Terminal Digits Research Articles

O05 TERMINAL DIGIT PATTERN IN COMMUNITY-BASED HYPERTENSION SCREENING PROGRAMS: 5-YEAR ANALYSIS FROM MAY MEASURE MONTH NEPAL

Background and Objectives: Terminal digit preference leads to misclassification of hypertension. Despite strong promotion of community-based hypertension screening, the extent of terminal digit preference in such programs is not well understood. We aimed to identify the proportion of blood pressure (BP) ending in zero, and factors associated with the most repeated digit. Methods: A cross-sectional study was conducted using data from May Measure Month (MMM) Nepal 2017, 2018, 2020, 2021, and 2022. Participants with available data on the type of BP monitors were included. In MMM Nepal, adults≥18 years of age were eligible and recruited via convenience sampling. Data enumerators are community health workers or college students trained for BP measurement through short trainings. Without bias, the proportion of BP ending in zero is expected to be 10% and 20% for automated and manual monitors, respectively. Results: A total of 48,442 participant were included with 29.2% age≥50 years and 51.8% females. BP appeared to be normally distributed with “spikes” at terminal digits of zero (Figure 1). 90.9% of participants were measured their BP with automated monitors and 8.1% with manual monitors. The proportion of BP ending in zero was about 1.7 and 4.8 times greater than the expected proportion using automated and manual monitors, respectively (automated: 17.0% [SBP], 16.7% [DBP], manual: 95.3% [SBP], 93.8% [DBP]). Logistic regression showed age≥50 (OR 1.13 [95%CI 1.06, 1.20]) and SBP≥140mmHg (1.63 [1.49, 1.78]) were associated with SBP ending in zero, and age≥50 (1.14 [1.08, 1.22]) and DBP≥90 mmHg (2.11 [1.96, 2.28]) were associated with DBP ending in zero, both after controlling for sex, smoking, alcohol use, diabetes, cardiovascular diseases, antihypertensive medicine use, and the type of BP monitors used. Conclusion: The proportion of BP ending in zero was higher than expected with any type of BP monitors used. More studies are needed to investigate whether these distributions were by chance or due to errors.

Age reporting by and for older people in Uganda: relationships with frailty, human capital and population registration

In this article, we investigate the accuracy of age reporting by people aged 60 and older and proxy reporting by their carers in a peri-urban area of Uganda, and analyse the factors that influence reporting by both groups. We find a high level of age heaping on terminal digits 0 and 5, indicating poor knowledge of age. Contrary to other studies, we find that literate people were more likely to exhibit age heaping. We link this to the absence of birth registration for this cohort and the introduction of National Identification (ID) cards in Uganda five years before our survey. We conclude that age heaping is better interpreted as an indicator of registration machinery than of human capital. We also find that the health, functional capabilities and education of older people influenced the age ascribed to them by their carers. Carers who knew the older people less well were more likely to overestimate their age, and carers of healthy and more educated people were more likely to report a younger age than that reported by the older people themselves. Where people don’t know their age, the age they report may also be influenced by their health and capabilities, making it difficult to establish true relationships between chronological age and outcomes such as health. In many disciplines, self-reported age or age reported by proxy respondents is accepted uncritically by researchers, but our study shows that in peri-urban Uganda age reporting remains approximate and biased, and this has strong implications for appropriate targeting and monitoring of interventions to support healthy ageing in such contexts.

Vital sign measurements demonstrate terminal digit bias and boundary effects.

The measurement and recording of vital signs may be impacted by biases, including preferences for even and round numbers. However, other biases, such as variation due to defined numerical boundaries (also known as boundary effects), may be present in vital signs data and have not yet been investigated in a medical setting. We aimed to assess vital signs data for such biases. These parameters are clinically significant as they influence care escalation. Vital signs data (heart rate, respiratory rate, oxygen saturation and systolic blood pressure) were collected from a tertiary hospital electronic medical record over a 2-year period. These data were analysed using polynomial regression with additional terms to assess for underreporting of out-of-range observations and overreporting numbers with terminal digits of 0 (round numbers), 2 (even numbers) and 5. It was found that heart rate, oxygen saturation and systolic blood pressure demonstrated 'boundary effects', with values inside the 'normal' range disproportionately more likely to be recorded. Even number bias was observed in systolic heart rate, respiratory rate and blood pressure. Preference for multiples of 5 was observed for heart rate and blood pressure. Independent overrepresentation of multiples of 10 was demonstrated in heart rate data. Although often considered objective, vital signs data are affected by bias. These biases may impact the care patients receive. Additionally, it may have implications for creating and training machine learning models that utilise vital signs data.

