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1. Engagement With a Behavior Change App for Alcohol Reduction: Data Visualization for Longitudinal Observational Study

Author

Bell, Lauren, Garnett, Claire, Qian, Tianchen, Perski, Olga, Williamson, Elizabeth, and Potts, Henry WW

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

BackgroundBehavior change apps can develop iteratively, where the app evolves into a complex, dynamic, or personalized intervention through cycles of research, development, and implementation. Understanding how existing users engage with an app (eg, frequency, amount, depth, and duration of use) can help guide further incremental improvements. We aim to explore how simple visualizations can provide a good understanding of temporal patterns of engagement, as usage data are often longitudinal and rich. ObjectiveThis study aims to visualize behavioral engagement with Drink Less, a behavior change app to help reduce hazardous and harmful alcohol consumption in the general adult population of the United Kingdom. MethodsWe explored behavioral engagement among 19,233 existing users of Drink Less. Users were included in the sample if they were from the United Kingdom; were 18 years or older; were interested in reducing their alcohol consumption; had a baseline Alcohol Use Disorders Identification Test score of 8 or above, indicative of excessive drinking; and had downloaded the app between May 17, 2017, and January 22, 2019 (615 days). Measures of when sessions begin, length of sessions, time to disengagement, and patterns of use were visualized with heat maps, timeline plots, k-modes clustering analyses, and Kaplan-Meier plots. ResultsThe daily 11 AM notification is strongly associated with a change in engagement in the following hour; reduction in behavioral engagement over time, with 50.00% (9617/19,233) of users disengaging (defined as no use for 7 or more consecutive days) 22 days after download; identification of 3 distinct trajectories of use, namely engagers (4651/19,233, 24.18% of users), slow disengagers (3679/19,233, 19.13% of users), and fast disengagers (10,903/19,233, 56.68% of users); and limited depth of engagement with 85.076% (7,095,348/8,340,005) of screen views occurring within the Self-monitoring and Feedback module. In addition, a peak of both frequency and amount of time spent per session was observed in the evenings. ConclusionsVisualizations play an important role in understanding engagement with behavior change apps. Here, we discuss how simple visualizations helped identify important patterns of engagement with Drink Less. Our visualizations of behavioral engagement suggest that the daily notification substantially impacts engagement. Furthermore, the visualizations suggest that a fixed notification policy can be effective for maintaining engagement for some users but ineffective for others. We conclude that optimizing the notification policy to target both effectiveness and engagement is a worthwhile investment. Our future goal is to both understand the causal effect of the notification on engagement and further optimize the notification policy within Drink Less by tailoring to contextual circumstances of individuals over time. Such tailoring will be informed from the findings of our micro-randomized trial (MRT), and these visualizations were useful in both gaining a better understanding of engagement and designing the MRT.

Published
2020
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2. Notifications to Improve Engagement With an Alcohol Reduction App: Protocol for a Micro-Randomized Trial

Author

Bell, Lauren, Garnett, Claire, Qian, Tianchen, Perski, Olga, Potts, Henry W W, and Williamson, Elizabeth

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundDrink Less is a behavior change app that aims to help users in the general adult population reduce hazardous and harmful alcohol consumption. The app includes a daily push notification, delivered at 11 am, asking users to “Please complete your mood and drinking diaries.” Previous analysis of Drink Less engagement data suggests the current notification strongly influences how users engage with the app in the subsequent hour. To exploit a potential increase of vulnerability of excess drinking and opportunity to engage with the app in the evenings, we changed the delivery time from 11 am to 8 pm. We now aim to further optimise the content and sequence of notifications, testing 30 new evidence-informed notifications targeting the user’s perceived usefulness of the app. ObjectiveThe primary objective is to assess whether sending a notification at 8 pm increases behavioral engagement (opening the app) in the subsequent hour. Secondary objectives include comparing the effect of the new bank of messages with the standard message and effect moderation over time. We also aim to more generally understand the role notifications have on the overall duration, depth, and frequency of engagement with Drink Less over the first 30 days after download. MethodsThis is a protocol for a micro-randomized trial with two additional parallel arms. Inclusion criteria are Drink Less users who (1) consent to participate in the trial; (2) self-report a baseline Alcohol Use Disorders Identification Test score of 8 or above; (3) reside in the United Kingdom; (4) age ≥18 years and; (5) report interest in drinking less alcohol. In the micro-randomized trial, participants will be randomized daily at 8 pm to receive no notification, a notification with text from the new message bank, or the standard message. The primary outcome is the time-varying, binary outcome of “Did the user open the app in the hour from 8 pm to 9 pm?”. The primary analysis will estimate the marginal relative risk for the notifications using an estimator developed for micro-randomized trials with binary outcomes. Participants randomized to the parallel arms will receive no notifications (Secondary Arm A), or the standard notification delivered daily at 11 am (Secondary Arm B) over 30 days, allowing the comparison of overall engagement between different notification delivery strategies. ResultsApproval was granted by the University College of London’s Departmental Research Ethics Committee (CEHP/2016/556) on October 11, 2019, and The London School of Hygiene and Tropical Medicine Interventions Research Ethics Committee (17929) on November 27, 2019. Recruitment began on January 2, 2020, and is ongoing. ConclusionsUnderstanding how push notifications may impact engagement with a behavior change app can lead to further improvements in engagement, and ultimately help users reduce their alcohol consumption. This understanding may also be generalizable to other apps that target a variety of behavior changes. International Registered Report Identifier (IRRID)DERR1-10.2196/18690

Published
2020
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3. Estimating Causal Effects for Binary Outcomes Using Per-Decision Inverse Probability Weighting

Author

Bao, Yihan, Bell, Lauren, Williamson, Elizabeth, Garnett, Claire, and Qian, Tianchen

