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A comparison of response rate, data quality, and cost in the collection of data on sexual history and personal behaviors. Mail survey approaches and in-person interview.

The authors examined differences in rate of response, data quality, and cost between mail approaches and in-person interview in the collection of data on sexual history and personal behaviors. A sample of women from a midwestern United States university (n = 342) was identified from health service medical records as having been seen for a sexually transmitted disease (cases) or a contraceptive visit (controls) during the latter half of 1985. The women were randomly assigned to one of three data collection strategies. A total of 268 subjects (78%) participated. Results indicated no differences in validity by method of data collection or by case-control status but there were significant differences in completeness, cost, and response rates. In-person interviews resulted in more complete data than mail approaches, although all instruments had low proportions of missing data (0.001-0.006). Response rate differences were not found when data collection methodologies were compared (75-82%) but were found in case-control analyses. Cases were consistently less likely to participate and significantly less likely to respond by mail (p less than 0.05). The cost of the in-person interview was approximately four times that of the mail survey for the data collection. Implications of the case-control response rate difference suggest that mail methodologies, although low in cost, may introduce sampling bias in studies of sexually transmitted diseases.

Adolescent

Maximum a posteriori estimation with Good's roughness for three-dimensional optical-sectioning microscopy.

The three-dimensional image-reconstruction problem solved here for optical-sectioning microscopy is to estimate the fluorescence intensity lambda(x), where x epsilon R3, given a series of Poisson counting process measurements [Mj(dx)]jJ = 1, each with intensity [formula: see text] with [formula: see text] being the point spread of the optics focused to the jth plane and sj(y) the detection probability for detector point y at focal depth j. A maximum a posteriori reconstruction generated by inducing a prior distribution on the space of images via Good's three-dimensional rotationally invariant roughness penalty [formula: see text] It is proven that the sequence of iterates that is generated by using the expectation maximization algorithm is monotonically increasing in posterior probability, with stable points of the iteration satisfying the necessary maximizer conditions of the maximum a posteriori solution. The algorithms were implemented on the DECmpp-SX, a 64 x 64 parallel processor, running at < 2 s/(64(3), 3-D iteration). Results are demonstrated from simulated as well as amoebae and volvox data. We study performance comparisons of the algorithms for the missing-data problems corresponding to fast data collection for rapid motion studies in which every other focal plane is removed and for imaging with limited detector areas and efficiency.

Algorithms

Studies on occupational health: a critique.

A critique of 48 recent articles dealing with occupational health was undertaken by two readers using a set of questions devised to assess adherence to selected methodologic principles concerning data quality. Articles were read independently, responses to assessment questions were discussed and differences between readers reconciled. The greatest inattention to principles was found in the areas of sample size; definition of exposure; description, standardization, and validation of data sources; use of "blind" observers; and the possible effect of missing data on the results. Rigorus attention to these methodologic principles is necessary if the results of studies are to be accepted and applied in the prevention and control of occupational hazards.

Occupational Medicine

A method for assessing patterns of familial resemblance in complex human pedigrees, with an application to the nevus-count data in Utah kindreds.

An analytic method is described for estimating phenotypic correlations between pairs of members of specific relationships in pedigrees. In estimating correlations, this new method allows simultaneous adjustment for available covariates such as age, gender, environmental factors, and variables reflecting ascertainment mode, through mean- and variance-regression models. The estimated correlations and regression coefficients corresponding to covariates are consistent and asymptotically normally distributed. Differing from a full-likelihood approach, this new method does not require the assumption of a particular joint distribution of phenotypes from a pedigree, such as the multivariate normal distribution, but instead only requires correct specification of mean- and variance-regression models. Within this framework, missing data, if they are missing completely at random, can be ignored without biasing estimates. The method is illustrated by an application using nevus-count data from 28 Utah kinships. The results from the analysis are that covariate-adjusted nevus counts are correlated between parents and children (correlation .22; P less than .001) and between siblings (correlation .32; P less than .001), while the correlation of -.04 between husband and wife is not significantly different (P = .31) from 0. This result is consistent with a genetic etiology of nevus count.

Dysplastic Nevus Syndrome

Closed-form estimates for missing counts in two-way contingency tables.

One method for analyzing contingency tables with missing observations is to model the missing-data mechanism using log-linear models. Previous methods for obtaining estimates (of missing counts and parameters) have required an iterative algorithm. In many cases, however, one can obtain estimates by use of a simple algebraic formula. We illustrate the method with data on smoking and birth weight.

