Best Practices for Biostatistical Consultation and Collaboration in Academic Health Centers

Given the increasing level and scope of biostatistics expertise needed at academic health centers today, we developed best practices guidelines for biostatistics units to be more effective in providing biostatistical support to their institutions, and in fostering an environment in which unit members can thrive professionally. Our recommendations focus on the key areas of: (1) funding sources and mechanisms; (2) providing and prioritizing access to biostatistical resources; and (3) interacting with investigators. We recommend that the leadership of biostatistics units negotiate for sufficient long-term infrastructure support to ensure stability and continuity of funding for personnel, align project budgets closely with actual level of biostatistical effort, devise and consistently apply strategies for prioritizing and tracking effort on studies, and clearly stipulate with investigators prior to project initiation policies regarding funding, lead time, and authorship.     

Evaluation of long-term health care services through a latent Markov model with covariates

We focus on the evaluation of the long-term health care services provided to elderly patients by nursing homes of four different health districts in the Umbria region (Italy). To this end, we analyze data coming from a longitudinal survey aimed at assessing several aspects of patient health conditions and develop an extended version of the latent Markov model with covariates, which allows us to deal with dropout and intermittent missing data patterns that are common in longitudinal studies. Maximum likelihood estimates are obtained by a two-step approach that allows for fast estimation of model parameters and prevents some drawbacks of the standard maximum likelihood method encountered in the presence of many response variables and covariates. In the application to the observed data, we show how to obtain indicators of the effectiveness of the health care services delivered by each health district, by means of a resampling procedure.     

SURVEY DESIGN

Survey design involves planning and documenting questionnaires, sample selection and survey operations. It constitutes a simultaneous solution to numerous interrelated conceptual and practical design issues, more than may usually be settled effectively, or even recognised, in any reasonable time by contemplation alone. The alternative is an iterative approach, making a trial plan, testing and then improving it, and, if necessary, repeating it until a satisfactory plan is evolved. Pilot testing can then become the focus of design decisions by providing relevant data and operating experience, and by using experimental methods, as a basis for adroit revision of trial survey plans. This paper concerns the planning of efficient survey design processes along these lines.     

Nonparametric-likelihood inference based on cost-effectively-sampled-data

Costs associated with the evaluation of biomarkers can restrict the number of relevant biological samples to be measured. This common problem has been dealt with extensively in the epidemiologic and biostatistical literature that proposes to apply different cost-efficient procedures, including pooling and random sampling strategies. The pooling design has been widely addressed as a very efficient sampling method under certain parametric assumptions regarding data distribution. When cost is not a main factor in the evaluation of biomarkers but measurement is subject to a limit of detection, a common instrument limitation on the measurement process, the pooling design can partially overcome this instrumental limitation. In certain situations, the pooling design can provide data that is less informative than a simple random sample; however this is not always the case. Pooled-data-based nonparametric inferences have not been well addressed in the literature. In this article, a distribution-free method based on the empirical likelihood technique is proposed to substitute the traditional parametric-likelihood approach, providing the true coverage, confidence interval estimation and powerful tests based on data obtained after the cost-efficient designs. We also consider several nonparametric tests to compare with the proposed procedure. We examine the proposed methodology via a broad Monte Carlo study and a real data example.     

From Binding to Digitization: Issues in Newspaper Preservation in Nigerian Academic Libraries

This article examines the importance of newspapers to research, education, and economic development for Nigeria and advocates the need to preserve newspapers. The authors discuss critical preservation issues related to newspapers and emphasize the urgent need to address their deteriorating state in Nigerian academic libraries. The article also examines the binding preservation method practiced among academic libraries and observes that the method is not adequate. It recommends that academic libraries in Nigeria should adopt the digitization model for newspaper preservation. The article identifies the digital divide, poor technological infrastructure, inadequate funding, lack of expertise, and copyright prohibitions as challenges of digitization and makes recommendations.     

The demand to initiate medical care: A morbidity specific analysis

The dependence of the one year probability of utilizing preventive services and the one year probability of utilizing visits for acute micro-organism disease in the Kaiser-Oregon Prepaid Medical Care System on ten (10) explanatory factors has been investigated using a multiple logistic function analysis.Our results demonstrate the importance of disaggregating the population and the type of medical care when investigating the determinants of utilizing service. This is especially important for understanding the underlying structure of medical care utilization decisions.The study also illustrates a potentially fruitful application of the multivariate logistic analysis to the fields of health care planning and policy analysis. The use of specific types of medical care in the short-term is probabilistic and depends on many factors. For most groups, the multivariate logistic approach produces an analysis reasonably consistent with the actual data.Further research is needed to test the predictive ability of these types of utilization models and to investigate the determinants of other morbidity specific types of medical care utilization. The problem will then be to develop a model of the quantity of alternative types of services utilized-conditioned on the number of persons initiating service for alternative health reasons.     

