Data envelopment analysis in the presence of measurement error: case study from the National Database of Nursing Quality Indicators® (NDNQI®)

Data envelopment analysis (DEA) is the most commonly used approach for evaluating healthcare efficiency [B. Hollingsworth, The measurement of efficiency and productivity of health care delivery. Health Economics 17(10) (2008), pp. 1107–1128], but a long-standing concern is that DEA assumes that data are measured without error. This is quite unlikely, and DEA and other efficiency analysis techniques may yield biased efficiency estimates if it is not realized [B.J. Gajewski, R. Lee, M. Bott, U. Piamjariyakul, and R.L. Taunton, On estimating the distribution of data envelopment analysis efficiency scores: an application to nursing homes’ care planning process. Journal of Applied Statistics 36(9) (2009), pp. 933–944; J. Ruggiero, Data envelopment analysis with stochastic data. Journal of the Operational Research Society 55 (2004), pp. 1008–1012]. We propose to address measurement error systematically using a Bayesian method (Bayesian DEA). We will apply Bayesian DEA to data from the National Database of Nursing Quality Indicators^® to estimate nursing units’ efficiency. Several external reliability studies inform the posterior distribution of the measurement error on the DEA variables. We will discuss the case of generalizing the approach to situations where an external reliability study is not feasible.     

A Comparative Pharmacokinetic Estimate of Mercury in U.S. Infants Following Yearly Exposures to Inactivated Influenza Vaccines Containing Thimerosal

The use of thimerosal preservative in childhood vaccines has been largely eliminated over the past decade in the United States because vaccines have been reformulated in single‐dose vials that do not require preservative. An exception is the inactivated influenza vaccines, which are formulated in both multidose vials requiring preservative and preservative‐free single‐dose vials. As part of an ongoing evaluation by USFDA of the safety of biologics throughout their lifecycle, the infant body burden of mercury following scheduled exposures to thimerosal preservative in inactivated influenza vaccines in the United States was estimated and compared to the infant body burden of mercury following daily exposures to dietary methylmercury at the reference dose established by the USEPA. Body burdens were estimated using kinetic parameters derived from experiments conducted in infant monkeys that were exposed episodically to thimerosal or MeHg at identical doses. We found that the body burden of mercury (AUC) in infants (including low birth weight) over the first 4.5 years of life following yearly exposures to thimerosal was two orders of magnitude lower than that estimated for exposures to the lowest regulatory threshold for MeHg over the same time period. In addition, peak body burdens of mercury following episodic exposures to thimerosal in this worst‐case analysis did not exceed the corresponding safe body burden of mercury from methylmercury at any time, even for low‐birth‐weight infants. Our pharmacokinetic analysis supports the acknowledged safety of thimerosal when used as a preservative at current levels in certain multidose infant vaccines in the United States.     

Understanding the Dynamics of the Individual Donor’s Trust Damage in the Philanthropic Sector

Although trust is long known to be critical to predict behaviors in a charitable context, little research has examined trust damage and its effects on giving behavior. Trust damage is an intermediate state between trust and distrust, rather than a simple reversal or extension, and can change over time. Our research explores individual donor’s trust damage through a dynamic evolution. Across the longitudinal survey, we conclude that the trust damage of pre-giving, giving, and post-giving stage plays different roles in the decision-making process. Trust damage does not play a direct role in the giving intention, but it can indirectly affect giving intention through its impact on perceived benefit and perceived risk. Individual donor’s satisfaction has a strong effect on post-giving trust or continual trust damage, which in turn positively affects future giving intention and behavior. Several important insights for practitioners in the nonprofit sector are also discussed.     

