Allocation Bias Research Articles

Measuring Total Factor Productivity in General Technical Progress Framework

The classical Solow's total factor productivity accounting assumes that technical progress is Hicks neutral, which is a special situation in the reality of world economy. This paper expands the setting of technical progress into general technical progress framework, which can cover Hicks neutral technical progress, Harrod neutral technical progress, Solow-neutral technical progress, and various factor-biased technical changes. According to the principle of statistical index number, this paper decomposes the output index into a total factor input index and a total factor productivity index, and adopts normalized CES production function with factor-augmenting technical progress to derive the calculation formulas of the total factor input index and the total factor productivity index, and constructs a new economic growth accounting system, and finds the counteraction and compensation mechanism for diminishing marginal returns. If the factor substitution elasticity is 1 or there is no technical progress bias and factor allocation bias, then the new accounting equation degenerates into the classic Solow growth accounting equation. The new accounting system can measure the influence of total factor input and total factor productivity to economic growth, but also can measure the influences of factor input intensity and factor allocation bias in the growth rate of total factor input, and the influences of technical progress intensity and technical progress bias in the growth rate of total factor productivity. Therefore it is more precise and accurate than classical method.

Racial Bias in Risk Allocation and Resource Utilisation: A Contributing Factor to Ethnic Minority Overrepresentation in Missing Person Investigations?

Racial Bias in Risk Allocation and Resource Utilisation: A Contributing Factor to Ethnic Minority Overrepresentation in Missing Person Investigations?

Intracranial voltage profiles from untangled human deep sources reveal multisource composition and source allocation bias.

Intracranial potentials are used as functional biomarkers of neural networks. As potentials spread away from the source populations, they become mixed in the recordings. In humans, interindividual differences in the gyral architecture of the cortex pose an additional challenge, as functional areas vary in location and extent. We used source separation techniques to disentangle mixing potentials obtained by exploratory deep arrays implanted in epileptic patients of either sex to gain access to the number, location, relative contribution and dynamics of co-active sources. The unique spatial profiles of separated generators made it possible to discern dozens of independent cortical areas for each patient, whose stability maintained even during seizure, enabling the follow up of activity for days and across states. Through matching these profiles to MRI, we associated each with limited portions of sulci and gyri, and determined the local or remote origin of the corresponding sources. We also plotted source-specific 3D coverage across arrays. In average, individual recording sites are contributed to by 3-5 local and distant generators from areas up to several centimeters apart. During seizure, 13-85 % of generators were involved, and a few appeared anew. Significant bias in location assignment using raw potentials is revealed, including numerous false positives when determining the site of origin of a seizure. This is not amended by bipolar montage, which introduce additional errors of its own. In this way, source disentangling reveals the multisource nature and far intracranial spread of potentials in humans, while efficiently addressing patient-specific anatomofunctional cortical divergence.Significance Statement Field potentials are used to better localize zones showing normal and pathological activity. However, as potentials spread throughout the brain volume, they mix with others and make their place of origin uncertain, even when recorded intracranially. We used advanced algorithms to disentangle the activity of each these zones by their unique spatial profiles, which allowed us to determine the 3D outline of normal and epileptic areas and follow their activity for days. Dozens of independent sources per patient can be explored and precisely located. The findings show that standard stereoEEG recordings are contributed by 3-5 populations, which after separation will help to plan clinical intervention to break epileptic networks by more accurately marking epileptic foci and avoiding false positives.

