BACKGROUND & AIMS: OBJECTIVES:A number of observational studies have reported that, in patients with chronic obstructive pulmonary disease (COPD), β blockers (BBs) decrease risk of mortality and COPD exacerbations. To address important methodological concerns of these studies, we compared the effectiveness and safety of cardioselective BBs versus non-dihydropyridine calcium channel blockers (non-DHP CCBs) in patients with COPD and acute coronary syndromes (ACS) using a propensity score (PS)-matched, active comparator, new user design. We also assessed for potential unmeasured confounding by examining a short-term COPD hospitalisation outcome. SETTING AND PARTICIPANTS:We identified 22 985 patients with COPD and ACS starting cardioselective BBs or non-DHP CCBs across 5 claims databases from the USA, Italy and Taiwan. PRIMARY AND SECONDARY OUTCOME MEASURES:Stratified Cox regression models were used to estimate HRs for mortality, cardiovascular (CV) hospitalisations and COPD hospitalisations in each database after variable-ratio PS matching. Results were combined with random-effects meta-analyses. RESULTS:Cardioselective BBs were not associated with reduced risk of mortality (HR, 0.90; 95% CI 0.78 to 1.02) or CV hospitalisations (HR, 1.06; 95% CI 0.91 to 1.23), although statistical heterogeneity was observed across databases. In contrast, a consistent, inverse association for COPD hospitalisations was identified across databases (HR, 0.54; 95% CI 0.47 to 0.61), which persisted even within the first 30 days of follow-up (HR, 0.55; 95% CI 0.37 to 0.82). Results were similar across a variety of sensitivity analyses, including PS trimming, high dimensional-PS matching and restricting to high-risk patients. CONCLUSIONS:This multinational study found a large inverse association between cardioselective BBs and short-term COPD hospitalisations. The persistence of this bias despite state-of-the-art pharmacoepidemiologic methods calls into question the ability of claims data to address confounding in studies of BBs in patients with COPD.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To compare the characteristics and survival of participants and nonparticipants in a community-based study of myocardial infarction (MI). PARTICIPANTS AND METHODS:Residents of Olmsted County, MN, who presented with elevated cardiac troponin T levels from September 1, 2002, through December 31, 2005, were prospectively enrolled and classified with standardized criteria for MI. With specific Institutional Review Board approval, the medical records of patients with MI who did not provide consent but who had given general research authorization were reviewed, as was done for their consenting peers. RESULTS:During the study period, 2277 individuals with elevated cardiac troponin T levels were approached, of whom 1863 (82 percent) consented to participate. Among the 414 nonparticipants, 375 (91 percent) had general research authorization. Of the 558 with general research authorization who met the criteria for incident (ie, first-ever) MI, 67 (12 percent) refused to participate. These participants tended to be older (mean plus or minus SD age, 71 plus or minus 14 vs 67 plus or minus 15 years; P equals .04), were more likely to be of races other than white (9 percent vs 2 percent; P equals .01), and had more comorbidities, including peripheral vascular disease (P equals .02), chronic pulmonary disease (P equals .06), heart failure (P equals .07), and impaired creatinine clearance (P equals .02). No significant differences were detected in cardiovascular risk factors or MI characteristics. During a median follow-up of 517 days, nonparticipants experienced increased mortality rates compared with participants (hazard ratio, 1.97; 95 percent confidence interval, 1.21 to 3.20), which was largely attributable to their older age and excess comorbidities (adjusted hazard ratio, 1.43; 95 percent confidence interval, 0.86 to 2.35). CONCLUSION:In this community-based study of MI, nonparticipants experienced worse survival rates than participants largely because of differences in demographic and clinical characteristics. These differences should be kept in mind when interpreting study results, particularly if participation is low.

背景与目标：

BACKGROUND & AIMS: :A systematic review of PDE-5 inhibitors for erectile dysfunction was performed to evaluate the utility of quantitative methods for identifying and exploring the influence of bias and study quality on pooled outcomes from meta-analyses. We included 123 randomized controlled trials (RCTs). Methodological quality was poorly reported. All three drugs appeared highly effective. Indirect adjusted analyses showed no differences between the three drugs. Funnel plots and statistical tests showed no evidence of small-study effects for sildenafil whereas there was evidence of such bias for tadalafil and vardenafil. Adjustment for missing studies using trim and fill techniques did not alter the pooled estimates substantially. The exclusion of previous sildenafil nonresponders was associated with larger treatment effects for tadalafil. This investigation was hampered by poor reporting of methodological quality, a low number of studies, heterogeneity and large effect sizes. Despite such limitations, a comprehensive assessment of biases should be a routine in systematic reviews.

