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

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

On the Unequal Burden of Obesity: Obesity's Adverse Consequences Are Contingent on Regional Obesity Prevalence.

Obesity has adverse consequences for those affected. We tested whether the association between obesity and its adverse consequences is reduced in regions in which obesity is prevalent and whether lower weight bias in high-obese regions can account for this reduction. Studies 1 and 2 used data from the United States (N = 2,846,132 adults across 2,546 counties) and United Kingdom (N = 180,615 adults across 380 districts) that assessed obesity's adverse consequences in diverse domains: close relationships, economic outcomes, and health. Both studies revealed that the association between obesity and its adverse consequences is reduced (or absent) in high-obese regions. Study 3 used another large-scale data set (N = 409,837 across 2,928 U.S. counties) and revealed that lower weight bias in high-obese regions seems to account for (i.e., mediate) the reduction in obesity's adverse consequences. Overall, our findings suggest that obesity's adverse consequences are partly social and, thus, not inevitable.

Leveraging Temporal Trends for Training Contextual Word Embeddings to Address Bias in Biomedical Applications: Development Study.

BACKGROUND: Women have been underrepresented in clinical trials for many years. Machine-learning models trained on clinical trial abstracts may capture and amplify biases in the data. Specifically, word embeddings are models that enable representing words as vectors and are the building block of most natural language processing systems. If word embeddings are trained on clinical trial abstracts, predictive models that use the embeddings will exhibit gender performance gaps. OBJECTIVE: We aim to capture temporal trends in clinical trials through temporal distribution matching on contextual word embeddings (specifically, BERT) and explore its effect on the bias manifested in downstream tasks. METHODS: We present TeDi-BERT, a method to harness the temporal trend of increasing women's inclusion in clinical trials to train contextual word embeddings. We implement temporal distribution matching through an adversarial classifier, trying to distinguish old from new clinical trial abstracts based on their embeddings. The temporal distribution matching acts as a form of domain adaptation from older to more recent clinical trials. We evaluate our model on 2 clinical tasks: prediction of unplanned readmission to the intensive care unit and hospital length of stay prediction. We also conduct an algorithmic analysis of the proposed method. RESULTS: In readmission prediction, TeDi-BERT achieved area under the receiver operating characteristic curve of 0.64 for female patients versus the baseline of 0.62 (P<.001), and 0.66 for male patients versus the baseline of 0.64 (P<.001). In the length of stay regression, TeDi-BERT achieved a mean absolute error of 4.56 (95% CI 4.44-4.68) for female patients versus 4.62 (95% CI 4.50-4.74, P<.001) and 4.54 (95% CI 4.44-4.65) for male patients versus 4.6 (95% CI 4.50-4.71, P<.001). CONCLUSIONS: In both clinical tasks, TeDi-BERT improved performance for female patients, as expected; but it also improved performance for male patients. Our results show that accuracy for one gender does not need to be exchanged for bias reduction, but rather that good science improves clinical results for all. Contextual word embedding models trained to capture temporal trends can help mitigate the effects of bias that changes over time in the training data.

Late Talkers can generalise trained labels by object shape similarities, but not unfamiliar labels.

Late talkers (LTs) exhibit delayed vocabulary development, which might stem from a lack of a typical word learning strategy to generalise object labels by shape, called the 'shape bias'. We investigated whether LTs can acquire a shape bias and whether this accelerates vocabulary learning. Fourteen LTs were randomly allocated to either a shape training group (Mage = 2.76 years, 6 males), which was taught that objects similar in shape have the same name, or a control group (Mage = 2.61 years, 4 males), which was taught real words without any focus on object shape. After seven training sessions, children in the shape training group generalised trained labels by shape (d = 1.28), but not unfamiliar labels. Children in the control group extended all labels randomly. Training did not affect expressive vocabulary.

Survival Analysis of Conversion Surgery in Borderline Resectable and Locally Advanced Unresectable Pancreatic Ductal Adenocarcinoma Addressing Selection and Immortal Time Bias: A Retrospective Single-Center Study.