The impact of allocation bias on test decisions in clinical trials with multiple endpoints using multiple testing strategies

BackgroundConsidering multiple endpoints in clinical trials provide a more comprehensive understanding of treatment effects and may lead to increased power or reduced sample size, which may be beneficial in rare diseases. Besides the small sample sizes, allocation bias is an issue that affects the validity of these trials. We investigate the impact of allocation bias on testing decisions in clinical trials with multiple endpoints and offer a tool for selecting an appropriate randomization procedure (RP).MethodsWe derive a model for quantifying the effect of allocation bias depending on the RP in the case of two-arm parallel group trials with continuous multiple endpoints. We focus on two approaches to analyze multiple endpoints, either the Šidák procedure to show efficacy in at least one endpoint and the all-or-none procedure to show efficacy in all endpoints.ResultsTo evaluate the impact of allocation bias on the test decision we propose a biasing policy for multiple endpoints. The impact of allocation on the test decision is measured by the family-wise error rate of the Šidák procedure and the type I error rate of the all-or-none procedure. Using the biasing policy we derive formulas to calculate these error rates. In simulations we show that, for the Šidák procedure as well as for the all-or-none procedure, allocation bias leads to inflation of the mean family-wise error and mean type I error, respectively. The strength of this inflation is affected by the choice of the RP.ConclusionAllocation bias should be considered during the design phase of a trial to increase validity. The developed methodology is useful for selecting an appropriate RP for a clinical trial with multiple endpoints to minimize allocation bias effects.

Pituitary apoplexy: a comprehensive analysis of 93 cases across functioning and non-functioning pituitary adenomas from a single-center.

Pituitary apoplexy (PA) is a rare clinical syndrome due to acute/subacute pituitary hemorrhage and/or infarction; data on PA in functioning pituitary adenoma (FPA) is scarce. A retrospective record-review of details of PA in non-functioning (NFPA) and FPA managed at tertiary endocrine center. 93 patients [56 males; 33.3% FPA: 5 acromegaly, 14 prolactinoma, and 12 Cushing's Disease (CD)] diagnosed with PA were included. Median age was 40 years, with younger age of presentation in FPA. Type A (acute) [49.5%] and headache (78.5%) were the commonest presentations, with PA being the initial manifestation in 98.4% of NFPA. Median (range) Pituitary Apoplexy Score (PAS) was 2 (0-8). Median tumor diameter was 2.5cm, with larger tumors in FPA (3.2cm vs. 2.3cm). 29 (46.7%) NFPA-PA and 14 (45.2%) FPA-PA patients [71% prolactinoma, 33% in CD, and none in acromegaly] were conservatively managed. In the NFPA cohort, those managed surgically had significantly higher PAS (4 vs. 1) and larger tumor size (2.6 vs. 1.8cm); however, both arms had comparable recovery of neuro-visual, radiological, and hormonal outcomes. In FPA cohort, CD and acromegaly required definitive treatment, whereas prolactinomas were effectively managed (clinical and biochemical recovery) with oral cabergoline and glucocorticoids. Matching PAS cohorts (to overcome allocation bias for management approach) in macroadenomas (excluding prolactinoma) showed comparable neuro-deficit and hormonal recovery between surgical and conservative approaches. PA in FPA has distinct features and management issues. Carefully selected patients (PAS guided) in NFPA with PA for conservative management have comparable outcomes to surgery.

3D mineral prospectivity modeling at the Axi epithermal gold deposit, NW China by using a feature adaptive fusion strategy

Mineralization distribution is always intricately affected by multiple ore-controlling geological units that play different roles in a mineral system (e.g., driver, trap, and throttle). How to effectively balance and integrate ore-controlling features from various 3D geological models during 3D mineral prospectivity modeling (MPM) is still a challenging task. In this paper, we introduce a novel approach, the feature adaptive fusion convolutional neural networks (CNN), which is designed to learn multiple 3D geological models with ore-controlling functions. The method is validated in the Axi epithermal gold deposit, northwestern China that mineralization distribution is jointly controlled by fault, volcanic phase, and phyllic alteration. The geology units are firstly constructed by explicit-implicit modeling and their ore-controlling features are subsequently described by high-frequency Laplace-Beltrami eigenfunctions and reassembled into multi-channel images as input to CNN. To learn the differences in ore-controlling effects among various geological units, we designed a fully connected layer to achieve adaptive quantification and weighted integration of the ore-controlling features by automatically optimizing weight allocation parameters and bias vectors using the neural network intelligence. Comparison results between the proposed method and other prospectivity methods suggest that the feature adaptive fusion CNN produces more reliable predictions, characterized by: (1) high consistency with known mineralization, (2) the highest AUC value and success rate, and (3) accurate prediction of deep voxels explored by drilling. Therefore, the proposed method effectively integrates the ore-controlling effects of multiple geological units and is suitable for complex scenarios of 3D MPM. Utilizing the prospectivity results generated by our method, we identified five potential mineralization in the Axi gold deposit, laying a robust foundation for future gold exploration.

