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• A platform that processes down payments instantaneously yet delays withdrawals without transparent justification develops an uneven experience that deteriorates depend on with time.
• We included families with children with lipomeningocele as controls because our study was primarily designed to investigate associations between arsenic and spina bifida (myelomeningocele and meningocele), and lipomeningocele would be present in the population that would give rise to cases.
• As a result of the predominance of GWAS including European populations, risk alleles in GWAS databases skew towards those with high MAFs in populations with European ancestry (Gurdasani et al., 2019; Kim et al., 2018; Martin et al., 2017).
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• We stopped enrolling controls and collecting water in March 2020 because of COVID-19 restrictions, and this led to an uneven number of cases and controls.

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A challenge faced in conducting genomic research in the study population was a lack of a replication sample, preventing us from validating the current findings in another study population. We did not exclude these individuals in our GWAS analysis because lipomeningoceles are considered to have different etiologies than that of myelomeningocele and meningocele, and also occur during a different developmental stage (Agopian et al., 2012; Chan et al., 2017). As a result of the predominance of GWAS including European populations, risk alleles in GWAS databases skew towards those with high MAFs in populations with European ancestry (Gurdasani et al., 2019; Kim et al., 2018; Martin et al., 2017). We were able to identify novel variants outside of the traditionally explored biological pathways, such as folate metabolism.

Online Dictionary

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Table 1

The data that support the findings of this study are available to researchers trained in human subjects research and privacy protections upon reasonable request from the corresponding author. The Bangladesh Medical Research Council and the Human Research Committees at Boston Children’s Hospital and the National Institute of Neurosciences & Hospital approved all study protocols, which were conducted in accordance with the Declaration of Helsinki. The data analysis was performed with the computational resources provided by the Research Computing Group at Boston Children’s Hospital and Harvard Medical School (Boston, MA), including High-Performance Computing Clusters Enkefalos 2 (E2), Massachusetts Green High-Performance Computing Center (MGHPCC), and the BioGrids scientific software made available for data analysis. We are grateful to the field staff at the National Institute of Neurosciences and Hospital (NINS) and study participants for their contributions. We have shared biospecimens and data from the project with investigators focused on neural tube defect research and are planning to be involved in future genetic analyses across studies from multiple geographic areas.

Data Availability Statement

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