The Impact of Race, Ethnicity, and Sex on Fairness in Artificial Intelligence for Glaucoma Prediction Models.

Objective: Despite advances in artificial intelligence (AI) in glaucoma prediction, most works lack multicenter focus and do not consider fairness concerning sex, race, or ethnicity. This study aims to examine the impact of these sensitive attributes on developing fair AI models that predict glaucoma progression to necessitating incisional glaucoma surgery. Design: Database study. Participants: Thirty-nine thousand ninety patients with glaucoma, as identified by International Classification of Disease codes from 7 academic eye centers participating in the Sight OUtcomes Research Collaborative. Methods: We developed XGBoost models using 3 approaches: (1) excluding sensitive attributes as input features, (2) including them explicitly as input features, and (3) training separate models for each group. Model input features included demographic details, diagnosis codes, medications, and clinical information (intraocular pressure, visual acuity, etc.), from electronic health records. The models were trained on patients from 5 sites (N = 27 999) and evaluated on a held-out internal test set (N = 3499) and 2 external test sets consisting of N = 1550 and N = 2542 patients. Main Outcomes and Measures: Area under the receiver operating characteristic curve (AUROC) and equalized odds on the test set and external sites. Results: Six thousand six hundred eighty-two (17.1%) of 39 090 patients underwent glaucoma surgery with a mean age of 70.1 (standard deviation 14.6) years, 54.5% female, 62.3% White, 22.1% Black, and 4.7% Latinx/Hispanic. We found that not including the sensitive attributes led to better classification performance (AUROC: 0.77-0.82) but worsened fairness when evaluated on the internal test set. However, on external test sites, the opposite was true: including sensitive attributes resulted in better classification performance (AUROC: external #1 - [0.73-0.81], external #2 - [0.67-0.70]), but varying degrees of fairness for sex and race as measured by equalized odds. Conclusions: Artificial intelligence models predicting whether patients with glaucoma progress to surgery demonstrated bias with respect to sex, race, and ethnicity. The effect of sensitive attribute inclusion and exclusion on fairness and performance varied based on internal versus external test sets. Prior to deployment, AI models should be evaluated for fairness on the target population. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Estimating the prevalence of chronic kidney disease in the older population using health screening data in Japan.

BACKGROUND: In aging societies, the prevalence of chronic kidney disease (CKD) is expected to increase but may be underestimated because many asymptomatic patients remain undiagnosed. This study aimed to estimate the CKD prevalence among the general older population in Japan. METHODS: This cross-sectional study used health screening data from the Japan Health Insurance Association collected between April 2014 and March 2023. Data from older people aged 65-90 years who underwent renal function screening for estimated glomerular filtration rate (eGFR) and urine protein tests were analyzed. CKD was defined as eGFR < 60 mL/min/1.73 m2 or proteinuria ≥ 1 + . Inverse probability weighting was used to account for the selection bias. The variables used for weighting were age, sex, insurance status, and the number of previous screenings. RESULTS: Among 2.98 million older individuals, 588,809 (19.7%) had undergone screening (median [IQR] age, 69.9 [67.9-76.2] years, 337,862 women [57.4%]). Regarding the weighted CKD prevalence, 25.3% of the individuals aged 65-90 years had CKD; 11.8% of those aged 65-75 years and 34.6% of those aged 75 years and over showed an increase in prevalence with age. Among the patients with CKD, over half exhibited mild renal dysfunction without proteinuria. Hypertension and diabetes were common comorbidities in older patients with CKD. CONCLUSIONS: This cross-sectional study revealed that the weighted prevalence of CKD in the older population aged 65-90 years was high (one in four individuals), indicating that it increases with age. Further studies are required to examine the clinical significance of these findings.

Linguistic analysis of letters of recommendation for pediatric otolaryngology: A pilot study.