背景与目标： : 对勃起功能障碍的PDE-5抑制剂进行了系统评价，以评估定量方法在鉴定和探索偏倚和研究质量对荟萃分析汇总结果的影响方面的实用性。我们纳入了123随机对照试验 (RCTs)。方法学质量报道不佳。这三种药物都非常有效。间接校正分析显示三种药物之间没有差异。漏斗图和统计测试没有证据表明西地那非的小研究效果，而有证据表明他达拉非和伐地那非存在这种偏倚。使用trim和fill技术对缺失研究进行的调整不会显着改变汇总的估计值。排除先前的西地那非无反应者与他达拉非更大的治疗效果相关。这项研究受到方法质量报告不佳，研究数量少，异质性和大效应大小的阻碍。尽管有这些限制，但对偏见的全面评估应该是系统审查的常规。

BACKGROUND & AIMS: :Current literature and clinical guidelines do not include pregnant women as an a priori risk group for COVID-19. However, a gender vision of health begs the question: Why are pregnant women not considered a risk group for COVID-19? The answer is clear: historically, most community scientific studies have not considered female gender, or pregnancy as a state, to be a focus of special interest or effort. Unfortunately, this bias seems to be maintained in the COVID-19 epidemic: most current guidelines for diagnosing SARS-CoV-2 infection during pregnancy apply the same standard criteria as for the general population. This pandemic is an opportunity to begin redressing this historic gender bias against pregnant women, and to achieve this, we recommend two actions that are easy to implement, and would have a large impact. First, routinely test for SARS-CoV-2 infection in all pregnant women with clinical or epidemiological suspicion, regardless of gestational age or the clinical severity. Second, routinely test for SARS-CoV-2 infection in all pregnant women at admission for delivery. These actions are essential to understand the true impact of COVID-19 throughout pregnancy, and will improve how we manage many aspects of pre- and postnatal care. It is the scientific community's responsibility to guide, even to anticipate, the recommendations of our respective governments' health policies. If we do not agree to consider pregnant women as a distinct priority subgroup of the population during this pandemic, once again we will miss an opportunity to overcome this historic bias.

背景与目标： : 目前的文献和临床指南没有将孕妇作为新型冠状病毒肺炎的先验风险人群。然而，性别对健康的看法回避了一个问题: 为什么孕妇不被认为新型冠状病毒肺炎的风险群体？答案很明确: 从历史上看，大多数社区科学研究都没有将女性性别或怀孕视为一种状态，作为特别感兴趣或努力的重点。不幸的是，这种偏见似乎在COVID-19流行病中得以维持: 目前大多数诊断怀孕期间SARS-CoV-2感染的指南都采用与普通人群相同的标准。这场大流行是一个机会，可以开始纠正这种针对孕妇的历史性性别偏见，为了实现这一目标，我们建议采取两项易于实施并产生重大影响的行动。首先，对所有有临床或流行病学怀疑的孕妇进行常规SARS-CoV-2感染检测，无论胎龄或临床严重程度如何。第二，在所有孕妇入院分娩时常规检测SARS-CoV-2感染情况。这些行动对于了解新型冠状病毒肺炎在整个怀孕期间的真正影响至关重要，并将改善我们如何管理产前和产后护理的许多方面。科学界有责任指导甚至预测我们各自政府卫生政策的建议。如果我们不同意在这场大流行期间将孕妇视为人口中的一个独特的优先群体，我们将再次错过克服这一历史性偏见的机会。

BACKGROUND & AIMS: :Gestational weight gain (GWG) is an important predictor of adverse pregnancy outcomes including gestational diabetes, preterm birth, delivery by caesarean and post-partum weight retention. The Institute of Medicine guidelines on GWG are widely adopted, and GWG is widely researched as an outcome of interest in lifestyle interventions during pregnancy. However, estimation of prepregnancy weight and measurement of weight prior to delivery introduce bias into measures of GWG. This review discusses the sources of bias in measures of GWG and the potential effect of bias on the relationship between adverse pregnancy outcomes associated with GWG. Bias in measures of GWG can be minimized by using measured weight at the first antenatal appointment in early pregnancy rather than self-reported prepregnancy weight and by adjusting for gestational age when the last weight is collected earlier than the delivery date. Bias owing to gestational age is an important potential confounder in the relationship between GWG and adverse pregnancy outcomes.

