Assumption-lean falsification tests of rate double-robustness of double-machine-learning estimators.

The class of doubly robust (DR) functionals studied by Rotnitzky et al. (2021) is of central importance in economics and biostatistics. It strictly includes both (i) the class of mean-square continuous functionals that can be written as an expectation of an affine functional of a conditional expectation studied by Chernozhukov et al. (2022b) and the class of functionals studied by Robins et al. (2008). The present state-of-the-art estimators for DR functionals ψ are double-machine-learning (DML) estimators (Chernozhukov et al., 2018). A DML estimator ψ^1 of ψ depends on estimates p^(x) and b^x of a pair of nuisance functions p(x) and bx, and is said to satisfy "rate double-robustness" if the Cauchy-Schwarz upper bound of its bias is o(n-1/2). Were it achievable, our scientific goal would have been to construct valid, assumption-lean (i.e. no complexity-reducing assumptions on b or p) tests of the validity of a nominal (1-α) Wald confidence interval (CI) centered at ψ^1. But this would require a test of the bias to be o(n-1/2), which can be shown not to exist. We therefore adopt the less ambitious goal of falsifying, when possible, an analyst's justification for her claim that the reported (1-α) Wald CI is valid. In many instances, an analyst justifies her claim by imposing complexity-reducing assumptions on b and p to ensure "rate double-robustness". Here we exhibit valid, assumption-lean tests of H0: "rate double-robustness holds", with non-trivial power against certain alternatives. If H0 is rejected, we will have falsified her justification. However, no assumption-lean test of H0, including ours, can be a consistent test. Thus, the failure of our test to reject is not meaningful evidence in favor of H0.

Lead exposure across the life course and age at death.

BACKGROUND: Lead (Pb) exposure has been associated with an increased risk of all-cause mortality, even at low levels. Little is known about how the timing of Pb exposure throughout life may influence these relationships. Quantifying the amount of Pb present in various tissues of the body provides measurements of exposure from different periods of life. These include bone, tooth enamel, which is the hard outer layer of the crown, and tooth cementum, which is the calcified connective tissue covering the tooth root. The purpose of the study was to examine Pb exposure at multiple periods throughout life, including childhood (enamel), adulthood (cementum), and later life (bone), and to estimate their associations with age at death. METHODS: 208 skeleton donors (born 1910-1960) from an ongoing case-control study were included in this study. Pb was measured in tibia (shin), bone using X-Ray Florescence and in teeth using Laser-Ablation Inductively Coupled Plasma Mass Spectroscopy. After excluding unusually high measurements (>2sd), this resulted in a final sample of 111 with all exposure measures. Correlations across measures were determined using partial Spearman correlations. Associations between Pb exposure and age at death were estimated using Multivariable Linear Regression. RESULTS: Pb measures across exposure periods were all significantly correlated, with the highest correlation between cementum and tibia measures (r = 0.61). Donors were largely female (63.0 %), White (97.3 %), and attended some college (49.5 %). Single exposure models found that higher tooth cementum Pb (-1.27; 95 % CI: -2.48, -0.06) and tibia bone Pb (-0.91; 95 % CI: -1.67, -0.15) were significantly associated with an earlier age at death. When considered simultaneously, only cementum Pb remained significant (-1.51; 95 % CI: -2.92, -0.11). Secondary analyses suggest that the outer cementum Pb may be especially associated with an earlier age at death. CONCLUSION: Results suggest that higher Pb exposure is associated with an earlier age at death, with adulthood as the life period of most relevance. Additional studies using Pb exposure measures from different life stages should be conducted.

Multi-omics analysis in human retina uncovers ultraconserved cis-regulatory elements at rare eye disease loci.

Cross-species genome comparisons have revealed a substantial number of ultraconserved non-coding elements (UCNEs). Several of these elements have proved to be essential tissue- and cell type-specific cis-regulators of developmental gene expression. Here, we characterize a set of UCNEs as candidate CREs (cCREs) during retinal development and evaluate the contribution of their genomic variation to rare eye diseases, for which pathogenic non-coding variants are emerging. Integration of bulk and single-cell retinal multi-omics data reveals 594 genes under potential cis-regulatory control of UCNEs, of which 45 are implicated in rare eye disease. Mining of candidate cis-regulatory UCNEs in WGS data derived from the rare eye disease cohort of Genomics England reveals 178 ultrarare variants within 84 UCNEs associated with 29 disease genes. Overall, we provide a comprehensive annotation of ultraconserved non-coding regions acting as cCREs during retinal development which can be targets of non-coding variation underlying rare eye diseases.