OBJECTIVES: To analyze the language of letters of recommendation for pediatric otolaryngology fellowship for possible gender and/or racial bias. To refine methodology for future investigation of gender and language within letters of recommendation for pediatric otolaryngology fellowship. METHODS: Practicing pediatric otolaryngologists were recruited as survey participants. A total of 10 letters of recommendation were screened to represent an equal number of applicants who identify as male and female and an equal number of applicants who identify as White and applicants who identify as Black, Indigenous, or a Person of Color. Names, pronouns, location, and other identifying information were removed from the letters. Survey participants were asked to read each letter and categorize the applicant's gender and race as well as that of the letter writer. The letters were also subject to analysis by WordStat linguistic software. RESULTS: A total of 35 pediatric otolaryngologists participated in the survey. Participants assigned gender of the applicant correctly in 43 % of letters and gender of the letter writer correctly in 53 % of letters. Race of the applicant was judged correctly in 65 % of letters. Participants indicated words such as caring, hard-working, and prepared led them to assume the applicant was female, which was corroborated by linguistic analysis. No such words were identified as predictive of race. CONCLUSION: This pilot study suggests that while there are certain linguistic associations with gender among applications to pediatric otolaryngology fellowship, they may not impact biases held by the reader. This is relevant given a recent rise in the number of female applicants to this subspecialty and ongoing unfilled fellowship positions. Future studies are needed to determine if such associations exist and ultimately affect match potential and success within the field. These studies will require analysis of more letters and with more survey respondents, along with a higher in-depth linguistic analysis. LAY SUMMARY: This pilot study aims to evaluate letters of recommendation for pediatric otolaryngology fellowship applications for gender bias with the goal of outlining future studies. There were certain words associated with a given gender, which could impact applicants' potential to match. LEVEL OF EVIDENCE: NA.

Racial Biases Associated With Pulse Oximetry: Longitudinal Social Network Analysis of Social Media Advocacy Impact.

BACKGROUND: Pulse oximetry is a noninvasive method widely used in critical care and various clinical settings to monitor blood oxygen saturation. During the COVID-19 pandemic, its application for at-home oxygen saturation monitoring became prevalent. Further investigations found that pulse oximetry devices show decreased accuracy when used on individuals with darker skin tones. This study aimed to investigate the influence of X (previously known as Twitter) on the dissemination of information and the extent to which it raised health care sector awareness regarding racial disparities in pulse oximetry. OBJECTIVE: This study aimed to explore the impact of social media, specifically X, on increasing awareness of racial disparities in the accuracy of pulse oximetry and to map this analysis against the evolution of published literature on this topic. METHODS: We used social network analysis drawing upon Network Overview Discovery and Exploration for Excel Pro (NodeXL Pro; Social Media Research Foundation) to examine the impact of X conversations concerning pulse oximetry devices. Searches were conducted using the Twitter Academic Track application programming interface (as it was known then). These searches were performed each year (January to December) from 2012 to 2022 to cover 11 years with up to 52,052 users, generating 188,051 posts. We identified the nature of influencers in this field and monitored the temporal dissemination of information about social events and regulatory changes. Furthermore, our social media analysis was mapped against the evolution of published literature on this topic, which we located using PubMed. RESULTS: Conversations on X increased health care awareness of racial bias in pulse oximetry. They also facilitated the rapid dissemination of information, attaining a substantial audience within a compressed time frame, which may have impacted regulatory action announced concerning the investigation of racial biases in pulse oximetry. This increased awareness led to a surge in scientific research on the subject, highlighting a growing recognition of the necessity to understand and address these disparities in medical technology and its usage. CONCLUSIONS: Social media platforms such as X enabled researchers, health experts, patients, and the public to rapidly share information, increasing awareness of potential racial bias. These platforms also helped connect individuals interested in these topics and facilitated discussions that spurred further research. Our research provides a basis for understanding the role of X and other social media platforms in spreading health-related information about potential biases in medical devices such as pulse oximeters.

First record of rhynchosaurs (Archosauromorpha: Rhynchosauria: Hyperodapedontinae) from the early Late Triassic Santacruzodon Assemblage Zone of the Santa Maria Supersequence, Brazil.

