Gaussian Copula Regression in the Presence of Thresholds

Park and Gupta\xe2\x80\x99s (2012) introduction of the Gaussian Copula (GC) approach to deal with endogeneity has made a significant impact on empirical marketing research with many papers using this approach. Recent studies have however started to explore and examine the approach and its underlying assumptions more closely, resulting in a more critical picture of it. A particular challenge is the non-testable assumption that the dependency structure between the endogenous regressor and the error term should be described by a Gaussian copula. In general, there exists a limited understanding of what this assumption implies, what causes its violation, and potential remedies. Our study addresses this explicitly. We provide a detailed discussion of the dependency structure assumption and how thresholds in the data can lead to its violation and biased results. We use real and simulated data to show how threshold detection before applying the GC approach can overcome this problem and thereby provide researchers with a useful tool to increase the likelihood of the GC approach\xe2\x80\x99s assumptions being met

Why Do People Eat the Same Breakfast Every Day? Goals and Circadian Rhythms of Variety Seeking in Meals

People exhibit a circadian rhythm in the variety of foods they eat. Many people happily eat the same foods for breakfast day after day, yet seek more variety in the foods they eat for lunch and dinner. We identify psychological goals as a driver of this diurnal pattern of variety seeking, complementing other biological and cultural drivers. People are more likely to pursue hedonic goals for meals as the day progresses, which leads them to seek more variety for dinners and lunches than breakfasts. We find evidentiary support for our theory in studies with French and American participants (N = 4481) using diary data, event reconstruction methods, and experiments. Both endogenously and exogenously induced variation in hedonic goal activation modulates variety seeking in meals across days. Hedonic goal activation predicts variety seeking for meals when controlling for factors including time devoted to meal preparation and eating, the presence or absence of other people, and whether people ate a meal inside or outside their home. Goal activation also explain differences in time spent on meals, whereas increasing time spent on meals does not increase variety seeking. Finally, we observed that a similar increase in hedonic goal activation enacts a larger increase in variety seeking at breakfast than at lunch than at dinner, suggesting a diminishing marginal effect of hedonic goal activation on variety seeking.</p

Patient-reported outcome measures and clinical outcomes in children with foregut anomalies

Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child\xe2\x80\x99s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.</p

Multiple pathways of risk taking in adolescence

In this review, we describe multiple pathways that may lead to risk-taking in adolescence. We review behavioral and neuroimaging studies showing heightened risk-taking tendencies and associated neural reward activity in mid to late adolescence, but evidence points to risk taking as highly context and sample dependent. Here, we suggest that individual differences, specifically reward drive, may be a differential susceptibility factor that shows heightened sensitivity in adolescents and that makes some adolescents more sensitive to their environment. Furthermore, we review evidence that an elevated reward drive in mid-adolescence in interaction with prosocial and cognitive development can lead to various trajectories of risk taking. In this review we propose to extend existing models with individual-difference factors, specifically reward drive, and accompanying developmental processes, including cognitive control and prosocial development, that drive the development of multiple pathways of risk taking.</p

Cost-effectiveness of multiparametric magnetic resonance imaging and MRI-guided biopsy in a population-based prostate cancer screening setting using a micro-simulation model

Background: The introduction of multiparametric magnetic resonance imaging (mpMRI) and MRI-guided biopsy has improved the diagnosis of prostate cancer. However, it remains uncertain whether it is cost-effective, especially in a population-based screening strategy. Methods: We used a micro-simulation model to assess the cost-effectiveness of an MRI-based prostate cancer screening in comparison to the classical prostate-specific antigen (PSA) screening, at a population level. The test sensitivity parameters for the mpMRI and MRI-guided biopsy, grade misclassification rates, utility estimates, and the unit costs of different interventions were obtained from literature. We assumed the same screening attendance rate and biopsy compliance rate for both strategies. A probabilistic sensitivity analysis, consisting of 1000 model runs, was performed to estimate a mean incremental cost-effectiveness ratio (ICER) and assess uncertainty. A \xe2\x82\xac20,000 willingness-to-pay (WTP) threshold per quality-adjusted life year (QALY) gained, and a discounting rate of 3.5% was considered in the analysis. Results: The MRI-based screening improved the life-years (LY) and QALYs gained by 3.5 and 3, respectively, in comparison to the classical screening pathway. Based on the probabilistic sensitivity analyses, the MRI screening pathway leads to total discounted mean incremental costs of \xe2\x82\xac15,413 (95% confidence interval (CI) of \xe2\x82\xac14,556\xe2\x80\x93\xe2\x82\xac16,272) compared to the classical screening pathway. The corresponding discounted mean incremental QALYs gained was 1.36 (95% CI of 1.31\xe2\x80\x931.40), resulting in a mean ICER of \xe2\x82\xac11,355 per QALY gained. At a WTP threshold of \xe2\x82\xac20,000, the MRI screening pathway has about 84% chance to be more cost-effective than the classical screening pathway. Conclusions: For triennial screening from age 55\xe2\x80\x9364, incorporation of mpMRI as a reflex test after a positive PSA test result with a subsequent MRI-guided biopsy has a high probability to be more cost-effective as compared with the classical prostate cancer screening pathway.</p

