induction (4 courses of R-CHOP), MRD-negativity was achieved in 77 % and 53 % of patients as determined by PCR-IGH and BCL2::IGH. After the full completion of the FL-2015 protocol, MRD was not detected in 96 % of patients (according to PCR-IGH). Three-year overall survival, disease-free survival, progression-free survival and event-free survival were respectively: 90 %, 90 %, 95 % and 85 % (with the same standarderror of 9 %) at a median follow-up (by inverse Kaplan-Meier estimate) of 19 months (range: from 1 to 91 months) There were no deaths due to early toxicity within 100 days of auto-HSCT. Prognostically unfavorable independent statistically significant (р &lt; 0.01; Wald test; hazard ratio &gt; 1) predictors of progression and refractoriness according to the results of multivariate analysis using the Fine-Grey competing risk model (р = 0.052 for the model) were: bone marrow disease, ECOG high risk, patient age &gt; 50 years, stage 4 disease, elevated serum lactate dehydrogenase and B-symptoms. Conclusion. The use of HDCT with auto-HSCT in the first line in patients with FL is highly effective and can significantly reduce the incidence of POD24 and early mortality from the tumor. The study is ongoing.

THE INFLUENCE OF THE BANDWAGON EFFECT, DIGITAL PAYMENT, AND INCOME ON PURCHASE DECISIONS FOR THE KOREAN WAVE ASSOCIATED PRODUCT

The number of enthusiasm about the Korean Wave is on the rise. This remains across Indonesia as well, allowing for a yearly public consumption of Korean Wave items to exceed 20 million rupiahs. This study aims to determine the influence of several factors considered to drive purchasing decisions, such as the bandwagon effect, digital payments, and income on purchasing decisions for products associated with the Korean Wave (Hallyu). This research is a descriptive quantitative research in which the data collection method was carried out by distributing questionnaires to individuals who were categorized as Generation Z. The data obtained were then processed and tested using the binary logistic regression method with the Wald test method to determine the partial effect and the statistical G test to determine the effect simultaneously. The results showed that the bandwagon effect (X1) and digital payments (X2) partially had a significant effect on purchasing decisions (Y), while income (X3) partially had no significant effect on purchasing decisions (Y). Then the bandwagon effect (X1), digital payments (X2), and income (X3) simultaneously influence purchasing decisions (Y).

Human Papillomavirus Awareness by Educational Level and by Race and Ethnicity

Understanding disparities in human papillomavirus (HPV) awareness is crucial, given its association with vaccine uptake. To investigate differences in HPV awareness by educational attainment, race, ethnicity, and their intersectionality. This cross-sectional study used the Health Information National Trends Survey (HINTS) 5 cycles 1 to 4 data (January 26, 2017, to June 15, 2020). The data were analyzed from December 12, 2022, to June 20, 2023. A sample of the noninstitutionalized civilian US population 18 years or older was included in the analysis. Weighted prevalence of HPV awareness, HPV vaccine awareness, and knowledge that HPV causes cancer, stratified by educational attainment and by race and ethnicity. Interaction between educational attainment and race and ethnicity was assessed using a Wald test. A total of 15 637 participants had educational attainment data available; of these, 51.2% were women, and the median age was 58 (IQR, 44-69) years. A total of 14 444 participants had race and ethnicity information available; of these, 4.6% were Asian, 13.9% were Black, 15.3% were Hispanic, 62.6% were White, and 3.6% were of other race or ethnicity (including American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and more than 1 race or ethnicity). Awareness of HPV by educational attainment ranged from 40.4% for less than high school to 78.2% for college or higher; awareness by race and ethnicity ranged from 46.9% among Asian individuals to 70.2% among White individuals. Awareness of HPV vaccines across educational attainment ranged from 34.7% among those with less than high school to 74.7% among those with a college degree or higher and by race and ethnicity from 48.4% among Asian individuals to 68.2% among White individuals. Among adults who were aware of HPV, knowledge that HPV causes cervical cancer differed by educational attainment, ranging from 51.7% among those with less than high school to 84.7% among those with a college degree or higher, and by race and ethnicity, ranging from 66.0% among Black individuals to 77.9% among Asian individuals. The interaction between educational attainment and race and ethnicity on HPV awareness and HPV vaccine awareness was not significant; however, within each educational attainment level, awareness differed by race and ethnicity, with the lowest awareness consistently among Asian individuals regardless of educational attainment. Within each racial and ethnic group, HPV awareness and HPV vaccine awareness significantly decreased with decreasing educational attainment. Disparities in HPV awareness were evident across social factors, with the lowest awareness among Asian individuals and individuals with lower educational attainment. These results emphasize the importance of considering social factors in HPV awareness campaigns to increase HPV vaccination.