Building a Values‐Informed Mental Model for New Orleans Climate Risk Management

Individuals use values to frame their beliefs and simplify their understanding when confronted with complex and uncertain situations. The high complexity and deep uncertainty involved in climate risk management (CRM) lead to individuals’ values likely being coupled to and contributing to their understanding of specific climate risk factors and management strategies. Most mental model approaches, however, which are commonly used to inform our understanding of people's beliefs, ignore values. In response, we developed a “Values‐informed Mental Model” research approach, or ViMM, to elicit individuals’ values alongside their beliefs and determine which values people use to understand and assess specific climate risk factors and CRM strategies. Our results show that participants consistently used one of three values to frame their understanding of risk factors and CRM strategies in New Orleans: (1) fostering a healthy economy, wealth, and job creation, (2) protecting and promoting healthy ecosystems and biodiversity, and (3) preserving New Orleans’ unique culture, traditions, and historically significant neighborhoods. While the first value frame is common in analyses of CRM strategies, the latter two are often ignored, despite their mirroring commonly accepted pillars of sustainability. Other values like distributive justice and fairness were prioritized differently depending on the risk factor or strategy being discussed. These results suggest that the ViMM method could be a critical first step in CRM decision‐support processes and may encourage adoption of CRM strategies more in line with stakeholders’ values.     

Positioning urban rivers within urban ecology

Rivers are important components of many urban systems, and research into urban rivers is increasing internationally, both in scope and intensity. As an introduction to a special section on urban rivers, this short article briefly highlights some key trends in urban river research based on a survey of published articles from Web of Knowledge, before summarising the contributions made by the special section papers. In particular, there has been a general increase in work on urban rivers since the 1990s, with a more dramatic increase from 2001. Most published research has concentrated on water quality and its wider environmental implications; ecologically, many studies have focused on autecology, community ecology or river restoration/rehabilitation, with the main emphasis on macroinvertebrates or fish. Geographically, most studies have taken place in North America (mainly the US) and Asia (mainly China). In the large majority of cases research has been on relatively small rivers within urbanised catchments rather than large, heavily urbanised systems within major towns or cities. Given the wide range of topics and studies relating to urban river research, a detailed meta-analysis of the urban river ecology literature would be a useful endeavour. The six papers included in the special section of this issue provide a sample of some of key and emerging themes within recent urban river research, and originate from a session on the understanding and management of urban rivers held at the Royal Geographical Society (with IBG) Annual Meeting in 2010, at Imperial College London.     

Shift Work and Work to Family Fit: Does Schedule Control Matter?

We used the 2008 National Study of the Changing Workforce to investigate the effects of shift work on individuals. We investigated if shift workers would have poorer work to family fit than workers with regular day schedules or flexible schedules. We also investigated if control of work schedule would moderate the possible negative effects of shift work. Results indicate that shift work is associated with increased work to family conflict, especially for women. In addition, the results indicate that women have greater work to family conflict compared to men when workers have more work schedule control. Implications of the findings are discussed.     

The star-shaped Λ-coalescent and Fleming–Viot process

The star-shaped Λ-coalescent and corresponding Λ-Fleming–Viot process, where the Λ measure has a single atom at unity, are studied in this article. The transition functions and stationary distribution of the Λ-Fleming–Viot process are derived in a two-type model with mutation. The distribution of the number of non-mutant lines back in time in the star-shaped Λ-coalescent is found. Extensions are made to a model with d types, either with parent-independent mutation or general Markov mutation, and an infinitely-many-types model, when d → ∞. An eigenfunction expansion for the transition functions is found, which has polynomial right eigenfunctions and left eigenfunctions described by hyperfunctions. A further star-shaped model with general frequency-dependent change is considered and the stationary distribution in the Fleming–Viot process derived. This model includes a star-shaped Λ-Fleming–Viot process with mutation and selection. In a general Λ-coalescent explicit formulae for the transition functions and stationary distribution, when there is mutation, are unknown. However, in this article, explicit formulae are derived in the star-shaped coalescent.     

‘There is always this feeling of otherness’: exploring the lived experiences of visually impaired immigrant women in Canada

This paper explores the experiences of immigrant women with visual impairment in the Greater Toronto and Hamilton Area (GTHA) of Canada. Conceptually, the paper draws from feminist disability theory and critical scholarship on blindness to consider the discursive and material processes shaping women’s experiences across different socio-cultural contexts. Empirically, the paper draws from in-depth interviews with seven women. The analysis is organized around three themes. The first explores women’s understandings of visual impairment. The second examines the ways in which women’s experiences of visual impairment are shaped by meanings and attitudes that circulate within their cultural communities, and the extent to which immigration might challenge or reinforce these meanings. The third examines the shifting barriers and opportunities women face with respect to social and economic participation. We close by identifying the conceptual implications of our research.