Alternative causal inference methods in population health research: Evaluating tradeoffs and triangulating evidence.

Population health researchers from different fields often address similar substantive questions but rely on different study designs, reflecting their home disciplines. This is especially true in studies involving causal inference, for which semantic and substantive differences inhibit interdisciplinary dialogue and collaboration. In this paper, we group nonrandomized study designs into two categories: those that use confounder-control (such as regression adjustment or propensity score matching) and those that rely on an instrument (such as instrumental variables, regression discontinuity, or differences-in-differences approaches). Using the Shadish, Cook, and Campbell framework for evaluating threats to validity, we contrast the assumptions, strengths, and limitations of these two approaches and illustrate differences with examples from the literature on education and health. Across disciplines, all methods to test a hypothesized causal relationship involve unverifiable assumptions, and rarely is there clear justification for exclusive reliance on one method. Each method entails trade-offs between statistical power, internal validity, measurement quality, and generalizability. The choice between confounder-control and instrument-based methods should be guided by these tradeoffs and consideration of the most important limitations of previous work in the area. Our goals are to foster common understanding of the methods available for causal inference in population health research and the tradeoffs between them; to encourage researchers to objectively evaluate what can be learned from methods outside one's home discipline; and to facilitate the selection of methods that best answer the investigator's scientific questions

The Use of Complementary and Alternative Medicine Supplements of Potential Concern during Breast Cancer Chemotherapy

Objective. While many Complementary and Alternative Medicines (CAM) are unlikely to interact negatively with conventional oncology treatment, some ingestible CAM substances have biological activities that may reduce the effectiveness of chemotherapy or radiation. This study surveyed women with breast cancer in order to document the extent to which women with breast cancer use these CAM substances of concern concurrently with conventional treatments. Methods. A total of 398 women completed a survey describing their use of CAM at various time points in their cancer treatment. This report focuses on a subsample of 250 women receiving chemotherapy or radiation who reported using specific one or more of several chemotherapies. Results. Of those participating, 104 (43.7%) of those receiving chemotherapy (n=238) and 45 (32.3%) of those receiving radiation (139; 58.4% of all patients) reported using one or more CAM substances that could be cause for concern when taken concurrently. Conclusion. Research is needed to understand the real risks associated with CAM and conventional polypharmacy. If risks associated with CAM conventional polypharmacy use prove to be substantial then improved systems to assure all women get advice regarding herb and supplement use during breast cancer treatment appear to be needed

The effect of interior heat flux on the atmospheric circulation of hot and ultra-hot Jupiters

Many hot and ultra-hot Jupiters have inflated radii, implying that their interiors retain significant entropy from formation. These hot interiors lead to an enhanced internal heat flux that impinges upon the atmosphere from below. In this work, we study the effect of this hot interior on the atmospheric circulation and thermal structure of hot and ultra-hot Jupiters. To do so, we incorporate the population-level predictions from evolutionary models of hot and ultra-hot Jupiters as input for a suite of General Circulation Models (GCMs) of their atmospheric circulation with varying semi-major axis and surface gravity. We conduct simulations with and without a hot interior, and find that there are significant local differences in temperature of up to hundreds of Kelvin and in wind speeds of hundreds of m s$^{-1}$ or more across the observable atmosphere. These differences persist throughout the parameter regime studied, and are dependent on surface gravity through the impact on photosphere pressure. These results imply that the internal evolution and atmospheric thermal structure and dynamics of hot and ultra-hot Jupiters are coupled. As a result, a joint approach including both evolutionary models and GCMs may be required to make robust predictions for the atmospheric circulation of hot and ultra-hot Jupiters.Comment: Accepted at ApJL, 17 pages, 8 figure

Powering population health research: Considerations for plausible and actionable effect sizes

Evidence for Action (E4A), a signature program of the Robert Wood Johnson Foundation, funds investigator-initiated research on the impacts of social programs and policies on population health and health inequities. Across thousands of letters of intent and full proposals E4A has received since 2015, one of the most common methodological challenges faced by applicants is selecting realistic effect sizes to inform power and sample size calculations. E4A prioritizes health studies that are both (1) adequately powered to detect effect sizes that may reasonably be expected for the given intervention and (2) likely to achieve intervention effects sizes that, if demonstrated, correspond to actionable evidence for population health stakeholders. However, little guidance exists to inform the selection of effect sizes for population health research proposals. We draw on examples of five rigorously evaluated population health interventions. These examples illustrate considerations for selecting realistic and actionable effect sizes as inputs to power and sample size calculations for research proposals to study population health interventions. We show that plausible effects sizes for population health inteventions may be smaller than commonly cited guidelines suggest. Effect sizes achieved with population health interventions depend on the characteristics of the intervention, the target population, and the outcomes studied. Population health impact depends on the proportion of the population receiving the intervention. When adequately powered, even studies of interventions with small effect sizes can offer valuable evidence to inform population health if such interventions can be implemented broadly. Demonstrating the effectiveness of such interventions, however, requires large sample sizes.Comment: 24 pages, 1 figur

Building the evidence on Making Health a Shared Value: Insights and considerations for research.