Algorithms

The use of lung function tests in identifying factors that affect lung growth and aging.

Lung function tests are used both clinically, in assessing disease, and epidemiologically, in identifying those factors which influence the growth and aging process of the lungs. The user must beware of several common pitfalls in the use of these tests, however. First, the commonly used tests of lung function can only identify patterns of dysfunction, not specific pathologic processes. Second, these tests are subject to many sources of intra- and inter-subject variability, making it difficult to dissect out the signal (for example, the rate of lung aging in adults) from the noise which may greatly exceed the signal. Finally, the analysis of longitudinal pulmonary function data is complicated by the alinearity of the growth and aging process, missing data, variable follow-up times, information censoring mechanisms and covariate processes, and problems in defining abnormality.

Adolescent

A longitudinal study of the reporting of emotional and somatic symptoms during and after pregnancy.

One hundred and eight pregnant women, most of their husbands and a comparison group of non-expectant parents were recruited for a long-term study which involved responding to a 55-item Symptom Checklist (SCL) and the Beck Depression Inventory three times during pregnancy and once during the first postpartum month. Responses to the SCL were factor analysed, and the four groups were then compared on their factor scores as well as their scores on the Beck Depression Inventory (BDI) using discriminant analysis and trend analysis. The discriminant analyses were done twice: once using all the data provided by all subjects and once using only subjects with no missing data. At each measurement period, the pregnant women were distinguished from the other groups by a different factor of the SCL: at 3-5 months, it was 'Feeling Sick'; at 6-8 months, it was 'Feeling Overweight'; at 9 months, it was 'Feeling Overweight/Physical Stress'; and at postpartum, it was 'Physical Stress'. Also, trend analysis showed a significant tendency for the scores of pregnant women on the SCL 'Negative Emotional State', factor and on the BDI to increase over time, in contrast to those of the other groups.

Adaptation, Psychological

The use of a computer in the organization of a large-scale co-operative controlled clinical trial of the treatment of pulmonary tuberculosis.

The organization of controlled clinical trials requires well-defined clerical procedures which, with large-scale studies, are so monotonous that it is difficult to attract and keep staff of a sufficiently high calibre. In a large-scale trial of pulmonary tuberculosis, a computer is being used to undertake much of the routine clerical work, including (1) the preparation of an appointments diary, which also specifies the exact requirements for the trial, and (2) the storage of all the data on magnetic tape so that periodic checks can be made for missing data and interim and final analyses can be produced rapidly. These arrangements reduce the time spent by clerical and statistical staff to a minimum. Although a strict evaluation of the effect of introducing the computer has not yet been made, this approach does appear to be sufficiently promising to warrant further investigations of a similar type.

Antitubercular Agents

Cytogenetic effects of inhaled ozone in man.

Peripheral blood samples were collected from 30 normal male volunteers before and at intervals after inhaling 0.4 ppm ozone for 4 h. Data from 4 of the subjects were excluded from the analysis because of missing data points. The blood samples were cultured for 48 h, slides made and stained with a uniform Giemsa stain, and 100 metaphase spreads per subject per treatment scored for chromosome aberrations. Cells with suspected aberrations were photographed, destained, restained with a banding procedure and rephotographed to identify the specific chromosomes and regions involved. Pre-exposure, immediate post-exposure, 3 days post-exposure, 2 weeks post-exposure and 4 weeks post-exposure means for the percentage of cells with 46 chromosomes were 93.0, 93.6, 91.7, 94.5 and 94.2, respectively; in the same order, the mean number of cells with chromatid and/or chromosome breaks per order, the mean number of cells with chromatid and/or chromosome breaks per 100 cells was 0.96, 0.85, 1.00, 0.88 and 0.81 respectively, and for chromatid and/or chromosome gaps per 100 cells: 1.35, 0.96, 1.35, 0.81 and 0.77, respectively. The means for each of these parameters as well as the mean frequencies of complex aberrations are not statistically significantly different between blood sampling times. The distribution of aberrations by chromosome and light and dark bands is not significantly influenced by ozone exposure. These data indicate no apparent detectable human cytogenetic effect due to exposure to ozone under the conditions of this experiment.

Adult

Methodological issues facing studies of atherosclerotic change.

