The role of the minimum clinically important difference and its impact on designing a trial

The minimum clinically important difference (MCID) between treatments is recognized as a key concept in the design and interpretation of results from a clinical trial. Yet even assuming such a difference can be derived, it is not necessarily clear how it should be used. In this paper, we consider three possible roles for the MCID. They are: (1) using the MCID to determine the required sample size so that the trial has a pre-specified statistical power to conclude a significant treatment effect when the treatment effect is equal to the MCID; (2) requiring with high probability, the observed treatment effect in a trial, in addition to being statistically significant, to be at least as large as the MCID; (3) demonstrating via hypothesis testing that the effect of the new treatment is at least as large as the MCID. We will examine the implications of the three different possible roles of the MCID on sample size, expectations of a new treatment, and the chance for a successful trial. We also give our opinion on how the MCID should generally be used in the design and interpretation of results from a clinical trial.     

The Low Income Gap: A New Indicator Based on a Minimum Income Standard

Social Indicators Research - A method to measure vulnerability to multidimensional poverty is proposed under a mean–risk behaviour approach. We extend the unidimensional downside...     

Articulating secession: self-determination,decolonization and stateless independence amongst the Kanaka Maoli

Two assumptions reign supreme in the secession literature. The first is that separatist groups seeking autonomy necessarily fall into one of two camps, one that stresses essentialist criteria for social membership, the other emphasizing instead a socially constructed collective identity. The second assumption is that secession can only be defined as taking place in the context of a separatist group whose claim to independence hinges on the attempt to galvanize a new state. This article challenges both assumptions by looking to a provocative counter-site. Amongst the Kanaka Maoli of Hawai'i secession is increasingly framed precisely as a rejection of those Western idioms that have historically undergirded colonial expropriation and racial subjection. As such, secession is being framed not as a struggle for new statehood, but rather as a reinvigoration of indigenous lifeworlds. In so doing, the Kanaka Maoli are asserting community boundaries in ways that contest the idea that indigenous identity is solely about biological criteria such as blood quantum, but also challenge the notion that indigenous self-determination can be reduced to postmodern identity politics. The argument I defend suggests that articulation theory can offer us orienting power in situating some of the stakes of Kanaka Maoli stateless secession. Articulation theory expresses the idea that identities are volatile collective self-assertions that take place at discrepant scales of interactive exchange. This article argues that we can detect some important emergent practices of articulation at play in the Kanaka Maoli's experimental revisioning of what secession can mean today.     

Union wages, rents, and skills in health care labor markets

We examine the effect of unions on the earnings of health care workers, with emphasis on the measurement and sources of union wage premiums. Using data constructed from the 1973 though 1994 Current Population Surveys, standard union premium estimates are found to be substantially lower among workers in health care than in other sectors of the economy, and to be smaller among higher skill than among lower skill occupational groups. Longitudinal analysis of workers switching union status, which controls for worker-specific skills, indicates a small impact of unions on earnings within both high and low skilled health care occupations. Evidence is found for small, but significant, union threat effects in health care labor markets. It has been argued that recent legal changes in bargaining unit determination should enhance union organizing and bargaining power. Although we cannot rule this out, such effects are not readily apparent in our data. The authors appreciate the assistance of David Macpherson, who helped develop the CPS data files used in the paper.     

The association between mental health and acute infectious illness among a national sample of 18- to 24-year-old college students

Poor mental health is associated with physical illness, but this association is poorly characterized among college students. OBJECTIVE AND PARTICIPANTS: Using American College Health Association-National College Health Assessment data, the authors characterized poor mental health (depression, anxiety, negative affect) and examined the relationship between poor mental health and acute infectious illnesses (bronchitis, ear infection, sinusitis, strep throat) among 47,202 US college students. METHODS: The authors used frequency and cross-tabulation analyses to characterize mental health and determine univariate associations among variables. They used binary logistic regression to determine the association between poor mental health and acute infectious illness, controlling for research-derived covariates. RESULTS: The prevalence of acute infectious illness ranged from 8% to 29%. The prevalence of anxiety and depression ranged from 12% to 20%, respectively. Depression, anxiety, and exhaustion were associated with acute infectious illness across all dependent measures, with odds ratios ranging from .56 to .91. CONCLUSIONS: Poor mental health is associated with acute infectious illness among college students.     

In the eye of the beholder: pretesting the effectiveness of health education materials.

Health educators at the University of Massachusetts evaluated five posters to determine whether students comprehended, identified with, and were motivated by the messages, which dealt with aspects of safer sex, alcohol use, and stress management. Pretesting, they suggest, provides an opportunity for remedying design flaws before distributing materials, improving effectiveness, and saving money by assuring that the target audience receives the intended message. Six suggestions for improving effectiveness and acceptability of printed health education materials are offered.     

THE CREATION OF POLITICAL SOLIDARITY IN SOCIAL MOVEMENT ORGANIZATIONS*

This article examines the debate within resource mobilization theory concerning the motivation of participants in social movement organizations. Conclusions based on a case study of a Chicago community organization emphasize the importance of political solidarity in movement groups. An argument is made for a stage model of mobilization in which different types of incentives dominate motivation at different levels of involvement in the organization.