Multilevel analysis for a longitudinal clinical trial

This study applies the multilevel analysis technique to longitudinal data of a large clinical trial. The technique accounts for the correlation at different levels when modeling repeated blood pressure measurements taken throughout the trial. This modeling allows for closer inspection of the remaining correlation and non-homogeneity of variance in the data. Three methods of modeling the correlation were compared. ^

Comparison of a traditional and a multilevel Cox Proportional Hazards model

Hierarchically clustered populations are often encountered in public health research, but the traditional methods used in analyzing this type of data are not always adequate. In the case of survival time data, more appropriate methods have only begun to surface in the last couple of decades. Such methods include multilevel statistical techniques which, although more complicated to implement than traditional methods, are more appropriate. ^ One population that is known to exhibit a hierarchical structure is that of patients who utilize the health care system of the Department of Veterans Affairs where patients are grouped not only by hospital, but also by geographic network (VISN). This project analyzes survival time data sets housed at the Houston Veterans Affairs Medical Center Research Department using two different Cox Proportional Hazards regression models, a traditional model and a multilevel model. VISNs that exhibit significantly higher or lower survival rates than the rest are identified separately for each model. ^ In this particular case, although there are differences in the results of the two models, it is not enough to warrant using the more complex multilevel technique. This is shown by the small estimates of variance associated with levels two and three in the multilevel Cox analysis. Much of the differences that are exhibited in identification of VISNs with high or low survival rates is attributable to computer hardware difficulties rather than to any significant improvements in the model. ^

The association of area socioeconomic status and cancer screening: A systematic review and multilevel study

Background. The gap between actual and ideal rates of routine cancer screening in the U.S., particularly for colorectal cancer screening (CRCS) (1;2), is responsible for an unnecessary burden of morbidity and mortality, particularly for disadvantaged groups. Knowledge about the effects of individual and area influences is being advanced by a growing body of research that has examined the association of area socioeconomic status (SES) and cancer screening after controlling for individual SES. The findings from this emerging and heterogeneous research in the cancer screening literature have been mixed. Moreover, multilevel studies in this area have not yet adequately explored the possibility of differential associations by population subgroup, despite some evidence suggesting gender-specific effects. ^ Objectives and methods. This dissertation reports on a systematic review of studies on the association of area SES and cancer screening and a multilevel study of the association between area SES and CRCS. The specific aims of the systematic review are to: (1) describe the study designs, constructs, methods, and measures; (2) describe the association of area SES and cancer screening; and (3) identify neglected areas of research. ^ The empiric study linked a pooled sample of respondents aged ≥50 years without a personal history of colorectal cancer from the 2003 and 2005 California Health Interview Surveys with a comprehensive set of census-tract level area SES measures from the 2000 U.S. Census. Two-level random intercept models were used to test 2 hypotheses: (1) area SES will be associated with adherence to two modalities of CRCS after controlling for individual SES; and (2) gender will moderate the relationship between area socioeconomic status and adherence to both modalities of CRCS. ^ Results. The systematic review identified 19 eligible studies that demonstrated variability in study designs, methods, constructs, and measures. The majority of tested associations were either not statistically significant or significant and in the positive direction, indicating that as area SES increased, the odds of CRCS increased. The multilevel study demonstrated that while multiple aspects of area SES were associated with CRCS after controlling for individual SES, associations differed by screening modality and in the case of endoscopy, they also differed by gender. ^ Conclusions. Conceptual and methodologic heterogeneity and weaknesses in the literature to date limit definitive conclusions about the underlying relationships between area SES and cancer screening. The multilevel study provided partial support for both hypotheses. Future research should continue to explore the role of gender as a moderating influence with the aim of identifying the mechanisms linking area SES and cancer prevention behaviors. ^

Single nucleotide polymorphisms (SNPs) associated with TGF-beta pathway and their significance in systemic sclerosis - A multilevel analysis

Systemic sclerosis (SSc) or Scleroderma is a complex disease and its etiopathogenesis remains unelucidated. Fibrosis in multiple organs is a key feature of SSc and studies have shown that transforming growth factor-β (TGF-β) pathway has a crucial role in fibrotic responses. For a complex disease such as SSc, expression quantitative trait loci (eQTL) analysis is a powerful tool for identifying genetic variations that affect expression of genes involved in this disease. In this study, a multilevel model is described to perform a multivariate eQTL for identifying genetic variation (SNPs) specifically associated with the expression of three members of TGF-β pathway, CTGF, SPARC and COL3A1. The uniqueness of this model is that all three genes were included in one model, rather than one gene being examined at a time. A protein might contribute to multiple pathways and this approach allows the identification of important genetic variations linked to multiple genes belonging to the same pathway. In this study, 29 SNPs were identified and 16 of them located in known genes. Exploring the roles of these genes in TGF-β regulation will help elucidate the etiology of SSc, which will in turn help to better manage this complex disease. ^