BACKGROUND: The association between coronary heart disease and lesions of the coronary arteries has led to investigations of different interventions on atherosclerotic change. Currently, B-mode ultrasound of the peripheral arterial vessels, rather than arteriography of the coronary arteries, provides the most accurate evaluation of atherosclerotic disease extent in the patient. METHODS AND RESULTS: When measuring the effect of risk factor modification on atherosclerotic change, it is important to select appropriate methods and end points for quantifying disease and evaluating subsequent change. Measurements must be valid, precise, and reliable and require appropriate a priori definitions of end points and their change. Consistent methodology within studies is crucial. Multiple measurements and data reduction methods can increase the efficiency of comparisons and merit careful consideration. Missing data arising from nonvisualization of sites complicate analyses. Identifying both covariates of atherosclerotic change and possible confounding interventions require monitoring biochemical, physiological, and/or clinical variables and making inferences from these. CONCLUSIONS: To strengthen the rationale for use of B-mode ultrasonography in assessing the natural history of atherosclerosis, four methodological issues must be addressed: evaluation of primary end points using composite and/or individual measurements of atherosclerotic assessment from the carotid arteries, evaluation of new methodology that may allow assessment of the anatomy of specific lesions and/or their potential for rupture, development of methods making complementary use of both angiographic measurements of lumen diameter and ultrasound assessment of the arterial wall, and concrete demonstration of a direct link between increasing intimal-medial thickness and subsequent clinical events. The use of a continuous variable (intimal-medial thickness) in ultrasound studies offers cost/benefit advantages; this methodology continues to evolve.

Arteriosclerosis

Creation and validation of medical data.

The problems of creating and validating medical data are discussed. These difficulties relate to the structuring of data and its definiton. The necessity for clarity of thought, coherence and logic in data collection is stressed. Difficulty in medical and lay staff training shows that this is a continuing problem. Data validation must be the major province of senior as well as junior doctors. It is an absoulte essential continuing process and without valid data most analyses are not worthwhile because of high error rates and/or too much missing data.

Humans

Reconstruction algorithm for incomplete projections in the framework of linear operators in normed linear spaces.

Based on the linearity of the Radon transform and the convolution-backprojection reconstruction algorithm, a new linear-vector space notation is introduced that is of general use in computed tomography (CT). Using this notation, a consistency condition for the completion of incomplete projection data is described. This consistency condition leads to singular or ill-conditioned systems of linear equations for the unknown projection data. Using regularization methods, an algorithm for the consistent projection completion is presented that can exploit symmetries of the missing data region. The performance of the new algorithm is documented with simulated and actualy measured CT-projection data. The algorithm quantitatively improves CT reconstructions with realistic amounts of data and noise and can be used for the completion of arbitrary regions of missing projections.

Fourier Analysis

Analyzing individual status and change with hierarchical linear models: illustration with depression in college students.

A recently developed class of multilevel or hierarchical linear models (HLM) provides an intuitive and efficient way to estimate individual growth or change curves. The approach also models the between-subjects variation of the individual change curves with treatment factors and individual attributes. Unlike other repeated measures analysis methods common in the behavioral sciences, HLM allows the fit of data with unequal numbers of repeated observations for each subject, variable timing of observations, and missing data, features which are often characteristic of data from field studies. The application of HLM for the analysis of repeated psychological measures is discussed and illustrated here with depression data for college students. Strengths and limitations of the approach are discussed.

Adaptation, Psychological

Descriptive study of prognostic factors influencing survival of compensated silicotic patients.

The objective of this study was to assess survival and the prognostic influencing survival of compensated silicotic patients. All workers compensated for silicosis in the Province of Quebec from 1938 to 1985 (n = 1,165) were included. Clinical data were those collected during the exam that led to a compensation decision. Due to missing data, a subcohort of 961 patients was used for multivariate analysis of clinical prognostic factors with the Cox proportional hazards model. The following factors made an independent contribution to survival: age at compensation, smoking, dyspnea, expectoration, abnormal breath sounds, radiographic appearance, and vital capacity. On the basis of the model, patients with small opacities alone on their chest radiograph and who did not have dyspnea, expectoration, or abnormal breath sounds had a survival similar to the average Quebec man; other patients had a poorer survival. We conclude that it is possible to identify at the time of compensation, silicotic patients who are likely to have a life expectancy similar to that of the general population. Symptoms and physical signs as well as radiographic and lung function abnormalities appear to be useful prognostic indicators in compensated silicotic patients.

Dyspnea

Gestational age reporting and preterm delivery.

