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.     

Point Estimates of Test Sensitivity and Specificity from Sample Means and Variances

In a wide variety of biomedical and clinical research studies, sample statistics from diagnostic marker measurements are presented as a means of distinguishing between two populations, such as with and without disease. Intuitively, a larger difference between the mean values of a marker for the two populations, and a smaller spread of values within each population, should lead to more reliable classification rules based on this marker. We formalize this intuitive notion by deriving practical, new, closed-form expressions for the sensitivity and specificity of three different discriminant tests defined in terms of the sample means and standard deviations of diagnostic marker measurements. The three discriminant tests evaluated are based, respectively, on the Euclidean distance and the Mahalanobis distance between means, and a likelihood ratio analysis. Expressions for the effects of measurement error are also presented. Our final expressions assume that the diagnostic markers follow independent normal distributions for the two populations, although it will be clear that other known distributions may be similarly analyzed. We then discuss applications drawn from the medical literature, although the formalism is clearly not restricted to that application.     

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.     

Migrant domestic workers and shifting strategies in organizing

The mobilization of domestic workers in the United States has strengthened and grown nationally in the last 15 years, and scholars have been paying particular attention to the ways their organizing has undertaken innovative strategies to address social, cultural, and legal exclusions specific to migrant domestic workers. Research has focused on historicizing the entrenched colonial legacy of servitude and domesticity, but more recently studies have concentrated on documenting the challenges and victories domestic workers have achieved as a result of their legislative state campaigns for a Domestic Worker Bill of Rights. This article reviews recent research that analyzes the complex strategies employed in organizing, and the role that migrant domestic workers play in challenging the boundaries of citizenship and integrating a transnational dimension to domestic worker organizing. Although research shows that enforcement continues to be a central issue in states where a Domestic Workers Bill of Rights has been enacted, migrant domestic workers continue to strengthen the coalitional power that has shown to transform new directions in organizing that demand alternate ways of contemplating workers experiences as generating different principles of justice.     

Eliciting children’s recall regarding home life and relationships

Abstract

Child interviews form an important component of custody evaluations. Yet, research on children’s responses to questions about home life and relationships is lacking. In the present study, children (N?=?47) aged 6 to 10?years were interviewed about their daily routines and family relationships. Responses to four categories of questions were compared: open and specific questions about routines, and negative and positive aspects of family relationships. Responses were coded for amount of information, informativeness, topic pertinence, and refusals to answer. Results suggested that questions about everyday routines and relationships elicit relevant and informative responses from children. It is suggested that interviewers begin with open-ended questions regarding daily routines to structure family law interviews with children.     

Meningococcal serogroup B outbreak response University of Wisconsin-Madison

A meningococcal serogroup B (MenB) outbreak at a large public university prompted an emergency response to immunize undergraduates. Objective: To report on a successful meningococcal serogroup B (MenB) vaccine clinic response at a large public university. Methods: We assembled the team leaders to write this case report. Results: Activation of the emergency plan and points of dispensing required cooperation of many units on campus under the leadership of university health officials with support from Centers for Disease Control and Prevention, state division of public health and the city-county health department. Significant efforts to provide consistent messages to students and parents regarding the outbreak and the availability of the MenB vaccines were made. Volunteers were recruited to staff the clinics alongside university healthcare providers. Over 22,000 doses of vaccine were administered. Conclusion: We report our experience and lessons learned which may be helpful to universities in preventing and responding to disease outbreaks.     

Amassing rural power in the fight against fracking in Maryland: A report from the field

ABSTRACT

Social workers can mobilize vulnerable populations to shape policy decisions about industrial practices that could have adverse impacts on their wellbeing. One such practice is hydraulic fracturing or “fracking” to extract oil and natural gas from shale rock deposits. There is scant social work literature on mobilizing opposition to fracking despite a proliferation of literature from other disciplines. This article documents the campaign in Maryland that led to the adoption of the first legislative ban on fracking in a U.S. state with shale gas reserves, using social movement theory to identify factors that led to this successful outcome.