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NLCD: A method to discover nonlinear causal relations among genes.

Distinguishing correlation from causation is a fundamental challenge in many scientific fields, including biology, especially when interventions like randomized controlled trials are infeasible and only observational data are available. Methods based on statistical tests of conditional independence within the Mendelian Randomization framework can detect causality between two observed variables that are each associated with a third instrumental variable. However, these methods for detecting causal relationships between traits (e.g., two gene expression or clinical traits associated with a genetic variant, all observed in the same population) often assume a linear relationship, thereby hindering the discovery of causal gene networks from genomics data. We have developed NLCD, a method for NonLinear Causal Discovery from genomics data based on nonlinear regression modeling and conditional feature importance scoring. NLCD uses these techniques to extend the statistical tests in an existing linear causal discovery method called the Causal Inference Test (CIT). We benchmarked NLCD against current state-of-the-art methods: CIT, Findr, and MRPC. On simulated datasets, NLCD performs comparably to most methods in detecting linear relations (Average AUPRC (Area Under the Precision-Recall Curve) of NLCD = 0.94, CIT = 0.94, Findr = 0.94, and MRPC = 0.99), and outperforms them in detecting nonlinear (sine and sawtooth type) relations between two genes (Average AUPRC of NLCD = 0.76, CIT = 0.60, Findr = 0.56, and MRPC = 0.73). When tested on a nonlinear subset of a yeast genomic dataset to recover known causal relations involving transcription factors, NLCD and CIT performed comparable to each other and slightly better than Findr and MRPC (Average AUPRC of NLCD = 0.82, CIT = 0.81, Findr = 0.71, and MRPC = 0.54). On application to a human genomic dataset, NLCD revealed active causal gene pairs (IRF1 → PSME1 and HLA-C → HLA-T) in the muscle tissue, and clarified the promises and challenges in discovering causal gene networks in tissues under in vivo human settings.

Humans↗

Agreement between three commercially available instruments for measuring short-term heart rate variability.

Numerous instruments are commercially available to measure heart rate variability, yet little is known regarding the agreement between such instruments. The objective of this study is to assess agreement between measures of heart rate variability in three commercially available instruments. Thirty subjects (20 males) of median age 27.5 (range 19-59 years) underwent simultaneous ECG recordings, under three different resting conditions: supine, standing and supine with controlled breathing, using three commercially available analysers. Intraclass correlation coefficients tended to show excellent agreement (lower 95% C.I., R > 0.75) between all instruments under all conditions. However, further analysis of selected measurements using the limits of agreement method revealed large variation in values generated by all instruments. There was also an evidence of systematic bias between one instrument and the remaining two. The latter finding was due to discrepant ECG recording protocols that were unrelated to consistent operator timing. This study demonstrates that measures of HRV generated by the three instruments did not agree well in all cases. Discrepancies were due to the recording protocols of the systems. This may lead to incomparable results between instruments. It is therefore recommended that: (a) if different instruments are used in the same study or (b) multi-centre study designs are planned or (c) heart rate variability results are discussed with reference to studies using other instruments, levels of agreement need to be reported to ensure comparability.

Adult↗

Square-wave adsorptive cathodic stripping voltammetry of pantoprazole.

Adsorption and reduction of pantoprazole were investigated by cyclic and square-wave voltammetry on a hanging mercury drop electrode in Britton-Robinson buffers at pH 2.0-11.0. The reduction process gave rise to a single peak within the entire pH range. Study of the variation of the reduction signal with solution variables such as pH and concentration of pantoprazole and instrumental variables such as accumulation time and potential, frequency, pulse height and pulse amplitude, has resulted in optimization of the reduction signal for analytical purposes. The voltammetric procedure was applied successfully to give a rapid and precise assay of pantoprazole in a tablet dosage form.

2-Pyridinylmethylsulfinylbenzimidazoles↗

Addressing measurement error bias in nurse staffing research.

OBJECTIVE: To assess the extent of measurement error bias due to methods used to allocate nursing staff to the acute care inpatient setting and to recommend estimation methods designed to overcome this bias. DATA SOURCES/STUDY SETTING: Secondary data obtained from the California Office of Statewide Health Planning and Development (OSHPD) and the Centers for Medicare and Medicaid Services' Healthcare Cost Report Information System for 279 general acute care hospitals from 1996 to 2001. STUDY DESIGN: California OSHPD provides detailed nurse staffing data for acute care inpatients. We estimate the measurement error and the resulting bias from applying different staffing allocation methods. Estimates of the measurement errors also allow insights into the best choices for alternate estimation strategies. PRINCIPAL FINDINGS: The bias induced by the adjusted patient days method (and its modification) is smaller than for other methods, but the bias is still substantial: in the benchmark simple regression model, the estimated coefficient for staffing level on quality of care is expected to be one-third smaller than its true value (and the bias is larger in a multiple regression model). Instrumental variable estimation, using one staffing allocation measure as an instrument for another, addresses this bias, but only particular choices of staffing allocation measures and instruments are suitable. CONCLUSIONS: Staffing allocation methods induce substantial attenuation bias, but there are easily implemented estimation methods that overcome this bias.