Mechanical evaluation of human cadaveric lumbar soft tissues suggests possible physiological stress shielding within musculoskeletal soft tissues by the thoracolumbar fascia.

This study investigates the potential for stress shielding within musculoskeletal soft tissues through analysis of stress distributions between lumbar fascial and muscle tissues via mechanical testing. Using a custom apparatus, 51 posterior thoracolumbar fascia (TLF) samples and 18 erector spinae (ES) cadaveric samples underwent tensile testing involving three loading-unloading cycles, followed by loading to 6% strain, to mechanically characterize samples. Parallel tensile testing using 20 pairs of two TLF samples, and seven pairs of TLF and ES samples was then conducted for stress distribution analysis between tissues. P<0.05 was deemed significant. The TLF and ES exhibited an average elastic modulus of 150.9MPa and 0.6MPa, respectively. At 6% strain, parallel testing of the TLF pairs yielded an average tensile stress of 8.4MPa and 1.7MPa (p<0.001) exhibited by the stiffer and less stiff TLF samples, respectively. Similarly, TLF-ES parallel testing resulted in average tensile stresses of 7.1MPa and 0.07MPa of the TLF and ES (p<0.002). Results suggest elevated loading towards stiffer TLF samples relative to less stiff TLF and ES samples. In soft tissues affected by LBP, skewed stress distributions may result in the TLF withstanding the majority of stress, yielding cyclical stress shielding that may contribute to and/or promote LBP. This novel study demonstrates a potential load allocation bias towards the TLF, laying the foundation for stress shielding within lumbar musculoskeletal soft tissues affected by degenerative musculoskeletal conditions.

On-clamp vs off-clamp robot-assisted partial nephrectomy for achieving modified trifecta: inverse probability of treatment weighting analysis from a high-volume tertiary robotic center.

On-clamp partial nephrectomy for the surgical treatment of renal masses poses the risk of ischemia and greater post-operative renal function loss. Conversely, the off-clamp technique might enhance renal function preservation by avoiding any ischemia time. Nevertheless, the debate persists regarding the efficacy of the on- versus off-clamp partial nephrectomy in achieving better surgical, functional, and oncological outcomes. We retrospectively assessed the data from patients undergoing Robot-Assisted Partial Nephrectomy (RAPN) from 2016 and 2023 in a tertiary robotic center. Inverse probability of treatment weighting (IPTW) was used to account for selection bias in treatment allocation. The main objective of the study was assessing the achievement rates of a modified trifecta within the two groups. Multivariable logistic regression analysis (MLRA) was employed to assess the predictors of trifecta achievement. 532 patients were included in the analysis, of whom 74.1% vs. 25.9% underwent on- and off-clamp, respectively. Balancing the two groups for the main predictors of on-clamp surgery, there were no significant differences between on- and off-clamp in terms of estimated blood loss, transfusion rate, intra- and post-operative complications, positive surgical margins, and post-operative mean reduction of eGFR. Finally, no differences were found in the rate of "trifecta" achievement between on-clamp and off-clamp RAPN (24.6% vs. 21%, p = 0.82). At MLRA, off-clamp technique was not a predictor of trifecta achievement compared to the on-clamp technique (off-clamp vs. on-clamp, aOR 1.24, 95% CIs [0.65-2.36], p = 0.58). Our study revealed that clamping technique does not imply clinically relevant differences in reaching trifecta outcomes.

