Toward an Effective Design of Behavioral Health Care Delivery: An Empirical Analysis of Care for Depression

A criticism of behavioral health care delivery is that it has largely missed the social determinants of behavioral health disorders and their diagnosis. Toward addressing this criticism, this study evaluates the delivery of behavioral health care as a part of primary care operations. Focusing on the treatment of depression, the study results show that: (i) primary care clinics operating in communities with superior social environment characteristics are associated with improved depression outcomes in the short term, and (ii) psychosocial resources (social and emotional support) and the built environment (man‐made resources and infrastructure to support human activity) of primary care clinics are associated with sustaining the improvement in depression outcome in the long term. Centering our attention on IT‐enabled, evidence‐based, and affordable primary care as mechanisms that can enable the integration of behavioral and medical care delivery, the results suggest that IT‐enabled and evidence‐based primary care are associated with improvements in depression outcomes. We also find that the effect of improving the affordability of behavioral health care delivery depends on the community's socioeconomic status. Primary care clinics in socioeconomically disadvantaged communities practicing cost‐containment are associated with improvements in depression outcomes, and, therefore, can contribute toward reducing disparities in behavioral health care delivery. Counter to our original expectations, we find that the effect of evidence‐based care on improvements on depression outcomes increases as the availability of medically trained behavioral health care specialists practicing in a community increases lending support to concerns that primary care clinics in resource‐rich communities obtain greater benefit from quality improvement interventions.     

Gender Differences in Emotion Expression in Low-Income Adolescents Under Stress

Gender roles in mainstream US culture suggest that girls express more happiness, sadness, anxiety, and shame/embarrassment than boys, while boys express more anger and externalizing emotions, such as contempt. However, gender roles and emotion expression may be different in low-income and ethnically diverse families, as children and parents are often faced with greater environmental stressors and may have different gender expectations. This study examined gender differences in emotion expression in low-income adolescents, an understudied population. One hundred and seventy nine adolescents (aged 14–17) participated in the Trier Social Stress Test (TSST). Trained coders rated adolescents’ expressions of happiness, sadness, anxiety, shame/embarrassment, anger, and contempt during the TSST using a micro-analytic coding system. Analyses showed that, consistent with gender roles, girls expressed higher levels of happiness and shame than boys; however, contrary to traditional gender roles, girls showed higher levels of contempt than boys. Also, in contrast to cultural stereotypes, there were no differences in anger between boys and girls. Findings suggest gender-role inconsistent displays of externalizing emotions in low-income adolescents under acute stress, and may reflect different emotion socialization experiences in this group.     

Robust inference in generalized linear models for longitudinal data

The author develops a robust quasi‐likelihood method, which appears to be useful for down‐weighting any influential data points when estimating the model parameters. He illustrates the computational issues of the method in an example. He uses simulations to study the behaviour of the robust estimates when data are contaminated with outliers, and he compares these estimates to those obtained by the ordinary quasi‐likelihood method.     

On the construction of m-associate PBIB designs I

The m-associate triangular association scheme has been discussed, and several series of partially balanced incomplete block (PBIB) designs with m-associate triangular association scheme have been obtained in Section 1. In Section 2, an m-associate triangular-group divisible association scheme $\text{(T}{}_{\mathrm{q}}\text{—}\text{GD}\text{m}\text{, 1<q<m)}$ has been introduced and several series of PBIB designs with m-associate triangular group divisible association scheme, from m-associate triangular PBIB designs have been constructed. Some numerical values to the three associate triangular designs, and three associate triangular group divisible designs in the range b, v≦100; r, k≦10, with their average efficiencies are given, respectively, in Tables I and II, in Section 3, where as usual v denotes the number of treatments, b the number of blocks, r the number of replications of each treatment, and k the block size.     

Joint modeling tumor burden and time to event data in oncology trials

The tumor burden (TB) process is postulated to be the primary mechanism through which most anticancer treatments provide benefit. In phase II oncology trials, the biologic effects of a therapeutic agent are often analyzed using conventional endpoints for best response, such as objective response rate and progression‐free survival, both of which causes loss of information. On the other hand, graphical methods including spider plot and waterfall plot lack any statistical inference when there is more than one treatment arm. Therefore, longitudinal analysis of TB data is well recognized as a better approach for treatment evaluation. However, longitudinal TB process suffers from informative missingness because of progression or death. We propose to analyze the treatment effect on tumor growth kinetics using a joint modeling framework accounting for the informative missing mechanism. Our approach is illustrated by multisetting simulation studies and an application to a nonsmall‐cell lung cancer data set. The proposed analyses can be performed in early‐phase clinical trials to better characterize treatment effect and thereby inform decision‐making. Copyright © 2014 John Wiley & Sons, Ltd.     

Unbiased Estimation of the Distribution Function of an Exponential Population Using Order Statistics with Application in Ranked Set Sampling

In this paper we consider the problem of unbiased estimation of the distribution function of an exponential population using order statistics based on a random sample. We present a (unique) unbiased estimator based on a single, say ith, order statistic and study some properties of the estimator for i = 2. We also indicate how this estimator can be utilized to obtain unbiased estimators when a few selected order statistics are available as well as when the sample is selected following an alternative sampling procedure known as ranked set sampling. It is further proved that for a ranked set sample of size two, the proposed estimator is uniformly better than the conventional nonparametric unbiased estimator, further, for a general sample size, a modified ranked set sampling procedure provides an unbiased estimator uniformly better than the conventional nonparametric unbiased estimator based on the usual ranked set sampling procedure.     

Robust small area estimation

Small area estimation has received considerable attention in recent years because of growing demand for small area statistics. Basic area‐level and unit‐level models have been studied in the literature to obtain empirical best linear unbiased prediction (EBLUP) estimators of small area means. Although this classical method is useful for estimating the small area means efficiently under normality assumptions, it can be highly influenced by the presence of outliers in the data. In this article, the authors investigate the robustness properties of the classical estimators and propose a resistant method for small area estimation, which is useful for downweighting any influential observations in the data when estimating the model parameters. To estimate the mean squared errors of the robust estimators of small area means, a parametric bootstrap method is adopted here, which is applicable to models with block diagonal covariance structures. Simulations are carried out to study the behaviour of the proposed robust estimators in the presence of outliers, and these estimators are also compared to the EBLUP estimators. Performance of the bootstrap mean squared error estimator is also investigated in the simulation study. The proposed robust method is also applied to some real data to estimate crop areas for counties in Iowa, using farm‐interview data on crop areas and LANDSAT satellite data as auxiliary information. The Canadian Journal of Statistics 37: 381–399; 2009 © 2009 Statistical Society of Canada     

Bayesian analysis of life-testing problems involving the weibull distribution

Credible and highest posterior density intervals for the reliability function and parameters of a two-parameter Weibull process are obtained and the estimates compared with their corresponding classical counterparts.