背景与目标： : 妊娠体重增加 (GWG) 是不良妊娠结局的重要预测指标，包括妊娠糖尿病，早产，剖腹产和产后体重保持。医学研究所关于GWG的指南被广泛采用，并且GWG被广泛研究，这是对怀孕期间生活方式干预的兴趣的结果。但是，孕前体重的估计和分娩前体重的测量将偏差引入了GWG的测量中。这篇综述讨论了GWG测量中偏倚的来源以及偏倚对与GWG相关的不良妊娠结局之间关系的潜在影响。通过在怀孕初期首次产前预约时使用测量的体重，而不是自我报告的孕前体重，以及在分娩日期之前收集最后一次体重时调整胎龄，可以最大程度地减少GWG测量的偏差。由于胎龄引起的偏见是GWG与不良妊娠结局之间关系的重要潜在混杂因素。

BACKGROUND & AIMS: :Around the world volunteers and non-professionals collect data as part of environmental citizen science projects, collecting wildlife observations, measures of water quality and much more. However, where projects allow flexibility in how, where, and when data are collected there will be variation in the behaviour of participants which results in biases in the datasets collected. We develop a method to quantify this behavioural variation, describing the key drivers and providing a tool to account for biases in models that use these data. We used a suite of metrics to describe the temporal and spatial behaviour of participants, as well as variation in the data they collected. These were applied to 5,268 users of the iRecord Butterflies mobile phone app, a multi-species environmental citizen science project. In contrast to previous studies, after removing transient participants (those active on few days and who contribute few records), we do not find evidence of clustering of participants; instead, participants fall along four continuous axes that describe variation in participants' behaviour: recording intensity, spatial extent, recording potential and rarity recording. Our results support a move away from labelling participants as belonging to one behavioural group or another in favour of placing them along axes of participant behaviour that better represent the continuous variation between individuals. Understanding participant behaviour could support better use of the data, by accounting for biases in the data collection process.

背景与目标： : 作为环境公民科学项目的一部分，世界各地的志愿者和非专业人士收集数据，收集野生动植物观察，水质测量等。但是，如果项目允许灵活地收集数据的方式，地点和时间，则参与者的行为会有所不同，从而导致收集的数据集存在偏差。我们开发了一种量化这种行为变化的方法，描述了关键驱动因素，并提供了一种工具来解决使用这些数据的模型中的偏差。我们使用了一套指标来描述参与者的时间和空间行为，以及他们收集的数据的变化。这些被应用于多物种环境公民科学项目iRecord蝴蝶手机应用程序的5,268用户。与以前的研究相反，在删除了短暂的参与者 (那些在几天内活跃并且贡献很少的记录的参与者) 之后，我们没有发现参与者聚集的证据; 相反，参与者沿着四个连续的轴下降，这些轴描述了参与者行为的变化: 记录强度，空间范围，记录潜力和稀有记录。我们的结果支持将参与者标记为一个或另一个行为群体，而将其置于参与者行为的轴上，以更好地代表个体之间的连续变化。通过考虑数据收集过程中的偏差，了解参与者的行为可以支持更好地使用数据。

BACKGROUND & AIMS: :The ability to accurately characterize DNA variant proportions using PCR amplification is key to many genetic studies, including studying tumor heterogeneity, 16S microbiome, viral and immune receptor sequencing. We develop a novel generalizable ultrasensitive amplicon barcoding approach that significantly reduces the inflation/deflation of DNA variant proportions due to PCR amplification biases and sequencing errors. This method was applied to immune receptor sequencing, where it significantly improves the quality and estimation of diversity of the resulting library.

背景与目标： : 使用PCR扩增准确表征DNA变异比例的能力是许多遗传研究的关键，包括研究肿瘤异质性，16s微生物组，病毒和免疫受体测序。我们开发了一种新型的可推广的超灵敏扩增子条形码编码方法，该方法可显着减少由于PCR扩增偏差和测序错误而导致的DNA变体比例的膨胀/收缩。该方法应用于免疫受体测序，可显着提高所得文库的质量和多样性估计。

BACKGROUND & AIMS: :To fully understand the attractiveness bias, we propose that contextual factors or affordances should be integrated into the mating-based evolutionary account of Maestripieri et al. We review examples highlighting the role of contextual factors in the perception of attractiveness and in attractiveness bias. These suggest contextual factors differentially afford the development of preference for attractive others into observed habits of mind.