Evaluación de la satisfacción de los pacientes en un hospital homeopático gubernamental en Bengala Occidental, India / Assessment of patient satisfaction in a government homeopathic hospital in West Bengal, India

Introducción y objetivos: la determinación del grado de satisfacción de los pa¬cientes de un hospital homeopático puede producir un impacto sustancial en los esfuerzos para mejorar el estado de salud y la calidad de la atención proporcionada. En este trabajo, los investigadores evaluaron el grado de satisfacción de los pacientes después de recibir consulta médica, al igual que la validez y la confiabilidad del interrogatorio al que se sometieron. Métodos: estudio transversal con diseño observacional realizado en febre¬ro de 2013, con 390 voluntarios, en cinco unidades de consulta externa de la Facultad y Hospital de Medicina Homeopática Mahesh Bhattacharyya, perteneciente a la red pública de Bengala Occidental (Howrah, India). Fue auto-aplicado un breve cuestionario de satisfacción con consultas médicas, elaborado en Japón y traduci¬do al bengalí, con 12 ítems de respuesta múltiple en una escala tipo Likert de cinco puntos. El cuestionario generó cinco subescalas: satisfacción general, examen completo, cuidado completo de la persona, duración de la consulta y centralidad en el paciente. Las respuestas de cada ítem y sub-escala también incluían una escala visual analógica (EVA) de 100 mm. Resultados: el cuestionario se mostró válido y confiable. Su consistencia interna fue comprobada por valores entre 0.7 y 0.9 del coeficiente alfa de Cronbach (α), y la confiabilidad test-retest por el coeficiente kappa de Cohen (κ), cuyo valor fue superior a 0.7 en todos los ítems. La validez concurrente del coeficiente r de Pearson correspondiente al puntaje total del cuestionario y las EVA fue de 0.60, p<0.001; puntaje de cada escala 0.8 < r < 0.9, p<0.0001, y puntaje de cada ítem 0.8 < r < 0.9, p<0.0001.[...] En general, los pacientes reportaron alta satisfacción. Nuevos estudios son necesarios para adaptar el cuestionario utilizado en este trabajo a otros idiomas para uso global. (AU)

Discovering the degree of patient satisfaction in a homeopathic hospital setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a five-point Likert scale was used. The questionnaire generated five subscales - overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100 mm were provided with each single question item and each subscale. The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s alpha (α) were between 0.7-0.9 and test-retest reliability Cohen’s kappa (κ) was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, p<0.001; each subscale scores 0.8 < r < 0.9, p<0.0001, and each question score 0.8 < r < 0.9, p<0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (p< 0.05, df=4.95% CI) establishing discriminant validity. Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages. (AU)

Evaluación de la satisfacción de los pacientes en un hospital homeopático gubernamental en Bengala Occidental, India / Assessment of patient satisfaction in a government homeopathic hospital in West Bengal, India

Introducción y objetivos: la determinación del grado de satisfacción de los pa¬cientes de un hospital homeopático puede producir un impacto sustancial en los esfuerzos para mejorar el estado de salud y la calidad de la atención proporcionada. En este trabajo, los investigadores evaluaron el grado de satisfacción de los pacientes después de recibir consulta médica, al igual que la validez y la confiabilidad del interrogatorio al que se sometieron. Métodos: estudio transversal con diseño observacional realizado en febre¬ro de 2013, con 390 voluntarios, en cinco unidades de consulta externa de la Facultad y Hospital de Medicina Homeopática Mahesh Bhattacharyya, perteneciente a la red pública de Bengala Occidental (Howrah, India). Fue auto-aplicado un breve cuestionario de satisfacción con consultas médicas, elaborado en Japón y traduci¬do al bengalí, con 12 ítems de respuesta múltiple en una escala tipo Likert de cinco puntos. El cuestionario generó cinco subescalas: satisfacción general, examen completo, cuidado completo de la persona, duración de la consulta y centralidad en el paciente. Las respuestas de cada ítem y sub-escala también incluían una escala visual analógica (EVA) de 100 mm. Resultados: el cuestionario se mostró válido y confiable. Su consistencia interna fue comprobada por valores entre 0.7 y 0.9 del coeficiente alfa de Cronbach (α), y la confiabilidad test-retest por el coeficiente kappa de Cohen (κ), cuyo valor fue superior a 0.7 en todos los ítems. La validez concurrente del coeficiente r de Pearson correspondiente al puntaje total del cuestionario y las EVA fue de 0.60, p<0.001; puntaje de cada escala 0.8 < r < 0.9, p<0.0001, y puntaje de cada ítem 0.8 < r < 0.9, p<0.0001.[...] En general, los pacientes reportaron alta satisfacción. Nuevos estudios son necesarios para adaptar el cuestionario utilizado en este trabajo a otros idiomas para uso global.