Subjects
Statistics - Methodology, Statistics - Applications
Abstract

Micro-randomized trials are commonly conducted for optimizing mobile health interventions such as push notifications for behavior change. In analyzing such trials, causal excursion effects are often of primary interest, and their estimation typically involves inverse probability weighting (IPW). However, in a micro-randomized trial, additional treatments can often occur during the time window over which an outcome is defined, and this can greatly inflate the variance of the causal effect estimator because IPW would involve a product of numerous weights. To reduce variance and improve estimation efficiency, we propose two new estimators using a modified version of IPW, which we call "per-decision IPW". The second estimator further improves efficiency using the projection idea from the semiparametric efficiency theory. These estimators are applicable when the outcome is binary and can be expressed as the maximum of a series of sub-outcomes defined over sub-intervals of time. We establish the estimators' consistency and asymptotic normality. Through simulation studies and real data applications, we demonstrate substantial efficiency improvement of the proposed estimator over existing estimators. The new estimators can be used to improve the precision of primary and secondary analyses for micro-randomized trials with binary outcomes., Comment: Published by Biostatistics

Published
2023

4. Multiple Imputation Approaches for Epoch-level Accelerometer data in Trials

Author

Tackney, Mia S., Williamson, Elizabeth, Cook, Derek G., Limb, Elizabeth, Harris, Tess, and Carpenter, James

Subjects
Statistics - Methodology, Statistics - Applications
Abstract

Clinical trials that investigate interventions on physical activity often use accelerometers to measure step count at a very granular level, often in 5-second epochs. Participants typically wear the accelerometer for a week-long period at baseline, and for one or more week-long follow-up periods after the intervention. The data is usually aggregated to provide daily or weekly step counts for the primary analysis. Missing data are common as participants may not wear the device as per protocol. Approaches to handling missing data in the literature have largely defined missingness on the day level using a threshold on daily wear time, which leads to loss of information on the time of day when data are missing. We propose an approach to identifying and classifying missingness at the finer epoch-level, and then present two approaches to handling missingness. Firstly, we present a parametric approach which takes into account the number of missing epochs per day. Secondly, we describe a non-parametric approach to Multiple Imputation (MI) where missing periods during the day are replaced by donor data from the same person where possible, or data from a different person who is matched on demographic and physical activity-related variables. Our simulation studies comparing these approaches in a number of settings show that the non-parametric approach leads to estimates of the effect of treatment that are least biased while maintaining small standard errors. We illustrate the application of these different MI strategies to the analysis of the 2017 PACE-UP Trial. The proposed framework of classifying missingness and applying MI at the epoch-level is likely to be applicable to a number of different outcomes and data from other wearable devices., Comment: 32 pages, 16 figures, 2 tables

Published
2023

5. Effectiveness and risk of ARB and ACEi among different ethnic groups in England: A reference trial (ONTARGET) emulation analysis using UK Clinical Practice Research Datalink Aurum-linked data

Author

Baptiste, Paris J., Wong, Angel Y. S., Schultze, Anna, Clase, Catherine M., Leyrat, Clémence, Williamson, Elizabeth, Powell, Emma, Mann, Johannes F. E., Cunnington, Marianne, Teo, Koon, Bangdiwala, Shrikant I., Gao, Peggy, Wing, Kevin, and Tomlinson, Laurie

Subjects
England -- Health aspects, Angiotensin II receptor blockers -- Statistics -- Complications and side effects, Minorities -- Drug therapy -- Statistics, ACE inhibitors -- Statistics -- Complications and side effects, Ethnic groups -- Statistics -- Drug therapy, Drugs -- Adverse and side effects, Angioneurotic edema -- Risk factors -- Statistics, Biological sciences
Abstract

Background Guidelines by the National Institute for Health and Care Excellence recommend an angiotensin receptor blocker (ARB) rather than an angiotensin-converting enzyme inhibitor (ACEi) for the treatment of hypertension for people of African and Caribbean descent, due to an increased risk of angioedema associated with ACEi use observed in US trials. However, the effectiveness and risk of these drugs in Black populations in UK routine care is unknown. Methods and findings We applied a reference trial emulation approach to UK Clinical Practice Research Datalink Aurum data (linked with data from Hospital Episode Statistics and Office for National Statistics) to study the comparative effectiveness of ARB and ACEi in ethnic minority groups in England, after benchmarking results against the ONTARGET trial. Approximately 17,593 Black, 30,805 South Asian, and 524,623 White patients receiving a prescription for ARB/ACEi between 1 January 2001 and 31 July 2019 were included with a median follow-up of 5.2 years. The primary composite outcome was cardiovascular-related death, myocardial infarction, stroke, or hospitalisation for heart failure with individual components studied as secondary outcomes. Angioedema was a safety endpoint. We assessed outcomes using an inverse-probability-weighted Cox proportional hazards model for ARB versus ACEi with heterogeneity by ethnicity assessed on the relative and absolute scale. For the primary outcome, 27,327 (18.0%) events were recorded in the ARB group (event rate: 25% per 5.5 person-years) and 80,624 (19.1%) events (event rate: 26% per 5.5 person-years) in the ACEi group. We benchmarked results against ONTARGET and observed hazard ratio (HR) 0.96 (95% CI: 0.95, 0.98) for the primary outcome, with an absolute incidence rate difference (IRD)% of -1.01 (95% CI: -1.42, -0.60) per 5.5 person-years. We found no evidence of treatment effect heterogeneity by ethnicity for the primary outcome on the multiplicative (P.sub.int = 0.422) or additive scale (P.sub.int = 0.287). Results were consistent for most secondary outcomes. However, for cardiovascular-related death, which occurred in 37,554 (6.6%) people, there was strong evidence of heterogeneity on the multiplicative (P.sub.int = 0.002) and additive scale (P.sub.int < 0.001). Compared to ACEi, ARB were associated with more events in Black individuals (HR 1.20 (95% CI: 1.02, 1.40); IRD% 1.07 (95% CI: 0.10, 2.04); number-needed-to-harm (NNH): 93) and associated with fewer events in White individuals (HR 0.91 (95% CI: 0.88, 0.93); IRD% -0.87 (95% CI: -1.10, -0.63); number-needed-to-treat (NNT): 115), and no differences in South Asian individuals (HR 0.97 (95% CI: 0.86, 1.09); IRD% -0.17 (95% CI: -0.87, 0.53)). For angioedema, HR 0.56 (95% CI: 0.46, 0.67) with no heterogeneity for ARB versus ACEi on the multiplicative scale (P.sub.int = 0.306). However, there was heterogeneity on the additive scale (P.sub.int = 0.023). Absolute risks were higher in Black individuals (IRD% -0.49 (95% CI: -0.79, -0.18); NNT: 204) compared with White individuals (IRD% -0.06 (95% CI: -0.09, -0.03); NNT: 1667) and no difference among South Asian individuals (IRD% -0.05 (95% CI: -0.15, 0.05) for ARB versus ACEi. Conclusions These results demonstrate variation in drug effects of ACEi and ARB for some outcomes by ethnicity and suggest the potential for adverse consequences from current UK guideline recommendations for ARB in preference to ACEi for Black individuals., Author(s): Paris J. Baptiste 1,2,*, Angel Y. S. Wong 2, Anna Schultze 2, Catherine M. Clase 3,4, Clémence Leyrat 5, Elizabeth Williamson 5, Emma Powell 2, Johannes F. E. Mann [...]