Spatial Patterns of Heaping in Age Data among Literates, Illiterates, and Numeracy-Literacy Correlates: A Cross-Sectional Analysis of Census 2011, of India.

Accurate information on age is an essential prerequisite for demographic and epidemiological studies. This study analyzed the age data quality among the literate and illiterate (combined, rural, urban) population and examined the association between data quality and literacy. Secondary data on age statistics and literacy were obtained from census 2011. We measured age data quality for literates and illiterates (combined, rural, urban) by transforming Whipple's index known as ABCC, abbreviated based on surnames of the developers A'Hearn, Baten, and Crayen (2009). Correlation tests between literacy and ABCC were performed. RStudio (Version 1.3.1073) was used. Computed ABCC indices in majority states (union territories) for literates (data quality rough) were higher than illiterates (data quality very rough). Urban data among literates and rural data among illiterates were comparatively superior. Correlation between ABCC and literacy rates for (i) literate combined (R = 0.84, P = 3.5e-10), (ii) literate rural (R = 0.8, P = 1.1e-08), (iii) literate urban (R = 0.8, P = 1e-08), (iv) illiterate combined (R = 0.54, P = 9e-04), (v) illiterate rural (R = 0.48, P = 0.0034), and (vi) illiterate urban (R = 0.73, P = 6.4e-07) was significant. Age data quality for both literates and illiterates was poor. There was heaping at terminal digits "0" and "5" even among literates, which contradicts the theoretical expectation of quality data among literates. Correlations between data quality and literacy were significant, with comparatively lower magnitude among illiterates, which indicates the role of literacy in yielding quality data. Awareness, training, ADHAAR-based enumeration, and digitization may be suggested for better age data.

Quality of child anthropometric data from SISVAN, Brazil, 2008-2017.

To evaluate the quality of anthropometric data of children recorded in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2017. Descriptive study on the quality of anthropometric data of children under five years of age admitted in primary care services of the Unified Health System, from the individual databases of SISVAN. Data quality was annually assessed using the indicators: coverage, completeness, sex ratio, age distribution, weight and height digit preference, implausible z-score values, standard deviation, and normality of z-scores. In total, 73,745,023 records and 29,852,480 children were identified. Coverage increased from 17.7% in 2008 to 45.4% in 2017. Completeness of birth date, weight, and height corresponded to almost 100% in all years. The sex ratio was balanced and approximately similar to the expected ratio, ranging from 0.8 to 1. The age distribution revealed higher percentages of registrations from the ages of two to four years until mid-2015. A preference for terminal digits "zero" and "five" was identified among weight and height records. The percentages of implausible z-scores exceeded 1% for all anthropometric indices, with values decreasing from 2014 onwards. A high dispersion of z-scores, including standard deviations between 1.2 and 1.6, was identified mainly in the indices including height and in the records of children under two years of age and residents in the North, Northeast, and Midwest regions. The distribution of z-scores was symmetric for all indices and platykurtic for height/age and weight/age. The quality of SISVAN anthropometric data for children under five years of age has improved substantially between 2008 and 2017. Some indicators require attention, particularly for height measurements, whose quality was lower especially among groups more vulnerable to nutritional problems.

A Further Examination of Excesses or Deficits of Terminal Zeroes in Scientific Research: Using Binomial Testing to Assess Probabilities for Different Anomaly Classifications as a Function of Different Sample Sizes of Coefficients with Terminal Digits

A Further Examination of Excesses or Deficits of Terminal Zeroes in Scientific Research: Using Binomial Testing to Assess Probabilities for Different Anomaly Classifications as a Function of Different Sample Sizes of Coefficients with Terminal Digits

Blood pressure measurement and blood pressure control in Veterans Affairs medical centers.