Rhynchosauria is a group of extinct, exclusively Triassic, terrestrial, and herbivorous archosauromorphs, characterized by a peculiar maxillary-mandibular apparatus. They reached global distribution during the Carnian, with the Hyperodapedontinae clade. The rhynchosaurian record from South America is included in the Ladinian-?earliest Carnian Dinodontosaurus Assemblage Zone (Pinheiros-Chiniquá Sequence, Brazil) and Tarjadia Assemblage Zone (Chañares Formation, Argentina), and for strictly Carnian Hyperodapedon Assemblage Zone (Lower Candelária Sequence, Brazil) and Ischigualasto Formation (Argentina). Here, we present the first record of Hyperodapedontinae from the Brazilian Early Carnian Santacruzodon Assemblage Zone (Santa Cruz Sequence). The most diagnostic elements belong to a nearly complete left pes, which presents a combination of hyperodapedontine traits. The presence of a second individual of cf. Hyperodapedontinae is based on a fragmentary, isolated left metatarsal IV. An isolated fragment of premaxilla could belong to the second specimen (based on preservation mode) or to a third individual. This new report fills a gap within the South American rhynchosaurian distribution, strengthening biostratigraphic correlation with other regions from Gondwana (i.e., Madagascar), where similar and coeval faunas are known. The inclusion of these specimens in a phylogenetic dataset resulted in low resolution results, due to missing data because postcranial characters for rhynchosaurs are still poorly explored.

Deletion of arrestin-3 does not reduce drug-seeking behavior in a longitudinal paradigm of oral morphine self-administration.

Introduction: Opioid drugs are potent analgesics that mimic the endogenous opioid peptides, endorphins and enkephalins, by activating the µ-opioid receptor. Opioid use is limited by side effects, including significant risk of opioid use disorder. Improvement of the effect/side effect profile of opioid medications is a key pursuit of opioid research, yet there is no consensus on how to achieve this goal. One hypothesis is that the degree of arrestin-3 recruitment to the µ-opioid receptor impacts therapeutic utility. However, it is not clear whether increased or decreased interaction of the µ-opioid receptor with arrestin-3 would reduce compulsive drug-seeking. Methods: We utilized three genotypes of mice with varying abilities to recruit arrestin-3 to the µ-opioid receptor in response to morphine in a novel longitudinal operant self-administration model. We also created a quantitative method to define compulsivity in drug-seeking based on a multi-variate analysis of several operant response variables. Results: We demonstrate that arrestin-3 knockout and wild type mice have highly variable drug-seeking behavior with few genotype differences. In contrast, in mice where the µ-opioid receptor strongly recruits arrestin-3, drug-seeking behavior is much less varied. We found that mice lacking arrestin-3 were more likely to meet the criteria for compulsivity whereas mice with enhanced arrestin-3 recruitment did not develop a compulsive phenotype. Conclusion: These experiments show that a lack of arrestin-3 is not protective against the abuse liability of morphine in an operant self-administration context. Our data also suggest that opioids that engage both G protein and arrestin-3, recapitulating the endogenous signaling pattern, will reduce abuse liability.

Assessing inter- and intra-rater reliability of movement scores and the effects of body-shape using a custom visualisation tool: an exploratory study.

BACKGROUND: The literature shows conflicting results regarding inter- and intra-rater reliability, even for the same movement screen. The purpose of this study was to assess inter- and intra-rater reliability of movement scores within and between sessions of expert assessors and the effects of body-shape on reliability during a movement screen using a custom online visualisation software. METHODS: Kinematic data from 542 athletes performing seven movement tasks were used to create animations (i.e., avatar representations) using motion and shape capture from sparse markers (MoSh). For each task, assessors viewed a total of 90 animations. Using a custom developed visualisation tool, expert assessors completed two identical sessions where they rated each animation on a scale of 1-10. The arithmetic mean of weighted Cohen's kappa for each task and day were calculated to test reliability. RESULTS: Across tasks, inter-rater reliability ranged from slight to fair agreement and intra-rater reliability had slightly better reliability with slight to moderate agreement. When looking at the average kappa values, intra-rater reliability within session with and without body manipulation and between sessions were 0.45, 0.37, and 0.35, respectively. CONCLUSIONS: Based on these results, supplementary or alternative methods should be explored and are likely required to increase scoring objectivity and reliability even within expert assessors. To help future research and practitioners, the custom visualisation software has been made available to the public.

Stress produces negative judgement bias in cuttlefish.

