Assessing accuracy of a continuous screening test in the presence of verification bias

Summary.  In studies to assess the accuracy of a screening test, often definitive disease assessment is too invasive or expensive to be ascertained on all the study subjects. Although it may be more ethical or cost effective to ascertain the true disease status with a higher rate in study subjects where the screening test or additional information is suggestive of disease, estimates of accuracy can be biased in a study with such a design. This bias is known as verification bias. Verification bias correction methods that accommodate screening tests with binary or ordinal responses have been developed; however, no verification bias correction methods exist for tests with continuous results. We propose and compare imputation and reweighting bias-corrected estimators of true and false positive rates, receiver operating characteristic curves and area under the receiver operating characteristic curve for continuous tests. Distribution theory and simulation studies are used to compare the proposed estimators with respect to bias, relative efficiency and robustness to model misspecification. The bias correction estimators proposed are applied to data from a study of screening tests for neonatal hearing loss.     

Improving performance? The adoption and implementation of quality systems in U.K. nonprofits

There are increasing and multiple pressures on nonprofit organizations to demonstrate excellence in performance. Although there is a growing literature on the various approaches to performance improvement taken by nonprofits, little is known about the processes involved in the adoption and implementation of specific approaches. This article is about the adoption and use of one approach to performance improvement, “quality systems,” in the U.K. nonprofit sector. We report findings about factors that encourage nonprofits to adopt quality systems. We also analyze the distinctive challenges of implementing quality approaches in a nonprofit sector context and suggest critical success factors. The article concludes with a discussion of the organizational and policy implications of applying the management concepts of quality and performance to the nonprofit sector.     

Community versus development? Land use and development policy in Vermont as a tool toward community viability

This paper examines Vermont's Land Use and Development Law (Act250) as a means of promoting community development through publicpolicy. Central to the law are mechanisms that invite citizenparticipation in the development and planning process. Accordingly,citizens can organize and undertake collective action againstdevelopment projects that are understood as posing a threatto the ongoing life of the community. A case is explored inwhich citizens organized under the banner of Act 250 to preventWal-Mart from entering their community, in order to protecta vulnerable downtown area that had centred public and commerciallife for generations.     

Child‐Care Usage and Mother‐Infant “Quality Time”

Mothers' time‐use patterns were compared in families in which infants spent more than 30 hours per week in child care (In‐Care group; n= 143) versus 0 hours per week (At‐Home group; n= 183) from birth to 6 months of age. In‐Care group mothers spent about 12 fewer hours per week interacting with their infants, for about 32% less time; fathers of these infants were more involved in caregiving. The groups did not differ in the quality of mother‐infant interaction. In the In‐Care group, quantity of interaction was related to greater separation anxiety and concerns about effects of maternal employment. Time‐use data were not related to child outcomes at 15 months of age. Results suggest that the effect of extensive time spent apart on the quantity and quality of mother‐infant interaction may be smaller than anticipated.     

Children's involvement in their parents' divorce: implications for practice

The paper reports findings from a research study that explored children's experience of divorce. It shows that children experience parental divorce as a crisis in their lives but that they are able to mobilise internal and external resources to regain a new point of balance. In doing so, children demonstrate the degree to which they are active and competent participants in the process of family dissolution. The implications of the data are then considered in relation to engaging with children involved in divorce and in relation to some of the cultural presumptions that might militate against hearing what they have to say about their experiences. Copyright © 2002 John Wiley & Sons, Ltd.     

In Whose Backyard?: Concern About Siting a Nuclear Waste Facility*

Proponents of hazardous and nuclear waste depositories label opponents to local siting of such facilities “NIMBYs” (Not In My Backyard). This study assesses the extent to which the NIMBY label and the strategies of industry proponents to reduce opposition function on a reasonable set of assumptions. Using survey data and multiple regression techniques, the levels of concern of residents living in the county selected as the site of a low level radioactive waste disposal facility (imminent threat condition) are compared with a statewide sample (hypothetical threat condition). Consistent with proponents' theoretical assumptions, the levels of concern are greater for respondents under conditions of imminent threat than of hypothetical threat. However, within the host county, levels of concern are lowest, albeit most polarized, in the community closest to the proposed site. A conflict theory approach enhances an understanding of these findings by suggesting that within the most proximate community levels of concern are lowest for citizens who stand to gain the most economic benefits from the facility but highest for those citizens who are least likely to derive tangible gains.     

Couple Attitudes and Agreement Regarding Pregnancy Wantedness in the Philippines

We compare husbands' and wives' views of the wantedness of their most recent pregnancy in the Philippines, a country where relatively high levels of unintended fertility persist. This research is an extension of earlier work that looked separately at individual men's and women's responses. We analyze survey data for 369 couples and find that those most at risk of experiencing a pregnancy that neither spouse wanted tended to be higher parity couples, those who were more fatalistic, those who were practicing Catholics who attended religious services frequently, and those among whom the husband was the sole breadwinner. Higher parity women and older women were also more apt to experience a pregnancy that was wanted by only 1 spouse. Women who had difficulty discussing sexual matters with their husbands were more likely than other women to have a pregnancy that their husbands wanted but they did not.