The Veterans Affairs (VA) medical centers provide care for millions of Veterans at high risk of cardiovascular disease and accurate BP measurement in this population is vital for optimal BP control. Few studies have examined terminal digit preference (TDP), a marker of BP measurement bias, clinician perceptions of BP measurement, and BP control in VA medical centers. This mixed methods study examined BP measurements from Veterans aged 18 to 85 years with hypertension and a primary care visit within 8 VA medical centers. TDP for all clinic BP measurements was examined using a goodness of fit test assuming 10% frequency for each digit. Interviews were also conducted with clinicians from 3 VA medical centers to assess perceptions of BP measurement. The mean age of the 98,433 Veterans (93% male) was 68.5 years (SD 12.7). BP was controlled(<140/90mmHg) in 76.5% and control rates ranged from 72.2% to 81.0% across the 8 VA medical centers. Frequency of terminal digits 0 through 9 differed significantly from 10% for both SBP and DBP within each center (P<.001) but level of TDP differed by center. The highest BP control rates were noted in centers with highest TDP for digits 0 and 8 for both SBP and DBP. Clinicians reported use of semi-automated oscillometric devices for clinic BP measurement, but elevated BP readings were often confirmed by auscultatory methods. Significant TDP exists for BP measurement in VA medical centers, which reflects continued use of auscultatory methods.

Evaluation of Age-Sex Data Collected in the 1991, 2001 and 2011 Population and Housing Censuses of Namibia

This paper examined the accuracy of age-sex data reported in the Namibia population censuses with the aim to establish patterns and trends in the quality of age-sex reporting. To date, Namibia has conducted three population and housing censuses. However, it is not clear if there has been any advancement in the quality of data collected on age and sex over the years. The study followed a cross-sectional study design using the 1991, 2001 and 2011 population censuses data from Namibia Statistics Agency. We computed Whipple’s and Myers’s Blended indexes to measure age heaping. The age-sex ratio and UN joint score were used to ascertain the possibility of population undercounts and displacement between age groups. The results show that age heaping was fairly accurate in all three censuses. Analysis of single-age distribution showed a minimal digit preference and avoidance across all three censuses. Likewise, Myers blended index portrayed that terminal digits 0, 1, 2, 5, 8 and 9 were preferred the most by both sexes in all three censuses. The Whipple’s Index showed a two-point decline from 106 in 1991 to 104 in 2001 and 2011 suggesting an improvement in age reporting. The UN joint score for Namibia found that the data collected in all three censuses were inaccurate in terms of age-sex displacement.

Digital Mucous Cyst: An Educational Image and Mini-Review

Background: Digital mucous cyst is a benign painless skin lesion most commonly observed on the dorsum of the terminal digits, and sometimes on the toes. The lesion generally solitary and less than 10 mm in diameter. It can be opalescent or has the color of the skin. Diagnosis of the condition can be established on clinical basis. Patients and methods: A healthy man who was born in 1983 consulted us about a small lump on the dorsum of the left thumb. Images are presented, diagnosis is described, and a brief educational review is presented. Results: The lump was painless and has been noticed more than two years ago. It was cystic in nature and located on the dorsum of the terminal phalanx of the left thumb. It was less than 10 mm in diameter. The diagnosis of digital mucous cyst was made. Conclusion: Although consensus has not been confirmed regarding the treatment of digital mucous cyst, small and asymptomatic lesion needs no further treatment or follow-up.

Association of an Automated Blood Pressure Measurement Quality Improvement Program With Terminal Digit Preference and Recorded Mean Blood Pressure in 11 Clinics

Terminal digit preference has been shown to be associated with inaccurate blood pressure (BP) recording. To evaluate whether converting from manual BP measurement with aneroid sphygmomanometers to automated BP measurement was associated with terminal digit preference, mean levels of recorded BP, and the rate at which hypertension was diagnosed. This quality improvement study was conducted from May 9, 2021, to March 24, 2022, using interrupted time series analysis of medical record data from 11 primary care clinics in a single health care system from April 2008 to April 2015. The study population was patients aged 18 to 75 years who had their BP measured and recorded at least once during the study period. Manual BP measurement before April 2012 vs automated BP measurement with the Omron HEM-907XL monitor from May 2012 to April 2015. The main outcome was the distribution of terminal digits and mean systolic BP (SBP) values obtained during 4 years of manual measurement vs 3 years of automated measurement, assessed using a generalized linear mixed regression model with a random intercept for clinic and adjusted for seasonal fluctuations and patient demographic and clinical characteristics. The study included 1 541 227 BP measurements from 225 504 unique patients during the entire study period, with 849 978 BP measurements from 165 137 patients (mean [SD] age, 47.1 [15.2] years; 58.2% female) during the manual measurement period and 691 249 measurements from 149 080 patients (mean [SD] age, 48.4 [15.3] years; 56.3% female) during the automated measurement period. With manual measurement, 32.8% of SBP terminal digits were 0 (20% was the expected value because nursing staff was instructed to record BP to the nearest even digit). This proportion decreased to 12.4% during the automated measurement period (expected value, 10%) when both even and odd digits were to be recorded. After automated measurement was implemented, the mean SBP estimated with statistical modeling increased by 5.09 mm Hg (95% CI, 4.98-5.19 mm Hg). Fewer BP values recorded during the automated than the manual measurement period were below 140/90 mm Hg (69.9% vs 84.3%; difference, -14.5%; 95% CI, -14.6% to -14.3%) and below 130/80 mm Hg (42.1% vs 60.0%; difference, -17.9%; 95% CI, -18.0% to -17.7%). The proportion of patients with a diagnosis of hypertension was 4.3 percentage points higher (23.4% vs 19.1%) during the automated measurement period. In this quality improvement study, automated BP measurement was associated with decreased terminal digit preference and significantly higher mean BP levels. The method of BP measurement was also associated with the rate at which hypertension was diagnosed. These findings may have implications for pay-for-performance programs, which may create an incentive to record BP levels that meet a particular goal and a disincentive to adopt automated measurement of BP.

