Author: Anonymous

You will roll a fair six-sided die.  You will win $4 is the roll is 5 or higher, and lose $3 if the roll is 4 or lower.  Find the expected value of the die roll to the nearest penny. [positiveornegative]$[15ones].[15tenths][15hundredths]

Study Design (Modified) Initiation of either metformin use or sulfonylurea use was defined as not having a history of use of either medication before entering the study and refilling at least 1 prescription within 60 days after the end of the supply of the first prescription (30). The date of the first refill was denoted as the index date. We did not exclude the patients with type 2 diabetes who used other types of antidiabetic medication before the first prescription of either metformin or a sulfonylurea. Because metformin is contraindicated for patients with severe chronic kidney disease (31), we excluded persons with severe chronic kidney disease (30), defined as an estimated glomerular filtration rate less than 30 mL/minute/1.73 m2 on at least 2 occasions more than 90 days apart or at least 1 Read code for advanced chronic kidney disease (32). In addition, we also excluded persons who had a history of VTE before the index date or who had no general practitioner visit or specialist referral within 1 year before the index date. Assessment of outcomes (Modified) The primary outcome of interest was a diagnosis of incident VTE (the combined endpoint of PE and DVT), with secondary outcomes of PE and DVT separately. An individual was considered to have developed the outcome of interest if he or she had a recorded Read code of PE or DVT and received anticoagulant treatment (36). Since VTE is potentially fatal and some individuals might have died before receiving an anticoagulant, we also considered participants to have developed VTE if they died within 1 month after a recorded code of PE or DVT but without a prescription for an anticoagulant or autopsy results (37). Note: Read codes are a thesaurus of terms, synonyms, and abbreviations used in medical practice in the UK and can be mapped on to ICD-10 codes. Results (Modified) Table 1 Metformin Sulfonylurea Total VTE 555 75 630 No VTE 116,917 13,760 130,677 Total 117,472 13,835 131,307 Question 1c: Using data from Table 1, calculate the appropriate crude relative measure of association comparing VTE among those using metformin and those using sulfonylurea. Show your formula in the free-text space provided. Round your final answer to two decimal places (0.00). 

Question 1g: Based on your calculations in Question 1f and the DAG below, what role does biological sex play in the relationship between metformin and VTE? Briefly justify your answer in the context of the question and provide a general conclusion based on your findings (2-4 sentences). Assume anything greater than a 1% change from the crude measure of association is a notable difference between measures. 

EC Question 2: 

Wu, K., Feskanich, D., Fuchs, C.S., Willett, W.C., Hollis, B.W. and Giovannucci, E.L., 2007. A nested case–control study of plasma 25-hydroxyvitamin D concentrations and risk of colorectal cancer. Journal of the National Cancer Institute, 99(14), pp.1120-1129. Study Purpose and Design (Modified): Wu et al conducted a study to investigate the relationship between low vitamin D status (25-hydroxyvitamin D level 90%) were confirmed through medical records; the remaining cases were confirmed by corroborating information on cancer diagnosis from participants (i.e., through consent forms sent by participants). Participants without cancer were identified by the year (same year) and month (within 1 month) of blood donation. Results (Modified) Vitamin D Status Colorectal Cancer No Colorectal Cancer Total Deficient 103 167 270 Not Deficient 76 189 265 Total 179 356 535 Question 2a. Calculate the appropriate relative measure of association for this study comparing those who are not vitamin D deficient (exposed) to those who are vitamin D deficient (unexposed). Show your calculations in the free-text space provided. Round your final answer to two decimal places (i.e., 0.00). 

Sha, T., Zhang, Y., Li, C., Lei, G., Wu, J., Li, X., Yang, Z., Zeng, C. and Wei, J., 2022. Association of metformin use with risk of venous thromboembolism in adults with type 2 diabetes: a general-population–based cohort study. American Journal of Epidemiology, 191(5), pp.856-866. Study Abstract (Modified) Metformin is hypothesized to protect against the risk of venous thromboembolism (VTE); however, there is a paucity of data supporting this hypothesis. Among individuals aged 40–90 years with a diagnosis of type 2 diabetes in the Health Improvement Network database (2000–2019), we compared [outcomes of] VTE, pulmonary embolism, and deep vein thrombosis among metformin initiators with those among sulfonylurea initiators. Individuals were followed from their first prescription refill to an incident VTE, drug discontinuation, switching or augmenting, plan disenrollment, or the end of the study, whichever occurred first… Question 1a: What was the purpose of the study conducted by Sha et al?

Covariate Assessments (Modified): Information on lifestyle or dietary factors was obtained from the biannual questionnaires (i.e., 1986, 1988, 1990, 1992, and 1994) or food frequency questionnaires (FFQs; i.e., 1986, 1990, and 1994). To better approximate long-term nutrient intake, we calculated cumulatively updated intake using information from the 1986, 1990, and 1994 FFQs ( 19 ). Because plasma [vitamin D] concentrations reflect recent intake, [dietary] intakes of vitamin D… were calculated using the information from the FFQ closest to the time the blood sample was provided (1994 FFQ) or, if not available, from the most recent questionnaire administered before 1994 (96% of participants in the HPFS had provided information on dietary intake in 1994). Note: Suppose that in addition to the timing information provided above, the authors also noted that the FFQs asked participants to complete dietary assessments for the past 30 days. Food Frequency Questionnaires (FFQs) are detailed dietary assessments that capture the consumption of specific food items and portion sizes over the recall time period. They are used to determine nutrient intake for participants. Question 2e: Diet is considered to be a confounder of the relationship between sufficient vitamin D levels and colorectal cancer. Based on the information provided about dietary data collection for this study, describe the type(s) of bias that may impact study findings. How might this relate to the measurement of the exposure of interest? How might these biases impact study findings? Your answer should be 5-7 sentences.

Question 2d: Based on the 95% CI you calculated in Question 2c, provide an interpretation of this confidence interval. What additional information does the confidence interval provide that the p-value does not? Briefly explain in the context of the study. 

Which of the following therapy characteristics are associated with enhanced motor learning and skill acquisition in dysphagia therapy?

If a patient “refuses” to adhere to a recommended diet, we should have them sign a waiver and discharge them from caseload. This statement is FALSE. Review the choices below and pick the most appropriate reasoning for it. (Check ONLY 3 responses; Partial credit available)