Strengths and Limitations. The limitations to our investigations are the test setting for interpretations; there was only one glass slide for each skin biopsy case (although pathologists were asked to assume it was representative); and pathologists were unable to perform immunohistochemical staining or other diagnostic tests. In addition, pathologists were not provided detailed clinical history for the cases, and they were not able to procure a second opinion if desired. Pathologists were also given only four different options for treatment suggestions, which may have limited the ability to fully communicate their suggestions. Furthermore, we are currently refining the MPATH-Dx schema, in light of new research evidence on Class II and III categories, and we are aware there is disagreement on some of the MPATH-Dx classifications and their respective treatment recommendations2–5. Author Manuscript Strengths of our study include the broad spectrum and high number of cases and the large number of participating pathologists from across the U.S. While other studies have found variation in diagnostic interpretations of melanocytic lesions between pathologists6–9,20–31, our study is unique in that it quantifies variation in treatment suggestions. Our study also identified pathologist characteristics associated with providing treatment suggestions that are discordant with national guidelines. Author Manuscript Xxxxx et al. Page 8
Strengths and Limitations. The overall distribution of patients at the four urgency levels in this study is similar to the one found by a larger prospective trial comparing CTA to ADAPT, indicating a representative sample was collected in our study. (5) Although the sample size of 100 seemed sufficient, it is still relatively small compared to the number of annual visits to the ED and the broad spectrum of patients. The number of raters and their experience range (nurses, nursing students, SOSU assistants) reflect the reality of the triage process according to the working procedures in Danish ED’s. This represents a strength regarding the credibility and application of the results to the clinical situation, but the heterogeneity of the group may have resulted in a decreased level of agreement. The large number of raters also introduces an increased statistical uncertainty as reflected in the wide confidence interval. The ED personnel had limited experience with the use of CTA and received only a brief instruction prior to using the triage system. Because the data was collected alternately in the three sections of the ED and sporadically during the study period, the personnel were not given an opportunity of increasing their experience using the system over time. Their lack of experience with the method may have reduced the level of agreement, and it is possible that the interrater agreement would increase over time, if the CTA was implemented as the standard triage method in the ED.
Strengths and Limitations. As demonstrated with Figure 15 to Figure 20, one of the strengths of the disaggregate approach is that ZIP code areas with increased deaths and DALYs that could be results of underlying socioeconomic and health environment inequity in the neighborhoods can be identified geographically. Such inequities cannot be identified with aggregate approach at the regional level. A geospatially disaggregated ITHIM tool can help visualize the health impacts of different planning scenarios, which can help planners and policy makers reach informed decisions about the region’s future that address the well-beings of every citizen. However, spatial resolution of such analysis is limited by available resources at the neighborhood levels. For example, Xxxxxxxxxx, Xxxxxx, Xx, Igbinedion, and London (2017) noted difficulties in obtaining health and leisure time physical activity data at the ZIP code level. Instead, simplified assumptions were made to approximate values for these ZIP codes based on regional statistics. Thus, the study could not fully address the benefits and challenges inherent in modeling disaggregate health outcomes. The research team recommended performing sensitivity analysis to various model formulations to identify the potential range of uncertainties resulting from the data limitation.