Published
2024
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7. Clinical coding of long COVID in primary care 2020–2023 in a cohort of 19 million adults: an OpenSAFELY analysis

Author

Walker, Alex, Green, Amelia, Mehrkar, Amir, Schaffer, Andrea, Brown, Andrew, Goldacre, Ben, Butler-Cole, Ben, MacKenna, Brian, Morton, Caroline, Walters, Caroline, Stables, Catherine, Cunningham, Christine, Wood, Christopher, Andrews, Colm, Evans, David, Hickman, George, Curtis, Helen, Drysdale, Henry, Dillingham, Iain, Morley, Jessica, Massey, Jon, Nab, Linda, Hopcroft, Lisa, Fisher, Louis, Bridges, Lucy, Wiedemann, Milan, DeVito, Nicholas, Macdonald, Orla, Inglesby, Peter, Smith, Rebecca, Croker, Richard, Park, Robin, Higgins, Rose, Bacon, Sebastian, Davy, Simon, Maude, Steven, O'Dwyer, Thomas, Ward, Tom, Speed, Victoria, Hulme, William, Hart, Liam, Stokes, Pete, Bhaskaran, Krishnan, Costello, Ruth, Cowling, Thomas, Douglas, Ian, Eggo, Rosalind, Evans, Stephen, Forbes, Harriet, Grieve, Richard, Grint, Daniel, Herrett, Emily, Langan, Sinead, Mahalingasivam, Viyaasan, Mansfield, Kathryn, Mathur, Rohini, McDonald, Helen, Parker, Edward, Rentsch, Christopher, Schultze, Anna, Smeeth, Liam, Tazare, John, Tomlinson, Laurie, Walker, Jemma, Williamson, Elizabeth, Wing, Kevin, Wong, Angel, Zheng, Bang, Bates, Christopher, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, O'Hanlon, Shaun, Eavis, Alex, Jarvis, Richard, Avramov, Dima, Griffiths, Paul, Fowles, Aaron, Parkes, Nasreen, Perera, Rafael, Harrison, David, Khunti, Kamlesh, Sterne, Jonathan, Quint, Jennifer, Henderson, Alasdair D., Butler-Cole, Ben FC., Tomlinson, Laurie A., Marks, Michael, Jit, Mark, Briggs, Andrew, Lin, Liang-Yu, Carlile, Oliver, Bates, Chris, Bacon, Sebastian CJ., Dennison, William A., Costello, Ruth E., Wei, Yinghui, Walker, Alex J., and Eggo, Rosalind M.

Published
2024
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9. Covariate adjustment in randomised trials: canonical link functions protect against model mis-specification

Author

White, Ian R., Morris, Tim P, and Williamson, Elizabeth

Subjects
Statistics - Methodology
Abstract

Covariate adjustment has the potential to increase power in the analysis of randomised trials, but mis-specification of the adjustment model could cause error. We explore what error is possible when the adjustment model omits a covariate by randomised treatment interaction, in a setting where the covariate is perfectly balanced between randomised treatments. We use mathematical arguments and analyses of single hypothetical data sets. We show that analysis by a generalised linear model with the canonical link function leads to no error under the null -- that is, if treatment effect is truly zero under the adjusted model then it is also zero under the unadjusted model. However, using non-canonical link functions does not give this property and leads to potentially important error under the null. The error is present even in large samples and hence constitutes bias. We conclude that covariate adjustment analyses of randomised trials should avoid non-canonical links. If a marginal risk difference is the target of estimation then this should not be estimated using an identity link; alternative preferable methods include standardisation and inverse probability of treatment weighting., Comment: 10 pages, 1 figure

Published
2021

10. Planning a method for covariate adjustment in individually-randomised trials: a practical guide

Author

Morris, Tim P., Walker, A. Sarah, Williamson, Elizabeth J., and White, Ian R.

Subjects
Statistics - Methodology
Abstract

Background: It has long been advised to account for baseline covariates in the analysis of confirmatory randomised trials, with the main statistical justifications being that this increases power and, when a randomisation scheme balanced covariates, permits a valid estimate of experimental error. There are various methods available to account for covariates but it is not clear how to choose among them. Methods: Taking the perspective of writing a statistical analysis plan, we consider how to choose between the three most promising broad approaches: direct adjustment, standardisation and inverse-probability-of-treatment weighting. Results: The three approaches are similar in being asymptotically efficient, in losing efficiency with mis-specified covariate functions, and in handling designed balance. If a marginal estimand is targeted (for example, a risk difference or survival difference), then direct adjustment should be avoided because it involves fitting non-standard models that are subject to convergence issues. Convergence is most likely with IPTW. Robust standard errors used by IPTW are anti-conservative at small sample sizes. All approaches can use similar methods to handle missing covariate data. With missing outcome data, each method has its own way to estimate a treatment effect in the all-randomised population. We illustrate some issues in a reanalysis of GetTested, a randomised trial designed to assess the effectiveness of an electonic sexually-transmitted-infection testing and results service. Conclusions: No single approach is always best: the choice will depend on the trial context. We encourage trialists to consider all three methods more routinely., Comment: 1 figure, 5 main tables, 2 appendices, 2 appendix tables

Published
2021

11. Impact of long COVID on health-related quality-of-life: an OpenSAFELY population cohort study using patient-reported outcome measures (OpenPROMPT)

