The Use of Risk Assessment to Decide the Control Strategy for Bluetongue in Italian Ruminant Populations

The affiliation, assessment and management of risks is a traditional part of veterinary medicine. In the past, veterinary services involved in this type of activity usually assessed risks qualitatively. However, since the 1990s, quantitative methods have become increasingly important. The establishment of the World Trade Organization in 1994, and the promulgation of its Agreement on the Application of Sanitary and Phytosanitary Measures (the "SPS Agreement") led to an increased application of import risk analysis and to significant improvements in the methodology of risk analysis as applied to international trade policy for animals and animal products. However, there was very little development of risk analysis in veterinary fields other than international trade and management of health risks to consumers of animal products and little has been published on its use in the choice and definition of control or prophylaxis strategies for animal diseases. This article describes a quantitative risk assessment, which was undertaken in Italy to help choose an appropriate national response strategy following an incursion of bluetongue, an infectious disease of sheep and goats. The results obtained in this study support the use of risk analysis as a tool to assist in choosing an appropriate animal disease management strategy. The use of risk analysis in the evaluation of disease management strategies also offers advantages in international trade. It makes easier the comparison of different strategies applied in the various countries, and thus facilitates the assessment of equivalence of the guarantees provided by different strategies.     

No lollygagging for Dr. Lally

Jim Lally considers himself something of a late-bloomer because he spent years in the Army before earning his bachelor's degree and going on to medical school. But he's making up for lost time quickly. He already owns his own hospital.     

'Caducean ceiling' blocks docs from CEO posts

Physician executives face numerous obstacles in their quest to become CEOs. Take a look at what's standing in the way.     

Malpractice insurance rates reach boiling point. Physicians burned by lawyers, lawsuits and jury awards

Costs of medical malpractice insurance are soaring. Major insurers are refusing to write policies. And doctors are struggling to pay their premiums. Find out what's behind the insurance crisis.     

Quantification of follow-up time in oncology clinical trials with a time-to-event endpoint: Asking the right questions

For the analysis of a time-to-event endpoint in a single-arm or randomized clinical trial it is generally perceived that interpretation of a given estimate of the survival function, or the comparison between two groups, hinges on some quantification of the amount of follow-up. Typically, a median of some loosely defined quantity is reported. However, whatever median is reported, is typically not answering the question(s) trialists actually have in terms of follow-up quantification. In this paper, inspired by the estimand framework, we formulate a comprehensive list of relevant scientific questions that trialists have when reporting time-to-event data. We illustrate how these questions should be answered, and that reference to an unclearly defined follow-up quantity is not needed at all. In drug development, key decisions are made based on randomized controlled trials, and we therefore also discuss relevant scientific questions not only when looking at a time-to-event endpoint in one group, but also for comparisons. We find that different thinking about some of the relevant scientific questions around follow-up is required depending on whether a proportional hazards assumption can be made or other patterns of survival functions are anticipated, for example, delayed separation, crossing survival functions, or the potential for cure. We conclude the paper with practical recommendations.     

Using Policy-Relevant Administrative Data in Mixed Methods: A Study of Employment Instability and Parents’ Use of Child Care Subsidies

In the United States, government subsidies help low-income families pay for child care when parents are working, yet policies that tie subsidy eligibility closely to employment may result in frequent disruptions in program participation for families. This paper uses a mixed methods research design that links administrative records on families and children to data collected through surveys and in-depth interviews to examine employment instability and job characteristics of parents using child care subsidies. The results suggest that parents experience substantial employment instability (employment loss and unpredictable schedules) and that exiting the subsidy program is frequently related to employment-related eligibility factors. Overall, the use of administrative data integrated with other methods provides substantial opportunities for researchers to explore complex social phenomenon and provide insights in the evaluation of social programs.