Digit preference in Nigerian censuses data of 1991 and 2006

&#x0D; Background: censuses in developing countries are prone to errors of age misreporting due to ignorance, low literacy levels and other social, economic and cultural factors. Ages are commonly rounded with great affinity for 0 or 5. This tendency to digit preference and/or avoidance results in age heaping or concentration of ages at certain digits. This study examined the extent of digit preference in the Nigerian census data of 1991 and 2006.&#x0D; Methods: this study utilized age data from the 1991 and 2006 Nigerian censuses reported in single years. The Whipple and Myers indices were used to determine the extent of digit preference.&#x0D; Results: both the 1991 and 2006 census data showed the expected pattern of errors, with Whipple and Myers indices being beyond acceptable levels. The Whipple index for 1991 and 2006 was 293 and 251 respectively, while the Myers index was 62.3 and 67.1 respectively. There was a strong preference for terminal digits 0 and 5, followed by 8 whereas terminal digits 1 and 9 were strongly avoided.&#x0D; Conclusions: the quality of age data in Nigerian census data is poor as a result of misreporting and no significant improvement or difference was observed between 1991 and 2006 censuses.&#x0D;

Terminal digit preference and the accuracy of breast cancer diameter reporting based on Benford's law

BackgroundBreast cancer is the most frequent cancer in women all over the world, and it is one of the leading causes of cancer-related deaths in women. A pathologist's partiality for the last digit of a patient's name can lead to errors in the measurement of malignancies. This means that, rather than recording the exact measurement of a tumor, a pathologist might round it off to his preferred terminal digit. MethodsIt is a retrospective cross-sectional study in which data on primary tumor resection for 1000 breast cancer patients was obtained from KRL Hospital's patient directory from November 2016 to December 2020. The tumors were measured in cm to one decimal point along their longest dimension. Ki-67 markers were used to categorize the tumors into nine categories. Terminal digit preference was evaluated using Benford's law. ResultsThe recording of the Ki-67 index revealed evidence of pentameric preference. The numbers three, five, and six appeared more frequently in the histogram of the Ki-67 index distribution measured in percentage. The frequency of nine dropped dramatically. However, the influence of tumor size terminal digits on Ki-67 staining scores (low proliferative vs high proliferative) assessed using the Mann–Whitney U Test demonstrated that tumor size terminal digits had no significant effect on Ki-67 staining scores (p = 0.114). ConclusionThe Ki-67 index shows evidence of pentameric preference for digits three, five, and six. The frequency of nine has dropped dramatically. The influence of tumor size on terminal digits on staining scores (low proliferative vs. high proliferative) was assessed using the Mann–Whitney U Test.

Dirichlet, Sierpiński, and Benford

Sixty years ago, Sierpiński observed that for any positive integers A and B, and any g≥2, there are infinitely many primes whose base g-expansion begins with the digits of A and ends with those of B. Sierpiński's short proof rests on the prime number theorem for arithmetic progressions (PNT for APs). We explain how his result can be viewed as a natural intermediary between Dirichlet's theorem on primes in progressions and the PNT for APs. In addition to being of pedagogical interest, this perspective quickly yields a generalization of Sierpiński's result where the initial and terminal digits of p are prescribed in two coprime bases simultaneously; moreover, the proportion (Dirichlet density) of the corresponding primes is determined explicitly. The same quasielementary method shows that the arithmetic functions φ(n), σ(n), and d(n) obey “Benford's law” in a suitable sense.