This study examines recent trends in the reporting completeness and quality of gestational age estimates derived from the date of the last normal menses (DLNM) as reported in South Carolina vital records from 1974 to 1985. Noteworthy improvements in the completeness of reporting emerged during this period with a decline from 31.1 percent missing information in 1974 to 6.6 percent missing in 1985. Completeness of reporting and strategies for imputing values for missing data were analyzed for their impact on the calculation of the percentage of preterm live births. The results indicate that the underreporting of gestational age can lead to marked underestimation of the preterm percentage in a population and to misinterpretation of trends in these percentages. Based on the results of this analysis, it is recommended that preterm percentages be based on cases with DLNM gestational age values between 20 and 50 weeks. Since cases with missing or implausible gestational age data have a greater risk of a poor pregnancy outcome, these findings emphasize the importance of identifying both the completeness of data reporting and the use of imputation and deletion strategies when employing population-based DLNM data to calculate gestational age related indicators.

Adolescent

Investigating drug plasma levels and clinical response using random regression models.

The reanalysis of the Riesby dataset using a random regression model indicates a significant effect of DMI plasma measurements on HAM-D scores across the four timepoints of the study. This effect is especially strong when the HAM-D change from baseline score is used in place of the actual HAM-D score at the four timepoints. A significant effect of IMI was not found for either the actual HAM-D score or the HAM-D change from baseline score. An endogenous effect was marginally significant when the actual HAM-D score was used; however, this effect was not observed when the HAM-D change score was used as the dependent measure. There also was evidence of a marginally significant effect due to autocorrelation of the residuals, indicating that the residuals at a given timepoint were related to the residuals from previous timepoints according to a first-order autoregressive process. In contrast, when the repeated measures MANOVA was used to analyze these data, a significant effect of DMI was not observed, since subjects without complete data at all timepoints had to be dropped from the analysis. In longitudinal psychiatric studies where missing data are the rule (rather than the exception), the random regression approach provides an attractive alternative to the traditional methods of analyzing longitudinal data.

Humans

Effect of antipsychotic withdrawal on extrapyramidal symptoms: statistical methods for analyzing single-sample repeated-measures data.

Using symptom severity ratings of extrapyramidal side effects (EPS) during a 4-week antipsychotic washout period, we illustrate particular problems associated with repeated measures of symptom severity and demonstrate four analysis methods. The often suggested analysis of variance and multivariate analysis of variance found no mean change in weekly Simpson Angus scores over the 4-week washout despite the fact that 43% had clinically significant EPS prior to drug discontinuation. On the other hand, the Friedman Analysis of Ranks and Cochran-Mantel-Haenszel (CMH) statistics found significant change over the washout period. These two less well-known techniques place fewer restrictions on the data, can be more sensitive to patterns of change, and may be more appropriate for psychiatric data. The CMH method is particularly attractive since it does not require complete data on all subjects as do many other techniques. This minimizes the number of cases lost to missing data and increases the generality of the results.

Adult

Consequences of prolonged inhalation of ozone on F344/N rats: collaborative studies. Part X: Robust composite scores based on median polish analysis.

This report describes some of the statistical methods used to analyze data from the National Toxicology Program/Health Effects Institute Collaborative Ozone Project. The purpose of the collaborative study was to assess the health effects of chronic ozone inhalation. Data were obtained from a subset of 164 F344/N rats dedicated to use by the Health Effects Institute from a standard ozone inhalation study conducted by Battelle Pacific Northwest Laboratories for the National Toxicology Program. The study involved eight groups of investigators, each assessing different types of ozone-related health effects. These included studies of respiratory function and of structural, cellular, and biochemical changes in the lungs and airways. Designing and analyzing a study with several groups of investigators raises many statistical challenges. The highest design priority for this study was that each investigation be individually interpretable as an independent study. This meant that each investigator had to receive an adequate number of animals, balanced with respect to level of ozone exposure and other factors such as the gender of the rats and the time they were killed. Another feature of the collaborative study was the opportunity it provided to assess and quantify the effect of ozone exposure on a broad spectrum of endpoints, and to explore the relations between the different types of effect. Maximizing the potential to assess these correlations required that the individual animals studied by the different groups of investigators overlap as much as possible. This aspect of the statistical design required careful consideration of the compatibility between various investigations. Fortunately, the degree of compatibility was substantial. In many cases, for example, it was possible to assess respiratory function in the animals before they were killed, and then to divide the tissue among several different investigators. This report concentrates on the methods that were specially developed to analyze the data for multiple endpoints collected in the study. Nonstandard techniques were required to accommodate the complex pattern of missing data that was inherent in the study design because no animals were measured by all investigators.

Administration, Inhalation