Implementing a smoking ban in an acute psychiatric admissions unit

In contrast to general medical hospitals, psychiatric hospitals often allow patients to smoke cigarettes. In addition to obvious health concerns, smoking can also interfere with clinical assessments and therapeutic activities, Implementation of a smoking ban on an acute male admissions unit did not result in any increase in aggressive behaviors. In addition, staff attitudes following the ban improved, and most staff members believed the ban was both ethical and beneficial to patients. Our research indicates that banning smoking on an acute admissions unit is feasible and well tolerated by patients and staff, although it may require extra vigilance for smoking-related contraband.     

Microarrays as a tool to investigate the biology of aging: a retrospective and a look to the future

The use of microarrays as a tool to investigate fundamental biological questions has become ubiquitous over the past several years. Microarrays are becoming as common as the polymerase chain reaction or any of the other tools in the molecular biologist's armory. Unlike experiments involving other tools, however, the design and analysis of microarray experiments present some unique problems to molecular biologists, problems with which statisticians have long been familiar. In this overview of microarrays and aging-related research, we will review selected highlights of microarray studies that have been carried out to study aging to date, as well as discuss some of the potential problems that routinely arise during these types of experiments, especially in the context of aging.     

This journal issue has also been published in eletronic format

Annoucement

This journal issue has also been published in eletronic format     

The empirical basis of risk assessment in child welfare: the accuracy of risk assessment and clinical judgment

The importance of risk assessment is juxtaposed with the lack of empirical support regarding the validity of risk inventories. This study compared risk ratings of one risk assessment tool to decisions made by case managers. The researchers sampled 450 children and compared predictive utility of risk assessment to child protection decisions. Risk assessment was consistent with clinical judgment in 74% to 81% of cases, more than previously reported in studies of risk assessment validity. Further analyses identified discriminate functions at the instrument's category and individual-item levels. The results have implications for the validity of the instrument and its utility in child welfare.     

Binge drinking during the first semester of college: continuation and desistance from high school patterns

Students' first semester on campus may set the stage for their alcohol use/misuse throughout college. The authors surveyed 274 randomly sampled first-semester freshmen at a large southwestern university on their past 2 weeks' binge drinking, their high school binge drinking, and psychosocial factors possibly associated with drinking. They conducted separate analyses among high school nonbinge drinkers (testing for predictors of college binge onset vs continued nonbinge drinking) and high school binge drinkers (testing for predictors of continued binge drinking in college vs desistance from drinking). In both analyses, the variables that predicted college binge drinking largely revolved around gregarious socializing (e.g, partying, having a social network of individuals who drank relatively heavily). Gender was predictive only among high school nonbinge drinkers; women had a higher probability than did men of adopting binge drinking in college.     

Measuring outcomes for children late placed for adoption

Selecting appropriate measures to assess the outcomes of permanent placement across a broad range of developmental dimensions is problematic. The Maudsley team are adapting and developing a package of instruments designed to identify the key influences on developmental recovery for a longitudinal sample of children late placed for adoption.     

Direct estimation of the percentile 'p-value' for the one-sample median test

In this paper we outline and illustrate an easy-to-use inference procedure for directly calculating the approximate bootstrap percentile-type p-value for the one-sample median test, i.e. we calculate the bootstrap p -value without resampling, by using a fractional order statistics based approach. The method parallels earlier work on fractionalorder-statistics-based non-parametric bootstrap percentile-type confidence intervals for quantiles. Monte Carlo simulation studies are performed, which illustrate that the fractional-order-statistics-based approach to the one-sample median test has accurate type I error control for small samples over a wide range of distributions; is easy to calculate; and is preferable to the sign test in terms of type I error control and power. Furthermore, the fractional-order-statistics-based median test is easily generalized to testing that any quantile has some hypothesized value; for example, tests for the upper or lower quartile may be performed using the same framework.     

What kind of information will be required if we are to reform health care?

The only logical way to avoid unnecessary future costs and improve quality is to analyze the past, providing input for the present. The informational management strategies are ready. There is continuous quality improvement, profiling with case-mix adjustment, and other techniques that will help us manage care and caring. But these strategies all rely on the customer being empowered to make truly informed decisions (the ethical principle of autonomy) and for us to advocate for patients (beneficence). Translating relevant data into information is the concentration of medical informatics. Virtually everyone in medical management can attest to the fact that, competitive forces notwithstanding, it is time for us to recognize not only that we are in the information business, but also that this information belongs to a larger community. Clearly, it is time to collaborate!     

Coordinating business strategy and technical planning

Business managers face the decisions discussed in this article regularly. Without a systematic framework, the business context for these decisions is more difficult to establish and to communicate in a company. Where technology is the life-blood of the company, the strategic decision-makers can ill-afford to have the technological resources allocated in a suboptimal fashion. Nor can they afford a business strategy which does not recognize the implications of their technological assets. This article describes an approach to technological strategy formulation that has successfully achieved this.