Energy Cost Of Selected Supine, Sitting, And Standing Sedentary Behaviors In Adults

Sedentary behaviors are persuasive in all societies. According to the 2018 American Time Use Survey, nearly 96% of adults spend 4-5 hours/day in sedentary behaviors that include watching TV, reading, computer use, relaxing and thinking. Since sedentary behaviors increase chronic disease risks, interest is high in knowing the energy costs of sedentary behaviors to help populations to reduce time spent in sedentary behaviors. PURPOSE: To update the energy costs of sedentary behaviors in the 2011 Adult Compendium of Physical Activities. METHODS: Energy cost in ml.kg-1.min-1 and heart rate in b.min-1 were measured by Cosmed K4b2 portable indirect calorimetry system in 10 males and 9 females (20-59y), mean age (31.6 ± 7.5 y), weight (63.4 ± 8.9 kg), and height (167.1 ± 5.8 cm). The subjects completed 17 randomly assigned behaviors in lying, reclining, sitting, and standing positions (doing nothing, watching TV, reading, writing, texting, typing, fidgeting) for 5 min with a 2 min rest between behaviors. Mean ± SD were computed with data presented as mean METs computed as VO2 ml.kg-1.min-1 / 3.5 ml.kg-1.min-1. Terminal digits for MET values were rounded to 0, 3, 5, or 8 to comply with format of the Compendium. RESULTS: Mean MET values are presented by behaviors and postures performed. Doing nothing (lie: 1.3, sit: 1.3. stand: 1.0); Watching TV (lie: 1.3, sit: 1.3); Reading (recline; 1.5, sit: 1.0); Writing (recline: 1.5, sit: 1.3, stand: 1.3); Texting (recline: 1.3, sit: 1.0, stand: 1.0); Fidgeting (sit hands only: 1.5, sit feet only: 1.8, stand hands & feet: 2.0); Typing (stand: 1.3). Of the measured MET values, seven were the same as the Compendium, four were lower (on the order of 0.3 to 0.8 METs), and one was higher by 0.3 METs (Recline: read). Heart rates during the behaviors ranged from 62 to 80 beats.min-1. CONCLUSIONS: The measured mean MET values ranged from 1.0 to 2.0 METs, classified as inactive (1.0-1.49 METs) and light activity (1.5-2.9 METs). Duplication of measured MET values to those in the Compendium confirm the energy cost of common sedentary behaviors. Of the four behaviors with lower measured MET values, three had been estimated in the Compendium (Sit: read, text; Stand text). Four behaviors not in the 2011 Compendium were measured (Recline: write, text; Stand: write, text). Supported by the Shanghai University of Sport

Terminal digit preference: a source of measurement error in breast cancer diameter reporting

Objectives: Women diagnosed with breast cancer are offered treatment and therapy based on tumor characteristics, including tumor diameter. There is scarce knowledge whether tumor diameter is accurately reported, or whether it is unconsciously rounded to the nearest half-centimeter (terminal digit preference). This study aimed to assess the precision (number of digits) of breast cancer tumor diameters and whether they are affected by terminal digit preference. Furthermore, we aimed to assess the agreement between mammographic and histopathologic tumor diameter measurements.Material and Methods: This national registry study included reported mammographic and registered histopathologic tumor diameter information from the Cancer Registry of Norway for invasive breast cancers diagnosed during 2012–2016. Terminal digit preference was assessed using histograms. Agreement between mammographic and histopathologic measurements was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots.Results: Mammographic, histopathologic, or both tumor measurements were available for 7792, 13,541 and 6865 cases, respectively. All mammographic and 97.2% of histopathologic tumor diameters were recorded using whole mm. Terminal digits of zero or five were observed among 38.7% and 34.8% of mammographic and histopathologic measurements, respectively. There was moderate agreement between the two measurement methods (ICC = 0.52, 95% CI: 0.50–0.53). On average, mammographic measurements were 1.26 mm larger (95% limits of agreement: −22.29–24.73) than histopathologic measurements. This difference increased with increasing tumor size.Conclusion: Terminal digit preference was evident among breast cancer tumor diameters in this nationwide study. Further studies are needed to investigate the potential extent of under-staging and under-treatment resulting from this measurement error.