HPV vaccine coverage in Texas counties: An application of multilevel, small area estimation

Health departments, research institutions, policy-makers, and healthcare providers are often interested in knowing the health status of their clients/constituents. Without the resources, financially or administratively, to go out into the community and conduct health assessments directly, these entities frequently rely on data from population-based surveys to supply the information they need. Unfortunately, these surveys are ill-equipped for the job due to sample size and privacy concerns. Small area estimation (SAE) techniques have excellent potential in such circumstances, but have been underutilized in public health due to lack of awareness and confidence in applying its methods. The goal of this research is to make model-based SAE accessible to a broad readership using clear, example-based learning. Specifically, we applied the principles of multilevel, unit-level SAE to describe the geographic distribution of HPV vaccine coverage among females aged 11-26 in Texas.^ Multilevel (3 level: individual, county, public health region) random-intercept logit models of HPV vaccination (receipt of ≥ 1 dose Gardasil® ) were fit to data from the 2008 Behavioral Risk Factor Surveillance System (outcome and level 1 covariates) and a number of secondary sources (group-level covariates). Sampling weights were scaled (level 1) or constructed (levels 2 & 3), and incorporated at every level. Using the regression coefficients (and standard errors) from the final models, I simulated 10,000 datasets for each regression coefficient from the normal distribution and applied them to the logit model to estimate HPV vaccine coverage in each county and respective demographic subgroup. For simplicity, I only provide coverage estimates (and 95% confidence intervals) for counties.^ County-level coverage among females aged 11-17 varied from 6.8-29.0%. For females aged 18-26, coverage varied from 1.9%-23.8%. Aggregated to the state level, these values translate to indirect state estimates of 15.5% and 11.4%, respectively; both of which fall within the confidence intervals for the direct estimates of HPV vaccine coverage in Texas (Females 11-17: 17.7%, 95% CI: 13.6, 21.9; Females 18-26: 12.0%, 95% CI: 6.2, 17.7).^ Small area estimation has great potential for informing policy, program development and evaluation, and the provision of health services. Harnessing the flexibility of multilevel, unit-level SAE to estimate HPV vaccine coverage among females aged 11-26 in Texas counties, I have provided (1) practical guidance on how to conceptualize and conduct modelbased SAE, (2) a robust framework that can be applied to other health outcomes or geographic levels of aggregation, and (3) HPV vaccine coverage data that may inform the development of health education programs, the provision of health services, the planning of additional research studies, and the creation of local health policies.^

Bayesian estimation of multilevel item response model with missing data

This study proposed a novel statistical method that modeled the multiple outcomes and missing data process jointly using item response theory. This method follows the "intent-to-treat" principle in clinical trials and accounts for the correlation between outcomes and missing data process. This method may provide a good solution to chronic mental disorder study. ^ The simulation study demonstrated that if the true model is the proposed model with moderate or strong correlation, ignoring the within correlation may lead to overestimate of the treatment effect and result in more type I error than specified level. Even if the within correlation is small, the performance of proposed model is as good as naïve response model. Thus, the proposed model is robust for different correlation settings if the data is generated by the proposed model.^

Multibeam Converter - a tool to create Ocean Data View import files from multibeam files

The software Multibeam Converter is a tool to convert files or folders of files (ascii/tab-separated data files with or without metaheader), downloaded from PANGAEA via the search engine or the data warehouse to the ODV import format, e.g. for visualization or further processing. MultibeamConverter is distributed as freeware for the operating systems Microsoft Windows, Apple OS X and Linux.

LatLong Converter - converts positions from geodetic system to Gauss-Krüger or UTM coordinates

LatLongConverter converts positions from geodetic system to Gauss-Krüger or UTM coordinates. This program is distributed as freeware for the operating systems Microsoft Windows, Apple OS X and Linux.