Assessing the Relationship between Political Financing and Policy Bias in B40 Welfare Policies during COVID-19

This conceptual paper delves into the intricate relationship between political financing and policy bias in the implementation of welfare policies for the B40 (Below 40 is the 40% of the total population that earns the lowest tier of household income compared to the first group of T20-Top 20% and second category M40-Middle 40%) cluster in Kuala Lumpur Malaysia amidst the COVID-19 pandemic. The B40 cluster comprises the most economically vulnerable segment of the population residing in public housing (the heavily subsidized government-owned residential areas for underprivileged citizens with certain household income categories). This study aims to unravel how political financing influences the formulation and execution of welfare policies, potentially leading to bias in resource allocation and support provision. Through an exhaustive review of existing scholarly literature and analysis of pertinent case studies, this paper embarks on examining the degree to which political financing impacts the decision-making process concerning welfare policies. The analysis focuses on identifying potential biases in policy formulation that may favor the interests of political entities providing financial backing to policymakers. Furthermore, the study also explores the implications of such biases on the equitable distribution of resources to the B40 cluster during the global COVID-19 crisis. The conceptual framework employed in this paper draws from theories of political economy, corruption, and public policy. By dissecting the extant body of literature, the paper aims to offer a nuanced comprehension of the dynamics between political financing and policy bias in the realm of welfare policies for the B40 cluster. The eventual findings are poised to enrich the theoretical understanding of the influence exerted by political financing on the formulation and execution of welfare policies, particularly during periods of global crisis. By identifying policy biases stemming from political financing, this study aspires to catalyze critical discussions on the imperative of transparent and accountable decision-making processes. Such deliberations are vital to ensuring the fair and effective implementation of welfare policies for the B40 cluster in Kuala Lumpur amidst the COVID-19 pandemic. This paper thus serves as a clarion call for enhanced governance mechanisms and institutional reforms to uphold the principles of fairness, equity, and social justice in welfare policy formulation and implementation. This study contributes to the existing literature by shedding light on the nexus between political financing and policy bias in the context of welfare policies for vulnerable populations. It underscores the importance of addressing systemic flaws in governance and decision-making processes to mitigate the adverse effects of political influence on welfare policy outcomes. Moreover, the findings of this study have practical implications for policymakers, advocacy groups, civil society organizations and other stakeholders involved in shaping welfare policy agendas and advocating for reform initiatives. In conclusion, this paper calls for a concerted effort to promote transparency, accountability, and integrity in the formulation and implementation of welfare policies. By fostering a culture of ethical governance and democratic participation, policymakers can ensure that welfare programs serve the interests of the most vulnerable members of society and contribute to equitable and sustainable development outcomes.

Six-Year Outcomes of Total Arch Replacement vs Debranching With TEVAR for Aortic Arch Pathologies: Meta-Analysis of Kaplan-Meier-Derived Data From Propensity Score-Matched Studies.

Total arch replacement (TAR) and debranching plus thoracic endovascular aortic repair (TEVAR) serve as significant therapeutic options for aortic arch pathologies. It remains unclear whether one of these approaches should be considered preferable. Our study aimed to compare the long-term outcomes of these 2 approaches. We carried out a pooled meta-analysis of time-to-event data extracted from studies published by December 2023. Eligibility criteria included populations with any aortic arch pathology who underwent debranching plus TEVAR or TAR, propensity score-matched (PSM) studies (prospective/retrospective; single-center/multicentric), and the outcomes included follow-up for overall survival/mortality and/or reinterventions. Eleven PSM studies met our eligibility criteria, including a total of 1142 patients (571 matched pairs). We did not observe any statistically significant difference in the risk of all-cause death between the groups (hazard ratio [HR]=1.20, 95% confidence interval [CI]=0.91-1.56, p=0.202), but patients who underwent TAR had a significantly lower risk of late aortic reinterventions compared with patients who underwent debranching plus TEVAR (HR=0.38, 95% CI=0.23-0.64, p<0.001). Our meta-regression analyses for all-cause mortality identified statistically significant coefficients for age (coefficient=-0.047; p=0.012) and type A aortic dissections (coefficient=0.012; p=0.010). Debranching plus TEVAR and TAR demonstrate no statistically significant differences in terms of survival in patients with aortic arch pathologies, but TAR is associated with lower risk of late aortic reinterventions over time. Although older patients may benefit more from debranching plus TEVAR rather than from TAR, patients with dissections may benefit more from TAR. Although the 2 strategies seem to be equally valuable in terms of survival, total aortic arch replacement (when compared with debranching plus TEVAR to treat patients with aortic arch pathologies) is associated with reduction of late aortic reinterventions over time in patients with and without aortic dissections. However, we should consider debranching plus TEVAR in older patients as it is associated with lower risk of death in this population. The novelty of our study lies in the fact that, instead of comparing study-level effect estimates, we analyzed the outcomes with reconstructed time-to-event data. This offered us the opportunity of performing our analyses with a mathematically appropriate model which consider events and time; however, these findings might be under the influence of treatment allocation bias.

