Multiparameter evidence synthesis in epidemiology and medical decision-making: current approaches

Summary.  Alongside the development of meta-analysis as a tool for summarizing research literature, there is renewed interest in broader forms of quantitative synthesis that are aimed at combining evidence from different study designs or evidence on multiple parameters. These have been proposed under various headings: the confidence profile method, cross-design synthesis, hierarchical models and generalized evidence synthesis. Models that are used in health technology assessment are also referred to as representing a synthesis of evidence in a mathematical structure. Here we review alternative approaches to statistical evidence synthesis, and their implications for epidemiology and medical decision-making. The methods include hierarchical models, models informed by evidence on different functions of several parameters and models incorporating both of these features. The need to check for consistency of evidence when using these powerful methods is emphasized. We develop a rationale for evidence synthesis that is based on Bayesian decision modelling and expected value of information theory, which stresses not only the need for a lack of bias in estimates of treatment effects but also a lack of bias in assessments of uncertainty. The increasing reliance of governmental bodies like the UK National Institute for Clinical Excellence on complex evidence synthesis in decision modelling is discussed.     

ALL-BIAS DESIGNS FOR POLYNOMIAL SPLINE REGRESSION MODELS

Polynomial spline regression models of low degree have proved useful in modeling responses from designed experiments in science and engineering when simple polynomial models are inadequate. Where there is uncertainty in the number and location of the knots, or breakpoints, of the spline, then designs that minimize the systematic errors resulting from model misspecification may be appropriate. This paper gives a method for constructing such all‐bias designs for a single variable spline when the distinct knots in the assumed and true models come from some specified set. A class of designs is defined in terms of the inter‐knot intervals and sufficient conditions are obtained for a design within this class to be all‐bias under linear, quadratic and cubic spline models. An example of the construction of all‐bias designs is given.     

Studying the Effects of the Audience on Verbal Behavior

The Analysis of Verbal Behavior -     

Bayesian analysis of discrete time warranty data

Summary.  The analysis of warranty claim data, and their use for prediction, has been a topic of active research in recent years. Field data comprising numbers of units returned under guarantee are examined, covering both situations in which the ages of the failed units are known and in which they are not. The latter case poses particular computational problems for likelihood-based methods because of the large number of feasible failure patterns that must be included as contributions to the likelihood function. For prediction of future warranty exposure, which is of central concern to the manufacturer, the Bayesian approach is adopted. For this, Markov chain Monte Carlo methodology is developed.     

Estimation of Hazard, Density and Survivor Functions for Randomly Censored Data

Maximum likelihood estimation and goodness-of-fit techniques are used within a competing risks framework to obtain maximum likelihood estimates of hazard, density, and survivor functions for randomly right-censored variables. Goodness-of- fit techniques are used to fit distributions to the crude lifetimes, which are used to obtain an estimate of the hazard function, which, in turn, is used to construct the survivor and density functions of the net lifetime of the variable of interest. If only one of the crude lifetimes can be adequately characterized by a parametric model, then semi-parametric estimates may be obtained using a maximum likelihood estimate of one crude lifetime and the empirical distribution function of the other. Simulation studies show that the survivor function estimates from crude lifetimes compare favourably with those given by the product-limit estimator when crude lifetimes are chosen correctly. Other advantages are discussed.     

Gender and the 'New Paradigm' of Health

This article provides a critical review of literature on the relationship between gender and the 'new paradigm' of health. An overview of the feminist critique of health is given, from the Women's Health Movement of the late 1960s and early feminist debates about medicalisation, to more recent discussions about structural inequalities between men and women, eating disorders, and AIDS. I then go on to explore the feminist response to the so-called 'new paradigm' of health (an approach that emphasises health promotion, individual responsibility for health, and body-monitoring). Arguments that health promotion initiatives target women and confirm their position as principal guardians of health within the family are considered, as well as literature on the breast cancer awareness campaign. I then explore the growing body of literature on masculinity and health, and its account of the relationship between gender and current ideas about healthiness. Finally, I offer up some suggestions for the direction a new feminist critique of health might take.     

Neither ‘family’ nor ‘corporate’ farming: Australian tomato growers as farm family entrepreneurs

For the past two decades there has been much debate about the future of family farming. The basic question on which this debate has turned is whether current pressures on family farm systems should be understood as symptomatic of a terminal condition, in which farmers are replaced progressively by corporate ownership; or whether family farms will persist as a social formation, albeit increasingly subsumed by off-farm interests. Using evidence from the Australian processing tomato sector, this article documents the changing social and economic formation of ‘family farming’. We argue that in this industry, the appropriate way to describe farmers is through the deployment of that a new category of farming; farm family entrepreneurs. This phrase is coined to describe the situation where family units remain at the social and economic heart of farm ownership and operation, but in the context where they relate to their land-based assets through legal and financial structures characteristic of the wider economy. As this article explores, this formation seems to represent an accommodating modus operandi for farm units within neo-liberal agricultural governance. Nevertheless, however, this duality of family-based structures and capitalist entrepreneurialism inevitably provokes a series of tensions, whose resolution requires a variety of organizational strategies to be put in place.