N-Acetylcysteine Alleviates the Progression of Chronic Kidney Disease: A Three-Year Cohort Study.

Background and Objectives: The prevalence of chronic kidney disease (CKD) is approximately 10% of the population in many countries. CKD progresses to end-stage renal disease (ESRD), resulting in adverse outcomes, prolonged hospitalization, and increased healthcare costs. Therefore, reducing CKD progression to ESRD is recognized as an important health issue. Materials and Methods: Data from the study participants with stage 3 to stage 5 CKD (n = 7668) were collected from the National Health Insurance (NHI) program in Taiwan (1 November 2014 to 31 December 2020). CKD patients who had ingested or not ingested N-acetylcysteine (NAC) for three years were divided into the study group (NAC users; n = 165) and the control group (NAC non-users; n = 165) to explore whether NAC use could alleviate CKD progression and reduce the risks associated with hemodialysis in CKD patients. Results: The levels of serum creatinine (SCr) and estimated globular filtration rate (eGFR) were nearly unchanged and/or slightly changed in NAC users, but the SCr levels were slightly increased, and the eGFR levels were significantly decreased in NAC non-users at the six-month interval during the three years. A statistical difference was observed between the two groups for both levels from 12 months to 36 months. The incidence rate of hemodialysis was significantly lower in NAC users than in non-NAC users (4.8% vs. 12.7%, Wald test = 5.947, p = 0.015, OR = 34.9). These results indicated that NAC use may improve renal function of CKD patients by modulating SCr and eGFR and, in turn, reducing the risk of hemodialysis. Conclusions: We investigated whether NAC could be used to reduce CKD progression to ESRD. For the three-year retrospective study, the incidence rate of hemodialysis was significantly lower in NAC users than in non-NAC users via modulating SCr and eGRF levels. NAC use might be a useful clinical approach for reducing CKD progression to ESRD.

Nexus between Aging and Health Expenditure: An Evidence from Nepal

Nepal, like many countries, is currently experiencing a significant shift in its demographic landscape, characterized by a rapidly aging population. This study investigates the causal relationship between aging and healthcare expenditure in Nepal. To examine this causal connection, we employed a parsimonious VAR-based Wald test, Granger causality analysis, impulse response functions (IRFs), and forecast error variance decompositions using time series data from 2000 to 2020. The findings of the analysis reveal a substantial positive correlation between the proportion of elderly people and healthcare expenditure, indicating that as the population ages, healthcare costs and the demand for healthcare services tend to rise. The IRF analysis further confirmed that an innovation or shock in the aging index (AI) led to a subsequent increase in per capita health expenditure (HPC). Granger causality also reveals a unidirectional causal linkage from the aging index to per capita health expenditure. In addition, the study highlights the positive impact of aging on life expectancy in Nepal. These findings have important policy implications for Nepal. As the population continues to age, policymakers must allocate healthcare resources effectively, invest in geriatric care, and develop a robust healthcare infrastructure. Comprehensive long-term planning and strong social support systems are crucial to ensure the well-being of the elderly population and to mitigate the associated challenges.

Investigating Asymmetric Effects of Electronic Payment on Money Supply for India using Non-linear ARDL Model

Money supply in India is analysed using a non-linear autoregressive distributed lag (NARDL) model to see how several factors, such as electronic payments, exchange rate, interest rates and inflation, affect the money supply. The Augmented Dickey–Fuller unit root test and the Phillips–Perron unit root test are utilized to confirm that the variables are stationary. In the bounds test of the NARDL as well as Johansen–Juselius cointegration test, this study finds evidence of cointegration amongst variable used in the study. NARDL testing model is employed to investigate the dissimilar influences on variables with short- and long-run dynamics. Short-term estimates suggest that the money supply ( M1) is most responsive to positive shocks involving retail payments, the exchange rate and interest rates, but negative shocks involving card payment and prepaid payment instruments. A reduction in card payment, as well as a positive increase in retail payment, the prepaid payment instrument, the exchange rate and the interest rate, would all have major effects on M3 in short run. In addition, a long-term finding demonstrates that all of the variables have a significant influence on the money supply ( M1) in its mixed form while all of the factors, with the exception of the one involving card payments, have a considerable impact on the money supply ( M3). Wald test results confirm the existence of asymmetric influences which can have significant lessons for policymakers.