背景与目标： : 为了充分理解吸引力偏差，我们建议将情境因素或承受能力整合到maestribieri等人基于交配的进化论中。我们回顾了一些例子，突出了情境因素在吸引力感知和吸引力偏差中的作用。这些表明上下文因素不同地使对有吸引力的他人的偏好发展成为观察到的思维习惯。

BACKGROUND & AIMS: :In continuous test norming, the test score distribution is estimated as a continuous function of predictor(s). A flexible approach for norm estimation is the use of generalized additive models for location, scale, and shape. It is unknown how sensitive their estimates are to model flexibility and sample size. Generally, a flexible model that fits at the population level has smaller bias than its restricted nonfitting version, yet it has larger sampling variability. We investigated how model flexibility relates to bias, variance, and total variability in estimates of normalized z scores under empirically relevant conditions, involving the skew Student t and normal distributions as population distributions. We considered both transversal and longitudinal assumption violations. We found that models with too strict distributional assumptions yield biased estimates, whereas too flexible models yield increased variance. The skew Student t distribution, unlike the Box-Cox Power Exponential distribution, appeared problematic to estimate for normally distributed data. Recommendations for empirical norming practice are provided.

背景与目标： : 在连续测试规范中，测试分数分布被估计为预测因子的连续函数。一种灵活的范数估计方法是将广义加性模型用于位置，比例和形状。未知他们的估计对模型灵活性和样本量有多敏感。通常，适合总体水平的灵活模型比其受限的非拟合版本具有较小的偏差，但其采样变异性更大。我们研究了在与经验相关的条件下，模型的灵活性与归一化z分数的估计中的偏差，方差和总变异性之间的关系，其中涉及倾斜学生t和正态分布作为总体分布。我们考虑了横向和纵向假设的违反。我们发现，分布假设过于严格的模型会产生有偏差的估计，而过于灵活的模型会产生增加的方差。与Box-Cox幂指数分布不同，倾斜学生t分布似乎难以估计正态分布数据。提供了经验规范实践的建议。

BACKGROUND & AIMS: In contrast to T cell recognition of conventional peptide/MHC, T cell recognition of superantigen is not MHC-restricted. However, an influence of MHC polymorphism on specificity is consistent with accumulating data suggesting a TCR/MHC interaction during T cell recognition of superantigen. We have previously shown that T cells from V beta 8.1 beta-chain transgenic mice show an unexpected bias against recognition of Mls-1 presented by H-2d spleen cells. In the current studies we have examined whether thymic positive selection in H-2d mice, which selects T cells that see conventional antigen preferentially in the context of H-2d, is able to overcome the strong bias against recognition of Mls-1/H-2d. The data show that transgenic T cells from both H-2d and H-2k mice have comparable reactivity. The failure of thymic positive selection to overcome the bias against Mls-1/H-2d suggests that the orientation of the putative TCR/MHC interaction during recognition of Mls-1 is not the same as during recognition of conventional peptide/MHC.

背景与目标： 与常规肽/MHC的T细胞识别相反，超抗原的T细胞识别不受MHC限制。然而，MHC多态性对特异性的影响与积累的数据一致，这些数据表明在T细胞识别超抗原期间存在TCR/MHC相互作用。我们先前已经表明，来自V β 8.1 β 链转基因小鼠的T细胞显示出对H-2d脾细胞呈现的Mls-1识别的意外偏倚。在当前的研究中，我们检查了H-2d小鼠中的胸腺阳性选择是否能够克服对Mls-1/H-2d识别的强烈偏见，该选择在H-2d的背景下优先看到常规抗原的T细胞。数据显示来自H-2d和H-2k小鼠的转基因T细胞具有相当的反应性。胸腺阳性选择未能克服对Mls-1/H-2d的偏见，这表明在识别Mls-1过程中假定的TCR/MHC相互作用的方向与在识别常规肽/MHC过程中不同。

