The `Why' behind including `Y' in your imputation model

Missing data is a common challenge when analyzing epidemiological data, and imputation is often used to address this issue. Here, we investigate the scenario where a covariate used in an analysis has missingness and will be imputed. There are recommendations to include the outcome from the analysis model in the imputation model for missing covariates, but it is not necessarily clear if this recommmendation always holds and why this is sometimes true. We examine deterministic imputation (i.e., single imputation where the imputed values are treated as fixed) and stochastic imputation (i.e., single imputation with a random value or multiple imputation) methods and their implications for estimating the relationship between the imputed covariate and the outcome. We mathematically demonstrate that including the outcome variable in imputation models is not just a recommendation but a requirement to achieve unbiased results when using stochastic imputation methods. Moreover, we dispel common misconceptions about deterministic imputation models and demonstrate why the outcome should not be included in these models. This paper aims to bridge the gap between imputation in theory and in practice, providing mathematical derivations to explain common statistical recommendations. We offer a better understanding of the considerations involved in imputing missing covariates and emphasize when it is necessary to include the outcome variable in the imputation model

Using Small-Area Analysis to Estimate County-Level Racial Disparities in Obesity Demonstrating the Necessity of Targeted Interventions

Data on the national and state levels is often used to inform policy decisions and strategies designed to reduce racial disparities in obesity. Obesity-related health outcomes are realized on the individual level, and policies based on state and national-level data may be inappropriate due to the variations in health outcomes within and between states. To examine county-level variation of obesity within states, we use a small-area analysis technique to fill the void for county-level obesity data by race. Five years of Behavioral Risk Factor Surveillance System data are used to estimate the prevalence of obesity by county, both overall and race-stratified. A modified weighting system is used based on demographics at the county level using 2010 census data. We fit a multilevel reweighted regression model to obtain county-level prevalence estimates by race. We compare the distribution of prevalence estimates of non-Hispanic Blacks to non-Hispanic Whites. For 25 of the 26 states included in our analysis there is a statistically significant difference between within-state county-level average obesity prevalence rates for non-Hispanic Whites and non-Hispanic Blacks. This study provides information needed to target disparities interventions and resources to the local areas with greatest need; it also identifies the necessity of doing so

The Mechanism Underlying the Hypotensive Effect of Isometric Handgrip Training: Is it Cardiac Output Mediated?

Isometric handgrip (IHG) training lowers blood pressure (BP) in normotensive individuals yet the mechanisms remain equivocal, and some evidence suggests that men and women respond differently to training. To date, non-sex specific mechanisms influencing total peripheral resistance, either in response to a single IHG bout or with training, have been a primary research focus, and the effects of acute and chronic IHG on cardiac output (Q) in either sex are under-explored. The purpose of the current study was two-fold: 1) to investigate the effects of IHG training (4, 2-minute sustained bilateral isometric contractions at 30% of maximal contraction, 1-minute rest between, 3X/week for 10 weeks) on resting Q, and 2) to examine the Q response to an IHG bout, and the effects of training on this response. Resting BP (Dinamap Carescape v100, Critikon) was measured after 10 minutes of seated rest in twenty-two normotensive participants (10 women; mean age= 24 ± 5.0 years). To assess Q, aortic root diameter (ARD; 3S-RS probe; Vivid I, GE Healthcare), velocity-timed integral (VTI; P2D probe; Vivid I), and HR (Dinamap) were measured pre- and post- an IHG bout. Both variables were re-assessed post-training. Reductions in resting systolic BP of a similar magnitude (p>0.05) were observed in both men (2.4 ± 6.2 mmHg) and women (2.9 ± 4.6 mmHg) following 10 weeks of training (p=0.04). This was accompanied by reductions in resting Q (p=0.007) in both men (6.6 ± 2.2 to 6.3 ± 1.8 L/min) and women (5.8 ± 0.7 to 5.1 ± 0.8 L/min) and reductions in HR (p=0.036), both of which were similar between sexes (all p>0.05). In both groups, no changes in Q were observed in response to an IHG bout, and this response was similar pre- and post- training (all p>0.05). In conclusion, resting Q is reduced with training, potentially implicating it as a mechanism of post-training BP reductions. The acute response to an IHG bout remains unchanged with training

The predictive power of depression screening procedures for veterans with coronary artery disease