Strengths and Limitations. This was the first study to examine the race-specific effect of socioeconomic measures on rates of invasive pneumococcal disease in children. This study had multiple strengths. First, the effect of multiple socioeconomic measures was examined rather than just using income to define socioeconomic status. Socioeconomic factors are not interchangeable, so it is important to examine the effect of multiple different variables after considering potential mechanistic explanations for their association with the disease of interest (46). Second, socioeconomic variables were examined as exposures rather than just using them to control for potential confounders. Third, the surveillance region and the cases contained a high percentage of both black and white individuals allowing for sufficient examination of race-specific effects of socioeconomic factors on disease rates. This study also had several notable limitations. First, this study only examined 905 cases, which was not as large of a sample size as in other studies, especially considering that this study stratified on race. Second, although a significant difference in invasive pneumococcal disease rate existed between white race and “other” race, no valid conclusions were possible regarding individuals of “other” race because of the heterogeneity of that racial group. Because of the small number of individuals of Asian, Native American/Alaskan, and Hawaiian/Pacific Islander descent, all of those cases had to be combined into one racial category. This heterogeneous collection likely did not accurately represent the association between socioeconomic factors and invasive pneumococcal disease rates in all of those races. Third, because census tract-level data was only available from the decennial census, all socioeconomic variables and population denominators were obtained from the 2000 census, which likely overestimated disease rates and may have resulted in misclassification of socioeconomic status for cases in later years. Fourth, because population denominators were not available for PCV7 vaccination rates and underlying disease rates, the final models were unable to control for those factors and were limited to stratified analyses. Lastly, area-based socioeconomic measures are not proxies for individual- level socioeconomic status, so it is possible that significant associations exist between socioeconomic factors and invasive pneumococcal disease rates in children even though they were not observed in this stu...
Strengths and Limitations. The current work should be interpreted in light of a number of strengths and limitations as below described. This is the first systematic review of twin studies on hoarding to date, providing an overview of the results on aetiological risk factors for hoarding behaviour. The review was furthermore completed using a wide and systematic search of the literature, including the grey literature, in an attempt to avoid omitting any relevant data. The objective of the current review was to investigate heritability of hoarding symptoms and attempt to shed light on any gender- and age-related effects on risk factors for hoarding. A limitation of the study is that despite the use a wide literature search approach, only six studies met inclusion criteria, two of which were carried out on the same twin sample albeit using different measures (Xxxxxxxxx et al., 2009; Xxxxxxxxx et al., 2011). While general conclusions on the heritability and role of the environment in predisposing individuals to hoarding could be drawn, the limited number of studies including male and female twins did not allow us to draw firm conclusions on the impact of age and gender on heritability estimates for hoarding at this stage. Further research is needed to provide additional data and clarify this issue further. Although beyond the scope of the current review, undertaking a meta-analysis might allow the estimation of genetic and environmental factors being more rigorously assessed; this in turn would allow a better examination and quantification of the reasons behind the variation in results in twin studies of hoarding.
Strengths and Limitations. To my knowledge this is the first study examining arguments for and against issuing policy recommendations for cognitive health in aging. The issue is of immediate and of long-ranging public health concern due to public fears about cognition, the exorbitant personal and monetary costs of caring for people with dementia, and the projections that cognitive impairment prevalence will rise with continuing population aging. The arguments by prominent cognitive health experts provocatively question whether the randomized controlled trial standard used by the State-of-the-Science Conference on Preventing Dementia and Cognitive Decline for conclusions is an inappropriate standard for public health-
Strengths and Limitations. A previous study by Xxxxxx & Xxxxxxxx investigated the cost of conducting clinical trials using data from Medidata Solutions, Inc. and found that among biomedical research and development (R&D), grant cost per patient is increasing over time at a rate of 7.5% from 1989 to 2011 (2013). More importantly, they found that the growth rate of clinical trials pertaining to cardiovascular therapeutic areas in the United States increased at an average 14.1% between 2000 and 0000 (Xxxxxx & Xxxxxxxx, 2013). Therefore, our results indicate an increase of 14.56% (described earlier as roughly 15%) per year from 1999-2012 are in agreement with previous literature. Study strengths include strict trial selection criteria, inclusion of impactful variables, and the analysis of transparent, traceable, and publicly available information. Limitations of this partial evaluation study include concerns about sample size, indirect costs, and a few necessary assumptions. The small sample size provides a wide 95% confidence interval, and may have reduced generalizability as a limited, partial evaluation (Xxxxxxxx, 2008; Kumar, Williams, & Xxxxx, 2006). Additionally, there were challenges to collecting data because even among government-only sponsors, individual trial funding data from United States Department of Defense (DOD) and U.S. Department of Veterans Affairs (VA) could not be traced, limiting the trial database to xxxxxxxxxxxxxx.xxx. According to previous literature, trial data from xxxxxxxxxxxxxx.xxx may sometimes show incomplete information, because up to 29% of registered trials remain unpublished (Roumiantseva et al., 2013; Xxxxx et al., 2013). More importantly, this study did not include indirect costs and costs associated with clinical phases that could have provided more information as to the factors impacting cost trends. Additionally, a major limitation is present due to the nature of analyzing study duration and participant enrollment by year first received. More specifically, those studies received more recently by xxxxxxxxxxxxxx.xxx are faced with a temporal bias such that more recent trials are shorter and therefore have smaller durations and potentially less patient enrollment as well as costs. Further studies investigating more complete figures on industry-inclusive funding, private donations, and outcome variables should proceed with acknowledgment of these limitations. Other research, such as a trial focusing on cancer trial costs per patient, looks beyond pub...