Judgement bias tasks (JBTs) are used to assess the emotional state and welfare of animals in zoos, farms and laboratories, based on the interpretation of an ambiguous or intermediate cue. Animals in positive affective states are more likely to interpret the ambiguous cue positively, whereas animals experiencing negative affect are more likely to interpret ambiguous cues pessimistically. Here, we developed a modified JBT assay for the stumpy-spined cuttlefish, Sepia bandensis, to determine whether cuttlefish exhibit negative affective states resulting from external stressors. Positive and neutral visual cues were presented twice daily until animals learned to associate food with the reinforced visual cue. After training, one treatment group was exposed to combined exposure and handling stress produced by 6 days of impoverished housing and simulated net capture. Our control group received no stress experience. In test trials performed after the stress experience, stressed animals showed higher latencies to approach ambiguous cues, spent significantly less time in rooms with ambiguous cues once they entered, and were less likely to enter first into the ambiguous cue-paired room compared with controls. These behaviours suggest that stress induces pessimistic judgement bias in cuttlefish, the first indication of this capacity in cephalopods.

How context influences the processing of relevant information and judgment accuracy-the role of information restriction in judgment processes in diagnosing misconceptions.

To adapt teaching to the prerequisites of students, teachers have various options at their disposal to gather and process information as the basis to form a judgment, such as carrying out tests, talking to and observing the behavior of students, or administering tasks. The complexity of such a judgment arises from the multitude of observations and their different possible explanations. This complexity might be reduced when teachers focus on one hypothesis instead of considering multiple hypotheses, interpret information in a confirmatory way, and not collect diagnostically relevant information. However, in this way, they run the risk of undesirable biased judgments. It therefore seems important to improve diagnostic judgments by selecting and processing information in a more reflective way. Research indicates that if information on a student is not easily available but restricted (e.g., by time pressure, difficult access to the student or high effort), a teacher who wants to make a careful decision is forced to rely on more reflective processes in the selection of tasks and in the interpretation of solutions. The present experimental study therefore investigates how the restricted availability of information in a specific diagnostic situation-when diagnostically inexperienced prospective mathematics teachers determine misconceptions in decimal fractions-influences the underlying cognitive processes. We assume that restricting the availability of information on student behavior augments the attentional focus and therefore reduces cognitive biases. Such more reflective processing can be observed by an increased time spent per piece of information, which should lead to the processing of relevant information and further increase judgment accuracy. To investigate these hypotheses, prospective teachers without prior knowledge in diagnosing misconceptions (N = 81) were asked to diagnose misconceptions on decimal fractions of virtual students by collecting information on students' solutions. Data concerning the effects of restricting the availability of information on teachers' cognitive processes were analyzed. The results show that with restricted information, participants indeed select a greater proportion of diagnostically relevant tasks, which positively influences judgment accuracy. These results are discussed with respect to their significance for framing teacher training and for further research.

Comparing self-other distinction across motor, cognitive and affective domains.

The self-other distinction (SOD) is a process by which humans disentangle self from other-related mental representations. This online study investigated two unresolved questions: (i) whether partially the same processes underpin SOD for motor, cognitive and affective representations, and (ii) whether SOD overlaps with domain-general cognitive control processes. Participants (N = 243) performed three SOD tasks (motor: automatic imitation inhibition (AIT); cognitive: visual perspective-taking (VPT); affective: emotional egocentricity bias (av-EEB) tasks) and two cognitive control tasks (Stroop and stop-signal reaction time (SSRT) tasks). Correlation analyses showed no associations among the motor, cognitive and affective SOD indexes. Similarly, distinct SOD clusters emerged in the hierarchical clustering dendrogram, indicating clear separations among SODs. However, the results of multidimensional scaling suggested a tendency towards two clusters, as evidenced by the proximity of AIT and VPT indexes in relation to EEB indexes. AIT spatial laterality and Stroop domain-general cognitive control confounded AIT and VPT indexes, albeit slightly differently depending on the analysis method used. SSRT showed neither associations with SODs nor with other domain-general indexes. These findings underscore the complexity of SOD processes and have notable implications for basic and applied research, e.g. in the domain of clinical disorders affected by deficiencies in SOD.

Impact of Skin Pigmentation on Pulse Oximetry Blood Oxygenation and Wearable Pulse Rate Accuracy: Systematic Review and Meta-Analysis.