Author

Walker, Alex, Green, Amelia, Mehrkar, Amir, Schaffer, Andrea, Brown, Andrew, Goldacre, Ben, Butler-Cole, Ben, MacKenna, Brian, Morton, Caroline, Walters, Caroline, Stables, Catherine, Cunningham, Christine, Wood, Christopher, Andrews, Colm, Evans, David, Hickman, George, Curtis, Helen, Drysdale, Henry, Dillingham, Iain, Morley, Jessica, Massey, Jon, Nab, Linda, Hopcroft, Lisa, Fisher, Louis, Bridges, Lucy, Wiedemann, Milan, DeVito, Nicholas, Macdonald, Orla, Inglesby, Peter, Smith, Rebecca, Croker, Richard, Park, Robin, Higgins, Rose, Bacon, Sebastian, Davy, Simon, Maude, Steven, O'Dwyer, Thomas, Ward, Tom, Speed, Victoria, Hulme, William, Hart, Liam, Stokes, Pete, Bhaskaran, Krishnan, Costello, Ruth, Cowling, Thomas, Douglas, Ian, Eggo, Rosalind, Evans, Stephen, Forbes, Harriet, Grieve, Richard, Grint, Daniel, Herrett, Emily, Langan, Sinead, Mahalingasivam, Viyaasan, Mansfield, Kathryn, Mathur, Rohini, McDonald, Helen, Parker, Edward, Rentsch, Christopher, Schultze, Anna, Smeeth, Liam, Tazare, John, Tomlinson, Laurie, Walker, Jemma, Williamson, Elizabeth, Wing, Kevin, Wong, Angel, Zheng, Bang, Bates, Christopher, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, O'Hanlon, Shaun, Eavis, Alex, Jarvis, Richard, Avramov, Dima, Griffiths, Paul, Fowles, Aaron, Parkes, Nasreen, Perera, Rafael, Harrison, David, Khunti, Kamlesh, Sterne, Jonathan, Quint, Jennifer, Carlile, Oliver, Briggs, Andrew, Henderson, Alasdair D., Butler-Cole, Ben F.C., Tomlinson, Laurie A., Marks, Michael, Jit, Mark, Lin, Liang-Yu, Bates, Chris, Bacon, Sebastian C.J., Dennison, William A., Costello, Ruth E., Walker, Alex J., and Eggo, Rosalind M.

Published
2024
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12. Swift Rise Puts Trump Loyalist In the Spotlight

Author

Williamson, Elizabeth

Subjects
Electioneering, Political consultants -- Evaluation, Political campaigns, Presidential candidates -- Political activity
Abstract

The MAGA loyalist Mr. Patel aims to run the C.I.A. if Donald Trump wins the presidency. But critics say his swagger masks deep inexperience. As President Donald J. Trump battled […]

Published
2024

13. Court Ruling Clears Way For Infowars To Be Sold

Author

Williamson, Elizabeth

Subjects
Newtown, Connecticut School Shootings, 2012, Libel and slander -- Cases, Computer services industry -- Mergers, acquisitions and divestments -- Reorganization and restructuring, Damages -- Cases, Talk show hosts -- Cases -- Finance, Company legal issue, Company organization, Company financing, Company acquisition/merger, Computer services industry, Company restructuring/company reorganization, General interest, News, opinion and commentary
Abstract

A sale of the Infowars website and other property is set for November, and could determine the conspiracy theorist's fate as a broadcaster. A Houston bankruptcy judge ruled on Tuesday [...]