Internet financial services, environmental technology, and happiness: Implications for sustainable development

Integrating the internet and financial services gives people the luxury to reduce financial stress and anxiety by giving consumers more power over their financial situation. Likewise, the adoption of environmental technologies helps improve environmental quality, which positively impacts mental and physical health and thus increases the sense of well-being and happiness. Therefore, the main focus of the study is to analyze the influence of financial services and environmental technologies on happiness. For analyzing the short and long-run impacts of financial services and environmental technologies on happiness, we have utilized the ARDL model and QARDL models. The findings of the ARDL model confirm the positive influence of financial services, environmental technologies, national income, financial development, and education on happiness in the short and long term. Similarly, the QARDL model also suggests the favorable long-run effects of financial services and environmental technologies on happiness at most quantiles. The long-run Wald test confirms the asymmetric influence of all variables on happiness, while in the short-term, excluding education, all other variables exert asymmetric impacts on happiness. Thus, to promote happiness, policymakers should try to increase the role of internet-based financial services and increases investment in research and development activities to enhance environment-related technologies. However, the study is limited to China, it should be expanded to other regions.

A Wald test on the problem of homogeneity of variances

In this article, we propose a Wald test for homogeneity of variance in several normal distributions. The Wald test is an asymptotic test, and it is known that asymptotic tests perform well in large sample sizes, but not in small sample sizes. For this reason, we modified this test using a parametric bootstrap method called the computational approach test. To evaluate the efficiency of the proposed test against the existing tests in the literature, we compared this test in terms of the estimated size and power of tests. The results of our simulation study show that the proposed test performs well in especially small and different sample sizes under normal distributions. Besides, we illustrate the proposed test using a numerical example.

Abstract 18363: Readmission &amp; Temporal Trends of Post LVAD Placement Complications in Patients With End-Stage Heart Failure

Introduction: 5-10% of heart failure (HF) patients progress to advanced stages. Left ventricular assist devices (LVADs) have emerged as a favored therapy for end-stage HF as destination therapy or as a bridge to heart transplantation. However, complications and provider expertise hinder its widespread use. Third generation LVAD was introduced in 2018 to enhance usability and reduce complications. We aim to investigate the temporal trends in post-LVAD complications with the latest generation LVAD vs the previous version. Methods: We utilized the 2016-2020 Nationwide Readmission Database to identify patients ≥ 18 years of age with advanced HF implanted with an LVAD. Variables were identified using International Classification of Diseases, Tenth revision codes. We compared 2 groups based on the implant year (2016-2018 and 2019-2020). The primary outcome was 30-day readmission (30-dr), while secondary outcomes were trends in complications, mortality rate, and healthcare cost. Multivariate analyses and descriptive bivariate analyses were performed. A p-value &lt;0.05 was considered statistically significant. Results: We identified 7,975 patients (21.3% females) of which 17.1 % (n = 1,214) were readmitted within 30 days. Readmission rates were 17.7% (n = 778) for 2016-2018 and 16.2% (n = 435) for 2019-2020 (adjusted Wald test, p = 0.26). The 2019-2020 group exhibited lower rates of cardiac device complications, vasopressor usage, cardiac tamponade, and peri-procedural circulatory complications than the 2016-2018 group (adjusted Wald test, p &lt; 0.05). No significant differences in mortality or LOS were observed between the two groups (adjusted Wald test, p &gt; 0.05). Healthcare costs were higher in the 2019-2020 group (mean $276,439 vs $315,332, adjusted Wald test, p = 0.01). Conclusions: Complications following LVAD placement continue to impede broader adoption for advanced HF. Nonetheless, advancements in newer LVAD generations and improved provider expertise hold promise for increased utilization. Our study indicates a decline in complications, including cardiac tamponade and post-procedural complications, which may be attributed to newer device innovations. Further research is necessary to explore this correlation in greater depth.