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71.
In this work, we develop modeling and estimation approach for the analysis of cross-sectional clustered data with multimodal conditional distributions where the main interest is in analysis of subpopulations. It is proposed to model such data in a hierarchical model with conditional distributions viewed as finite mixtures of normal components. With a large number of observations in the lowest level clusters, a two-stage estimation approach is used. In the first stage, the normal mixture parameters in each lowest level cluster are estimated using robust methods. Robust alternatives to the maximum likelihood estimation are used to provide stable results even for data with conditional distributions such that their components may not quite meet normality assumptions. Then the lowest level cluster-specific means and standard deviations are modeled in a mixed effects model in the second stage. A small simulation study was conducted to compare performance of finite normal mixture population parameter estimates based on robust and maximum likelihood estimation in stage 1. The proposed modeling approach is illustrated through the analysis of mice tendon fibril diameters data. Analyses results address genotype differences between corresponding components in the mixtures and demonstrate advantages of robust estimation in stage 1.  相似文献   
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The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components—care coordination, case management, and patient engagement—which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment’s emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.  相似文献   
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We consider circular block designs for field-trials when there are two-sided spatial interference between neighbouring plots of the same blocks. The parameter of interest is total effects that is the sum of direct effect of treatment and neighbour effects, which correspond to the use of a single treatment in the whole field. We determine universally optimal approximate designs. When the number of blocks may be large, we propose efficient exact designs generated by a single sequence of treatment. We also give efficiency factors of the usual binary block neighbour balanced designs which can be used when the number of blocks is small.  相似文献   
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Abstract

This study is part of a nationwide research project dealing with all suicides in Finland. It includes all suicides among university students during the 1-year period from April 1, 1987, to March 31, 1988. Ten students (6 men and 4 women) committed suicide during the period studied. The observed suicide rates per 100,000 students per year were 13.8 (95% CI = 5.1–30.1) for men and 9.0 (95% CI = 2.4–22.8) for women. The difference between the observed and expected suicide rate for men (13.8 v 47.7, standard mortality rate [SMR] = 29) was statistically significant. For women (9.0 v 8.3, SMR = 108), the difference was not statistically significant. Most of the suicides had experienced serious difficulties since early childhood, including narcissistic problems, difficulties in human relations, severe depressive periods, previous suicidal behavior, and alcohol problems; they had also had earlier psychiatric treatment.  相似文献   
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Social work's role in creating social solidarity requires an engagement with identity politics through careful negotiation of the boundary between the private and the public spheres and hence ensuring a balance between personal freedom to define one's specific identity and the public entitlement to belong to a political community as citizens. Current political and cultural trends, reflected also in social policies, impact severely on that boundary maintenance task inasmuch as privatisation encroaches on formerly public domains while simultaneously details of private concerns receive public attention through their commercialisation by the new media. It is suggested that social work's political role be asserted more explicitly in terms of the application of the Global Agenda which needs to penetrate to the level of person‐to‐person interaction.  相似文献   
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History is often viewed unfavorably by students. In this article the author asserts that students’ disfavor of history may originate from the narrow pedagogical flavor of the history class. The purpose of this article is to describe the three traditions of history education, with their accompanying strengths and weaknesses. Three sample lessons on immigration in United States History are provided to illustrate how these three traditions of history education may actually harmoniously coexist within a history curricula as a means to meet the learning needs of students.  相似文献   
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