Published
2024

14. Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platform

Author

Chaturvedi, Nishi, Park, Chloe, Carnemolla, Alisia, Williams, Dylan, Knueppel, Anika, Boyd, Andy, Turner, Emma L., Evans, Katharine M., Thomas, Richard, Berman, Samantha, McLachlan, Stela, Crane, Matthew, Whitehorn, Rebecca, Oakley, Jacqui, Foster, Diane, Woodward, Hannah, Campbell, Kirsteen C., Timpson, Nicholas, Kwong, Alex, Soares, Ana Goncalves, Griffith, Gareth, Toms, Renin, Jones, Louise, Annie, Herbert, Mitchell, Ruth, Palmer, Tom, Sterne, Jonathan, Walker, Venexia, Huntley, Lizzie, Fox, Laura, Denholm, Rachel, Knight, Rochelle, Northstone, Kate, Kanagaratnam, Arun, Horne, Elsie, Forbes, Harriet, North, Teri, Taylor, Kurt, Arab, Marwa A.L., Walker, Scott, Coronado, Jose I.C., Karthikeyan, Arun S., Ploubidis, George, Moltrecht, Bettina, Booth, Charlotte, Parsons, Sam, Wielgoszewska, Bozena, Bridger-Staatz, Charis, Steves, Claire, Thompson, Ellen, Garcia, Paz, Cheetham, Nathan, Bowyer, Ruth, Freydin, Maxim, Roberts, Amy, Goldacre, Ben, Walker, Alex, Morley, Jess, Hulme, William, Nab, Linda, Fisher, Louis, MacKenna, Brian, Andrews, Colm, Curtis, Helen, Hopcroft, Lisa, Green, Amelia, Patalay, Praveetha, Maddock, Jane, Patel, Kishan, Stafford, Jean, Jacques, Wels, Tilling, Kate, Macleod, John, McElroy, Eoin, Shah, Anoop, Silverwood, Richard, Denaxas, Spiros, Flaig, Robin, McCartney, Daniel, Campbell, Archie, Tomlinson, Laurie, Tazare, John, Zheng, Bang, Smeeth, Liam, Herrett, Emily, Cowling, Thomas, Mansfield, Kate, Costello, Ruth E., Wang, Kevin, Mansfield, Kathryn, Mahalingasivam, Viyaasan, Douglas, Ian, Langan, Sinead, Brophy, Sinead, Parker, Michael, Kennedy, Jonathan, McEachan, Rosie, Wright, John, Willan, Kathryn, Badrick, Ellena, Santorelli, Gillian, Yang, Tiffany, Hou, Bo, Steptoe, Andrew, Giorgio, Di Gessa, Zhu, Jingmin, Zaninotto, Paola, Wood, Angela, Cezard, Genevieve, Ip, Samantha, Bolton, Tom, Sampri, Alexia, Rafeti, Elena, Almaghrabi, Fatima, Sheikh, Aziz, Shah, Syed A., Katikireddi, Vittal, Shaw, Richard, Hamilton, Olivia, Green, Michael, Kromydas, Theocharis, Kopasker, Daniel, Greaves, Felix, Willans, Robert, Glen, Fiona, Sharp, Steve, Hughes, Alun, Wong, Andrew, Howes, Lee Hamill, Rapala, Alicja, Nigrelli, Lidia, McArdle, Fintan, Beckford, Chelsea, Raman, Betty, Dobson, Richard, Folarin, Amos, Stewart, Callum, Ranjan, Yatharth, Carpentieri, Jd, Sheard, Laura, Fang, Chao, Baz, Sarah, Gibson, Andy, Kellas, John, Neubauer, Stefan, Piechnik, Stefan, Lukaschuk, Elena, Saunders, Laura C., Wild, James M., Smith, Stephen, Jezzard, Peter, Tunnicliffe, Elizabeth, Sanders, Zeena-Britt, Finnigan, Lucy, Ferreira, Vanessa, Green, Mark, Rhead, Rebecca, Kibble, Milla, Wei, Yinghui, Lemanska, Agnieszka, Perez-Reche, Francisco, Piehlmaier, Dominik, Teece, Lucy, Parker, Edward, Walker, Alex J., Inglesby, Peter, Curtis, Helen J., Morton, Caroline E., Morley, Jessica, Mehrkar, Amir, Bacon, Sebastian C.J., Hickman, George, Croker, Richard, Evans, David, Ward, Tom, DeVito, Nicholas J., Green, Amelia C.A., Massey, Jon, Smith, Rebecca M., Hulme, William J., Davy, Simon, Andrews, Colm D., Hopcroft, Lisa E.M., Drysdale, Henry, Dillingham, Iain, Park, Robin Y., Higgins, Rose, Cunningham, Christine, Wiedemann, Milan, Maude, Steven, Macdonald, Orla, Butler-Cole, Ben F.C., O'Dwyer, Thomas, Stables, Catherine L., Wood, Christopher, Brown, Andrew D., Speed, Victoria, Bridges, Lucy, Schaffer, Andrea L., Walters, Caroline E., Rentsch, Christopher T., Bhaskaran, Krishnan, Schultze, Anna, Williamson, Elizabeth J., McDonald, Helen I., Tomlinson, Laurie A., Mathur, Rohini, Eggo, Rosalind M., Wing, Kevin, Wong, Angel Y.S., Grieve, Richard, Grint, Daniel J., Mansfield, Kathryn E., Douglas, Ian J., Evans, Stephen J.W., Walker, Jemma L., Cowling, Thomas E., Herrett, Emily L., Parker, Edward P.K., Bates, Christopher, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, O'Hanlon, Shaun, Eavis, Alex, Jarvis, Richard, Avramov, Dima, Griffiths, Paul, Fowles, Aaron, Parkes, Nasreen, Nicholson, Brian, Perera, Rafael, Harrison, David, Khunti, Kamlesh, Sterne, Jonathan AC., Quint, Jennifer, Henderson, Alasdair D., Carreira, Helena, Bidulka, Patrick, Warren-Gash, Charlotte, Hayes, Joseph F., Quint, Jennifer K., Katikireddi, Srinivasa Vittal, and Langan, Sinéad M.

Published
2023
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15. Propensity scores using missingness pattern information: a practical guide

Author

Blake, Helen A., Leyrat, Clemence, Mansfield, Kathryn E., Seaman, Shaun, Tomlinson, Laurie A., Carpenter, James, and Williamson, Elizabeth J.

Subjects
Statistics - Methodology
Abstract

Electronic health records are a valuable data source for investigating health-related questions, and propensity score analysis has become an increasingly popular approach to address confounding bias in such investigations. However, because electronic health records are typically routinely recorded as part of standard clinical care, there are often missing values, particularly for potential confounders. In our motivating study -- using electronic health records to investigate the effect of renin-angiotensin system blockers on the risk of acute kidney injury -- two key confounders, ethnicity and chronic kidney disease stage, have $59\%$ and $53\%$ missing data, respectively. The missingness pattern approach (MPA), a variant of the missing indicator approach, has been proposed as a method for handling partially observed confounders in propensity score analysis. In the MPA, propensity scores are estimated separately for each missingness pattern present in the data. Although the assumptions underlying the validity of the MPA are stated in the literature, it can be difficult in practice to assess their plausibility. In this paper, we explore the MPA's underlying assumptions by using causal diagrams to assess their plausibility in a range of simple scenarios, drawing general conclusions about situations in which they are likely to be violated. We present a framework providing practical guidance for assessing whether the MPA's assumptions are plausible in a particular setting and thus deciding when the MPA is appropriate. We apply our framework to our motivating study, showing that the MPA's underlying assumptions appear reasonable, and we demonstrate the application of MPA to this study., Comment: 46 pages, 7 figures (2 in appendix), 3 tables (1 in appendix)

Published
2019

16. A Storied Washington House, Left Vacant in a 22-Year Battle

Author

Williamson, Elizabeth

Subjects
Residential real estate -- History, Homeowners -- Social aspects
Abstract

The home of the former Washington Post publisher was once a hub of power and comity. But after an 'insane' renovation spat, its new owner is looking to sell. President-elect […]

Published
2024

17. Sandy Hook Families Chasing Jones's Money Turn on Each Other

Author

Williamson, Elizabeth

Subjects
Newtown, Connecticut School Shootings, 2012, Libel and slander -- Cases, Talk show hosts -- Finance -- Cases, Company legal issue, Company financing, General interest, News, opinion and commentary
Abstract

A scramble for the Infowars host's meager assets pits Sandy Hook victims' families against one another in court. Alex Jones does not, for now, have to turn over the Infowars [...]

Published
2024

18. Judge Orders Sale of Jones's Personal Assets, but Keeps Infowars in Business

Author

Williamson, Elizabeth

Subjects
Newtown, Connecticut School Shootings, 2012, Libel and slander -- Cases, Damages -- Cases, Talk show hosts -- Cases, Company legal issue, General interest, News, opinion and commentary
Abstract

The ruling will allow the conspiracy theorist to continue broadcasting on Infowars, while the Sandy Hook families pursue payment of $1.4 billion in defamation damages. A Houston bankruptcy judge on [...]