Strengths and Limitations. The relationship between geographic location and colorectal cancer survival has been studied in many countries using statewide and countrywide cancer registries including the SEER database (8, 28, 36, 51). However, no population-based research has been performed in the United States, to the knowledge of the author, to determine differences in early stage surgically treated colorectal cancer survival which may exist as a result of proximity to a metropolitan area, and by inference to cancer care. SEER’s 18 cancer registries house data on a significant proportion of the U.S. population and are widely distributed across the country (52). The large sample size of the study population increased statistical power, which lent to the validity of the analyses. In addition, re-categorization of USDA RUCC allowed for our study population to be assessed not only on sociodemographic characteristics, but also by proxy, on proximity from cancer care. The use of the exposure variable in this way provided a more in-depth analysis of the nuances surrounding early stage CRC survival. Furthermore, the use of this data allows for generalizability of study findings and possibly, advances in cancer research and cancer care. SEER data, however, posed several limitations. While SEER data provides information on major clinical and sociodemographic predictors, data on colorectal cancer screening and time to surgery are not available using SEER public-access database. Lead time is the time added to survival as a result of early screening and diagnosis of cancer. With increasing CRC screening trends, the presence of lead-time bias has become more evident in survival analysis and has been known to exaggerate relative survival estimates; however, because this study mainly focuses on the differences in survival across time, the risk of bias may have been reduced (63). With the ability to identify time to surgery, defined as duration of time from diagnosis to surgery, immortal time bias could have potentially been removed from the study by excluding immortal person-time from the survival analysis (59). Based on the sub-analysis performed earlier, it is anticipated that this bias was insignificant in this study; however, this limitation is worthy of note for future survival studies. More importantly for this study, the lack of facility-related data in SEER created a drawback in the direct assessment of access to and utilization of colorectal cancer care. Provision of variables which descri...
Strengths and Limitations. Actual data usage may differ from reported data usage. Also, although we explicitly defined research to mean as ―an activity that involves a research plan and data analysis to answer a research question intended to contribute to generalizable knowledge.‖(67) it is possible that some IPMs considered certain activities to be programmatic, and did not consider such investigations as ―research.‖ Our very high response rate for this survey limits some sources of bias and provides a representative set of results.
Strengths and Limitations. The systematic use of grounded theory in analyzing these FGDs provided a theory that the research team hopes can then be disseminated to stakeholders and presented for policy improvements. The use of Grounded Theory also allowed for the inclusive of context and gave a greater understanding of the full dietary and social changes taking place. Additionally, this study was led with local organizations that have existing relationships with the pastoralist communities of Morogoro and Tanga regions, and the FGDs were carried out by Tanzanian host country nationals in Kinyarwanda, all of which aided in the development of rapport. One weakness is that pastoral communities are very diverse. This means that the weight of each driver of diet change and the role of social connectedness will differ between communities. This means that caution must be taken when generalizing the results of this study to populations that are of different ethnic groups than those included here. It should be noted that factors biasing participants responses, such as seasonality, most recent foods eaten, and hunger at the time of the discussion could be present. Additionally, the lack of research among young adult pastoralists and social connectedness was limiting to the involvement of literature in deductive analysis.