BACKGROUND: Photoplethysmography (PPG) is a technology routinely used in clinical practice to assess blood oxygenation (SpO2) and pulse rate (PR). Skin pigmentation may influence accuracy, leading to health outcomes disparities. OBJECTIVE: This systematic review and meta-analysis primarily aimed to evaluate the accuracy of PPG-derived SpO2 and PR by skin pigmentation. Secondarily, we aimed to evaluate statistical biases and the clinical relevance of PPG-derived SpO2 and PR according to skin pigmentation. METHODS: We identified 23 pulse oximetry studies (n=59,684; 197,353 paired SpO2-arterial blood observations) and 4 wearable PR studies (n=176; 140,771 paired PPG-electrocardiography observations). We evaluated accuracy according to skin pigmentation group by comparing SpO2 accuracy root-mean-square values to the regulatory threshold of 3% and PR 95% limits of agreement values to +5 or -5 beats per minute (bpm), according to the standards of the American National Standards Institute, Association for the Advancement of Medical Instrumentation, and the International Electrotechnical Commission. We evaluated biases and clinical relevance using mean bias and 95% CI. RESULTS: For SpO2, accuracy root-mean-square values were 3.96%, 4.71%, and 4.15%, and pooled mean biases were 0.70% (95% CI 0.17%-1.22%), 0.27% (95% CI -0.64% to 1.19%), and 1.27% (95% CI 0.58%-1.95%) for light, medium, and dark pigmentation, respectively. For PR, 95% limits of agreement values were from -16.02 to 13.54, from -18.62 to 16.84, and from -33.69 to 32.54, and pooled mean biases were -1.24 (95% CI -5.31 to 2.83) bpm, -0.89 (95% CI -3.70 to 1.93) bpm, and -0.57 (95% CI -9.44 to 8.29) bpm for light, medium, and dark pigmentation, respectively. CONCLUSIONS: SpO2 and PR measurements may be inaccurate across all skin pigmentation groups, breaching U.S. Food and Drug Administration guidance and industry standard thresholds. Pulse oximeters significantly overestimate SpO2 for both light and dark skin pigmentation, but this overestimation may not be clinically relevant. PRs obtained from wearables exhibit no statistically or clinically significant bias based on skin pigmentation.

Physically stressed bees expect less reward in an active choice judgement bias test.

Emotion-like states in animals are commonly assessed using judgment bias tests that measure judgements of ambiguous cues. Some studies have used these tests to argue for emotion-like states in insects. However, most of these results could have other explanations, including changes in motivation and attention. To control for these explanations, we developed a novel judgment bias test, requiring bumblebees to make an active choice indicating their interpretation of ambiguous stimuli. Bumblebees were trained to associate high or low rewards, in two different reward chambers, with distinct colours. We subsequently presented bees with ambiguous colours between the two learnt colours. In response, physically stressed bees were less likely than control bees to enter the reward chamber associated with high reward. Signal detection and drift diffusion models showed that stressed bees were more likely to choose low reward locations in response to ambiguous cues. The signal detection model further showed that the behaviour of stressed bees was explained by a reduction in the estimated probability of high rewards. We thus provide strong evidence for judgement biases in bees and suggest that their stress-induced behaviour is explained by reduced expectation of higher rewards, as expected for a pessimistic judgement bias.

Comparative analysis of codon usage patterns in 16 chloroplast genomes of suborder Halimedineae.

The Halimedineae are marine green macroalgae that play crucial roles as primary producers in various habitats, including coral reefs, rocky shores, embayments, lagoons, and seagrass beds. Several tropical species have calcified thalli, which contribute significantly to the formation of coral reefs. In this study, we investigated the codon usage patterns and the main factors influencing codon usage bias in 16 chloroplast genomes of the suborder Halimedineae. Nucleotide composition analysis revealed that the codons of these species were enriched in A/U bases and preferred to end in A/U bases, and the distribution of GC content followed a trend of GC1 > GC2 > GC3. 30 optimal codons encoding 17 amino acids were identified, and most of the optimal codons and all of the over-expressed codons preferentially ended with A/U. The neutrality plot, effective number of codons (ENc) plot, and parity rule 2 (PR2) plot analysis indicated that natural selection played a major role in shaping codon usage bias of the most Halimedineae species. The genetic relationships based on their RSCU values and chloroplast protein-coding genes showed the closely related species have similar codon usage patterns. This study describes, for the first time, the codon usage patterns and characterization of Halimedineae chloroplast genomes, and provides new insights into the evolution of this suborder.

The I2 Test for Selection Bias Risk Assessment in Single Trials: Recommended Simulated Comparator Trial (SCT) Settings.