Bias↗

Measuring step kinematic variability on an instrumented treadmill: how many steps are enough?

Variability of step kinematics has been associated with falls by older adults. However, between-study differences with regard to the number of steps used to compute variability have varied by an order of magnitude. If the number of steps used to compute variability is too low there is the potential for a statistically spurious outcome. On the other hand, for subjects with mobility impairments a protocol requiring too many steps to estimate variability imposes an unnecessary burden on the subjects. We have determined the minimum number of steps needed to estimate the variability of spatial and temporal step kinematics. More than 700 steps were collected during level walking on an instrumented treadmill. Accurate estimation of step kinematic variability required at least 400 steps. The increased error in estimating the mean and standard deviations of the step kinematic variables with too few steps can impose an experimental cost with regard to statistical design considerations. The extent to which translation of these results can be made to the variability of spatial and temporal step kinematics collected during over-ground walking awaits further research.

Adult↗

Stripping voltammetric determination of indapamide in serum at castor oil-based carbon paste electrodes.

The diuretic drug indapamide has been characterized voltammetrically at carbon paste electrodes by means of cyclic and differential pulse voltammetry. An adsorptive stripping method at carbon paste electrode modified with castor oil for trace determination of indapamide was described. A study of the variation of the peak current with solution variables such as pH, ionic strength, concentration of indapamide, possible interference, and instrumental variables such as scan rate, pulse amplitude, preconcentration time, accumulation potential, paste composition has resulted in the optimization of the oxidation signal for analytical purposes. By anodic stripping differential pulse voltammetry, the calibration plot was linear in the range 5 x 10(-8) x 10(-7) M with a detection limit of 5 x 10(-9) M at carbon paste electrode modified with castor oil in pH 4.0. The preconcentration medium-exchange approach was utilized for selective determination of indapamide in spiked serum. A detection limit of 15 ng ml(-1) was obtained for dilute serum sample after 3 min accumulation and medium-exchange procedure.

Carbon↗

Primary nursing and quality of care: a Dutch study.

In an 850-bed Dutch hospital a study was carried out to compare the quality-of-care scores of a Primary Nursing group and a lagged experimental group. Process as well as outcome aspects of quality of care were investigated. The study consisted of three measuring moments: one pre-intervention at t1, March 1992, and two post-intervention moments at t2, November 1992 and t3, May 1993. The intervention was formed by the implementation of Primary Nursing in two experimental units after t1; this is the experimental group. After t2, Primary Nursing was also implemented in the three control units; this is the lagged experimental group. The process aspects of quality of care were covered by three dimensions: coordination of care, instrumental aspects of care and expressive aspects of care. The outcome aspects of quality of care were measured by evaluating four patient variables: self-care, initiative, patient stress and patient satisfaction. ANOVAs were used to test for significant differences between the experimental and lagged experimental group. The only significant difference in favour of the Primary Nursing group was found on the variable instrumental aspects of care. On the other variables no expected changes were observed. Finally, the implications of the findings are discussed.

Analysis of Variance↗

Effects of primary care depression treatment on minority patients' clinical status and employment.

BACKGROUND: The response of ethnic minorities to mental health care is largely unstudied. OBJECTIVE: To determine the effect of appropriate care for depression on ethnic minorities. DESIGN: Observational analysis of the effects of evidence-based depression care over 6 months on clinical outcomes and employment status is examined for ethnic minorities and nonminorities. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument. SETTING: Six managed care organizations across the United States. Patients One thousand three hundred fifty-six depressed adults, including 601 white, 258 Latino, 56 African American, and 24 Asian or Native American patients. Intervention Quality improvement interventions aimed at increasing guideline-concordant depression care. RESULTS: At 6 months, minority patients who received appropriate care, compared with those who did not receive it, had lower rates of probable depressive disorder (20.5% vs 70.5%); the findings were similar for nonminority patients (24.3% vs 71.2%). Nonminority patients who received appropriate care were found to have higher rates of employment than were those who did not receive appropriate care (71.4% vs 52.4%). This was not true of minority patients (68.2% vs 56.5%). CONCLUSIONS: Evidence-based care for depression is equally effective in reducing depressive disorders for minority and nonminority patients. However, functional outcomes of care, such as continued employment, may be more limited for minority than nonminority patients. Because minority members are less likely to get appropriate care, efforts should be made to engage minority members in effective care for depression.