Published
2024

19. Jones Seeks To Liquidate For His Lies

Author

Williamson, Elizabeth

Subjects
Psychological warfare, Freedom of speech, General interest, News, opinion and commentary
Abstract

But money to the families would fall far short of the more than $1.4 billion they were awarded by juries for Mr. Jones's lies about the 2012 school massacre. The [...]

Published
2024

20. Changes in COVID-19-related mortality across key demographic and clinical subgroups in England from 2020 to 2022: a retrospective cohort study using the OpenSAFELY platform

Author

Nab, Linda, Parker, Edward P K, Andrews, Colm D, Hulme, William J, Fisher, Louis, Morley, Jessica, Mehrkar, Amir, MacKenna, Brian, Inglesby, Peter, Morton, Caroline E, Bacon, Sebastian C J, Hickman, George, Evans, David, Ward, Tom, Smith, Rebecca M, Davy, Simon, Dillingham, Iain, Maude, Steven, Butler-Cole, Ben F C, O’Dwyer, Thomas, Stables, Catherine L, Bridges, Lucy, Bates, Christopher, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, Zheng, Bang, Williamson, Elizabeth J, Eggo, Rosalind M, Evans, Stephen J W, Goldacre, Ben, Tomlinson, Laurie A, and Walker, Alex J

Published
2023
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21. Predicting range shifts of African apes under global change scenarios

Author

Carvalho, Joana S., Graham, Bruce, Bocksberger, Gaёlle, Maisels, Fiona, Williamson, Elizabeth A., Wich, Serge, Sop, Tenekwetche, Amarasekaran, Bala, Barca, Benjamin, Barrie, Abdulai, Bergl, Richard A., Boesch, Christophe, Boesch, Hedwige, Brncic, Terry M., Buys, Bartelijntje, Chancellor, Rebecca, Danquah, Emmanuel, Doumbé, Osiris A., Le-Duc, Stephane Y., Galat-Luong, Anh, Ganas, Jessica, Gatti, Sylvain, Ghiurghi, Andrea, Goedmakers, Annemarie, Granier, Nicolas, Hakizimana, Dismas, Haurez, Barbara, Head, Josephine, Herbinger, Ilka, Hillers, Annika, Jones, Sorrel, Junker, Jessica, Maputla, Nakedi, Manasseh, Eno-Nku, McCarthy, Maureen S., Molokwu-Odozi, Mary, Morgan, Bethan J., Nakashima, Yoshihiro, N’Goran, Paul K., Nixon, Stuart, Nkembi, Louis, Normand, Emmanuelle, Nzooh, Laurent D.Z., Olson, Sarah H., Payne, Leon, Petre, Charles-Albert, Piel, Alex K., Pintea, Lilian, Plumptre, Andrew J., Rundus, Aaron, Serckx, Adeline, Stewart, Fiona A., Sunderland-Groves, Jacqueline, Tagg, Nikki, Todd, Angelique, Vosper, Ashley, Wenceslau, José F.C., Wessling, Erin G., Willie, Jacob, and Kühl, Hjalmar S.

Published
2021

23. A collaborative analysis of individual participant data from 19 prospective studies assesses circulating vitamin D and prostate cancer risk

Author

Travis, Ruth C, Perez-Cornago, Aurora, Appleby, Paul N, Albanes, Demetrius, Joshu, Corinne E, Lutsey, Pamela L, Mondul, Alison M, Platz, Elizabeth A, Weinstein, Stephanie J, Layne, Tracy M, Helzlsouer, Kathy J, Visvanathan, Kala, Palli, Domenico, Peeters, Petra H, Bueno-de-Mesquita, Bas, Trichopoulou, Antonia, Gunter, Marc J, Tsilidis, Konstantinos K, Sánchez, Maria-Jose, Olsen, Anja, Brenner, Hermann, Schöttker, Ben, Perna, Laura, Holleczek, Bernd, Knekt, Paul, Rissanen, Harri, Yeap, Bu B, Flicker, Leon, Almeida, Osvaldo P, Wong, Yuen Yee Elizabeth, Chan, June M, Giovannucci, Edward L, Stampfer, Meir J, Ursin, Giske, Gislefoss, Randi E, Bjørge, Tone, Meyer, Haakon E, Blomhoff, Rune, Tsugane, Shoichiro, Sawada, Norie, English, Dallas R, Eyles, Darryl W, Heath, Alicia K, Williamson, Elizabeth J, Manjer, Jonas, Malm, Johan, Almquist, Martin, Marchand, Loic Le, Haiman, Christopher A, Wilkens, Lynne R, Schenk, Jeannette M, Tangen, Cathy M, Black, Amanda, Cook, Michael B, Huang, Wen-Yi, Ziegler, Regina G, Martin, Richard M, Hamdy, Freddie C, Donovan, Jenny L, Neal, David E, Touvier, Mathilde, Hercberg, Serge, Galan, Pilar, Deschasaux, Mélanie, Key, Timothy J, and Allen, Naomi E

Subjects
Clinical Trials and Supportive Activities, Nutrition, Cancer, Prostate Cancer, Urologic Diseases, Prevention, Aging, Clinical Research, Aged, Case-Control Studies, Cross-Sectional Studies, Humans, Male, Middle Aged, Odds Ratio, Prospective Studies, Prostatic Neoplasms, Risk Assessment, Risk Factors, Vitamin D, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

Previous prospective studies assessing the relationship between circulating concentrations of vitamin D and prostate cancer risk have shown inconclusive results, particularly for risk of aggressive disease. In this study, we examine the association between prediagnostic concentrations of 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] and the risk of prostate cancer overall and by tumor characteristics. Principal investigators of 19 prospective studies provided individual participant data on circulating 25(OH)D and 1,25(OH)2D for up to 13,462 men with incident prostate cancer and 20,261 control participants. ORs for prostate cancer by study-specific fifths of season-standardized vitamin D concentration were estimated using multivariable-adjusted conditional logistic regression. 25(OH)D concentration was positively associated with risk for total prostate cancer (multivariable-adjusted OR comparing highest vs. lowest study-specific fifth was 1.22; 95% confidence interval, 1.13-1.31; P trend < 0.001). However, this association varied by disease aggressiveness (P heterogeneity = 0.014); higher circulating 25(OH)D was associated with a higher risk of nonaggressive disease (OR per 80 percentile increase = 1.24, 1.13-1.36) but not with aggressive disease (defined as stage 4, metastases, or prostate cancer death, 0.95, 0.78-1.15). 1,25(OH)2D concentration was not associated with risk for prostate cancer overall or by tumor characteristics. The absence of an association of vitamin D with aggressive disease does not support the hypothesis that vitamin D deficiency increases prostate cancer risk. Rather, the association of high circulating 25(OH)D concentration with a higher risk of nonaggressive prostate cancer may be influenced by detection bias. SIGNIFICANCE: This international collaboration comprises the largest prospective study on blood vitamin D and prostate cancer risk and shows no association with aggressive disease but some evidence of a higher risk of nonaggressive disease.