Selection bias in clinical trials is a form of systematic error and may be detected using the I² test with a 0/>0% threshold (bias: I² > 0%, no bias: I² = 0%). The test operates on the premise that effective randomisation eliminates in-between study heterogeneity beyond the play of chance in a baseline variable meta-analysis of all the trial's baseline variables. Since the I² statistic was originally designed to measure in-between study heterogeneity in meta-analyses, the test requires the generation of at least two simulated comparator trials (SCTs). During this process, three parameters are set: SCT sample size (NSCT), the minimum-maximum range of random values (RSCT), and the number of generated SCTs to be used (SCTN). Each of these parameters influences the 0/>0% threshold of the resulting I² point estimate, thereby affecting the test's sensitivity in indicating a positive result. The purpose of this technical report is to highlight the effect that SCT parameters have on the test's accuracy and to recommend appropriate parameter settings.

Protocol for a Series of Systematic Reviews and Network Meta-analyses of Randomized Controlled Trials of Medications for Patients with Overactive Bladder Symptoms.

Multiple randomized controlled trials (RCTs) have examined first-line pharmacological agents such as anticholinergics and ß3 agonists for the management of overactive bladder symptoms (OAB). Although earlier systematic reviews and (network) meta-analyses aimed to summarize the evidence, a substantial number of trials were not included, so a comprehensive and methodologically rigorous evaluation of the comparative effectiveness of all first-line pharmacological treatments is lacking. We aim to conduct a series of systematic reviews and network meta-analyses (NMAs) for a comprehensive assessment of the effectiveness and safety of first-line pharmacological treatments for OAB. Eligible studies will include RCTs comparing anticholinergics and ß3 agonists to one another or to placebo in adults with OAB or detrusor overactivity. Pairs of reviewers with methodological training will independently evaluate candidate studies to determine eligibility and extract relevant data. We will incorporate patient-important outcomes, including urinary urgency episodes, urgency incontinence episodes, any type of incontinence episodes, urinary frequency, nocturia, and adverse events. We will conduct the NMAs using a frequentist framework and a graph theory model for each outcome. Analysis will follow rigorous methodologies, including handling of missing data and assessment of the risk of bias. We will conduct sensitivity and subgroup analyses and will apply the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate evidence certainty. Our approach aims to address the knowledge gap in the treatment of OAB by synthesizing evidence from RCTs worldwide. We will employ robust statistical methods, including frequentist NMA, to general clinically relevant and patient-important insights. Sensitivity and subgroup analyses will enhance the robustness and generalizability of our findings. Our reviews strive to inform evidence-based decisions in the management of OAB, to ultimate improve patient outcomes. Our study results may guide health policy decisions, such as reimbursement policies, and future studies in functional urology. The protocol for the review series is registered on PROSPERO as CRD42023266915.

New Insight into the Role of Vitamin D in the Stroke Risk: A Meta-Analysis of Stratified Data by 25(OH)D Levels.

Mendelian Randomization (MR) studies have emerged as a powerful tool for investigating causal relationships between modifiable risk factors and clinical outcomes, using genetic variants as instrumental variables. In the context of vitamin D research, MR is a promising approach to elucidate the effects of vitamin D on various health outcomes, including adverse cardiovascular events. However, the validity of MR analyses relies heavily on the strength of the genetic associations found. "Weak instrument bias", arising from instruments with low explanatory power for the exposure of interest, can lead to biased estimates and compromise causal inference. We have, herein, briefly reviewed the challenges posed by weak instrument bias in a large MR study on vitamin D [25(OH)D] and stroke, exploring implications for the study's validity and reliability of findings. We have then added an original meta-analysis stratified by 25(OH)D levels. By using aggregated data from a recent MR study, an original meta-analysis stratified by population mean levels of 25(OH)D has indicated that interventions based on vitamin D supplementations in population mean levels ranging from 50 to 70 nmol/L are likely to translate into a 13% reduction of stroke risk (pooled odds ratio=0.873, 95% CI: 0.764-0.997, p-value=0.04). MR studies are a valuable approach for discerning causal relationships between exposures, such as vitamin D, and health outcomes. However, the effectiveness of MR analyses depends on the robustness of the genetic instruments employed. By recognizing and addressing weak instrument bias in MR studies of vitamin D, researchers can enhance the credibility and utility of causal inference in understanding the health effects of this essential nutrient. A metaanalysis stratified by population mean levels of 25(OH)D has revealed the potential benefits of targeted interventions with vitamin D supplementations for stroke.