How Great Wars End: Legacies and Lessons: German Studies Association Presidential Address 2018

How Great Wars End: Legacies and LessonsGerman Studies Association Presidential Address 2018 Mary Lindemann (bio) 2018 celebrated the centenary of the armistice that halted hostilities in WWI; it also marked the four-hundredth anniversary of the beginning of the Thirty Years' War. Such commemorative years offer the occasion for historical reflection and these two wars are no exception. There is, however, more reason to discuss the two wars and their aftermaths together, besides this convenient numerical coincidence of terminal digits. By examining the two "Great Wars" in tandem, I want to suggest ways in which scholars of both the modern and early modern worlds can benefit from each other's insights and bridge the divide that putatively separates them. In many ways, of course, the two wars could not have been more different. World War I (at least in Europe) was an industrialized war, of comparatively short duration, fought by national, often conscripted, armies, and pitted the nineteenth-century "isms"—nationalism, liberalism, socialism (and later Bolshevism)—and the great nineteenth-century powers against each other; it was also, for that matter, a world war or even a global conflict.1 The Thirty Years' War was, of course, eponymously long, yet neither a war of nations, nor ideologies, nor global. Thus, putting them in bed with one another may seem like creating a particularly unhappy relationship. These rather striking differences may be, however, as I argue here, not so striking as they first seem, especially when one considers not only the conflicts themselves but also their aftermaths and legacies. Of course, there has long existed a tradition of using the Great War of the seventeenth century to understand and contextualize events in subsequent German history, in ways that move far beyond the interpretation that the war contributed to German backwardness and set it early onto a separate and disastrous path: the Sonderweg. Still, and even if the historical memory of the Thirty Years' War may have become attenuated by the more recent, if not necessarily greater horrors of World War I and World War II,2 that of the Peace of Westphalia has not; in 2018 it became the Liebling (favored theme) of historians, politicians, and political pundits alike (in ways that the Treaty of Versailles certainly has failed to do). Just twenty-four hours after President Trump announced that the United States would pull out of the Iran nuclear [End Page 339] agreement (ironically on V-E Day), the political scientist/historian Herfried Münkler, in an interview with the Frankfurter Rundschau, spoke of the Peace of Westphalia as a "success story" bearing lessons for peacemakers in today's Middle East.3 Münkler is not alone, by any means, in turning to that seventeenth-century European peace for guidance in seeking to solve the problems of today's world.4 At a podium discussion earlier that year, the then Foreign Minister, Frank-Walter Steinmeier, suggested that "the Near East today needs a Westphalian peace," based on the principles of religious freedom, tolerance, and federalism.5 I hardly wish to review the lengthy debates on the Peace of Westphalia or assess its value as a model for solving contemporary problems; I will leave these debates and proposals to political scientists and policy makers and wish them well.6 I remain skeptical, however, that many of the lessons learned from that great peace will allow us to deal more effectively with current dilemmas. George Santayana's striking, and almost invariably misquoted, phrase—"Those who cannot remember the past are condemned to repeat it"7—has encouraged many facile conclusions and, unwittingly, perpetuated much foolishness. I have no desire to add to them by arguing that the history of the Thirty Years' War is a reliable guide through tangled contemporary political quandaries. Even the most subtle attempts to draw relevance from the peace concluded in 1648 will inevitably founder on the hidden sharp rocks of context and contingency. Moreover, the Peace of Westphalia and the much-praised "Westphalian settlement" have not been universally admired. In 1998 (another anniversary year), the then-secretary-general of NATO, Javier Solana, pointed out "the Westphalian system had its limits. … [Its] principle of sovereignly … also produce...

Assessment of Anthropometric Data Following Investments to Ensure Quality: Kenya Demographic Health Surveys Case Study, 2008 to 2009 and 2014.