Published
2019

25. A Bellicose Ally Eyes a Top Job If Trump Wins

Author

Williamson, Elizabeth

Subjects
United States. Department of State, Ambassadors, General interest, News, opinion and commentary
Abstract

Richard Grenell's quest to be secretary of state in a second Trump administration began late on Election Day in 2020, when the defeated president dispatched loyalists to run shambolic ''stop [...]

Published
2024

26. From Pizzagate to 2020 Vote: Forcing Liars to Pay or Apologize

Author

Williamson, Elizabeth

Subjects
Libel and slander -- Cases, Disinformation -- Cases, Attorneys -- Practice -- Evaluation, Company legal issue, General interest, News, opinion and commentary
Abstract

Michael J. Gottlieb can never remember the exact amount -- it's $148,169,000-- that a jury ordered Rudolph W. Giuliani to pay the Georgia election workers Ruby Freeman and Shaye Moss. [...]

Published
2024

27. From Pizzagate to the 2020 Election: Forcing Liars to Pay or Apologize

Author

Williamson, Elizabeth

Subjects
Willkie Farr & Gallagher L.L.P. -- Officials and employees, Election workers, News, opinion and commentary
Abstract

Michael J. Gottlieb can never remember the exact amount — it’s $148,169,000— that a jury ordered Rudolph W. Giuliani to pay the Georgia election workers Ruby Freeman and Shaye Moss. [...]

Published
2024

30. Describing the population experiencing COVID-19 vaccine breakthrough following second vaccination in England: a cohort study from OpenSAFELY

Author

Green, Amelia, Curtis, Helen, Hulme, William, Williamson, Elizabeth, McDonald, Helen, Bhaskaran, Krishnan, Rentsch, Christopher, Schultze, Anna, MacKenna, Brian, Mahalingasivam, Viyaasan, Tomlinson, Laurie, Walker, Alex, Fisher, Louis, Massey, Jon, Andrews, Colm, Hopcroft, Lisa, Morton, Caroline, Croker, Richard, Morley, Jessica, Mehrkar, Amir, Bacon, Seb, Evans, David, Inglesby, Peter, Hickman, George, Ward, Tom, Davy, Simon, Mathur, Rohini, Tazare, John, Eggo, Rosalind, Wing, Kevin, Wong, Angel, Forbes, Harriet, Bates, Chris, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, Douglas, Ian, Evans, Stephen, Smeeth, Liam, and Goldacre, Ben

Published
2022
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31. Comparison of methods for predicting COVID-19-related death in the general population using the OpenSAFELY platform

Author

Williamson, Elizabeth J., Tazare, John, Bhaskaran, Krishnan, McDonald, Helen I., Walker, Alex J., Tomlinson, Laurie, Wing, Kevin, Bacon, Sebastian, Bates, Chris, Curtis, Helen J., Forbes, Harriet J., Minassian, Caroline, Morton, Caroline E., Nightingale, Emily, Mehrkar, Amir, Evans, David, Nicholson, Brian D., Leon, David A., Inglesby, Peter, MacKenna, Brian, Davies, Nicholas G., DeVito, Nicholas J., Drysdale, Henry, Cockburn, Jonathan, Hulme, William J., Morley, Jessica, Douglas, Ian, Rentsch, Christopher T., Mathur, Rohini, Wong, Angel, Schultze, Anna, Croker, Richard, Parry, John, Hester, Frank, Harper, Sam, Grieve, Richard, Harrison, David A., Steyerberg, Ewout W., Eggo, Rosalind M., Diaz-Ordaz, Karla, Keogh, Ruth, Evans, Stephen J. W., Smeeth, Liam, and Goldacre, Ben

Published
2022
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34. Propensity score analysis with partially observed confounders: how should multiple imputation be used?

Author

Leyrat, Clemence, Seaman, Shaun R., White, Ian R., Douglas, Ian, Smeeth, Liam, Kim, Joseph, Resche-Rigon, Matthieu, Carpenter, James R., and Williamson, Elizabeth J.

Subjects
Statistics - Methodology, G.3
Abstract

Inverse probability of treatment weighting (IPTW) is a popular propensity score (PS)-based approach to estimate causal effects in observational studies at risk of confounding bias. A major issue when estimating the PS is the presence of partially observed covariates. Multiple imputation (MI) is a natural approach to handle missing data on covariates, but its use in the PS context raises three important questions: (i) should we apply Rubin's rules to the IPTW treatment effect estimates or to the PS estimates themselves? (ii) does the outcome have to be included in the imputation model? (iii) how should we estimate the variance of the IPTW estimator after MI? We performed a simulation study focusing on the effect of a binary treatment on a binary outcome with three confounders (two of them partially observed). We used MI with chained equations to create complete datasets and compared three ways of combining the results: combining treatment effect estimates (MIte); combining the PS across the imputed datasets (MIps); or combining the PS parameters and estimating the PS of the average covariates across the imputed datasets (MIpar). We also compared the performance of these methods to complete case (CC) analysis and the missingness pattern (MP) approach, a method which uses a different PS model for each pattern of missingness. We also studied empirically the consistency of these 3 MI estimators. Under a missing at random (MAR) mechanism, CC and MP analyses were biased in most cases when estimating the marginal treatment effect, whereas MI approaches had good performance in reducing bias as long as the outcome was included in the imputation model. However, only MIte was unbiased in all the studied scenarios and Rubin's rules provided good variance estimates for MIte., Comment: 54 pages

Published
2016

35. Culture Wars Put Librarians On Front Lines

Author

Williamson, Elizabeth

Subjects
Public libraries -- Political aspects, Library materials -- Censorship -- Laws, regulations and rules, Culture conflict -- Political aspects -- Forecasts and trends, Library administration -- Political aspects, Ideology -- Political aspects, Librarians -- Political aspects, Government regulation, Market trend/market analysis, General interest, News, opinion and commentary
Abstract

During 12 years as a youth librarian in northern Idaho, Denise Neujahr read to and befriended children of many backgrounds. Devout or atheist, gay or straight, all were welcome until [...]