Multiple imputation using auxiliary imputation variables that only predict missingness can increase bias due to data missing not at random.

BACKGROUND: Epidemiological and clinical studies often have missing data, frequently analysed using multiple imputation (MI). In general, MI estimates will be biased if data are missing not at random (MNAR). Bias due to data MNAR can be reduced by including other variables ("auxiliary variables") in imputation models, in addition to those required for the substantive analysis. Common advice is to take an inclusive approach to auxiliary variable selection (i.e. include all variables thought to be predictive of missingness and/or the missing values). There are no clear guidelines about the impact of this strategy when data may be MNAR. METHODS: We explore the impact of including an auxiliary variable predictive of missingness but, in truth, unrelated to the partially observed variable, when data are MNAR. We quantify, algebraically and by simulation, the magnitude of the additional bias of the MI estimator for the exposure coefficient (fitting either a linear or logistic regression model), when the (continuous or binary) partially observed variable is either the analysis outcome or the exposure. Here, "additional bias" refers to the difference in magnitude of the MI estimator when the imputation model includes (i) the auxiliary variable and the other analysis model variables; (ii) just the other analysis model variables, noting that both will be biased due to data MNAR. We illustrate the extent of this additional bias by re-analysing data from a birth cohort study. RESULTS: The additional bias can be relatively large when the outcome is partially observed and missingness is caused by the outcome itself, and even larger if missingness is caused by both the outcome and the exposure (when either the outcome or exposure is partially observed). CONCLUSIONS: When using MI, the naïve and commonly used strategy of including all available auxiliary variables should be avoided. We recommend including the variables most predictive of the partially observed variable as auxiliary variables, where these can be identified through consideration of the plausible casual diagrams and missingness mechanisms, as well as data exploration (noting that associations with the partially observed variable in the complete records may be distorted due to selection bias).

The Body Advocacy Movement-Health: a pilot randomized trial of a novel intervention targeting weight stigma among health professional students.

BACKGROUND: Weight stigma among healthcare professionals is associated with negative health impacts on patients, yet there are few effective strategies to combat weight stigma among health professional learners. The Body Advocacy Movement-Health (BAM-Health) is a novel group-based, peer-led stigma reduction intervention for health professional students that targets weight stigma across intrapersonal, interpersonal, and structural levels. The present study (1) assesses short-term impacts of BAM-Health participation on intrapersonal and interpersonal weight bias compared to an informational brochure control condition and (2) explores the feasibility and acceptability of BAM-Health among a sample of health professional students. METHODS: Sixty-seven health professional students participated in BAM-Health (n = 34) or received an informational brochure about weight stigma (n = 33). Participants completed validated self-report surveys assessing internalized weight/ appearance concerns and interpersonal weight stigma prior to their assigned intervention (baseline), immediately following intervention (post-intervention), and four weeks after intervention (follow-up). Baseline to post-intervention and baseline to follow-up effect sizes on each measure were calculated. At post-intervention, participants completed feedback surveys for thematic assessment. RESULTS: BAM-Health participation had a large baseline to post-intervention effect on internalized weight/ appearance concerns that diminished slightly at follow-up (Cohen's d = -0.88; d = -0.62). Receipt of the informational brochure had a small effect on internalized weight/ appearance concerns (d = -0.27); however, these changes were not sustained at follow-up (d = 0.04). BAM-Health participation resulted in reductions in interpersonal obesity stigma and anti-fatness with small effect sizes (d = -0.32; d = -0.31). The effect on obesity stigma was slightly amplified at follow-up (d = -0.43); however, decreases in anti-fatness were not sustained (d = -0.13). The brochure condition failed to demonstrate effects on anti-fatness (d = 0.13, d = 0.14) or obesity stigma (d = -0.12; d = -0.12) at either time point. Between-session attrition rates of 4.5%, favorable quantitative ratings on post-session acceptability surveys, and free responses demonstrating appreciation of the virtual group environment and session activities reflect feasibility and acceptability of BAM-Health. CONCLUSIONS: BAM-Health is a novel peer-led intervention that aims to reduce weight stigma among health professional students. BAM-Health met feasibility benchmarks and received positive feedback from participants, demonstrating acceptability and indicating interest among health professional students in analyzing and reducing weight stigma in their personal lives and careers. The intervention led to promising decreases in internalized and interpersonal weight stigma at post-intervention, some of which were sustained at follow-up. However, lack of effect on internalized weight/ appearance concerns measures may indicate that BAM-Health participants are more likely to reject weight stigma directed toward others following intervention, while maintaining thin ideals for themselves. Further investigation of BAM-Health with a larger sample and continued program development is warranted.

