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.     

Design optimization using ANOVA

This paper describes the design optimization of a robot sensor used for locating 3-D objects employing the Taguchi method in a computer simulation scenario. The location information from the sensor is to be utilized to control the movements of an industrial robot in a 'pick-and-place' or assembly operation. The Taguchi method, which is based on the Analysis-of-Variance (ANOVA) approach, is utilized to improve the performance of the sensor over a wider operating range. A review of the Taguchi method is presented along with step-by-step implementation details to identify and optimize the design parameters of the sensor. The method allows us to gauge the impact of various interactions present in the sensor system exclusively and permits us to single out those factors that have a dominant influence on the overall performance of the sensor. The investigation suggests that the Taguchi method is a more structured and efficient approach for achieving a robust design compared with the classical full factorial design approach.     

Still-births among the offspring of male radiation workers at the Sellafield nuclear reprocessing plant: detailed results and statistical aspects

Summary. This study investigates whether there was evidence of increasing risk of still-birth with increasing paternal exposure to ionizing radiation received during employment at the Sellafield nuclear installation before the child was conceived. A significant positive association is found between the total paternal preconceptional exposure to external ionizing radiation and the risk of still-birth (after adjustment for year of birth, social class, birth order and paternal age, odds ratio at 100 mSv 1.24 (95% confidence interval 1.04–1.45)). A summary of the principal scientific findings of this study has been published in the Lancet . This paper describes in detail the statistical methods that were used in the investigation and presents the results in full.     

Spatial variation in soil inorganic nitrogen across an arid urban ecosystem

We explored variations in inorganic soil nitrogen (N) concentrations across metropolitan Phoenix, Arizona, and the surrounding desert using a probability-based synoptic survey. Data were examined using spatial statistics on the entire region, as well as for the desert and urban sites separately. Concentrations of both NO₃-N and NH₄-N were markedly higher and more heterogeneous amongst urban compared to desert soils. Regional variation in soil NO₃-N concentration was best explained by latitude, land use history, population density, along with percent cover of impervious surfaces and lawn, whereas soil NH₄-N concentrations were related to only latitude and population density. Within the urban area, patterns in both soil NO₃-N and NH₄-N were best predicted by elevation, population density and type of irrigation in the surrounding neighborhood. Spatial autocorrelation of soil NO₃-N concentrations explained 49% of variation among desert sites but was absent between urban sites. We suggest that inorganic soil N concentrations are controlled by a number of ‘local’ or ‘neighborhood’ human-related drivers in the city, rather than factors related to an urban-rural gradient.     

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.     

Stjepan Metrović and Michel Maffesoli's 'implosive' defence of the Durkheimian tradition: theoretical convergences around Baudrillard's thesis on the 'end' of the social

This paper critically examines Metrovi? and Maffesoli's attempt to understand postmodernity through Émile Durkheim's nonrational link between society, religion and morality. Metrovi? (1991, 1997) and Maffesoli's (1996) work draws upon this emotional element when attempting to refute Baudrillard's (1983) cognitively focused, if implicit, critique of the Durkheimian tradition. Despite their best intentions, Metrovi? and Maffesoli still fail to exploit the partialities of Baudrillard's critique to the full. While both have some appreciation of the link between emotion and religion as found in Durkheim's The Elementary Forms of Religious Life (1912) they, nevertheless, fall short of grasping its full conceptual importance. This leads them to an implicit acceptance of Baudrillard's thesis on the ‘end’ of the social. This pitfall could have been avoided if Metrovi? and Maffesoli had built their respective analyses of the postmodern condition on a closer reading of The Elementary Forms. Reading this text alongside those other insights on emotion and social life as contained within Durkheim and Mauss's Primitive Classification (1903) and Talcott Parsons's subsequent writings on the sociological problem of religion, would have helped to distance the work of Metrovi? and Maffesoli from that of Baudrillard, and allowed them to offer a stronger and more comprehensive defence of the said tradition.     

A Bayesian Adjustment for Covariate Misclassification with Correlated Binary Outcome Data

Estimated associations between an outcome variable and misclassified covariates tend to be biased when the methods of estimation that ignore the classification error are applied. Available methods to account for misclassification often require the use of a validation sample (i.e. a gold standard). In practice, however, such a gold standard may be unavailable or impractical. We propose a Bayesian approach to adjust for misclassification in a binary covariate in the random effect logistic model when a gold standard is not available. This Markov Chain Monte Carlo (MCMC) approach uses two imperfect measures of a dichotomous exposure under the assumptions of conditional independence and non-differential misclassification. A simulated numerical example and a real clinical example are given to illustrate the proposed approach. Our results suggest that the estimated log odds of inpatient care and the corresponding standard deviation are much larger in our proposed method compared with the models ignoring misclassification. Ignoring misclassification produces downwardly biased estimates and underestimate uncertainty.