Developing Nations, the Digital Divide and Research Databases

The digital divide affects many nations of the developing world. The term encompasses inadequate funding, a lack of necessary computer and Internet skills, and a lack of English-language proficiency that hinder expansion and use of digital information resources. Visionary individuals and organizations can assist these countries with their information needs. Aggregated full-text databases serve as a prominent tool in closing the digital divide because they provide important research resources. Participating organizations must demonstrate the value of these resources to users and supply essential training to ensure success with electronic resource initiatives.     

Developing Nations,the Digital Divide and Research Databases

Abstract

The digital divide affects many nations of the developing world. The term encompasses inadequate funding, a lack of necessary computer and Internet skills, and a lack of English-language proficiency that hinder expansion and use of digital information resources. Visionary individuals and organizations can assist these countries with their information needs. Aggregated full-text databases serve as a prominent tool in closing the digital divide because they provide important research resources. Participating organizations must demonstrate the value of these resources to users and supply essential training to ensure success with electronic resource initiatives.     

Model assisted survey sampling strategies with randomized response

For estimating survey population totals with direct responses, use of QR-predictors motivated by postulated linear regression models and their asymptotic design-based analysis is rapidly becoming common. Their extension with randomized responses, to cover sensitive issues, is illustrated providing asymptotically optimal predictors along with variance estimators. Exact design unbiasedness requirement is replaced by asymptotic design unbiasedness restriction.     

中国各地区医疗卫生服务的生产效率分析

医疗卫生是与国民密切相关的一个问题,所以医疗卫生服务的生产效率如何倍受人们的关注。运用DEA模型可以对中国各地区的医疗卫生服务生产效率进行研究,分析不同地区效率高低的原因。结果显示,虽然总体上中国的医疗卫生服务的生产效率处于一个较低水平,但地区之间还是存在着很大的区别,并且地区间即便都是高效率或者低效率的地区,其投入和产出水平也不尽相同。     

Management of Electronic Serials in Academic Libraries: The Results of an Online Survey

This article presents the results of an online survey of academic librarians conducted in 2011 on the topic of electronic serials management. Since online journals had by 2011 become a major part of academic library serials collections, a central objective of this survey was to explore whether this had led to any degree of standardization in online serials management procedures across academic libraries. The focus of the survey was generally on issues affecting technical services, specifically exploring the impact of electronic serials on collection development, library staffing, and serials management tools. The responses to the survey did not reflect any significant level of uniformity among these libraries in any of these areas, suggesting that libraries primarily take into account the needs of their own institutions when formulating procedures for managing online serials.     

Management of Electronic Serials in Academic Libraries: The Results of an Online Survey

Abstract

This article presents the results of an online survey of academic librarians conducted in 2011 on the topic of electronic serials management. Since online journals had by 2011 become a major part of academic library serials collections, a central objective of this survey was to explore whether this had led to any degree of standardization in online serials management procedures across academic libraries. The focus of the survey was generally on issues affecting technical services, specifically exploring the impact of electronic serials on collection development, library staffing, and serials management tools. The responses to the survey did not reflect any significant level of uniformity among these libraries in any of these areas, suggesting that libraries primarily take into account the needs of their own institutions when formulating procedures for managing online serials.     

Serials Digest

Abstract

A collection manager and an acquisition librarian discuss difficult decisions to be made regarding electronic resources and associated value-added services. Balancing budget constraints with patron demands for easy access to information requires librarians to reevaluate assumptions about the electronic products and associated services that have quickly become staples of library life, even as these staples become increasingly untenable. The authors scrutinize the cost/benefit of continuing value-added services, such as providing access to abstracting and indexing tools and full MARC cataloging records of journal titles, as well as considering the adoption of new services such as federated search engines and link resolvers.     

The Cataloging of E-Book Readers: A Service Model-Oriented Approach

Abstract

The popularity of e-book readers has exploded over the past several years, and many libraries have begun purchasing and providing access to these devices for their patrons. A large body of academic literature addresses the popularity of e-book readers and the issues involved with purchasing them and licensing material for them, but there is a relatively slim body of literature regarding the cataloging of e-book readers. At present, there is no uniform approach to cataloging e-book readers and libraries are currently employing a number of different methods. This article will describe the approach to cataloging e-book readers adopted at the Z. Smith Reynolds Library of Wake Forest University, which is based on the local service model for e-readers that takes into account how patrons are expected to use the devices as well as licensing concerns about the use of titles on e-readers. In order to make the devices discoverable for patrons with a minimum of confusion, certain unusual cataloging practices are employed (such as coding e-readers as “realia” but giving them a general material designation (GMD) of “electronic resource”). This article argues that the RDA code should accommodate e-book readers by creating carrier types that accurately describe these devices in a way that patrons can understand.     