Evidence-based nutrition programs depend on accurate estimates of malnutrition derived from data collected in population representative surveys. The feasibility of obtaining accurate anthropometric data as part of national, multisectoral surveys has been a debated issue. The study aimed to evaluate changes in anthropometric data quality corresponding to investments by the Kenya Ministry of Health and nutrition sector partners for the 2014 Kenya Demographic Health Survey. Anthropometric data collected during the 2008 to 2009 and 2014 Kenya surveys were reanalyzed to assess standard parameters of quality: standard deviation, skewness, and kurtosis of z-score values for 3 anthropometric indicators (weight for height, height for age, and weight for age), percentage of children with missing measurements and outlier values, digit preference, and heaping of age. A total of 9936 households were selected in 2008 to 2009, and 39 679 households were selected in 2014. Standard deviation of z-scores for all 3 indicators was smaller in 2014 than in 2008 to 2009. Applying original Demographic and Health Survey exclusion criteria, weight for height z-scores were 1.16 in 2014, 10.1% narrower than 2008 to 2009. The percentage of outlying values declined significantly from 2008 to 2009 to 2014 for both height for age and weight for height ( P < .001). Digit preference scores in 2014 improved for both weight ( P = .011) and height ( P < .001) suggesting less rounding of terminal digits. All tests of data quality suggest an improvement in 2014 relative to 2008 to 2009, despite the complexity implied by the larger sample. This improvement corresponds with efforts to enhance training and supervision of anthropometry, suggesting a positive effect of these enhancements.

Pentameric last-digit preference and stage border avoidance in pathology measurement.

Cancer treatment relies on accurate staging, an essential aspect of which is determination of the size of a tumour. Measuring the size of a tumour in daily practice often proves problematic and results in rounding of values to approximate values. It has been shown that size values are most frequently reported with end digits of 0 or 5. We sought to determine whether this observation holds true in our national cancer registry of breast and lung tumours. Data from patients with breast and lung cancer were retrieved from the Netherlands National Cancer Registry and analysed for tumour size. Whereas a preference for terminal digits of 0 or 5 (pentameric preference) was clearly present for lung cancer, critical pentameric values at stage boundaries were avoided in breast cancer. In conclusion, pathologists adopt a practical approach to tumour size measurement by rounding values and avoiding stage border boundary values, thus circumventing potential difficulties in treatment decisions.

Melanoma staging: Varying precision and terminal digit clustering in Breslow thickness data is evident in a population-based study

Errors in Breslow thickness reporting can give misclassification of T category, an important classifier in melanoma staging. We sought to investigate precision (number of digits) and terminal digit clustering in Breslow thickness and potential consequences for T category. All first primary and morphologically verified invasive melanomas in Norway between 2008 and 2015 were included. A smoothing model was fitted to estimate the underlying Breslow thickness distribution without digit clustering. Thickness was reported for 13,057 (97.5%) patients; the median was 1.0mm (range, 0.09-85). It was reported as whole numbers (15.6%), to 1 decimal (78.2%) and 2 decimal places (6.2%)-thin tumors with more precision than thick tumors. Terminal digit clustering was found with marked peaks in the observed frequency distribution for terminal digits 0 and 5, and with drops around these peaks. Terminal digit clustering increased proportions of patients classified with T1 and T4 tumors and decreased proportions classified with T2 and T3. Breslow thickness was not reported in 2.5% of cases. The Norwegian recommendation of measurement to the nearest 0.1mm was not followed. Terminal digit clustering was marked, with consequences for T category. Pathologists, clinicians, and epidemiologists should know that clustering of thickness data around T category cut points can impact melanoma staging with consequent effect on patient management and prognosis.

Statistical analysis of numerical preclinical radiobiological data

Abstract Background Scientific fraud is an increasingly vexing problem. Many current programs for fraud detection focus on image manipulation, while techniques for detection based on anomalous patterns that may be discoverable in the underlying numerical data get much less attention, even though these techniques are often easy to apply. Methods We applied statistical techniques in considering and and comparing data sets from 10 researchers in one laboratory and three outside investigators to determine whether anomalous patterns in data from a research teaching specialist (RTS) were likely to have occurred by chance. Rightmost digits of values in RTS data sets were not, as expected, uniform. Equal pairs of terminal digits occurred at higher than expected frequency (&gt;10%) and an unexpectedly large number of data triples commonly produced in such research included values near their means as an element. We applied standard statistical tests (chi-square goodness of fit, binomial probabilities) to determine the likelihood of the first two anomalous patterns and developed a new statistical model to test the third. Results Application of the three tests to various data sets reported by RTS resulted in repeated rejection of the hypotheses (often at p-levels well below 0.001) that anomalous patterns in those data may have occurred by chance. Similar application to data sets from other investigators was entirely consistent with chance occurrence. Conclusions This analysis emphasizes the importance of access to raw data that form the bases of publications, reports, and grant applications in order to evaluate the correctness of the conclusions and the importance of applying statistical methods to detect anomalous, especially potentially fabricated, numerical results.