Published
2024

37. Cast as Criminals, America’s Librarians Rally to Their Own Defense

Author

Williamson, Elizabeth

Subjects
Teenagers, Youth, Librarians, News, opinion and commentary
Abstract

During 12 years as a youth librarian in northern Idaho, Denise Neujahr read to and befriended children of many backgrounds. Devout or atheist, gay or straight, all were welcome until [...]

Published
2024

42. Chesebro's Ex-Colleagues Struggle to Make Sense of His Journey to 'Stop the Steal'

Author

Williamson, Elizabeth

Subjects
Georgia -- Political aspects, Racketeering -- Cases, Attorneys -- Cases, Company legal issue, General interest, News, opinion and commentary
Abstract

Mr. Chesebro, a buttoned-down Harvard lawyer, evolved from left-leaning jurist to key player in the Trump false electors scandal. What happened? In January 2001, Kenneth Chesebro was a mild-mannered Harvard [...]

Published
2023

44. Judge Won't Let Jones Use Bankruptcy To Avoid Paying Sandy Hook Damages

Author

Williamson, Elizabeth

Subjects
Newtown Public School District. Sandy Hook Elementary School, Psychological warfare, Exemplary damages, Bankruptcy law, Bankruptcy, Company financing, Company bankruptcy, General interest, News, opinion and commentary
Abstract

A Texas court ruling means the Infowars broadcaster must pay most of the $1.4 billion he owes Sandy Hook families, regardless of whether his business survives. The judge in Alex [...]

Published
2023

45. Judge Won’t Let Alex Jones Use Bankruptcy to Avoid Sandy Hook Damages

Author

Williamson, Elizabeth

Subjects
Bankruptcy law, Bankruptcy, Company financing, Company bankruptcy, News, opinion and commentary
Abstract

A Texas court ruling means the Infowars broadcaster must pay most of the $1.4 billion he owes Sandy Hook families, regardless of whether his business survives. The judge in Alex [...]

Published
2023

46. Fighting to Save Sacred Parts of Black History

Author

Williamson, Elizabeth

Subjects
Juneteenth -- 2023 AD, Memorials -- 2023 AD, Floods -- Environmental aspects -- United States, Cemeteries -- Protection and preservation -- 2023 AD, Vandalism -- Investigations -- 2023 AD, Blacks -- History, Race discrimination -- Forecasts and trends -- 2023 AD, African Americans -- Social aspects -- 2023 AD, Company legal issue, Market trend/market analysis, General interest, News, opinion and commentary
Abstract

The child's headstone is inscribed simply ''Nannie,'' marking the grave of a 7-year-old girl who died on May 18, 1856. She is buried in one of Washington's oldest Black cemeteries, [...]

Published
2023

47. America’s Black Cemeteries and Three Women Trying to Save Them

Author

Williamson, Elizabeth

Subjects
Cemeteries, News, opinion and commentary
Abstract

The child’s headstone is inscribed simply “Nannie,” marking the grave of a 7-year-old girl who died on May 18, 1856. She is buried in one of Washington’s oldest Black cemeteries, [...]

Published
2023

48. Factors associated with COVID-19-related death using OpenSAFELY

Author

Williamson, Elizabeth J., Walker, Alex J., Bhaskaran, Krishnan, Bacon, Seb, Bates, Chris, Morton, Caroline E., Curtis, Helen J., Mehrkar, Amir, Evans, David, Inglesby, Peter, Cockburn, Jonathan, McDonald, Helen I., MacKenna, Brian, Tomlinson, Laurie, Douglas, Ian J., Rentsch, Christopher T., Mathur, Rohini, Wong, Angel Y. S., Grieve, Richard, Harrison, David, Forbes, Harriet, Schultze, Anna, Croker, Richard, Parry, John, Hester, Frank, Harper, Sam, Perera, Rafael, Evans, Stephen J. W., Smeeth, Liam, and Goldacre, Ben

Published
2020
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49. TATDN2 resolution of R-loops is required for survival of BRCA1-mutant cancer cells

Author

Jaiswal, Aruna S, primary, Dutta, Arijit, additional, Srinivasan, Gayathri, additional, Yuan, Yaxia, additional, Zhou, Daohong, additional, Shaheen, Montaser, additional, Sadideen, Doraid T, additional, Kirby, Austin, additional, Williamson, Elizabeth A, additional, Gupta, Yogesh K, additional, Olsen, Shaun K, additional, Xu, Mingjiang, additional, Loranc, Eva, additional, Mukhopadhyay, Pramiti, additional, Pertsemlidis, Alexander, additional, Bishop, Alexander J R, additional, Sung, Patrick, additional, Nickoloff, Jac A, additional, and Hromas, Robert, additional

Published
2023
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50. Challenges in Estimating Effectiveness of 2 Doses of COVID-19 Vaccines Beyond 6 Months in England

Author

Horne, Elsie M F, primary, Hulme, William J, additional, Keogh, Ruth H, additional, Palmer, Tom M, additional, Williamson, Elizabeth J, additional, Parker, Edward P K, additional, Walker, Venexia M, additional, Knight, Rochelle, additional, Wie, Yinghui, additional, Taylor, Kurt, additional, Fisher, Louis, additional, Morley, Jessica, additional, Mehrkar, Amir, additional, Dillingham, Iain, additional, Bacon, Sebastian, additional, Goldacre, Ben, additional, Sterne, Jonathan A C, additional, and Collaborative, The OpenSAFELY, additional

Published
2023
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