Discovering the degree of patient satisfaction in a homeopathic hospital setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a five-point Likert scale was used. The questionnaire generated five subscales - overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100 mm were provided with each single question item and each subscale. The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s alpha (α) were between 0.7-0.9 and test-retest reliability Cohen’s kappa (κ) was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, p<0.001; each subscale scores 0.8 < r < 0.9, p<0.0001, and each question score 0.8 < r < 0.9, p<0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (p< 0.05, df=4.95% CI) establishing discriminant validity. Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale. Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity. Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Introdução e objetivos: A determinação do grau de satisfação dos pacientes de um hospital homeopático, pode producir impacto substancial nos esforços para melhorar o o estado de saúde e a qualidade da atenção proporcionada. Neste estudo, avaliamos o grau de satisfação dos pacientes, depois das consultas médicas, bem como a validade e confiabilidade do questionário utilizado. Métodos: Estudo transversal com desenho observacional realizado em fevereiro de 2013 com 390 voluntários em 5 ambulatórios da Facultade e Hospital de Medicina Homeopática Mahesh Bhattacharyya, pertencente a rede pública Bengala Ocidental, Howrah, India. Foi autoaplicado um breve questionário japonês de satisfação com as consultas médicas, traduzido para o bengalí, com 12 ítems respondidos em uma escala tipo Likert de 5 pontos. O questionario gerou 5 sub-escalas: satisfação global; exame completo; atenção do paciente como um todo; duração da consulta; foco no paciente. As respostas de cada ítem e sub-escala também incluíam uma escala visual analógica de 100 mm. Resultados: O questionário se mostrou válido e confiável. Sua consistência interna foi comprovada por valores entre 0,7 e 0,9 do coeficiente α de Cronbach, e a confiabilidade teste-reteste pelo coeficiente kappa de Cohen, cujo valor foi superior a 0,7 em todos os ítens. A validez concorrente do coeficiente r de Pearson correspondente a pontuação total do questionário a as EVAs foram de 0,60, p<0,001; pontuação de cada escala 0,8 < r < 0,9, p<0,0001, e pontuação de cada ítem 0,8 < r < 0,9, p<0,0001. A comparação das pontuações médias das 5 subescalas correspondentes aos 5 ambulatorios resultaram en valores de razão F de 4,3-9,8 (p<0,05, df = 4, intervalo de confiança de 95%), comprovando a validez discriminante do questionário. Em geral, os pacientes reportaram alta satisfação. Novos estudos são necessários para adaptar o questionário utilizado neste estudo a outros idiomas, para uso global.

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India / 中西医结合学报

Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India.

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale. Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity. Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages. (AU)

Introdução e objetivos: A determinação do grau de satisfação dos pacientes de um hospital homeopático, pode producir impacto substancial nos esforços para melhorar o o estado de saúde e a qualidade da atenção proporcionada. Neste estudo, avaliamos o grau de satisfação dos pacientes, depois das consultas médicas, bem como a validade e confiabilidade do questionário utilizado. Métodos: Estudo transversal com desenho observacional realizado em fevereiro de 2013 com 390 voluntários em 5 ambulatórios da Facultade e Hospital de Medicina Homeopática Mahesh Bhattacharyya, pertencente a rede pública Bengala Ocidental, Howrah, India. Foi autoaplicado um breve questionário japonês de satisfação com as consultas médicas, traduzido para o bengalí, com 12 ítems respondidos em uma escala tipo Likert de 5 pontos. O questionario gerou 5 sub-escalas: satisfação global; exame completo; atenção do paciente como um todo; duração da consulta; foco no paciente. As respostas de cada ítem e sub-escala também incluíam uma escala visual analógica de 100 mm. Resultados: O questionário se mostrou válido e confiável. Sua consistência interna foi comprovada por valores entre 0,7 e 0,9 do coeficiente α de Cronbach, e a confiabilidade teste-reteste pelo coeficiente kappa de Cohen, cujo valor foi superior a 0,7 em todos os ítens. A validez concorrente do coeficiente r de Pearson correspondente a pontuação total do questionário a as EVAs foram de 0,60, p<0,001; pontuação de cada escala 0,8 < r < 0,9, p<0,0001, e pontuação de cada ítem 0,8 < r < 0,9, p<0,0001. A comparação das pontuações médias das 5 subescalas correspondentes aos 5 ambulatorios resultaram en valores de razão F de 4,3-9,8 (p<0,05, df = 4, intervalo de confiança de 95%), comprovando a validez discriminante do questionário. Em geral, os pacientes reportaram alta satisfação. Novos estudos são necessários para adaptar o questionário utilizado neste estudo a outros idiomas, para uso global. (AU)