Exploring multilevel social determinants of depressive symptoms for Tanzanian adolescents

Background Depression has substantial and enduring impacts for adolescents, particularly those living in poverty. Yet, evidence on its determinants in low-income countries remains scarce. We examined the social determinants of depressive symptoms for Tanzanian adolescents. Methods We used cross-sectional data for 2458 adolescents (aged 14-19), to describe associations with depressive symptoms within and across five domains-demographic, economic, neighbourhood, environmental and social-cultural-using linear mixed models. We estimated depressive symptoms using the 10-item Centre for Epidemiological Studies Depression Scale, which ranges from 0 to 30 and increases with additional symptoms. Results Factors associated with depressive symptoms in the fully adjusted models included experiencing five or more household economic shocks (\xce\xb2=2.40; 95% CI 1.48 to 3.32), experiencing droughts/floods (\xce\xb2=0.76; 95% CI 0.36 to 1.17), being in a relationship (\xce\xb2=1.82; 95% CI 1.30 to 2.33), and having moderate (\xce\xb2=1.26; 95% CI 0.80 to 1.71) or low (\xce\xb2=2.27; 95% CI 1.81 to 2.74) social support. Exclusive schooling was protective compared with being engaged in both school and paid work (\xce\xb2=1.07; 95% CI 0.05 to 2.61) and not engaged in either (\xce\xb2=0.73; 95% CI 0.24 to 1.22). Household size and relationship status were more important factors for girls, while employment status, and extreme precipitation were more important for boys. Conclusion Mental health is associated with determinants from multiple domains. Results suggest that environmental shocks related to climate change contribute to poor mental health in adolescents, highlighting an important area for intervention and research.</p

Current perspectives on video and audio recording inside the surgical operating room

The availability of intraoperative multimedia recording is increasing. Considering the growing call for physicians\xe2\x80\x99 accountability, it is inevitable that multimedia will play an important role in aiding quality control by improving the adequacy of operative reporting. However, the perspectives of medical professionals on this matter are poorly known. In this cross-disciplinary survey, we aimed to investigate the current viewpoints concerning the use of multimedia recording in the operating room. We conducted an electronic survey among all affiliated members of the Association of Surgeons of the Netherlands, the Dutch Urological Association and the Dutch Society of Obstetrics and Gynecology containing questions regarding current use of intraoperative recording and the level of likelihood or objection for certain scenarios. The response rate was 27.8%. The survey encompasses 370 (54.5%) surgeons, 71 (10.5%) urologists, 80 (11.8%) gynecologists, and 158 (23.3%) residents in training. 52.4% of respondents feel that the currently used operative report is insufficient for future quality requirements. 58.5% think it is unlikely they would behave differently during surgery when intra-operative video recording is applied. 82.8% think it is unlikely that their surgical methods would be altered. 63.8% of respondents preferred only video registration when intraoperative recording is implemented. The majority of respondents agree that the current method of operative reporting is insufficient for future quality requirements. There is support for intraoperative video recording, however, legal transparency is needed before either intraoperative video or audio recording could be implemented to protect not only the patients, but also the healthcare providers.</p