Sexual dimorphism and pollination mechanism of Zanthoxylum armatum, a vulnerable medicinally important dioecious tree

Among dioecious species, the differential strategy of resource allocation between male and female plants is depicted in their life-history traits and reproductive features. This is classified as sexual dimorphism. The strategies of resource allocation along with the habitat of these species pose an impact on their pollination mechanism and reproductive success. Zanthoxylum armatum DC (Rutaceae) is a small tree with wide economic and medicinal value. The species is naturally distributed in tropical parts of India and other countries. Due to overexploitation of natural populations in India, the species is rapidly declining. To restore the population of the species in the wild and establish commercial plantations, detailed knowledge of its reproductive biology is essential. Thus, the present study was conducted in natural population of Z. armatum growing in the union territory of Jammu and Kashmir, India. The study revealed sex-biased allocation and sexual dimorphism both in vegetative and reproductive traits. Such traits include more height and higher number of shoots, inflorescences, and flowers in male plants than in female plants. The natural populations of Z. armatum exhibit a male-biased sex ratio, and such biasness appears to be the outcome of resource allocation strategies and other demographic characteristics. Species possibly exhibit presence of ambophilous suite, i.e., a combination of wind and insect pollination in floral features. However, pollen dispersal by wind is up to limited distance, and thus wind may or may not be effective in fruit-set.

Mechanical Thrombectomy in Ischemic Stroke with a Large Infarct Core: A Meta-Analysis of Randomized Controlled Trials.

Background/Objectives: Endovascular treatment (EVT) is recommended for acute ischemic stroke due to large-vessel occlusion (LVO) and an Alberta Stroke Program Early CT Score (ASPECTS) ≥ 6. Randomized controlled trials (RCTs) have recently become available on EVT effects in people with LVO-related large core stroke (ASPECTS 0-5). Here, we provide an updated meta-analysis of the EVT effect on functional neurological status in people with large-core stroke. Methods: The study followed the PRISMA guidelines. PubMed, EMBASE and Cochrane Central were searched for RCTs comparing EVT vs. best medical treatment (BMT) in large-core LVO stroke. The primary outcome was functional independence at 90 days (modified Rankin Scale; mRS 0-2). The secondary outcomes were symptomatic intracranial hemorrhage (sICH), good functional outcome (mRS 0-3) and excellent functional outcome (mRS 0-1). EVT vs. BMT was compared through random effect meta-analysis. Heterogeneity was assessed with the I2 and Q test and risk of bias reported according to the RoB2 tool. Results: Six RCTs were included (n = 1656 patients). All studies had a moderate risk of bias, with blinding bias due to the nature of the intervention, potential allocation bias and incomplete outcome reporting. Functional independence was significantly more frequent in the EVT vs. BMT group (OR = 2.47, 95% CI = 1.52-4.03, p < 0.001). sICH rates (OR = 1.77, 95% CI = 1.01-3.11, p = 0.04) and good functional outcome (OR = 2.20; 95% CI = 1.72-2.81, p < 0.001) were more frequent in the EVT vs. BMT group, while the rates of mRS 0-1 did not differ. Conclusions: In patients with large-core stroke and LVO, EVT plus BMT as compared to BMT alone carries a significant increase in independent ambulation and good functional outcome at 3 months despite the marginal increase in sICH.