Design methodology in multiphase buck converter based on minimum time control for high efficiency RF amplifiers

This paper proposes an interleaved multiphase buck converter with minimum time control strategy for envelope amplifiers in high efficiency RF power amplifiers. The solution of the envelope amplifier is to combine the proposed converter with a linear regulator in series. High system efficiency can be obtained through modulating the supply voltage of the envelope amplifier with the fast output voltage variation of the converter working with several particular duty cycles that achieve total ripple cancellation. The transient model for minimum time control is explained, and the calculation of transient times that are pre-calculated and inserted into a look-up table is presented. The filter design trade-off that limits capability of envelope modulation is also discussed. The experimental results verify the fast voltage transient obtained with a 4-phase buck prototype.

Design of envelope amplifier based on interleaved multiphase buck converter with minimum time control for RF application

In this paper, an interleaved multiphase buck converter with minimum time control strategy for envelope amplifiers in high efficiency RF power amplifiers is proposed. The solution for the envelope amplifier is to combine the proposed converter with a linear regulator in series. High efficiency of envelope amplifier can be obtained through modulating the supply voltage of the linear regulator. Instead of tracking the envelope, the buck converter has discrete output voltage that corresponding to particular duty cycles which achieve total ripple cancellation. The transient model for minimum time control is explained, and the calculation of transient times that are pre-calculated and inserted into a lookup table is presented. The filter design trade-off that limits capability of envelope modulation is also discussed. The experimental results verify the fast voltage transient obtained with a 4-phase buck prototype.

High efficiency envelope tracking buck converter for RFPA using GaN HEMTs

—In this paper, application of a new technological solution for power switches based on Gallium Nitride and a filter design methodology for high efficiency Envelope Amplifier in RF transmitters are proposed. Comparing to Si MOSFETs, GaN HEMTs can provide higher efficiency of the Envelope Amplifier, due to better Figure Of Merit (lower product of on- resistance and gate charge). Benefits of their application were verified through the experimental results. The goal of the filter design is to generate the envelope reference with the minimum possible distortion and to improve the efficiency of the Amplifier, obtaining the optimum trade-off between conduction and switching losses.

Multiphase Buck Converter with Minimum Time Control Strategy for RF Envelope Modulation

Power amplifier supplied with constant supply voltage has very low efficiency in the transmitter. A DC-DC converter in series with a linear regulator can be used to obtain voltage modulation. Since this converter should be able to change the output voltage very fast, a multiphase buck converter with a minimum time control strategy is proposed. To modulate supply voltage of the envelope amplifier, the multiphase converter works with some particular duty cycle (i/n, i=1, 2 ... n, n is the number of phase) to generate discrete output voltages, and in these duty cycles the output current ripple can be completely cancelled. The transition times for the minimum time are pre-calculated and inserted in a look-up table. The theoretical background, the system model that is necessary in order to calculate the transition times and the experimental results obtained with a 4-phase buck prototype are given

Multiphase transformer-coupled converter: two different strategies for energy conversion

The operation of a multiphase topology, ideally, without energy storage presents the advantage of achieving very high efficiency over a wide load range as well as a fast dynamic response. However, ideal no-energy storage operation also implies a limitation in the regulation capability of the topology, the output voltage can only take discrete values. These features (high efficiency and discrete regulation capability) of the proposed energy conversion strategy enable the topology as a candidate for `DC-DC transformer' applications. The advantages, drawbacks and the operating principle of this concept, implemented with a `closed chain' magnetic structure have been already presented. In this work, the minimum energy storage operation, is applied to two different magnetic structures. These magnetic structures are called `closed chain' and `pyramidal' the main advantage of the `pyramidal' coupling structure is to improve the size of the converter without increasing the operating frequency. Both magnetic structures are analyzed, compared and experimentally implemented.

Optimum Design of an Envelope Tracking Buck Converter for RF PA using GaN HEMTs

In this paper, filter design methodology and application of GaN HEMTs for high efficiency Envelope Amplifier in RF transmitters are proposed. The main objectives of the filter design are generation of the envelope reference with the minimum possible distortion and high efficiency of the amplifier obtained by the optimum trade-off between conduction and switching losses. This optimum point was determined using power losses model for synchronous buck with sinusoidal output voltage and experimental results showed good correspondence with the model and verified the proposed methodology. On the other hand, comparing to Si MOSFETs, GaN HEMTs can provide higher efficiency of the envelope amplifier, due to superior conductivity and switching characteristics. Experimental results verified benefits of GaN devices comparing to the appliance of Si switching devices with very good Figure Of Merit, for this particular application