BACKGROUND: The purpose of this study was to provide a detailed evaluation of the oncological advantages of surgery following neoadjuvant chemotherapy (NAC) for patients with borderline resectable (BR) or unresectable (UR) pancreatic ductal adenocarcinoma (PDAC), with a focus on minimizing biases. Recently, NAC has become the standard care for BR or UR locally advanced (UR-LA) PDAC, however, many studies have assessed survival benefits and favorable variables without consideration for biases, particularly immortal time bias. PATIENTS AND METHODS: This study included patients diagnosed with BR or UR-LA PDAC at Juntendo University Hospital from 2019 to 2022. To mitigate bias, we applied methods such as propensity score matching (PSM), time-dependent covariate Cox proportional hazard regression analysis (TDC), landmark analysis, and multivariable Cox proportional hazards regression model. RESULTS: The study analyzed 124 patients, dividing them into a surgery group (n = 57) and a chemotherapy-only group (n = 67). After PSM, there were 21 matched pairs. Survival analysis using TDC analysis showed that the surgery group had significantly better overall survival compared with the chemotherapy-only group in both the entire cohort and the matched pairs. Cox regression analysis of the entire cohort also revealed a similar superiority of surgery, while the landmark analysis showed varying results depending on the landmark setting. CONCLUSIONS: After careful adjustment for selection and immortal time biases, surgery following NAC appears to significantly extend survival in patients with BR or UR PDAC.

Gender and age biases in the assessment of speech accuracy: A study of speech-language clinicians' ratings of /s/ accuracy.

PURPOSE: Typically developing children assigned male at birth (AMAB) and children assigned female at birth (AFAB) produce the fricative /s/ differently: AFAB children produce /s/ with a higher spectral peak frequency. This study examined whether implicit knowledge of these differences affects speech-language pathologists'/speech and language therapists' (SLPs'/SLTs') ratings of /s/ accuracy, by comparing ratings made in conditions where SLPs/SLTs were blind to children's sex assigned at birth (SAB) to conditions in which they were told this information. METHODS: SLPs (n = 95) varying in clinical experience rated the accuracy of word-initial /s/ productions (n = 87) of eight children with speech sound disorder in one of four conditions: one in which no information about the children was revealed, one in which children's SAB was revealed, one in which children's age was revealed, and one in which both were revealed. RESULTS: Despite there being no statistically significant differences between AFAB and AMAB children's /s/ production in researcher-determined accuracy or in one acoustic characteristic, spectral centroid, SLPs in all four conditions judged the /s/ productions of AFAB children as more accurate than AMAB children. Listeners were significantly less likely to judge the productions of AMAB children to be inaccurate in the conditions in which age or age and SAB were revealed. These effects were consistent across SLPs with greatly varying levels of clinical experience. CONCLUSION: Knowing or imputing children's age and SAB can affect ratings of /s/ accuracy. Clinicians should be mindful of these potential effects. Future research should understand how expectations about sociolinguistic variation in speech affect appraisals of their speech and language. WHAT THIS PAPER ADDS: What is already known on the subject Adult men and women produce /s/ differently. A consensus is that these differences reflect sociolinguistic gender marking, rather than being the passive consequence of vocal-tract differences. Recent studies have shown that children assigned female at birth (AFAB) and those assigned male at birth (AMAB) produce /s/ differently in ways that mirror the differences between adult men and women, and which presumably reflect gender marking. What this paper adds to existing knowledge We asked whether US-based speech-language pathologists' (SLPs) ratings of the accuracy of /s/ differ depending on whether they are rating an AFAB or an AMAB child, and whether these differences are greater in conditions in which people are told the sex assigned at birth of the child being rated. We found that SLPs were more likely to judge AFAB children's /s/ productions to be more accurate than AMAB children's, even though the productions from the AMAB and AFAB children that were used as stimuli were matched for accuracy as determined by trained researchers. What are the clinical implications of this work? SLPs/speech-language therapists should be sensitive to the influence of social variables when assessing /s/. SLPs/speech-language therapists might rate children's productions differently depending on whether they believe they are rating an AFAB or an AMAB child.

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

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

Association of Double-Blind Reviews with Increases in Women as First Authors: An Initial Report from the Journal of Cardiac Failure.