BACKGROUND & AIMS: :This initial, exploratory study on gender bias in collaborative medical decision making examined the degree to which physicians' reliance on a team member's patient care advice differs as a function of the gender of the advice giver. In 2018, 283 anesthesiologists read a brief, online clinical vignette and were randomly assigned to receive treatment advice from 1 of 8 possible sources (physician or nurse, man or woman, experienced or inexperienced). They then indicated their treatment decision, as well as the degree to which they relied upon the advice given.The results revealed 2 patterns consistent with gender bias in participants' advice taking. First, when treatment advice was delivered by an inexperienced physician, participants reported replying significantly more on the advice of a man versus a woman, F(1,61) = 4.24, P = .04. Second, participants' reliance on the advice of the woman physician was a function of her experience, F(1,62) = 6.96, P = .01, whereas reliance on the advice of the man physician was not, F(1,60) = 0.21, P = .65.These findings suggest women physicians, relative to men, may encounter additional hurdles to performing their jobs, especially at early stages in their careers. These hurdles are rooted in psychological biases of others, rather than objective features of cases or treatment settings. Cultural stereotypes may shape physicians' information use and decision-making processes (and hinder collaboration), even in contexts that appear to have little to do with social category membership. The authors recommend institutions adopt policies and practices encouraging equal attention to advice, regardless of the source, to help ensure advice taking is a function of information quality rather than the attributes of the advice giver. Such policies and practices may help surface and implement diverse expert perspectives in collaborative medical decision making, promoting better and more effective patient care.

背景与目标： : 这项关于协作医疗决策中性别偏见的初步探索性研究，考察了医生对团队成员的患者护理建议的依赖程度，这是建议给予者性别的函数。2018年，283名麻醉师阅读了一个简短的在线临床插图，并被随机分配接受来自8个可能来源 (医生或护士，男人或女人，有经验或没有经验) 中的1个的治疗建议。然后，他们指出了他们的治疗决定，以及他们依赖于给出的建议的程度。结果揭示了两种模式，与参与者建议的性别偏见一致。首先，当没有经验的医生提供治疗建议时，参与者报告对男人的建议比女人的建议要多，F(1,61) = 4.24，P = .04。其次，参与者对女医生建议的依赖是她经验的函数，F(1,62) = 6.96，P = 0.01，而对男医生建议的依赖则不是，F(1,60) = 0.21，P = .65。这些发现表明，相对于男性，女性医生在完成工作时可能会遇到更多障碍，尤其是在职业生涯的早期阶段。这些障碍源于他人的心理偏见，而不是病例或治疗环境的客观特征。文化刻板印象可能会影响医生的信息使用和决策过程 (并阻碍协作)，即使在似乎与社会类别成员身份无关的情况下也是如此。作者建议机构采取政策和做法，鼓励对建议的同等关注，无论来源如何，以帮助确保建议是信息质量的函数，而不是建议者的属性。此类政策和实践可能有助于在协作医疗决策中展现和实施不同的专家观点，从而促进更好，更有效的患者护理。

BACKGROUND & AIMS: OBJECTIVE:The current study examined experimentally whether a manipulated attention bias for food cues increases craving, chocolate intake and motivation to search for hidden chocolates. METHOD:To test the effect of attention for food on subsequent chocolate intake, attention for chocolate was experimentally modified by instructing participants to look at chocolate stimuli ("attend chocolate" group) or at non-food stimuli ("attend shoes" group) during a novel attention bias modification task (antisaccade task). Chocolate consumption, changes in craving and search time for hidden chocolates were assessed. Eye-movement recordings were used to monitor the accuracy during the experimental attention modification task as possible moderator of effects. Regression analyses were conducted to test the effect of attention modification and modification accuracy on chocolate intake, craving and motivation to search for hidden chocolates. RESULTS:Results showed that participants with higher accuracy (+1 SD), ate more chocolate when they had to attend to chocolate and ate less chocolate when they had to attend to non-food stimuli. In contrast, for participants with lower accuracy (-1 SD), the results were exactly reversed. No effects of the experimental attention modification on craving or search time for hidden chocolates were found. LIMITATION:We used chocolate as food stimuli so it remains unclear how our findings generalize to other types of food. CONCLUSION:These findings demonstrate further evidence for a link between attention for food and food intake, and provide an indication about the direction of this relationship.

背景与目标：

BACKGROUND & AIMS: :Older African Americans tend to perform poorly in comparison with older Whites on episodic memory tests. Observed group differences may reflect some combination of biological differences, measurement bias, and other confounding factors that differ across groups. Cognitive reserve refers to the hypothesis that factors, such as years of education, cognitive activity, and socioeconomic status, promote brain resilience in the face of pathological threats to brain integrity in late life. Educational quality, measured by reading test performance, has been postulated as an important aspect of cognitive reserve. Previous studies have not concurrently evaluated test bias and other explanations for observed differences between older African Americans and Whites. We combined data from two studies to address this question. We analyzed data from 273 African American and 720 White older adults. We assessed DIF using an item response theory/ordinal logistic regression approach. DIF and factors associated with cognitive reserve did not explain the relationship between race, and age- and sex-adjusted episodic memory test performance. However, reading level did explain this relationship. The results reinforce the importance of considering education quality, as measured by reading level, when assessing cognition among diverse older adults.