The Robert Wood Johnson Foundation (RWJF)'s Culture of Health Action Framework guides a movement to improve health and advance health equity across the nation. Action Area One of the Framework, Making Health a Shared Value, highlights the role of individual and community factors in achieving a societal commitment to health and health equity, centered around three drivers: Mindset and Expectations, Sense of Community, and Civic Engagement. To stimulate research about how Action Area One and its drivers may impact health, Evidence for Action (E4A), a signature research funding program of RWJF, developed and released a national Call for Proposals (CFP). The process of formulating the CFP and reviewing proposals surfaced important challenges for research on creating and sustaining shared values to foster and maintain a Culture of Health. In this essay, we describe these considerations and provide examples from funded projects regarding how challenges can be addressed

Intelligence quotient–adjusted memory impairment is associated with abnormal single photon emission computed tomography perfusion

Cognitive reserve among highly intelligent older individuals makes detection of early Alzheimer's disease (AD) difficult. We tested the hypothesis that mild memory impairment determined by IQ-adjusted norms is associated with single photon emission computed tomography (SPECT) perfusion abnormality at baseline and predictive of future decline. Twenty-three subjects with a Clinical Dementia Rating (CDR) score of 0, were reclassified after scores were adjusted for IQ into two groups, 10 as having mild memory impairments for ability (IQ-MI) and 13 as memory-normal (IQ-MN). Subjects underwent cognitive and functional assessments at baseline and annual follow-up for 3 years. Perfusion SPECT was acquired at baseline. At follow-up, the IQ-MI subjects demonstrated decline in memory, visuospatial processing, and phonemic fluency, and 6 of 10 had progressed to a CDR of 0.5, while the IQ-MN subjects did not show decline. The IQ-MI group had significantly lower perfusion than the IQ-MN group in parietal/precuneus, temporal, and opercular frontal regions. In contrast, higher perfusion was observed in IQ-MI compared with IQ-MN in the left medial frontal and rostral anterior cingulate regions. IQ-adjusted memory impairment in individuals with high cognitive reserve is associated with baseline SPECT abnormality in a pattern consistent with prodromal AD and predicts subsequent cognitive and functional decline

Spitzer phase curve observations and circulation models of the inflated ultra-hot Jupiter WASP-76b

The large radii of many hot Jupiters can only be matched by models that have hot interior adiabats, and recent theoretical work has shown that the interior evolution of hot Jupiters has a significant impact on their atmospheric structure. Due to its inflated radius, low gravity, and ultra-hot equilibrium temperature, WASP-76b is an ideal case study for the impact of internal evolution on observable properties. Hot interiors should most strongly affect the non-irradiated side of the planet, and thus full phase curve observations are critical to ascertain the effect of the interior on the atmospheres of hot Jupiters. In this work, we present the first Spitzer phase curve observations of WASP-76b. We find that WASP-76b has an ultra-hot day side and relatively cold nightside with brightness temperatures of $2471 \pm 27~\mathrm{K}$/$1518 \pm 61~\mathrm{K}$ at 3.6~\micron and $2699 \pm 32~\mathrm{K}$/$1259 \pm 44~\mathrm{K}$ at 4.5~\micron, respectively. These results provide evidence for a dayside thermal inversion. Both channels exhibit small phase offsets of $0.68 \pm 0.48^{\circ}$ at 3.6~\micron and $0.67 \pm 0.2^{\circ}$ at $4.5~\mu\mathrm{m}$. We compare our observations to a suite of general circulation models that consider two end-members of interior temperature along with a broad range of frictional drag strengths. Strong frictional drag is necessary to match the small phase offsets and cold nightside temperatures observed. From our suite of cloud-free GCMs, we find that only cases with a cold interior can reproduce the cold nightsides and large phase curve amplitude at 4.5~\micron, hinting that the hot interior adiabat of WASP-76b does not significantly impact its atmospheric dynamics or that clouds blanket its nightside.Comment: 24 pages, 10 Figures, 5 Tables. Accepted to AJ. Co-First Author

Characterizing college science instruction: The Three-Dimensional Learning Observation Protocol

The importance of improving STEM education is of perennial interest, and to this end, the education community needs ways to characterize transformation efforts. Three-dimensional learning (3DL) is one such approach to transformation, in which core ideas of the discipline, scientific practices, and crosscutting concepts are combined to support student development of disciplinary expertise. We have previously reported on an approach to the characterization of assessments, the Three-Dimensional Learning Assessment Protocol (3D-LAP), that can be used to identify whether assessments have the potential to engage students in 3DL. Here we present the development of a companion, the Three-Dimensional Learning Observation Protocol (3D-LOP), an observation protocol that can reliably distinguish between instruction that has potential for engagement with 3DL and instruction that does not. The 3D-LOP goes beyond other observation protocols, because it is intended not only to characterize the pedagogical approaches being used in the instructional environment, but also to identify whether students are being asked to engage with scientific practices, core ideas, and crosscutting concepts. We demonstrate herein that the 3D-LOP can be used reliably to code for the presence of 3DL; further, we present data that show the utility of the 3D-LOP in differentiating between instruction that has the potential to promote 3DL from instruction that does not. Our team plans to continue using this protocol to evaluate outcomes of instructional transformation projects. We also propose that the 3D-LOP can be used to support practitioners in developing curricular materials and selecting instructional strategies to promote engagement in three-dimensional instruction