Evaluation of alternative confidence intervals to address non-inferiority through the stratified difference between proportions

The confidence interval (CI) for the difference between two proportions has been an important and active research topic, especially in the context of non-inferiority hypothesis testing. Issues concerning the Type 1 error rate, power, coverage rate and aberrations have been extensively studied for non-stratified cases. However, stratified confidence intervals are frequently used in non-inferiority trials and similar settings. In this paper, several methods for stratified confidence intervals for the difference between two proportions, including existing methods and novel extensions from unstratified CIs, are evaluated across different scenarios. When sparsity across the strata is not a concern, adding imputed observations to the stratification analysis can strengthen Type-1 error control without substantial loss of power. When sparseness of data is a concern, most of the evaluated methods fail to control Type-1 error; the modified stratified t-test CI is an exception. We recommend the modified stratified t-test CI as the most useful and flexible method across the respective scenarios; the modified stratified Wald CI may be useful in settings where sparsity is unlikely. These findings substantially contribute to the application of stratified CIs for non-inferiority testing of differences between two proportions.     

Work,welfare, and wellbeing: The impacts of welfare conditionality on people with mental health impairments in the UK

The personal, economic, and social costs of mental ill health are increasingly acknowledged by many governments and international organisations. Simultaneously, in high-income nations, the reach of welfare conditionality has extended to encompass many people with mental health impairments as part of on-going welfare reforms. This is particularly the case in the UK where, especially since the introduction of Employment and Support Allowance in 2008, the rights and responsibilities of disabled people have been subject to contestation and redefinition. Following a review of the emergent international evidence on mental health and welfare conditionality, this paper explores two specific issues. First, the impacts of the application of welfare conditionality on benefit claimants with mental health impairments. Second, the effectiveness of welfare conditionality in supporting people with experience of mental ill health into paid work. In considering these questions, this paper presents original analysis of data generated in qualitative longitudinal interviews with 207 UK social security benefit recipients with experience of a range of mental health issues. The evidence suggests that welfare conditionality is largely ineffective in moving people with mental health impairments into, or closer to, paid work. Indeed, in many cases, it triggers negative health outcomes that make future employment less likely. It is concluded that the application of conditionality for people with mental health issues is inappropriate and should cease.     

Gambling with Stimulus Payments: Feeding Gaming Machines with Federal Dollars

In late 2008 and early 2009 the Australian Federal Government introduced a series of economic stimulus packages designed to maintain consumer spending in the early days of the Great Recession. When these packages were initiated the media suggested that the wide-spread availability of electronic gaming machines (EGMs, e.g. slot machines, poker machines, video lottery terminals) in Australia would result in stimulating the EGMs. Using state level monthly data we estimate that the stimulus packages led to an increase of 26 % in EGM revenues. This also resulted in over $60 million in additional tax revenue for State Governments. We also estimate a short-run aggregate income demand elasticity for EGMs to be approximately 2.     

Mixture Distributions Based Methods of Calibration for the Empirical Log-Likelihood Ratio

Empirical likelihood ratio confidence regions based on the chi-square calibration suffer from an undercoverage problem in that their actual coverage levels tend to be lower than the nominal levels. The finite sample distribution of the empirical log-likelihood ratio is recognized to have a mixture structure with a continuous component on [0, + ∞) and a point mass at + ∞. The undercoverage problem of the Chi-square calibration is partly due to its use of the continuous Chi-square distribution to approximate the mixture distribution of the empirical log-likelihood ratio. In this article, we propose two new methods of calibration which will take advantage of the mixture structure; we construct two new mixture distributions by using the F and chi-square distributions and use these to approximate the mixture distributions of the empirical log-likelihood ratio. The new methods of calibration are asymptotically equivalent to the chi-square calibration. But the new methods, in particular the F mixture based method, can be substantially more accurate than the chi-square calibration for small and moderately large sample sizes. The new methods are also as easy to use as the chi-square calibration.     

The supportive community: a new concept for enhancing the quality of life of elderly living in the community

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a "neighborhood facilitator," and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

Expert review of an approach to functional capacity evaluation

Functional capacity evaluation (FCE) is a widely used tool in work rehabilitation, despite the limited examination of the soundness of its measurement properties. This paper outlines the development of a new approach to FCE, the GAPP FCE, and reports on the findings of an expert review of aspects of its content validity and technical adequacy and how it meets established test criteria. Five expert occupational therapists reviewed the materials of the GAPP FCE then completed a questionnaire related to the content validity, technical adequacy and safety, reliability, validity, practicality and utility of the GAPP FCE. The experts gave support to most aspects of these criteria. The main issue identified by the review was related to interpretation and extrapolation of the FCE results for return to work. This and other issues are discussed in relation to recent developments in FCE and plans for future development of the GAPP FCE.     

Mental health need, awareness, and use of counseling services among international graduate students

OBJECTIVE AND PARTICIPANTS: The authors examined the prevalence of mental health needs in international graduate students, their knowledge of mental health services, and their use of on-campus and off-campus counseling services. METHODS: All registered graduate students in the Spring 2004 semester received an e-mail invitation to participate in a Web survey. Of the 3,121 completed surveys, 551 completed surveys were from international graduate students. RESULTS: Approximately 44% of international graduate students responded that they had had an emotional or stress-related problem that significantly affected their well-being or academic performance within the past year. International students who reported a more functional relationship with their advisors were less likely to report having an emotional or stress-related problem in the past year and using counseling services. International students who reported higher financial confidence were also less likely to use counseling services. CONCLUSIONS: There is an unmet mental health need among international graduate students. Special mental health outreach efforts should be directed at international graduate students, with particular attention on the relationship between students and their advisors and on adequate financial support for students.     

Evaluation of a research mentorship program in community care

This article describes the results of a qualitative case study evaluating a research mentorship program in community care settings in Ontario, Canada. The purpose of the program was to build evaluation and research capacity among staff of community care agencies through a mentorship program. Data were collected through in-depth, semi-structured interviews, focus group interviews, and written evaluations. Three themes were identified: taking hold, fostering hold, and holding on. Mentees took hold of new evaluation and research skills. Factors fostering hold included positive mentoring relationships and participation in relevant research projects. Mentees struggled to hold on to, and apply their skills within a community care context of challenges such as constrained resources and a mandate to provide client-centered care. The lessons learned include having trainees participate in relevant, time-limited evaluation and research projects, and early implementation of mechanisms to sustain integration of trainees' knowledge and skills within community care agencies.