Adolescent↗

Controlling for the endogeneity of peer substance use on adolescent alcohol and tobacco use.

This study examines whether the effects of peer substance use on adolescent alcohol and tobacco use are due to endogeneity of adolescents selecting their peer group. We analyzed data collected for a longitudinal analysis of a drug-use prevention programme for upper elementary school students. We used a two-step probit regression to control for the potentially endogenous explanatory variable peer substance use. Rigorous tests of endogeneity and the validity of the instrumental variables showed that controlling for the endogeneity of peer substance use to reduce bias is not worth the reduction in mean squared error in these data. Peer substance use has a positive and significant effect on adolescent substance use for both drinking and smoking. These results imply that peer influence is empirically more important than peer selection (endogeneity) in our sample of adolescents in grades 6-9. Living in a single-parent family was by far the strongest predictor of adolescent drinking and smoking.

Adolescent↗

The effects of primary care depression treatment on patients' clinical status and employment.

OBJECTIVE: To evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months. DATA SOURCES/STUDY SETTING: Data are from a randomized controlled trial of quality improvement for depression that included 938 adults with depressive disorder in 46 managed primary care clinics in five states. STUDY DESIGN: Observational analysis of the effects of evidence-based depression care over six months on health outcomes and employment. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument. DATA COLLECTION/EXTRACTION METHODS: Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data. PRINCIPAL FINDINGS: At six months, patients with appropriate care, compared to those without it, had lower rates of depressive disorder (24 percent versus 70 percent), better mental health-related quality of life, and higher rates of employment (72 percent versus 53 percent), each p<.05. CONCLUSIONS: Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.

Depressive Disorder↗

Methods to assess intended effects of drug treatment in observational studies are reviewed.

BACKGROUND AND OBJECTIVE: To review methods that seek to adjust for confounding in observational studies when assessing intended drug effects. METHODS: We reviewed the statistical, economical and medical literature on the development, comparison and use of methods adjusting for confounding. RESULTS: In addition to standard statistical techniques of (logistic) regression and Cox proportional hazards regression, alternative methods have been proposed to adjust for confounding in observational studies. A first group of methods focus on the main problem of nonrandomization by balancing treatment groups on observed covariates: selection, matching, stratification, multivariate confounder score, and propensity score methods, of which the latter can be combined with stratification or various matching methods. Another group of methods look for variables to be used like randomization in order to adjust also for unobserved covariates: instrumental variable methods, two-stage least squares, and grouped-treatment approach. Identifying these variables is difficult, however, and assumptions are strong. Sensitivity analyses are useful tools in assessing the robustness and plausibility of the estimated treatment effects to variations in assumptions about unmeasured confounders. CONCLUSION: In most studies regression-like techniques are routinely used for adjustment for confounding, although alternative methods are available. More complete empirical evaluations comparing these methods in different situations are needed.

Confounding Factors, Epidemiologic↗

Social support as a predictor of variability: an examination of the adjustment trajectories of recent widows.

The variability pattern of emotional well-being in recent widows across a 98-day period beginning in the first month post-loss has previously been modeled by dynamical systems and shown to be an oscillating process that damps across time. The goal of the present study was to examine how variables that comprise the social support network predict characteristics of these emotional shifts in 28 recent widows. In the present study, emotional support seeking led to a steeper overall trend, whereas perceived control for social support led to a shallower overall trend. When examining intraindividual variability, instrumental support seeking predicted a slower damping rate. Understanding the individual differences in the variability patterns of recent widows is a necessary step in identifying the etiology of adjustment to widowhood.

Adaptation, Psychological↗

Exploring the causal role of plasma metabolites in pediatric asthma: a Mendelian randomization study.