Weight stigma refers to negative attitudes or harmful behaviors directed toward oneself (internalized weight stigma) or others (interpersonal weight stigma) on the basis of body weight. Structural weight stigma refers to policies or norms that harm people who have higher body weights. Weight stigma in healthcare in particular can contribute to negative physical and emotional health outcomes among patients. To examine strategies to mitigate weight stigma in healthcare, health professional students at a large university in the United States ­ including students in medical, nursing, and physical therapy programs ­ participated in the Body Advocacy Movement-Health (BAM-Health), a program created to decrease weight stigma in this population. Participants completed surveys prior to and after BAM-Health that indicated modest reductions in internalized and interpersonal weight stigma four weeks after completion of the intervention, whereas those in the comparison arm did not demonstrate sustained changes in measures of weight stigma. Furthermore, participants indicated that they enjoyed involvement in BAM-Health and found it useful both personally and professionally. Future research with larger, more diverse sample sizes is necessary to determine whether BAM-Health is effective at reducing weight stigma among health professional students and whether it improves quality of care for patients in larger bodies.

Addressing Information Biases Within Electronic Health Record Data to Improve the Examination of Epidemiologic Associations With Diabetes Prevalence Among Young Adults: Cross-Sectional Study.

Background: Electronic health records (EHRs) are increasingly used for epidemiologic research to advance public health practice. However, key variables are susceptible to missing data or misclassification within EHRs, including demographic information or disease status, which could affect the estimation of disease prevalence or risk factor associations. Objective: In this paper, we applied methods from the literature on missing data and causal inference to assess whether we could mitigate information biases when estimating measures of association between potential risk factors and diabetes among a patient population of New York City young adults. Methods: We estimated the odds ratio (OR) for diabetes by race or ethnicity and asthma status using EHR data from NYU Langone Health. Methods from the missing data and causal inference literature were then applied to assess the ability to control for misclassification of health outcomes in the EHR data. We compared EHR-based associations with associations observed from 2 national health surveys, the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey, representing traditional public health surveillance systems. Results: Observed EHR-based associations between race or ethnicity and diabetes were comparable to health survey-based estimates, but the association between asthma and diabetes was significantly overestimated (OREHR 3.01, 95% CI 2.86-3.18 vs ORBRFSS 1.23, 95% CI 1.09-1.40). Missing data and causal inference methods reduced information biases in these estimates, yielding relative differences from traditional estimates below 50% (ORMissingData 1.79, 95% CI 1.67-1.92 and ORCausal 1.42, 95% CI 1.34-1.51). Conclusions: Findings suggest that without bias adjustment, EHR analyses may yield biased measures of association, driven in part by subgroup differences in health care use. However, applying missing data or causal inference frameworks can help control for and, importantly, characterize residual information biases in these estimates.

Quantitative analysis of construction risks in shallowly buried biased tunnel portal section.

To address the prominent problem of collapse instability in shallow buried soft ground tunnels, a non-invasive stochastic finite element method was introduced. Taking Fujian Puyan Wenbishan tunnel as the background project, ABAQUS finite element software was used to analyze the tunnel excavation mechanics and parameter sensitivity. And developed the software interface program based on Python to output explicit limit state equation for the key mechanical indexes of the tunnel, so as to evaluate the tunnel reliability under different excavation methods, quantitatively. Study results show a significant improvement in efficiency and accuracy when calculating the probability of failure in tunnel excavation by the non-invasive stochastic finite element method. The maximum displacement monitoring points for the Wenbishan tunnel portal section were all vault settlement, with displacements of 33.6 mm, 30.2 mm, and 25.3 mm, respectively, using the annular retained core soil method, single sidewall guide pit and double sidewall guide pit method, with probabilities of failure of 36.11%, 28.03%, and 20.02%. It is found that the reliability of the tunnel is mainly determined by the geotechnical weight, elastic modulus and cohesion of the weak sandy soil layer, which can provide ideas for this type of engineering researches.