A win ratio approach to comparing continuous non‐normal outcomes in clinical trials

Clinical trials are often designed to compare continuous non‐normal outcomes. The conventional statistical method for such a comparison is a non‐parametric Mann–Whitney test, which provides a P‐value for testing the hypothesis that the distributions of both treatment groups are identical, but does not provide a simple and straightforward estimate of treatment effect. For that, Hodges and Lehmann proposed estimating the shift parameter between two populations and its confidence interval (CI). However, such a shift parameter does not have a straightforward interpretation, and its CI contains zero in some cases when Mann–Whitney test produces a significant result. To overcome the aforementioned problems, we introduce the use of the win ratio for analysing such data. Patients in the new and control treatment are formed into all possible pairs. For each pair, the new treatment patient is labelled a ‘winner’ or a ‘loser’ if it is known who had the more favourable outcome. The win ratio is the total number of winners divided by the total numbers of losers. A 95% CI for the win ratio can be obtained using the bootstrap method. Statistical properties of the win ratio statistic are investigated using two real trial data sets and six simulation studies. Results show that the win ratio method has about the same power as the Mann–Whitney method. We recommend the use of the win ratio method for estimating the treatment effect (and CI) and the Mann–Whitney method for calculating the P‐value for comparing continuous non‐Normal outcomes when the amount of tied pairs is small. Copyright © 2016 John Wiley & Sons, Ltd.     

Spirit of aging rising: cross-cutting thematic modules to enrich foundation graduate social work courses

To enrich an urban generalist MSW program serving a diverse aging community, an innovative approach was initiated. A team of students, faculty and a field instructor collaborated in creating and evaluating 3 sets of cross-cutting thematic modules. An overview of the thematic modules (addressing elder abuse, family caregiving, and mental health), integrated across multiple curriculum areas (Human Behavior and the Social Environment, Macro/Policy, Practice and Research), is presented along with results of a faculty focus group evaluating the process of coordinating module content for one full week of class per foundation area (one topic per quarter).     

AD HOC MODEL BUILDING USING TIME-VARYING PARAMETER MODELS*

Decision support for managers and policy makers, such as required in planning and evaluation efforts, often requires ad hoc behavioral modeling to account for context-specific phenomena and to handle data limitations. This paper introduces a systematic approach useful for meeting these requirements in which time-varying parameter estimation plays an important role. A case study evaluating the impacts of public policy actions on residential natural gas conservation illustrates the approach.     

From the Mouths of Mothers: Can Drama Facilitate Reflective Learning for Social Workers?

This article explores and evaluates a cross-disciplinary small-scale project using applied theatre in social work education. The aim was to provide an ‘Affective Encounter’ where students could practice empathic engagement, understanding of the needs of children who have been sexually abused and their protective parents/carers and engage in the complexities of working with family members who may be resistant. The workshop took place five times over a period of three years and was attended by children and families social workers on a one year post-qualifying graduate diploma course. While the use of verbatim theatre does not offer a guarantee of factual truth, it provided the students with some performed moments of personal testimony which was taken word-for-word from mothers whose children had been sexually abused. This allowed the social workers to hear the marginalised narratives of the protective mothers and to practice without a negative impact on the service user. The evaluation identified from self-report the development of emotional and practical skills and knowledge of available resources. This paper focuses on the emotional skills reported and two emerging themes are discussed: learning for humane practice, and the use of this pedagogical approach to encourage affective reflection.     

Using relative utility curves to evaluate risk prediction

Summary.  Because many medical decisions are based on risk prediction models that are constructed from medical history and results of tests, the evaluation of these prediction models is important. This paper makes five contributions to this evaluation: the relative utility curve which gauges the potential for better prediction in terms of utilities, without the need for a reference level for one utility, while providing a sensitivity analysis for misspecification of utilities, the relevant region, which is the set of values of prediction performance that are consistent with the recommended treatment status in the absence of prediction, the test threshold, which is the minimum number of tests that would be traded for a true positive prediction in order for the expected utility to be non-negative, the evaluation of two-stage predictions that reduce test costs and connections between various measures of performance of prediction. An application involving the risk of cardiovascular disease is discussed.     

European‐American and African‐American Mothers' Emotion Socialization Practices Relate Differently to Their Children's Academic and Social‐emotional Competence

The current study examines whether the relation between mothers' responses to their children's negative emotions and teachers' reports of children's academic performance and social‐emotional competence are similar or different for European‐American and African‐American families. Two hundred mothers (137 European‐American, 63 African‐American) reported on their responses to their five‐year‐old children's negative emotions and 150 kindergarten teachers reported on these children's current academic standing and skillfulness with peers. Problem‐focused responses to children's negative emotions, which have traditionally been considered a supportive response, were positively associated with children's school competence for European‐American children, but expressive encouragement, another response considered supportive, was negatively associated with children's competence for African‐American children. The findings highlight the need to examine parental socialization practices from a culturally specific lens.     

Slope Estimation for Bivariate Longitudinal Outcomes Adjusting for Informative Right Censoring Using Discrete Survival Model: Application to the Renal Transplant Cohort

Patients undergoing renal transplantation are prone to graft failure which causes lost of follow-up measures on their blood urea nitrogen and serum creatinine levels. These two outcomes are measured repeatedly over time to assess renal function following transplantation. Loss of follow-up on these bivariate measures results in informative right censoring, a common problem in longitudinal data that should be adjusted for so that valid estimates are obtained. In this study, we propose a bivariate model that jointly models these two longitudinal correlated outcomes and generates population and individual slopes adjusting for informative right censoring using a discrete survival approach. The proposed approach is applied to the clinical dataset of patients who had undergone renal transplantation. A simulation study validates the effectiveness of the approach.     

A pattern-mixture odds ratio model for incomplete categorical data

Most models for incomplete data are formulated within the selection model framework. Pattern-mixture models are increasingly seen as a viable alternative, both from an interpretational as well as from a computational point of view (Little 1993, Hogan and Laird 1997, Ekholm and Skinner 1998). Whereas most applications are either for continuous normally distributed data or for simplified categorical settings such as contingency tables, we show how a multivariate odds ratio model (Molenberghs and Lesaffre 1994, 1998) can be used to fit pattern-mixture models to repeated binary outcomes with continuous covariates. Apart from point estimation, useful methods for interval estimation are presented and data from a clinical study are analyzed to illustrate the methods.