Using relative utility curves to evaluate risk prediction

Summary.  Because many medical decisions are based on risk prediction models that are constructed from medical history and results of tests, the evaluation of these prediction models is important. This paper makes five contributions to this evaluation: the relative utility curve which gauges the potential for better prediction in terms of utilities, without the need for a reference level for one utility, while providing a sensitivity analysis for misspecification of utilities, the relevant region, which is the set of values of prediction performance that are consistent with the recommended treatment status in the absence of prediction, the test threshold, which is the minimum number of tests that would be traded for a true positive prediction in order for the expected utility to be non-negative, the evaluation of two-stage predictions that reduce test costs and connections between various measures of performance of prediction. An application involving the risk of cardiovascular disease is discussed.     

Is education a risk factor or social vaccine against HIV/AIDS in Sub-Saharan Africa? The effect of schooling across public health periods

Early in the 30-year HIV/AIDS pandemic in Sub-Saharan Africa, epidemiological studies identified formal education attainment as a risk factor: educated Sub-Saharan Africans had a higher risk of contracting HIV/AIDS than their less educated peers. Later demographic research reported that by the mid-1990s the education effect had reversed, and education began to function as a social vaccine. Recent counter-evidence finds a curvilinear pattern, with the association between educational attainment and HIV/AIDS infection changing from positive to negative across the education gradient. To reconcile these inconsistent conclusions, a hypothesis is developed and tested that education at early stages functioned as a risk factor and later functioned (and continues to function) as a social vaccine. We reason that this shift in the direction of the education effect was concurrent with changes in the public health environment in SSA that early on heightened material benefits from educational attainment but later heightened cognitive benefits from schooling. Using the 2003/2004 Demographic Health Surveys from four Sub-Saharan African countries (Cameroon, Ghana, Kenya and Tanzania), we tested this hypothesis (differential effects of schooling) using non-linear regression analysis (probit), identifying the different public health periods and controlling for confounding factors. The results support the hypothesis that the education effect shifted historically in the HIV/AIDS pandemic in SSA as we hypothesized.     

Potential strategies to avoid progestogen-induced premenstrual disorders

Non-hormonal approaches to premenstrual syndrome (PMS) treatment such as selective serotonin reuptake inhibitors are by no means effective for all women and frequently we must resort to endocrine therapy. During many of the hormonal approaches, PMS-like symptoms can be introduced or re-introduced during the necessary cyclical or continuous progestogen component of the therapy. This is seen with combined oral contraception, progestogen only contraception, progestogen therapy for heavy menstrual bleeding and endometriosis, sequential hormone replacement therapy and any therapeutic strategy for premenstrual syndrome where it is necessary to provide endometrial protection, including estrogen suppression of ovulation or add-back during gonadotrophin releasing hormone suppression. The link to progestogen is very often missed by health professionals. When the pattern of symptoms mimics the cyclicity of PMS, it is termed progestogen-induced premenstrual disorder. The need to use progestogen to protect the endometrium from the proliferative actions of estrogen can pose insurmountable difficulties in managing premenstrual disorders. In the absence of any really useful evidence, nearly all practice in this area depends on clinician experience. We cannot afford to wait for adequate research evidence to be produced - it never will - and so we must rely on empirical findings, clinical experience, theoretical strategies and common sense.     

Public Perceptions About Sex Offenders and Community Protection Policies

Sex offenders and sex crimes provoke a great deal of anxiety in our society, and over the past decade, lawmakers have passed a variety of social policies designed to protect the public from sexual victimization. The purpose of this study was to examine public perceptions about sex offenders and community protection policies. Data were obtained from a sample of 193 residents in Melbourne, Florida. It was hypothesized that the public holds some inaccurate beliefs about sex offenders, and that there is strong public support for community protection policies. It was found that community members believe that sex offenders have very high recidivism rates, view sex offenders as a homogeneous group with regard to risk, and are skeptical about the benefits of sex offender treatment. The hypothesis that public perceptions contradict empirical research was supported. Community members were overwhelmingly in favor of public disclosure of information about registered sex offenders, although they did not express as much support for residence restrictions. Implications for public policy, and for the media's role in shaping public perceptions, are discussed.     

Management of Energy Technology for Sustainability: How to Fund Energy Technology Research and Development

Operations management methods have been applied profitably to a wide range of technology portfolio management problems, but have been slow to be adopted by governments and policy makers. We develop a framework that allows us to apply such techniques to a large and important public policy problem: energy technology R&D portfolio management under climate change. We apply a multi‐model approach, implementing probabilistic data derived from expert elicitations into a novel stochastic programming version of a dynamic integrated assessment model. We note that while the unifying framework we present can be applied to a range of models and data sets, the specific results depend on the data and assumptions used and therefore may not be generalizable. Nevertheless, the results are suggestive, and we find that the optimal technology portfolio for the set of projects considered is fairly robust to different specifications of climate uncertainty, to different policy environments, and to assumptions about the opportunity cost of investing. We also conclude that policy makers would do better to over‐invest in R&D rather than under‐invest. Finally, we show that R&D can play different roles in different types of policy environments, sometimes leading primarily to cost reduction, other times leading to better environmental outcomes.     

