Expressing Estimators of Expected Quality Adjusted Survival as Functions of Nelson-Aalen Estimators

Quality adjusted survival has been increasingly advocated in clinical trials to be assessed as a synthesis of survival and quality of life. We investigate nonparametric estimation of its expectation for a general multistate process with incomplete follow-up data. Upon establishing a representation of expected quality adjusted survival through marginal distributions of a set of defined events, we propose two estimators for expected quality adjusted survival. Expressed as functions of Nelson-Aalen estimators, the two estimators are strongly consistent and asymptotically normal. We derive their asymptotic variances and propose sample-based variance estimates, along with evaluation of asymptotic relative efficiency. Monte Carlo studies show that these estimation procedures perform well for practical sample sizes. We illustrate the methods using data from a national, multicenter AIDS clinical trial.     

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.     

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.     

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.

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.

     

Disasters,migrations, and the unintended consequences of urbanization: What’s the harm in getting out of harm’s way?

Under many circumstances, the global rural-to-urban migration trend may be increasingly adopted as a short-term coping strategy to shifting ecologies and natural disasters. While offering certain benefits from macro-level economic and public health perspectives, these migrations may also have unintended psychological consequences that are not easily understood through traditional disaster studies or cost–benefit analyses. If the goal of disaster and climate change research is to promote successful adaptation, then the long-term psychological well-being of people who have survived disaster and either adapted in situ or migrated into urban environments, is paramount. This article integrates research on disasters and climate change-induced migration with emerging perspectives from environmental psychology and the psychology of natural disasters to consider the potential costs of particular migration scenarios. We apply this analysis to the case of Shishmaref, Alaska, a rural Iñupiat community on the northwest coast of Alaska facing habitual flooding disasters linked to climate change. Findings from Shishmaref illustrate the cultural vitality of subsistence landscapes and the potential health risks of compromised human–ecological relationships due to migration and/or displacement. Recommendations for policy makers and researchers are offered for promoting long-term well-being among affected individuals and communities.     

The Effect of Social Responsiveness on Infants' Object‐Directed Imitation

Previous research has demonstrated that social interactions underlie the development of object‐directed imitation. For example, infants differentially learn object action sequences from a live social partner compared to a social partner over a video monitor; however, what is not well understood is what aspects of social interactions influence social learning. Previous studies have found variable influences of different types of caregiver responsiveness on attention, language, and cognitive development. Therefore, the purpose of this study was to examine how the responsive style of a social partner influenced the learning of object‐directed action sequences. Infants interacted with either a sensitive or redirective experimenter before the learning trial. Results revealed infants changed their patterns of engagement; infants interacting with a sensitive experimenter had longer periods of attentional engagement than infants interacting with a redirective experimenter. Furthermore, during the learning trial, the amount of sensitivity during interaction with the social partner predicted learning scores. These findings suggest that infants' attention is influenced by social partners' interactive style during ongoing interaction, which subsequently affects how infants learn from these social partners.     

Predicting engagement in a transition to parenthood program for couples

Fostering participant engagement is a challenging but essential component of effective prevention programs. To better understand which factors influence engagement, this study examines several predictors of couple engagement in Family Foundations (FF), a preventive intervention for first-time parents shown to enhance parent mental health, couple relations, parenting quality, and child adjustment through age 3 years. FF consists of a series of classes delivered through childbirth education departments at local hospitals. Baseline data on socio-demographics, parent mental health, and couple relationship quality were examined as predictors of participants’ level of engagement in FF (n = 89 couples, 178 individuals). Sociodemographic variables such as parent gender, socioeconomic status, and age predicted program engagement to a limited extent. However, findings indicated that marital status was the best predictor of engagement. Discussion focuses on how findings can inform the development of practices that promote engagement, such as the use of targeted outreach efforts for individuals most at risk of disengagement.     

The contribution of ergonomics to risk analysis in the design process: the case of a future control room

The aim of this paper is to highlight how ergonomics contributes to risk analysis and risk management in a design project for a new reactor, the French EPR (European Pressurized Reactor). An iterative ergonomics design process has been conducted over the last 10 years through a Human Factors Engineering program at the French energy company EDF. A parallel has been drawn between a risk management process and this ergonomics process based on International Organization for Standardization (ISO) publications such as ISO/IEC Guide 73, ISO Guide 51, etc. The contribution of ergonomics to risk analysis is illustrated by an example: the automatic diagnosis, which is a very important technical device for safety. Five main types of risk have been identified via ergonomic analyses during the different design stages. Counter-measures have been implemented and their efficacy tested within the scope of new campaigns to assess human factors. However, the management of risks in such a design project requires the participation both of the different design entities involved in the project and of other experts in aspects of risk management, such as human reliability. The organization of collaborative participation remains a challenge to be addressed.