Depression leads to a worse outcome for patients with coronary artery disease (CAD). Thus, accurately identifying depression in CAD patients is imperative. In many veterans affairs (VA) hospitals, patients are screened for depression once a year using the patient health questionnaire (PHQ-9). Although the PHQ-9 is generally considered a specific and sensitive measure of depression, there is reason to believe that these screening procedures may miss a large number of cases of depression within CAD patients and cardiology patients more generally. The goal of this study was to provide data as to the predictive power of this depression screening procedure by (a) comparing the prevalence rate of depression identified by the PHQ-9 to known prevalence rates and (b) examining whether patients identified as “depressed” also had conditions that consistently co-occur with depression (eg, post-traumatic stress disorder [PTSD], other medical issues). Participants were 813 consecutive patients who received an angiogram in the cardiac catheterization laboratory at a large VA Medical Center. Prevalence of depression was 6.9% in the overall sample and less than 6% when the sample was restricted to CAD patients with significant stenosis. Depression was significantly associated with PTSD, smoking, and alcohol problems. However, depression was not associated with other medical problems such as diabetes, renal failure, peripheral vascular disease, or anemia. In conclusion, the low prevalence rate of depression and lack of associations with comorbid medical problems may suggest that the VA’s depression screening procedures have low sensitivity for identifying depression in CAD patients. It is recommended that clinicians treating CAD regularly screen for depression and do not rely on archival depression screens

Effects of word predictability on eye movements during Arabic reading

Contextual predictability influences both the probability and duration of eye fixations on words when reading Latinate alphabetic scripts like English and German. However, it is unknown whether word predictability influences eye movements in reading similarly for Semitic languages like Arabic, which are alphabetic languages with very different visual and linguistic characteristics. Such knowledge is nevertheless important for establishing the generality of mechanisms of eye-movement control across different alphabetic writing systems. Accordingly, we investigated word predictability effects in Arabic in two eye-movement experiments. Both produced shorter fixation times for words with high compared to low predictability, consistent with previous findings. Predictability did not influence skipping probabilities for (four- to eight-letter) words of varying length and morphological complexity (Experiment 1). However, it did for short (three- to four-letter) words with simpler structures (Experiment 2). We suggest that word-skipping is reduced, and affected less by contextual predictability, in Arabic compared to Latinate alphabetic reading, because of specific orthographic and morphological characteristics of the Arabic script

Using Bilateral and Unilateral Exercise to Better Understand the Blood Pressure Lowering Effects of Isometric Handgrip Training: Preliminary Findings

Isometric handgrip (IHG) training reduces resting blood pressure (BP) in normotensive individuals following 8-10 weeks of unilateral (4 x 2 minute sustained contractions at 30% maximal voluntary contraction (MVC) performed by the non-dominant limb, separated by 4 minutes rest) or bilateral IHG training (contractions alternating between dominant and non-dominant limb, separated by 1 minute rest), performed 3-5 times per week. Investigating the effects of a single bout of unilateral or bilateral IHG on vascular function (brachial artery flow-mediated dilation (FMD) and low-flow mediated constriction (L-FMC)) may provide insight into the underlying hypotensive mechanisms of IHG training. Eight young adult (25.3 ± 3.81 years), normotensive (99.65/61.25 ± 11.72/9.14 mmHg) women performed a single bout of bilateral (n=4) or unilateral (n=4) IHG exercise. FMD and L-FMC were assessed using ultrasound pre- and post-IHG bout. Following a single IHG bout, no significant changes were observed in FMD (unilateral: pre- = 13.56 ± 7.8%, post- =17.26 ± 21%, bilateral: pre- = 17.11 ± 1.1%, post- = 21.18 ± 8.9%) or L-FMC (unilateral: pre- = 3.36 ± 11%, post- =-2.26 ± 16%, bilateral: pre- = -2.86 ± 3.1%, post- = -1.94 ± 9.7%) in either group (all p > 0.05). Taken together these preliminary data suggest that in young healthy women, irrespective of isometric exercise on 1 or 2 limbs, the endothelium is not altered significantly. Further research with a larger sample is warranted to confirm that mechanisms other than improved vascular function play a role in IHG-training induced BP lowering

Can δ18O help indicate the causes of recent lake area expansion on the western Tibetan Plateau? A case study from Aweng Co

© 2020, Springer Nature B.V. Glacier-fed lakes on the Tibetan Plateau (TP) have undergone rapid expansions since the late 1990s, concurrent with the changing climate. However, the dominant cause(s) of lake area increases is still debated. To identify the drivers of lake expansion, we studied Aweng Co, a glacier-fed lake in the western TP, where surface area has increased (0.74km2year−1) since the late 1970s and most rapidly (0.998 km2year−1) since the late 1990s. A water balance model was used to clarify the reasons for increased lake water volume, supported by stable isotope hydrology and the δ18O change recorded in recent sediments. Results showed that glacial meltwater probably had the biggest impact on changes in Aweng Co lake level in recent decades, but that precipitation was also an important contributor. Our study shows that δ18O of carbonate (δ18Ocarb) has great potential for indicating source changes of water supply in such lakes, but there is a need to be cautious when interpreting δ18Ocarb due to the influence of multiple hydrological factors, which can change in dominance over time