Human Health Risk Assessment of Penicillin/Aminopenicillin Resistance in Enterococci Due to Penicillin Use in Food Animals

Penicillin and ampicillin drugs are approved for use in food animals in the United States to treat, control, and prevent diseases, and penicillin is approved for use to improve growth rates in pigs and poultry. This article considers the possibility that such uses might increase the incidence of ampicillin-resistant Enterococcus faecium (AREF) of animal origin in human infections, leading to increased hospitalization and mortality due to reduced response to ampicillin or penicillin. We assess the risks from continued use of penicillin-based drugs in food animals in the United States, using several assumptions to overcome current scientific uncertainties and data gaps. Multiplying the total at-risk population of intensive care unit (ICU) patients by a series of estimated factors suggests that not more than 0.04 excess mortalities per year (under conservative assumptions) to 0.14 excess mortalities per year (under very conservative assumptions) might be prevented in the whole U.S. population if current use of penicillin drugs in food animals were discontinued and if this successfully reduced the prevalence of AREF infections among ICU patients. These calculations suggest that current penicillin usage in food animals in the United States presents very low (possibly zero) human health risks.     

Improving Risk-Based Decision Making for Terrorism Applications

How can we best allocate limited defensive resources to reduce terrorism risks? Dillon et al.'s Antiterrorism Risk-Based Decision Aid (ARDA) system provides a useful point of departure for addressing this crucial question by exhibiting a real-world system that calculates risk reduction scores for different portfolios of risk-reducing countermeasures and using them to rank-order different possible risk mitigation alternatives for Navy facilities. This comment points out some potential limitations of any scoring system that does not take into account risk externalities, interdependencies among threats, uncertainties that are correlated across targets, and attacker responses to alternative allocations of defensive resources. In at least some simple situations, allocations based on risk reduction scores and comparisons can inadvertently increase risks by providing intelligent attackers with valuable information, or they can fail to reduce risks as effectively as nonscoring, optimization-based approaches. These limitations of present scoring methods present exciting technical challenges and opportunities for risk analysts to develop improved methods for protecting facilities and infrastructure against terrorist threats.     

Improving Risk Management: From Lame Excuses to Principled Practice

The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame‐shifting “lame excuses” for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning—especially from near‐misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk‐reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management.     

Camera-Related Behaviors during Video Recorded Medical Interactions

Video recording provides an objective record of the content of medical interactions. However, there is concern that cameras may be reactive measurement devices that alter what normally transpires during interactions. This study addressed potential reactivity of cameras in medical interactions. Interactions between 45 patients and 14 medical oncologists were video recorded and coded for camera-related behaviors. Eleven of 45 patients performed none of the behaviors. Among the other patients, camera-related behaviors were infrequent and, on average, constituted about 0.1% (one-tenth of one percent) of total interaction time. Behaviors occurred most often in very early stages of interactions, and when physicians were absent from the room. Seven physicians showed camera-related behaviors, comprising less than 0.1% of the time they were in the interaction. Results suggest video recording can provide nonreactive means of studying medical interactions.

Checking validity of monotone domain mean estimators

Estimates of population characteristics such as domain means are often expected to follow monotonicity assumptions. Recently, a method to adaptively pool neighbouring domains was proposed, which ensures that the resulting domain mean estimates follow monotone constraints. The method leads to asymptotically valid estimation and inference, and can lead to substantial improvements in efficiency, in comparison with unconstrained domain estimators. However, assuming incorrect shape constraints may lead to biased estimators. Here, we develop the Cone Information Criterion for Survey Data as a diagnostic method to measure monotonicity departures on population domain means. We show that the criterion leads to a consistent methodology that makes an asymptotically correct decision choosing between unconstrained and constrained domain mean estimators. The Canadian Journal of Statistics 47: 315–331; 2019 © 2019 Statistical Society of Canada     

Fast and approximate exhaustive variable selection for generalised linear models with APES

We present APproximated Exhaustive Search (APES), which enables fast and approximated exhaustive variable selection in Generalised Linear Models (GLMs). While exhaustive variable selection remains as the gold standard in many model selection contexts, traditional exhaustive variable selection suffers from computational feasibility issues. More precisely, there is often a high cost associated with computing maximum likelihood estimates (MLE) for all subsets of GLMs. Efficient algorithms for exhaustive searches exist for linear models, most notably the leaps‐and‐bound algorithm and, more recently, the mixed integer optimisation (MIO) algorithm. The APES method learns from observational weights in a generalised linear regression super‐model and reformulates the GLM problem as a linear regression problem. In this way, APES can approximate a true exhaustive search in the original GLM space. Where exhaustive variable selection is not computationally feasible, we propose a best‐subset search, which also closely approximates a true exhaustive search. APES is made available in both as a standalone R package as well as part of the already existing mplot package.     

Some implications of common consequences in lotteries

This work studies the implications of some aspects of preferences toward risk in the choice between two binary lotteries exhibiting a common consequence. The results obtained are then applied to two different problems: the choice between two risky challenges characterized by different rewards in the case of success and different probabilities of success and the choice between self-protection and self-insurance in the presence of the risk of incurring financial loss.

     

DURATION MODELS FOR CREDIT RATING MIGRATION: EVIDENCE FROM THE FINANCIAL CRISIS

We introduce a specific duration model to analyze the prediction of the credit rating migration. We consider hazard rate processes based on multi‐state autoregressive conditional duration models. To take account of the economic context, we model the conditional mean of the duration between two ratings by means of a latent process. To this purpose, a dynamic‐ordered probit model is developed to describe the directions taken by the ratings in the presence of multiple states. As an illustration, we study the migration of credit rating during periods before and after the financial crisis. (JEL C14, C41, G24)     

Family Responsibilities,Productivity, and Earnings: A Study of Gender Differences Among Canadian Lawyers

This study examines whether men and women invest in different determinants of productivity and whether these investments affect productivity and salary in different ways. Hypotheses are tested from human and social capital theories that include more direct measures for family responsibilities and family-friendly firm arguments. Data from 670 law firm lawyers were used given they report a standardized measure of productivity in billable hours. Despite men investing more in their careers and women investing more in their families, both report similar productivity and their productivity is affected similarly by these factors. In addition, equally productive men and women are paid the same. The findings further our understanding of productivity and salary and the relevance of family responsibilities and family-friendly firms.

Housing interventions for homeless,pregnant/parenting women with addictions: a systematic review

Family homelessness is a growing problem in North America with most of these families headed by single women. Homeless women also experience high rates of pregnancy and addiction (drugs and alcohol). Housing interventions have been identified as key to addressing the complex needs of pregnant/early parenting, homeless women with addictions. The aim of this systematic review is to determine what housing models and programs for this population yield the best outcomes. We systematically searched 10 databases and retrieved eight articles describing four distinct studies that met the inclusion criteria for this review. Overall, improved outcomes were found for all intervention groups with the most recent and rigorous studies favoring models combining Housing First and case management. However, methodological limitations, study quality, and varied outcomes made comparison across studies difficult. Further research must be done in this area using standardized outcomes and rigorous designs to develop evidence-based best practice guidelines to address the unique needs of this population.