INTRODUCTION: Women continue to remain under-represented in academic publishing in cardiology. Some evidence suggests that double-blind peer reviews may mitigate the impact of gender bias. In July 2021, the Journal of Cardiac Failure implemented a process for the conduct of double-blind reviews after previously utilizing single-blind reviews with the aim of improving author diversity. The purpose of the current manuscript was to examine the association between changes in authorship characteristics and implementation of double-blind reviews. METHODS: Manuscripts were stratified into 3 eras: March - September 2021 (Era 1 - prior to double blind reviews), March - September 2022 (Era 2), and March - September 2023 (Era 3). All article types except invited editorials were included. Data were abstracted, including names, genders, ranks, and discipline of first and senior authors. RESULTS: A total of 310 manuscripts were included in the analysis. The proportion of women first authors increased from 24% in Era 1 to 34% in Era 2 to 39% in Era 3 while the percentage of women authors serving in a senior authorship role remained fairly stable over time around 21-22%. Even after adjusting for region, article type, first author discipline, and last author gender, there was an increase in female first author over time (p= 0.015). Manuscripts with a female senior author were significantly more likely to have a female first author. CONCLUSIONS: Our findings suggest that double-blind peer review may contribute to increased gender diversity of first authors and highlight areas for future improvement for JCF and academic publishing.

Comment on 'A PET reconstruction formulation that enforces non-negativity in projection space for bias reduction in Y-90 imaging'.

We read with great interest the paper by Limet al(2018Phys. Med. Biol.63035042) on bias reduction in Y-90 PET imaging. In particular, they proposed a new formulation of the tomographic reconstruction problem that enforces non-negativity in projection space as opposed to image space. We comment on the algorithm they derived from this formulation and bring some clarifications on the constraint that this algorithm respects.

Sampling Strategies for Assessing Male Clients of Female Sex Workers in Public Health Research: A Compilation of Global Evidence.

Clients of Female Sex Workers (FSWs) are major bridge population in HIV transmission. Any research among them remains challenging because they are hidden within society. The objective of this review was tocompile the global evidence on different sampling strategies used to access male clients of female sex workers for research purpose, the challenges faced during the sampling process andpossible sources of bias. Original articles and reports published globally in last 10 years, in English language and those with full text freely available online were included in this scoping review. A comprehensive search was carried out among the electronic peer-reviewed literature database (Pubmed and Web of Science) using a pre-designed peer reviewed search strategy. Narrative synthesis was applied out across all such articles. A total of 36 articles were finally included in this review. The common sampling techniques used include convenience sampling, referral by FSWs/ pimp/brothel manager/clients, time location cluster sampling, use of virtual network, anonymous telephone survey, referred by clinicians of STI clinic etc. Overall response rate varied between 35 and 90%. Major challenges in participant recruitment included non-response, feasibility issue specially to cater non-brothel-based clients, safety issue for investigators, over-representation of clients with lower socio-economic status, higher refusal rate for known HIV positive clients to provide biological sample etc. As different sampling techniques have comparable response rate, it can be recommended that a pilot study should be carried out in local context to finalise appropriate participant recruitment technique for a given population.

The problem with two-event sequence learning by pigeons.

Bonobos appear to show little evidence of learning to make one response (R1) to an AB sequence and a different response (R2) to sequences BB, AA, and BA (Lind et al. PLoS ONE 18(9):e0290546, 2023), yet under different conditions, pigeons can learn this (Weisman et al. Exp Psychol Anim Behav Process 6(4):312, 1980). Aspects of the bonobo procedure may have contributed to this failure. Most important, no response was required in the presence of the stimuli to encourage attention to them. Furthermore, learning to make one response to the target sequence and another to the other sequences involves a bias that allows for better than chance responding. With the two-alternative forced-choice procedure used with the bonobos, the R1 response is correct for one sequence, whereas the R2 response is correct for three sequences. To correct for this, there are three times as many AB trials as each of the other sequences. However, this correction allows a bias to develop in which reinforcement often can be obtained by using only the last stimulus seen as the basis of choice (e.g., when the last stimulus is B respond R1 when the last stimulus is A respond R2). This solution yields reinforcement on five out of six, or 83%, of the trials. In the present experiment with pigeons, using this two-alternative forced choice procedure, most subjects tended to base their choice on the last-seen stimulus. This design allowed subjects to use a suboptimal but relatively effective choice strategy.