BACKGROUND: Pediatric asthma (PA) is the prevailing chronic respiratory ailment in childhood. A better understanding of plasma metabolites is the goal for elucidating the molecular pathological mechanisms of PA and investigating novel therapeutic approaches. METHODS: Data for PA from Genome-Wide Association Studies (GWAS) was derived from the IEU-OpenGWAS project, featuring a collection of 1400 plasma metabolites. The inverse-variance weighting (IVW) method assessed causal relationships between plasma metabolites and PA, with measures taken to mitigate horizontal pleiotropy and heterogeneity. To select instrumental variables, a genome-wide significance threshold (p&#x2009;<&#x2009;5&#x2009;&#xd7;&#x2009;10-8) was applied to ensure robust genetic instruments. A Bonferroni correction controlled for multiple testing, with statistical significance defined as p&#x2009;<&#x2009;3.57&#x2009;&#xd7;&#x2009;10-5) (0.05/1400). To further substantiate outcomes, a reverse Mendelian randomization analysis was conducted. RESULTS: Research found 91 plasma metabolites linked to PA, ten of which showed significant associations. Of note, 20:4n6 levels (IVW: OR (95% CI) = 1.062 (1.030 to 1.094) and G/C16 (IVW: OR (95% CI) = 0.886 (0.832 to 0.943) were identified as pivotal exposure factors for PA. CONCLUSIONS: This study highlights 10 plasma metabolites that may have significant associations with PA incidence, with 20:4n6 levels and G/C16 potentially serving as valuable biomarkers for the early detection and management of PA.

Humans↗

Genetically predicted CXCL16 expression is associated with Parkinson's disease risk and peripheral immune cell dysregulation: a two-sample mendelian randomization study.

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder with limited disease-modifying therapies. PANoptosis, an integrated form of programmed cell death involving apoptosis, pyroptosis, and necroptosis, has been implicated in neuroinflammation-related neurodegeneration. However, the roles of PANoptosis-related genes in PD remain unclear. METHODS: We performed two-sample Mendelian randomization (MR) using cis-eQTL instruments from the eQTLGen Consortium for 30 PANoptosis-related genes, with PD GWAS data from Nalls et al. 2019 as the outcome. Instrumental variables were selected using a hierarchical strategy, with genome-wide significant cis-eQTLs as primary instruments and a relaxed threshold applied only for genes with fewer than three independent SNPs. Sensitivity analyses included MR-Egger, weighted median, MR-PRESSO, MR-RAPS, and leave-one-out analyses. SMR/HEIDI testing and two-step MR mediation using 731 peripheral immune traits were also performed. RESULTS: Genetically predicted higher CXCL16 expression was associated with increased PD risk (OR&#x2009;=&#x2009;1.115, 95% CI 1.060-1.173, p&#x2009;=&#x2009;2.4&#x2009;&#xd7;&#x2009;10-5), while higher FADD expression was associated with reduced PD risk (OR&#x2009;=&#x2009;0.861, 95% CI 0.790-0.939, p&#x2009;=&#x2009;7.1&#x2009;&#xd7;&#x2009;10-4). CASP1 and IFI27 were nominally significant and considered exploratory. Sensitivity analyses were directionally consistent, although MR-Egger estimates were imprecise. SMR/HEIDI supported CXCL16. Exploratory mediation analysis identified 63/66 candidate immune mediators after FDR correction. CONCLUSION: These findings provide MR-based genetic evidence linking CXCL16 expression to PD risk, with exploratory mediation through peripheral immune phenotypes. The CXCL16-immune cell-PD axis warrants further experimental validation.

Humans↗

An assessment of three portable peak flow meters.

Peak flow has become widely used as in independent measure of lung function, particularly in asthma, because it can be quickly and easily determined by simple portable instrumentation. Three relatively inexpensive devices, the Armstrong mini-Wright peak flow meter, Vitalograph pulmonary monitor, and HealthScan peak flow meter, were tested for accuracy and reproducibility. Five units of each type were individually connected in series to a pneumotachograph, and 20 measurements (five in each of four flow ranges) were made on each unit at pulsatile flows ranging from 120 to 480 Lpm. The mean percentage of discrepancy (D%) for each instrument of a particular model was calculated at each flow range, and these subsequently averaged to give an inter-instrument percentage of discrepancy at each flow for each model. Intra-instrument variability was also assessed as the mean percentage of discrepancy for all flow rates for each individual instrument. While only the Armstrong mini-wright peak flow meter meets flow range criteria established by the American Thoracic Society and American College of Chest Physicians for flow devices, only the HealthScan-Organon peak flow meter meets the established criteria for accuracy and reproducibility.

Peak Expiratory Flow Rate↗

Individual behaviour and tobacco consumption: a panel data approach.