The use of constructive-developmental theory to advance the understanding of leadership

Constructive-developmental theory is a stage theory of adult development that focuses on the growth and elaboration of a person's ways of understanding the self and the world. In this article we review how the constructive-developmental frameworks of Kegan [Kegan, R. (1982). The evolving self: Problem and process in human development. Cambridge, MA: Harvard University Press], Torbert [Torbert, W. R. (1987). Managing the corporate dream: Restructuring for long-term success. Homewood, IL: Dow Jones-Irwin.], and Kohlberg [Kohlberg, L. (1969). Stage and sequence: The cognitive developmental approach to socialization. In D. Goslin (Ed.), Handbook of socialization: Theory and research. New York: Rand McNally] have been applied in the theoretical and empirical literature on leadership and management. Although the literature has produced a number of propositions, the notion that a leader's order of development should impact his or her leadership effectiveness or managerial performance has generated the most research. We found mixed support for this proposition as well as a number of limitations in the research in general. To have a greater impact on the leadership field, constructive-developmental theory needs to generate more robust research, to link more clearly with on-going streams of leadership research, and to explore the contribution of aspects of the theory beyond individual order of development.     

An overview of the Salmonella enteritidis risk assessment for shell eggs and egg products.

This article summarizes a quantitative microbial risk assessment designed to characterize the public health impact of consumption of shell eggs and egg products contaminated with Salmonella Enteritidis (SE). This risk assessment's objectives were to: (1) establish the baseline risk of foodborne illness from SE, (2) identify and evaluate potential risk mitigation strategies, and (3) identify data gaps related to future research efforts. The risk assessment model has five modules. The Egg Production module estimates the number of eggs produced that are SE-contaminated. Shell Egg Processing, Egg Products Processing, and Preparation & Consumption modules estimate the increase or decrease in the numbers of SE organisms in eggs or egg products as they pass through storage, transportation, processing, and preparation. A Public Health Outcomes module then calculates the incidence of illnesses and four clinical outcomes, as well as the cases of reactive arthritis associated with SE infection following consumption. The baseline model estimates an average production of 2.3 million SE-contaminated shell eggs/year of the estimated 69 billion produced annually and predicts an average of 661,633, human illnesses per year from consumption of these eggs. The model estimates approximately 94% of these cases recover without medical care, 5% visit a physician, an additional 0.5% are hospitalized, and 0.05% result in death. The contribution of SE from commercially pasteurized egg products was estimated to be negligible. Five mitigation scenarios were selected for comparison of their individual and combined effects on the number of human illnesses. Results suggest that mitigation in only one segment of the farm-to-table continuum will be less effective than several applied in different segments. Key data gaps and areas for future research include the epidemiology of SE on farms, the bacteriology of SE in eggs, human behavior in food handling and preparation, and human responses to SE exposure.     

How useful is the term "Cumulative Trauma Disorder"?

Cumulative trauma disorder is a widely accepted construct that refers to illnesses of the soft tissues which supposedly occur due to biomechanical workplace risk factors. However, is the term "cumulative trauma disorder" a useful term for describing the illness attributed to it? This paper will scrutinize this question by specifying the meaning of "cumulative trauma disorder" and examining this construct to see if the belief in it is justified, and if this belief is leading to the elucidation of the phenomenon it is purporting to notate. Anomalous findings will be identified and used to help evaluate the accuracy of the belief system currently surrounding the term. Finally the ability of the construct "cumulative trauma disorder" to provide an adequate foundation for research in this area will be explored. A model of alternate pathomechanisms for this illness is advanced to provide a method of studying the disorders associated with the term.     

Family member response to violent infant kidnapping

All family members interviewed suffered from chronic posttraumatic stress disorder 5 or more years after an infant kidnapping. Psychiatric nurses should routinely assess for secondary victimization related to any type of traumatic stressor. Nurses should refer parents and families to materials available from the National Center for Missing and Exploited Children (NCMEC) (http://www.missingkids.com/).     

Including siblings in the treatment of child sexual abuse

Siblings are often not included in treatment programs for children who have been sexually abused. This article describes the necessity of including siblings in the treatment of victims of child sexual abuse. Including siblings in treatment permits families to realize the maximum benefits of therapy for the victim as well as each family member. Theoretical and practical reasons to include siblings in treatment are discussed (i.e., preventing future abuse, providing support for siblings, teaching siblings to refrain from victim-blaming). Case examples using a particular intervention approach at The Family Learning Program and results of client satisfaction surveys are described.