Development of hospice and palliative care in the United States

More than 30 years have passed since palliative care was introduced in the United States, and what began as a small rebellion has evolved into a fairly large health care industry. Although the palliative care movement has considerably improved the care given to those at the end of life, many challenges remain for palliative care providers in the United States. This article discusses the history of hospice and palliative care in the United States, the Medicare Hospice Benefit, the growth of hospice and palliative care, and challenges such as the need for regulatory change, workforce issues, improving access to care, and improving the quality of palliative care.     

Bank Loan Officers' Perceptions of Business Owners: The Role of Gender

There is a widely held belief that banks may be discriminating against female business owners. This study was designed to explore the perceptions held by bank loan officers of male and female business owners, using Bourdieu's theory of practice and Kelly's personal construct methodology. The research literature might lead to an expectation that the characteristics of the business owners would be relatively homogenous but that men and women business owners would be construed differently (for example women might be seen to lack drive). However, the results demonstrate heterogeneity in the constructs held by bank loan officers, and a particular concern with the character of the business owner. Significant gender differences were observed in only 20 of the 325 constructs elicited from 35 bank loan officers. Female bank loan officers were as likely as male bank loan officers to draw gender distinctions between business owners. Detailed multivariate analyses confirmed no evidence of systematic gender differences in the constructs held by bank loan officers of business owners.     

A generalisation of T‐optimality for discriminating between competing models with an application to pharmacokinetic studies

The T‐optimality criterion is used in optimal design to derive designs for model selection. To set up the method, it is required that one of the models is considered to be true. We term this local T‐optimality. In this work, we propose a generalisation of T‐optimality (termed robust T‐optimality) that relaxes the requirement that one of the candidate models is set as true. We then show an application to a nonlinear mixed effects model with two candidate non‐nested models and combine robust T‐optimality with robust D‐optimality. Optimal design under local T‐optimality was found to provide adequate power when the a priori assumed true model was the true model but poor power if the a priori assumed true model was not the true model. The robust T‐optimality method provided adequate power irrespective of which model was true. The robust T‐optimality method appears to have useful properties for nonlinear models, where both the parameter values and model structure are required to be known a priori, and the most likely model that would be applied to any new experiment is not known with certainty. Copyright © 2012 John Wiley & Sons, Ltd.     

Comparisons of Test Statistics Arising from Marginal Analyses of Multivariate Survival Data

We investigate the properties of several statistical tests for comparing treatment groups with respect to multivariate survival data, based on the marginal analysis approach introduced by Wei, Lin and Weissfeld [Regression Analysis of multivariate incomplete failure time data by modelling marginal distributians, JASA vol. 84 pp. 1065–1073]. We consider two types of directional tests, based on a constrained maximization and on linear combinations of the unconstrained maximizer of the working likelihood function, and the omnibus test arising from the same working likelihood. The directional tests are members of a larger class of tests, from which an asymptotically optimal test can be found. We compare the asymptotic powers of the tests under general contiguous alternatives for a variety of settings, and also consider the choice of the number of survival times to include in the multivariate outcome. We illustrate the results with simulations and with the results from a clinical trial examining recurring opportunistic infections in persons with HIV.     

Proposed best practice for statisticians in the reporting and publication of pharmaceutical industry‐sponsored clinical trials

In this paper we set out what we consider to be a set of best practices for statisticians in the reporting of pharmaceutical industry‐sponsored clinical trials. We make eight recommendations covering: author responsibilities and recognition; publication timing; conflicts of interest; freedom to act; full author access to data; trial registration and independent review. These recommendations are made in the context of the prominent role played by statisticians in the design, conduct, analysis and reporting of pharmaceutical sponsored trials and the perception of the reporting of these trials in the wider community. Copyright © 2010 John Wiley & Sons, Ltd.     

A method for obtaining randomized block designs in preclinical studies with multiple quantitative blocking variables

A method is proposed for block randomization of treatments to experimental units that can accommodate both multiple quantitative blocking variables and unbalanced designs. Hierarchical clustering in conjunction with leaf‐order optimization is used to block experimental units in multivariate space. The method is illustrated in the context of a diabetic mouse assay. A simulation study is presented to explore the utility of the proposed randomization method relative to that of a completely randomized approach, both in the presence and absence of covariate adjustment. An example R function is provided to illustrate the implementation of the method. Copyright © 2010 John Wiley & Sons, Ltd.     

Compliance Versus Risk in Assessing Occupational Exposures

Assessments of occupational exposures to chemicals are generally based upon the practice of compliance testing in which the probability of compliance is related to the exceedance [γ, the likelihood that any measurement would exceed an occupational exposure limit (OEL)] and the number of measurements obtained. On the other hand, workers’ chronic health risks generally depend upon cumulative lifetime exposures which are not directly related to the probability of compliance. In this paper we define the probability of “overexposure” (θ) as the likelihood that individual risk (a function of cumulative exposure) exceeds the risk inherent in the OEL (a function of the OEL and duration of exposure). We regard θ as a relevant measure of individual risk for chemicals, such as carcinogens, which produce chronic effects after long-term exposures but not necessarily for acutely-toxic substances which can produce effects relatively quickly. We apply a random-effects model to data from 179 groups of workers, exposed to a variety of chemical agents, and obtain parameter estimates for the group mean exposure and the within- and between-worker components of variance. These estimates are then combined with OELs to generate estimates of γ and θ. We show that compliance testing can significantly underestimate the health risk when sample sizes are small. That is, there can be large probabilities of compliance with typical sample sizes, despite the fact that large proportions of the working population have individual risks greater than the risk inherent in the OEL. We demonstrate further that, because the relationship between θ and γ depends upon the within- and between-worker components of variance, it cannot be assumed a priori that exceedance is a conservative surrogate for overexposure. Thus, we conclude that assessment practices which focus upon either compliance or exceedance are problematic and recommend that employers evaluate exposures relative to the probabilities of overexposure.     

On Bayesian learning from Bernoulli observations

We provide a reason for Bayesian updating, in the Bernoulli case, even when it is assumed that observations are independent and identically distributed with a fixed but unknown parameter _θ0${\theta }_0$. The motivation relies on the use of loss functions and asymptotics. Such a justification is important due to the recent interest and focus on Bayesian consistency which indeed assumes that the observations are independent and identically distributed rather than being conditionally independent with joint distribution depending on the choice of prior.