Outcomes of complete removal versus conservative therapy in cardiac implantable electronic device infections – A systematic review and Meta-analysis

BackgroundComplete removal of cardiac implantable electronic devices (CIEDs) is recommended in patients with CIED infections, including both systemic and localized pocket infection. The aim of the study was to provide an up-to-date and comprehensive assessment of evidence relating to the effect of complete CIED extraction in patients with a CIED infection. MethodsWe performed a systematic review and meta-analysis of studies reporting short- and mid-term outcomes in patients who had a device infection or infective endocarditis (IE) and underwent complete removal of the cardiac device (generator and leads) compared to those who received conservative therapy (no removal, partial removal, local antibiotic infiltration or isolated antibiotic therapy). The primary outcome was reinfection/relapse. Secondary outcomes were short-term (30-day/in-hospital) and mid-term (mean follow-up: 43.0 months) mortality. Random effects model was performed. ResultsThirty-two studies met the criteria for inclusion in the final analysis. Patients with complete CIED extraction (n = 905) exhibited a lower rate of relapse/re-infection compared to patients (n = 195) with a conservative treatment approach (n = 195, OR 0.02, 95%CI 0.01–0.06, p < 0.0001, mean-follow-up: 16.1 months). Additionally, these patients displayed a lower short- (OR 0.40, 95%CI 0.23–0.69, p = 0.01) and mid-term (OR 0.52, 95%CI 0.34–0.78, p = 0.002) mortality. ConclusionsThe analysis indicates that patients with a CIED infection who undergo complete CIED extraction exhibit a lower rate of relapse/re-infection. Additionally, a lower short- and mid-term mortality is observed, although it is acknowledged that this outcome may be influenced by treatment allocation bias.

Final assessment of the COVID-19 pandemic impact between the different social and economic strata population of the city of Buenos Aires

BackgroundDuring the pandemic, epidemiological communications reported an estimation of excess deaths. However, the final calculation requires a detailed analysis. The study aim was to ascertain the number and distribution of COVID-19 fatalities among various socio-economic strata in a large, moderate to low-income city. Study designObservational time series analysis in a large city, treated as a natural experiment. MethodsAnalysis of death certificates, demographic data, and health system records of positive RT-PCR COVID-19 tests from 2015 to 2021, categorizing by age, sex, and place of residence. The study measured the pandemic's impact on mortality, including COVID and non-COVID deaths, using corrected Poisson regression models for different demographics and assessing socio-economic status impact via ecological community-level analysis. ResultsCompared to the pre-pandemic period (2015–2019, IRR = 1.00), the sex- and age-adjusted rate of all-cause death increased significantly during the pandemic (2020–2021) IRR = 1.109 [1.054–1.167], p < 0.0001. This was observed in both males (IRR = 1.158 [1.1–1.219], p < 0.0001) and females (IRR = 1.068 [1.016–1.124], p = 0.01). There was no observed effect of the pandemic on the historical trend in the progressive reduction of mortality in people under 35 years of age. The increase in deaths was at the expense of COVID (+11,175 deaths) and cardiovascular causes (IRR = 1.114 [1.020–1.217] p = 0.017). During the pandemic, there was a significant increase in deaths at home (IRR = 1.219 [1197–1.242], p < 0.0001), especially in people dying of cardiovascular causes (IRR = 1.391 [1.360–1.422], p < 0.0001). The increase in the adjusted mortality rate during the pandemic was socially conditioned. ConclusionsThe pandemic not only led to increased COVID-19 mortality but also heightened fatalities from non-COVID causes, reflecting a potential bias in healthcare resource allocation towards SARS-CoV-2 at the expense of chronic pathologies care.

Skull Density Ratio as Arm-Allocation Parameter for a Controlled Focused Ultrasound Trial in Parkinson's Disease.