背景与目标： : 在情景记忆测试中，与年长的白人相比，年长的非洲裔美国人往往表现不佳。观察到的组差异可能反映了生物学差异，测量偏差和其他混杂因素的某种组合，这些因素在组之间有所不同。认知储备 (Cognitive reserve) 指的是这样一种假设，即在面对晚年大脑完整性的病理威胁时，诸如受教育年限，认知活动和社会经济地位等因素会促进大脑的复原力。以阅读测试成绩衡量的教育质量被认为是认知储备的重要方面。以前的研究没有同时评估测试偏倚和其他解释，以观察到老年非洲裔美国人和白人之间的差异。我们结合了两项研究的数据来解决这个问题。我们分析了273名非洲裔美国人和720名白人老年人的数据。我们使用项目反应理论/有序逻辑回归方法评估DIF。DIF和与认知储备相关的因素不能解释种族与年龄和性别调整后的情景记忆测试表现之间的关系。然而，阅读水平确实解释了这种关系。结果强调了在评估不同老年人之间的认知时，以阅读水平衡量的教育质量的重要性。

BACKGROUND & AIMS: OBJECTIVES:To develop and validate a new risk-of-bias tool for nonrandomized studies (NRSs). STUDY DESIGN AND SETTING:We developed the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). A validation process with 39 NRSs examined the reliability (interrater agreement), validity (the degree of correlation between the overall assessments of RoBANS and Methodological Index for Nonrandomized Studies [MINORS], obtained by plotting the overall risk of bias relative to effect size and funding source), face validity with eight experts, and completion time for the RoBANS approach. RESULTS:RoBANS contains six domains: the selection of participants, confounding variables, the measurement of exposure, the blinding of the outcome assessments, incomplete outcome data, and selective outcome reporting. The interrater agreement of the RoBANS tool except the measurement of exposure and selective outcome reporting domains ranged from fair to substantial. There was a moderate correlation between the overall risks of bias determined using RoBANS and MINORS. The observed differences in effect sizes and funding sources among the assessed studies were not correlated with the overall risk of bias in these studies. The mean time required to complete RoBANS was approximately 10 min. The external experts who were interviewed evaluated RoBANS as a "fair" assessment tool. CONCLUSIONS:RoBANS shows moderate reliability, promising feasibility, and validity. The further refinement of this tool and larger validation studies are required.

背景与目标：

BACKGROUND & AIMS: We compared the accuracy of the ST segment/heart rate (STHR) index and slope to standard criteria (> or =1 mm horizontal/downsloping ST-segment depression at J + 60 msec) in 1358 patients (152 underwent angiography). All exercise tests used the Cornell protocol and computer measurements of maximum ST-segment depression at J + 60 msec. Test accuracy was determined for the entire group with a probability-based method. Thresholds with equal specificity to standard criteria were determined. By using only patients who underwent angiography, neither STHR index nor slope was more accurate than standard criteria (maximum sensitivitystandard criteria, 42%; STHR index, 51%; STHR slope, 40%).

However, by using the entire group, both STHR index and slope were more accurate than standard criteria, but only STHR index achieved statistical significance (maximum sensitivitystandard criteria, 31%; STHR index, 60%; STHR slope, 47%). We conclude that heart rate-adjusted ST-segment criteria are more accurate than standard ST-segment criteria. A lack of demonstration of improved accuracy of STHR index and slope only occurs in patients affected by posttest referral bias.

背景与目标： 我们比较了1358例患者 (152接受血管造影) 的ST段/心率 (STHR) 指数和斜率与标准 (> 或 = 1毫米J + 60毫秒时的水平/向下倾斜ST段压低) 的准确性。所有运动测试均使用康奈尔协议和计算机测量J 60毫秒时最大ST段压低。使用基于概率的方法确定了整个组的测试准确性。确定了与标准标准具有相同特异性的阈值。通过仅使用接受血管造影的患者，stthr指数或斜率均不比标准标准 (最大敏感性标准标准，42%; Stthr指数，51%; Stthr斜率，40%) 更准确。
但是，通过使用整个组，STHR指数和斜率均比标准标准更准确，但只有STHR指数达到统计学显着性 (最大敏感性标准，31%; STHR指数，60%; STHR斜率，47%)。我们得出的结论是，心率调整后的ST段标准比标准ST段标准更准确。仅在受测试后转诊偏倚影响的患者中，缺乏提高stthr指数和斜率的准确性的证明。