This paper considers estimators of tobacco demand equations using Becker and Murphy's model of addiction with a complete panel of households for Spain. With these tools, we face two main problems: first, the endogeneity of past and future consumption and, second, the limited-dependent variable. To control these problems simultaneously is difficult and we proceed to confront them separately. We follow an instrumental variable approach (which also allows us to control for measurement errors in variables and non-independent effects) to tackle the first and we use a consistent within-group procedure to obtain the parameter vector of the structural form, once we have estimated T-Tobit models for the reduced form in order to deal with the limited-dependent variable problem.

Advertising↗

Universal screening for intimate partner violence in the emergency department: importance of patient and provider factors.

STUDY OBJECTIVE: Screening for intimate partner violence has been widely advocated in the health care setting, but efforts to assess effectiveness and ensure adequacy of universal screening are largely untested. We sought to identify barriers to screening of female emergency department patients for intimate partner violence during the first year of implementation of a screening protocol. METHODS: A retrospective, structured medical chart review of 1,638 randomly identified visits included demographic factors of age, race, marital status, employment status, insurance status, arrival mode, mechanism of presenting complaint, severity of condition, presentation time, and nurse gender. The study was conducted an an inner-city Level I trauma center with 43,000 annual ED visits and universal procedures for screening for intimate partner violence in place since February 1994. The participants were a cohort of 1,509 female patients, 18 years of age or older, who were discharged from the ED between July 1994 and June 1995. The main outcome measure was the odds of being screened as a function of patient and provider variables. Statistical analyses involved univariate and multivariate logistic regression on screening rates (Yes/No) as derived from universal screening instrument variables. RESULTS: Of 1,638 records reviewed, 483 patients (29.5%) were screened for intimate partner violence. Univariate analyses revealed that women presenting with nonpsychiatric, less acute complaints and those who presented during daylight hours were more likely to be screened than women who presented with psychiatric or more acute complaints, or during the night shift. Male and female nurse providers were equally likely to screen for intimate partner violence. Step-down multivariate analyses agreed with these findings. CONCLUSION: In this random sample of female patients, screening rates varied by severity of the patient's condition, type of presenting complaint, and presentation time.

Adolescent↗

Bayesian Mendelian randomization reveals a protective effect of later age at first sexual intercourse against erectile dysfunction.

Erectile dysfunction (ED) is a prevalent health condition with significant psychosocial impacts, yet the causal role of age at first sexual intercourse (AFS) remains unclear. This study investigated the causal effect of AFS on the risk of ED using Mendelian randomization (MR) and Bayesian methods. Five traditional 2-sample MR analyses and 5 Bayesian MR analyses were performed using genome-wide association studies summary statistics from European populations. Sensitivity analyses included MR Egger regression, MR-pleiotropy residual sum and outlier, and Cochran Q-test. In mixed-sex cohorts (Groups 1 and 2), inverse variance weighted results demonstrated significant protective effects: odds ratio (OR)&#x2005;=&#x2005;0.626, &#x3b8;&#x2005;=&#x2005;-0.469, P&#x2005;=&#x2005;2.73&#x2005;&#xd7;&#x2005;10-6 for Group 1 and OR&#x2005;=&#x2005;0.617, &#x3b8;&#x2005;=&#x2005;-0.483, P&#x2005;=&#x2005;3.56&#x2005;&#xd7;&#x2005;10-5 for Group 2. The analyses for male-specific cohorts (Groups 3-10) showed weaker but consistent effects. For Group 3, OR&#x2005;=&#x2005;0.643, &#x3b8;&#x2005;=&#x2005;-0.442, P&#x2005;=&#x2005;.010. For Group 4, some instrumental variables associated with confounders were removed. The result became statistically insignificant: OR&#x2005;=&#x2005;0.680, &#x3b8;&#x2005;=&#x2005;-0.385, P&#x2005;=&#x2005;.064. For Group 5, the instrument selection criteria were relaxed and significance was retained: OR&#x2005;=&#x2005;0.695, &#x3b8;&#x2005;=&#x2005;-0.364, P&#x2005;=&#x2005;.016. For Groups 6 to 10, Bayesian MR was used to strengthen the inferences. In particular, for Group 8, which has a strongly informed prior, a posterior mean &#x3b8;&#x2005;=&#x2005;-0.358 and a 95% credible interval (-0.575, -0.136) were obtained. This study provides evidence supporting a causal protective effect of later AFS on ED risk. While traditional MR analyses in male-specific cohorts yielded suggestive results, Bayesian MR analyses, which allow for the integration of prior evidence, provided more precise estimates and strengthened the causal inference. These findings may inform future sexual health policies. Strengths include the use of male-specific cohorts and Bayesian enhancement for weak instruments. Limitations include reliance on European-ancestry data and inability to stratify ED subtypes.

Male↗