Bias Hypotheses Sample Clauses

Bias Hypotheses. 3D imaging overestimated head circumference, while underestimating MUAC. Consideration of the protocol for manual measurements provides a hypothesis for the different directions of average bias. When measuring head circumference, anthropometrists were instructed to apply enough tension to compress the hair and underlying soft tissue. For MUAC, the measuring tape was s meant to be flush with the skin without any compression. 3D imaging may have overestimated head circumference because compression of soft tissue was not taken into account during calibration. If compression is the source of bias for head circumference, we may expect no average bias for MUAC because there is no compression for MUAC. Interestingly, for MUAC ≥ 16.7 cm we found essentially no systematic bias, and it was only among smaller children (MUAC 9.6-15.1 cm) that we found substantial underestimation. It is possible that underestimation by 3D imaging for MUAC was caused by manual measurement error. It can be more difficult to measure MUAC on younger children because increased adiposity along with decreased cooperation make it more difficult to maintain the measuring tape flush against the skin. It is possible that BINA anthropometrists systematically left small gaps between the skin and measuring tape when measuring MUAC of younger children, and that manual measurements are less accurate than 3D imaging for young children. The protocol for manually measuring head circumference may also help to explain another finding: 3D imaging was better at selecting the same children above or below SD cutoffs for stature and MUAC than it was for HC. The protocol for measuring manual HC calls for shifting the measuring tape up and down to select the largest circumference; there is no fixed position. The current 3D imaging system is based on measuring fixed, pre- specified points; and does not account for being able to shift the measuring tape up and down. To achieve excellent sensitivity 3D imaging system software may have to be developed to identify the largest circumference and not just rely on pre-specified points. When processing scans we returned the final 3D model to a “neutral” position to take stature measurements. Comparing the “neutral” position to WHO measuring protocol, we did not take into account the Frankfort Plane and the back of the head was not aligned with the heels, buttocks, and back of shoulders. It is not clear what effect model positioning had on the accuracy of scan-derived statu...
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