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.     

A continuous sampling plan using CUSUMs

A Continuous Sampling Plan, CSP-CUSUM, is proposed based on the use of Cumulative Sums (CUSUMs) for deciding when to switch between the phases of sampling inspection and 100% inspection. The Geometric CUSUM, also termed the Run-length CUSUM, is chosen for this purpose, and two separate CUSUMs are to be operated, one for each inspection phase. The conventional measures of performance for CSPs such as average outgoing quality, average fraction inspected, and average proportion passed under sampling inspection are evaluated for CSP-CUSUM, and comparisons with some standard CSPs are presented. An additional performance-measure, Average Cycle Length, is proposed. A table is provided to aid the choice of parameters for the operation of CSP-CUSUM. It is recommended that a Geometric CUSUM control chart be maintained in parallel with CSP-CUSUM to detect significant upward shifts in the incoming fraction defective.     

Sample sizes for estimation in clinical research

A sample size justification should be given for all clinical investigations. However, sometimes the objective of a trial is to estimate an effect with a view to planning a later definitive study. This paper describes the calculations for designing studies where one wishes to adopt an estimation approach through using confidence intervals around the overall response. Calculations are given for data anticipated to take a Normal form. Copyright © 2004 John Wiley & Sons, Ltd.     

Studying the Effects of the Audience on Verbal Behavior

The Analysis of Verbal Behavior -     

A sociolinguistic application of Bakhtin's authoritative and internally persuasive discourse

Through the use of two central Bakhtinian concepts, authoritative and internally persuasive discourse (word), this paper examines the tension between the ideology of linguistic hegemony as a source of power in the Greek public sphere and the condition of language shift faced by the Albanian‐speaking communities of modern Greece. I argue here that a cautious application of these two notions, which are relevant to linguistic ideology, can reveal crucial aspects of two processes: that of subordination to and that of questioning of the dominant linguistic ideology by local Albanian‐speaking communities. Thus, in language shift contexts, it is possible that no simple relations obtain that place social agents in unquestionable and easily predictable positions. Such an approach proves useful for the sociolinguistic study of threatened language communities.     

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.