The Structure of Scholarly Communications Within Academic Libraries

Academic libraries often define their administrative structure according to services they offer, including research services, cataloging and metadata, and acquisitions. Scholarly communications is something of a moving target, though. How are scholarly communication positions defined, what duties do they often include, and how do they fit within the library's administrative structure? Some of the first positions devoted to scholarly communications required JD's and focused on author's rights, copyright, and fair use. Yet other positions recently advertised group scholarly communication librarians within digital scholarship units, which not only create and maintain institutional repositories, they may also publish electronic journals and/or offer services related to data curation. This article provides a brief review of the findings recently published in a SPEC Kit, which focuses on ARL Libraries. The main intention, though, is to provide a wider context of scholarly communication activities across a variety of academic libraries. To do that, a survey of non-ARL Libraries was administered to review relevant positions, library organizations, and the variety of scholarly communication services offered. Lastly, a set of scholarly communication core services is proposed.     

Estimated Data Collection Organization Effect in the National Medical Care Expenditure Survey

The National Medical Care Expenditure Survey, which has a complex survey design, is further complicated by combining two independently drawn national samples of households from the Research Triangle Institute (RTI) and the National Opinion Research Center (NORC). It is assumed that since the structures of these national-area samples are similar, they are thereby compatible and allow for the derivation of statistically equivalent unbiased national estimates of relevant health parameters. In this paper, national parameter estimates of relevant demographic and health measures were separately produced for each of the two survey organizations and a determination was made regarding statistical equivalence across samples. In addition, the data-collection organization effect was estimated and tested within the framework of a multivariate analysis appropriate for complex survey data. The findings consistently revealed a statistically nonsignificant data-collection organization effect when testing for differences in domain estimates of the relevant health parameters under consideration.     

Random effects models for operational patient pathways

Patient flow modeling is a growing field of interest in health services research. Several techniques have been applied to model movement of patients within and between health-care facilities. However, individual patient experience during the delivery of care has always been overlooked. In this work, a random effects model is introduced to patient flow modeling and applied to a London Hospital Neonatal unit data. In particular, a random effects multinomial logit model is used to capture individual patient trajectories in the process of care with patient frailties modeled as random effects. Intuitively, both operational and clinical patient flow are modeled, the former being physical and the latter latent. Two variants of the model are proposed, one based on mere patient pathways and the other based on patient characteristics. Our technique could identify interesting pathways such as those that result in high probability of death (survival), pathways incurring the least (highest) cost of care or pathways with the least (highest) length of stay. Patient-specific discharge probabilities from the health care system could also be predicted. These are of interest to health-care managers in planning the scarce resources needed to run health-care institutions.     

Design-based analysis of embedded experiments with applications in the Dutch Labour Force Survey

Summary.  Previous research has proposed a design-based analysis procedure for experiments that are embedded in complex sampling designs in which the ultimate sampling units of an on-going sample survey are randomized over different treatments according to completely randomized designs or randomized block designs. Design-based Wald and t -statistics are applied to test whether sample means that are observed under various survey implementations are significantly different. This approach is generalized to experimental designs in which clusters of sampling units are randomized over the different treatments. Furthermore, test statistics are derived to test differences between ratios of two sample estimates that are observed under alternative survey implementations. The methods are illustrated with a simulation study and real life applications of experiments that are embedded in the Dutch Labour Force Survey. The functionality of a software package that was developed to conduct these analyses is described.     

Active controlled studies in antibiotic drug development

The increasing concern of antibacterial resistance has been well documented, as has the relative lack of antibiotic development. This paradox is in part due to challenges with clinical development of antibiotics. Because of their rapid progression, untreated bacterial infections are associated with significant morbidity and mortality. As a consequence, placebo-controlled studies of new agents are unethical. Rather, pivotal development studies are mostly conducted using non-inferiority designs versus an active comparator. Further, infections because of comparator-resistant isolates must usually be excluded from the trial programme. Unfortunately, the placebo-controlled data classically used in support of non-inferiority designs are largely unavailable for antibiotics. The only available data are from the 1930s and 1940s and their use is associated with significant concerns regarding constancy and assay sensitivity. Extended public debate on this challenge has led to proposed solutions by some in which these concerns are addressed by using very conservative approaches to trial design, endpoints and non-inferiority margins, in some cases leading to potentially impractical studies. To compound this challenge, different Regulatory Authorities seem to be taking different approaches to these key issues. If harmonisation does not occur, antibiotic development will become increasingly challenging, with the risk of further decreases in the amount of antibiotic drug development. However with clarity on Regulatory requirements and an ability to feasibly conduct global development programmes, it should be possible to bring much needed additional antibiotics to patients.