MR-guided focused ultrasound (FUS) thermoablation is an established therapy for movement disorders. FUS candidates must meet a predefined threshold of skull density ratio (SDR), a parameter that accounts for the efficiency in reaching ablative temperatures. Randomized sham-controlled trials to provide definitive therapeutic evidence employ pure randomization of subjects into active treatment or control arms. The latter design has several general limitations. To demonstrate that SDR values are not associated with clinically and demographically relevant variables in patients with Parkinson's disease (PD). This in turn would allow using SDR as an arm-allocation parameter, separating patients who will receive active FUS treatment and best medical management treatment (BMT). We studied a cohort of 215 PD patients who were candidates for FUS subthalamotomy to determine if the SDR was correlated with demographic or clinical variables that could introduce bias for group allocation in a controlled trial. SDR was unassociated with age, gender, and clinical motor features nor with levodopa daily dose in our cohort of PD patients. A negative association with age was found for the female subgroup. Our results show that in a PD population considered for FUS subthalamotomy treatment, the SDR may be a valid group-allocation parameter. This could be considered as the basis for a controlled study comparing FUS subthalamotomy vs BMT.

Bias in team decision-making for advanced heart failure therapies: model application

ABSTRACT Bias in advanced heart failure therapy allocation results in inequitable outcomes for minoritized populations. The purpose of this study was to examine how bias is introduced during group decision-making with an interprofessional team using Breathett’s Model of Heart Failure Decision-Making. This was a secondary qualitative descriptive analysis from a study focused on bias in advanced heart failure therapy allocation. Team meetings were recorded and transcribed from four heart failure centers. Breathett’s Model was applied both deductively and inductively to transcripts (n = 12). Bias was identified during discussions about patient characteristics, clinical fragility, and prior clinical decision-making. Some patients were labeled as “good citizens” or as adherent/non-adherent while others benefited from strong advocacy from interprofessional team members. Social determinants of health also impacted therapy allocation. Interprofessional collaboration with advanced heart failure therapy allocation may be enhanced with the inclusion of patient advocates and limit of clinical decision-making using subjective data.

Reduced risk of CIN2+ recurrence in women immunized with a 9-valent HPV vaccine post-excision: Retrospective cohort study

ABSTRACT The main aim of our study was to investigate the specific contribution of a 9-valent human papillomavirus vaccine (9vHPV) to the recurrence risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in women vaccinated post-excision. Therefore, we conducted a retrospective monocentric cohort study in women aged 22–49 years undergoing conization between 2014 and 2023. The 9vHPV-vaccinated women were matched to unvaccinated women for age and follow-up duration in a 1:2 ratio to eliminate allocation bias. The risk of CIN2+ recurrence was estimated by the incidence rate ratio using Poisson regression with adjustment for comorbidities, smoking status, nulliparity, CIN grade, positive cone margin, and HPV genotypes. The CIN2+ recurrence rates in 147 women enrolled in the analysis were 18 and 2 cases per 100,000 person-days for unvaccinated and vaccinated women, respectively, during a mean follow-up period of 30 months (±22 months). A reduction in CIN2+ recurrences by 90% (95% confidence interval: 12–99%) was documented in 9vHPV-vaccinated participants compared to women undergoing only surgical excision. Moreover, vaccinated women with a positive cone margin showed a 42% (though non-significant) reduction in relapse (p = .661). Full post-conization vaccination with the 9vHPV contributed to an additional reduction in the risk of CIN2+ recurrence. This finding is consistent with current knowledge and suggests a high adjuvant effect of the 9vHPV vaccine.

Limited evidence of biased offspring sex allocation in a cavity-nesting conspecific brood parasite.