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

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

An evaluation of the preprints produced at the beginning of the 2022 mpox public health emergency.

BACKGROUND: Preprints are scientific articles that have not undergone the peer-review process. They allow the latest evidence to be rapidly shared, however it is unclear whether they can be confidently used for decision-making during a public health emergency. This study aimed to compare the data and quality of preprints released during the first four months of the 2022 mpox outbreak to their published versions. METHODS: Eligible preprints (n = 76) posted between May to August 2022 were identified through an established mpox literature database and followed to July 2024 for changes in publication status. Quality of preprints and published studies was assessed by two independent reviewers to evaluate changes in quality, using validated tools that were available for the study design (n = 33). Tools included the Newcastle-Ottawa Scale; Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2); and JBI Critical Appraisal Checklists. The questions in each tool led to an overall quality assessment of high quality (no concerns with study design, conduct, and/or analysis), moderate quality (minor concerns) or low quality (several concerns). Changes in data (e.g. methods, outcomes, results) for preprint-published pairs (n = 60) were assessed by one reviewer and verified by a second. RESULTS: Preprints and published versions that could be evaluated for quality (n = 25 pairs) were mostly assessed as low quality. Minimal to no change in quality from preprint to published was identified: all observational studies (10/10), most case series (6/7) and all surveillance data analyses (3/3) had no change in overall quality, while some diagnostic test accuracy studies (3/5) improved or worsened their quality assessment scores. Among all pairs (n = 60), outcomes were often added in the published version (58%) and less commonly removed (18%). Numerical results changed from preprint to published in 53% of studies, however most of these studies (22/32) had changes that were minor and did not impact main conclusions of the study. CONCLUSIONS: This study suggests the minimal changes in quality, results and main conclusions from preprint to published versions supports the use of preprints, and the use of the same critical evaluation tools on preprints as applied to published studies, in decision-making during a public health emergency.

Healthy worker hire and survivor effects in a cohort of medical radiation workers.

BACKGROUND: The healthy worker effect may distort the association between exposure and health effects in workers. However, few studies have investigated both the healthy worker hire and survival effects simultaneously, and they are limited to mortality studies in male workers. METHODS: We utilized a data set comprising South Korean diagnostic medical radiation workers registered in the National Dose Registry between 1996 and 2011, and merged it with mortality and cancer incidence data. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were computed for comparison with the general population. To account for time-varying confounders influenced by prior occupational radiation exposure, we applied g-estimation using structural nested accelerated failure time models and compared the outcomes with those from Weibull regression. RESULTS: A total of 1831 deaths and 3759 first primary cancer cases were identified among 93 918 workers. Both male (SMR = 0.44; 95% CI: 0.42, 0.46) and female workers (SMR = 0.53; 95% CI: 0.46, 0.60) showed lower mortality rates compared with national rates. In the SIR analysis, male workers exhibited reduced risks of solid cancer whereas female workers had increased risks. The g-estimation-derived hazard ratios (HRs) from radiation exposure exceeded those from Weibull regression estimates for all-cause death (HR = 2.55; 95% CI: 1.97, 3.23) and all-cancer incidence (HR = 1.96; 95% CI: 1.52, 2.55) in male workers whereas female workers showed the opposite results. CONCLUSIONS: Comprehensive consideration of the healthy worker effect by sex is essential for estimating the unbiased impact of occupational exposure on health outcomes, notably in studies focusing on male mortality.

Analyzing Racial Differences in Imaging Joint Replacement Registries Using Generative Artificial Intelligence: Advancing Orthopaedic Data Equity.