Adherence to dietary guidelines and cognitive decline from middle age

BACKGROUND: Diet, in particular the Mediterranean diet, has been associated with better cognitive function and less cognitive decline in older populations. OBJECTIVES: To quantify associations of a healthy diet, defined by adherence to either the Mediterranean diet, the WHO guidelines, or Dutch Health Council dietary guidelines, with cognitive function and cognitive decline from middle age into old age. METHODS: From the Doetinchem Cohort Study, a large population-based longitudinal study, 3644 participants (51% females) aged 45-75 y at baseline, were included. Global cognitive function, memory, processing speed, and cognitive flexibility were assessed at 5-y time intervals up to 20-y follow-up. Adherence to the Mediterranean diet was measured with the modified Mediterranean Diet Score (mMDS), adherence to the WHO dietary guidelines with the Healthy Diet Indicator (HDI), and adherence to the Dutch Health Council dietary guidelines 2015 with the modified Dutch Healthy Diet 2015 index (mDHD15-index). The scores on the dietary indices were classified in tertiles (low, medium, high adherence). Linear mixed models were used to model level and change in cognitive function by adherence to healthy diets. RESULTS: The highest tertiles of the mMDS, HDI, and mDHD15-index were associated with better cognitive function compared with the lowest tertiles (P\xc2\xa0values &lt;0.01), for instance at age 65 y equal to being 2 y cognitively younger in global cognition. In addition, compared with the lowest tertiles, the highest tertiles of the mMDS, HDI, and mDHD15-index were statistically significantly associated with 6-7% slower global cognitive decline from age 55 to 75 y, but also slower decline in processing speed (for mMDS: 10%; 95% CI: 2, 18%; for mDHD15: 12%; 95% CI: 6, 21%) and cognitive flexibility (for mDHD15: 10%; 95% CI: 4, 18%). CONCLUSIONS: Healthier dietary habits, determined by higher adherence to dietary guidelines, are associated with better cognitive function and slower cognitive decline with aging from middle age onwards.</p

Non-invasive prenatal test uptake in socioeconomically disadvantaged neighborhoods

Objective: Non-Invasive Prenatal Testing (NIPT) is increasingly being implemented worldwide. In public health programs, equitable access to healthcare is a fundamental principle which also applies to fetal aneuploidy screening. However, the out-of-pocket costs of NIPT may lead to sociodemographic disparities in uptake of screening. This study assessed whether there is a difference in the uptake of NIPT in socioeconomically disadvantaged neighborhoods compared to all other neighborhoods in the Netherlands, where NIPT is implemented in a national screening program (TRIDENT-2 study). Method: NIPT uptake, postal code and age of 156,562 pregnant women who received pre-test counselling for prenatal screening in 2018 were retrieved from the national prenatal screening database. Postal codes were used as a proxy to categorize neighborhoods as being either socioeconomically disadvantaged or other. The out-of-pocket costs for NIPT were \xe2\x82\xac175. Results: NIPT uptake in socioeconomically disadvantaged neighborhoods was 20.3% whereas uptake in all other neighborhoods was 47.6% (p\xc2\xa0&lt;\xc2\xa00.001). The difference in NIPT uptake between socioeconomic disadvantaged neighborhoods and other areas was smaller for the youngest maternal age-group (\xe2\x89\xa425\xc2\xa0years) compared to other age-groups. Conclusion: The variation in uptake suggest underlying disparities in NIPT uptake, which undermines the goals of a national fetal aneuploidy screening program of providing reproductive autonomy and equitable access. This has ethical and policy implications for ensuring fair and responsible implementation of fetal aneuploidy screening.</p

The human hepatocyte TXG-MAPr

Mechanism-based risk assessment is urged to advance and fully permeate into current safety assessment practices, possibly at early phases of drug safety testing. Toxicogenomics is a promising source of mechanisms-revealing data, but interpretative analysis tools specific for the testing systems (e.g. hepatocytes) are lacking. In this study, we present the TXG-MAPr webtool (available at https://txg-mapr.eu/WGCNA_PHH/TGGATEs_PHH/), an R-Shiny-based implementation of weighted gene co-expression network analysis (WGCNA) obtained from the Primary Human Hepatocytes (PHH) TG-GATEs dataset. The 398 gene co-expression networks (modules) were annotated with functional information (pathway enrichment, transcription factor) to reveal their mechanistic interpretation. Several well-known stress response pathways were captured in the modules, were perturbed by specific stressors and showed preservation in rat systems (rat primary hepatocytes and rat in vivo liver), with the exception of DNA damage and oxidative stress responses. A subset of 87 well-annotated and preserved modules was used to evaluate mechanisms of toxicity of endoplasmic reticulum (ER) stress and oxidative stress inducers, including cyclosporine A, tunicamycin and acetaminophen. In addition, module responses can be calculated from external datasets obtained with different hepatocyte cells and platforms, including targeted RNA-seq data, therefore, imputing biological responses from a limited gene set. As another application, donors\xe2\x80\x99 sensitivity towards tunicamycin was investigated with the TXG-MAPr, identifying higher basal level of intrinsic immune response in donors with pre-existing liver pathology. In conclusion, we demonstrated that gene co-expression analysis coupled to an interactive visualization environment, the TXG-MAPr, is a promising approach to achieve mechanistic relevant, cross-species and cross-platform evaluation of toxicogenomic data.</p