Sex allocation theory predicts that mothers should bias investment in offspring toward the sex that yields higher fitness returns; one such bias may be a skewed offspring sex ratio. Sex allocation is well-studied in birds with cooperative breeding systems, with theory on local resource enhancement and production of helpers at the nest, but little theoretical or empirical work has focused on birds with brood parasitic breeding systems. Wood ducks (Aix sponsa) are a conspecific brood parasite, and rates of parasitism appear to increase with density. Because female wood ducks show high natal philopatry and nest sites are often limiting, local resource competition (LRC) theory predicts that females should overproduce male offspring-the dispersing sex-when competition (density) is high. However, the unique features of conspecific brood parasitism generate alternative predictions from other sex allocation theory, which we develop and test here. We experimentally manipulated nesting density of female wood ducks in 4 populations from 2013 to 2016, and analyzed the resulting sex allocation of >2000 ducklings. In contrast to predictions we did not find overproduction of male offspring by females in high-density populations, females in better condition, or parasitic females; modest support for LRC was found in overproduction of only female parasitic offspring with higher nest box availability. The lack of evidence for sex ratio biases, as expected for LRC and some aspects of brood parasitism, could reflect conflicting selection pressures from nest competition and brood parasitism, or that mechanisms of adaptive sex ratio bias are not possible.

Exploring the Impact of Son Preference on the Well-being of Daughters in Tanzania: A Multifaceted Analysis

In Tanzania, entrenched cultural norms favoring male offspring significantly influence family dynamics and pose considerable challenges to the well-being of daughters. This phenomenon, known as son preference, manifests in biased resource allocation, limited educational opportunities, and distinct healthcare differentials. This study delves into the multifaceted consequences of son preference on Tanzanian daughters, particularly in the Arusha Region. The cultural roots of son preference in Tanzania can be traced to historical and societal norms, where male heirs are traditionally viewed as primary caretakers and providers for aging parents. This mindset leads to biased resource allocation, impacting daughters' access to essential resources such as education, healthcare, and nutrition. Educational disparities are particularly pronounced, limiting girls' prospects and perpetuating gender-based inequalities in the workforce. The study employs a mixed-method approach, combining qualitative and quantitative data collection and analysis. It adopts a descriptive survey design, conducted in all seven district councils of Arusha Region. Both probability and non-probability sampling techniques are applied to select respondents, encompassing young women, girls, and stakeholders from various organizations. Results indicate a prevalent acknowledgment of son preference, particularly in pastoralist and agro-pastoralist communities. The study reveals how son preference affects education, health, and economic opportunities for daughters. Educational disparities, early marriage, unequal access to health care, and limited economic prospects are identified consequences. To address these challenges, the study emphasizes the need for a comprehensive approach involving changes in societal attitudes, policies promoting gender equality, and initiatives to empower girls. By challenging ingrained cultural norms, fostering educational opportunities, and ensuring equal access to healthcare, Tanzania can work towards dismantling barriers hindering the potential of its daughters. The study contributes to the discourse on gender equality, advocating for interventions that ensure the holistic development and flourishing of Tanzanian daughters.

Continuous Gesture Control of a Robot Arm: Performance Is Robust to a Variety of Hand-to-Robot Maps.

Despite advances in human-machine-interface design, we lack the ability to give people precise and fast control over high degree of freedom (DOF) systems, like robotic limbs. Attempts to improve control often focus on the static map that links user input to device commands; hypothesizing that the user's skill acquisition can be improved by finding an intuitive map. Here we investigate what map features affect skill acquisition. Each of our 36 participants used one of three maps that translated their 19-dimensional finger movement into the 5 robot joints and used the robot to pick up and move objects. The maps were each constructed to maximize a different control principle to reveal what features are most critical for user performance. 1) Principal Components Analysis to maximize the linear capture of finger variance, 2) our novel Egalitarian Principal Components Analysis to maximize the equality of variance captured by each component and 3) a Nonlinear Autoencoder to achieve both high variance capture and less biased variance allocation across latent dimensions Results: Despite large differences in the mapping structures there were no significant differences in group performance. Participants' natural aptitude had a far greater effect on performance than the map. Robot-user interfaces are becoming increasingly common and require new designs to make them easier to operate. Here we show that optimizing the map may not be the appropriate target to improve operator skill. Therefore, further efforts should focus on other aspects of the robot-user-interface such as feedback or learning environment.