Background: Discrepancies in medical data sets can perpetuate bias, especially when training deep learning models, potentially leading to biased outcomes in clinical applications. Understanding these biases is crucial for the development of equitable healthcare technologies. This study employs generative deep learning technology to explore and understand radiographic differences based on race among patients undergoing total hip arthroplasty. Methods: Utilizing a large institutional registry, we retrospectively analyzed pelvic radiographs from total hip arthroplasty patients, characterized by demographics and image features. Denoising diffusion probabilistic models generated radiographs conditioned on demographic and imaging characteristics. Fréchet Inception Distance assessed the generated image quality, showing the diversity and realism of the generated images. Sixty transition videos were generated that showed transforming White pelvises to their closest African American counterparts and vice versa while controlling for patients' sex, age, and body mass index. Two expert surgeons and 2 radiologists carefully studied these videos to understand the systematic differences that are present in the 2 races' radiographs. Results: Our data set included 480,407 pelvic radiographs, with a predominance of White patients over African Americans. The generative denoising diffusion probabilistic model created high-quality images and reached an Fréchet Inception Distance of 6.8. Experts identified 6 characteristics differentiating races, including interacetabular distance, osteoarthritis degree, obturator foramina shape, femoral neck-shaft angle, pelvic ring shape, and femoral cortical thickness. Conclusions: This study demonstrates the potential of generative models for understanding disparities in medical imaging data sets. By visualizing race-based differences, this method aids in identifying bias in downstream tasks, fostering the development of fairer healthcare practices.

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

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

Rooting for Their Own Gender: Preschoolers' Selective Preference for Winners.

Children's social preferences are influenced by the relative status of other individuals, but also by their social identity and the degree to which those individuals are like them. Previous studies have investigated these aspects separately and showed that in some circumstances children prefer high-status individuals and own-gender individuals. Gender is a particularly interesting case to study because it is a strong dimension of social identity, but also one of the most prevalent forms of social hierarchy, with males conceptualised as superior to females, by adults and children alike. Here we directly asked how children's social preferences are influenced by status (winner or loser of a zero-sum conflict) and winner gender (female or male) in different scenarios (same or mixed-gender). In Experiment 1, children saw same-gender conflicts between two females or two males and they displayed an overall preference for winners. In Experiment 2, participants watched two mixed-gender conflicts, one where the female prevailed and one where the male prevailed. In this case, children chose the winner, but only when they had the same gender as themselves. Experiment 3 confirmed that children preferred own-gender individuals in the absence of conflict or status. Overall, children are sensitive to the relative status of other individuals and use this information to make social decisions. However, preschoolers do not prefer just any individual who wins access to a resource. They preferred dominant individuals, but only when they were of their own gender. This suggests that children's dominance evaluations are modulated by children's social identity.

On approximate equality of Z-values of the statistical tests for win statistics (win ratio, win odds, and net benefit).

Dong et al. (2023) showed that the win statistics (win ratio, win odds, and net benefit) can complement each another to demonstrate the strength of treatment effects in randomized trials with prioritized multiple outcomes. This result was built on the connections among the point and variance estimates of the three statistics, and the approximate equality of Z-values in their statistical tests. However, the impact of this approximation was not clear. This Discussion refines this approach and shows that the approximate equality of Z-values for the win statistics holds more generally. Thus, the three win statistics consistently yield closely similar p-values. In addition, our simulations show an example that the naive approach without adjustment for censoring bias may produce a completely opposite conclusion from the true results, whereas the IPCW (inverse-probability-of-censoring weighting) approach can effectively adjust the win statistics to the corresponding true values (i.e. IPCW-adjusted win statistics are unbiased estimators of treatment effect).

Relation between Deese-Roediger-Mcdermott recall measures of false memory and the fading affect bias.

The fading affect bias (FAB) is the faster fading of unpleasant affect than pleasant affect for autobiographical event memories, and it is considered a healthy coping mechanism because it is positively related to healthy measures (e.g., self-esteem and positive PANAS), whereas it is negatively related to unhealthy measures (e.g., psychological distress and negative PANAS). Some researchers suggest that Deese-Roediger McDermott (DRM) critical lure false memories for words are conceptually equivalent to false memories for autobiographical event memories, which has not been examined. Based on the finding that false autobiographical event memories negatively predict FAB, the current study tested if false DRM word memories would negatively predict FAB for autobiographical event memories, which would demonstrate support for the conceptual equivalence of DRM memories and autobiographical event memories. We found that three measures of false word recall positively predicted FAB, which is a result that is contrary to prior findings and the contention that DRM false memories for words are conceptually the same as autobiographical event memories.

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

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