Comparison of response adaptive randomization features in multiarm clinical trials with control

We investigate multiple features of response adaptive randomization (RAR) in the context of a multiple arm randomized trial with control, where the primary goal is the identification of the best arm for use in a broader patient population. We maintain constant control allocation and vary the length of time until RAR is started, interim frequency, the underlying quantity used to calculate the randomization probabilities, and a threshold resulting in temporary arm dropping. We evaluate the designs on five metrics measuring benefit to the internal trial population, the future external population, and statistical estimation. Our results indicate these features have minimal interaction within the space explored, with preference for earlier activation of RAR, more frequent interim analyses, randomizing in proportion to the probability each arm is the best, and aggressive thresholding for temporarily dropping arms. The results illustrate useful principles for maximizing the benefit of RAR in practice.     

Does sorry work? The impact of apology laws on medical malpractice

Physicians’ apologies for adverse medical events are acknowledged as a factor in patients’ decisions to litigate. Apology laws which render physicians’ apologies inadmissible in court are written to encourage patient-physician communication and to overcome the physicians’ disinclination to apologize because apologies could invite lawsuits. We present a novel model of apologies and malpractice in order to examine whether state-level apology laws have an impact on malpractice lawsuits and settlements. Using a difference-in-differences estimation, we find that apology laws could expedite the resolution process. We also find that apology laws result in the greatest reduction in average payment size and settlement time in cases involving severe patient outcomes.     

Funders as principals

This article examines the tensions that surfaced for three nonprofit funding intermediaries—tensions between their historic practices and the new practices required to use performance measurement to ensure greater accountability and results among their grantees—and analyzes these tensions in light of literature on philanthropic and accountability relationships. From this analysis, the article makes three points. First, philanthropic relationships are not equivalent to accountability relationships. Second, because of these differences funders that adopt performance measurement may encounter tensions as these new practices challenge the importance of other philanthropic concerns. Third, without a systematic way to attend to these concerns when adopting performance measurement, funders face an impoverished choice: reward measurable results or fall back on supporting good intentions.     

A nonprofit manager's guide to online volunteering

As access to the Internet expands, volunteer managers have the option of using this new technology to manage pools of volunteers online. Online volunteering can appear deceptively simple: post an opening, select a volunteer, and then manage them by e‐mail. However, our evaluation of an active online volunteering service used by more than three hundred organizations and ten thousand potential volunteers indicates that additional planning and management are frequently needed. Through an analysis of two years of quantitative data and interviews with more than forty volunteers and managers, we have extracted suggested practices and programmatic implications for managers in the areas of program design, volunteer selection, training, ongoing operations, and evaluation.     

Preventive Health Behavior and Adaptive Accuracy of Risk Perceptions

This study examined the relation between health behavior and risk perceptions in the context of an acute livestock epidemic. Participants in a longitudinal web-based survey ( N = 195) were asked to report their meat consumption and their perceived risk in relation to bovine spongiform encephalopathy (BSE) and other related livestock diseases. Cross-sectional analyses at both measurement points (T1 and T2) showed that participants with low levels of preventive nutrition (high meat consumption) felt more at risk for BSE-related diseases than those reporting comparable higher levels of preventive behavior (low meat consumption), indicating relative accuracy. These results suggest that people recognize when their behavior is risky. More importantly, perceived risk also showed adaptive accuracy from a change perspective: increases in preventive nutrition from T1 to T2 were significantly associated with decreases in perceived risk between T1 and T2. Possible foundations and implications of an adaptive accuracy of risk perceptions are discussed.     

Canadian-Jewish Seniors: Marriage/Cohabitation After Age 65

This is an exploratory qualitative study of 10 seniors (5 men and 5 women), who remarried or lived together after the age of 65. They were all Jewish, lived in Toronto, Canada, and had been married previously. The subjects were interviewed in their own homes, using a questionnaire. The study attempts to explore the pathways to recoupling, how the partners met, the differences between the first and second partners, and the major issues faced by the subjects in moving into a new relationship. The results in this article are significantly presented through the words of the respondents. This gives the reader the flavor of what is involved in senior relationships. The conclusions summarize the major findings of the study, and make suggestions for further research. We focus on implications for health and wellbeing from our findings.