Cybernetic appropriateness review: Does it change physician hospital utilization patterns?

All hospital care can be characterized as either appropriate (i.e., efficatious and necessary) or inappropriate (i.e., services without benefit or services that could be provided in a less costly setting). A demonstration project combining an appropriateness determination methodology with a cybernetic control system was implemented in a study area that included six hospitals and approximately 400 practicing physicians. Project results to date indicate substantial improvements in the ratio of appropriate to inappropriate care for both hospitals and individual physicians. Evaluation research design problems and areas of future research are also discussed.     

Prevalence and correlates of alcohol use in a survey of rural elementary school students: the New Hampshire study.

Alcohol use by 1190 fourth, fifth and sixth grade students was assessed in a survey of four rural New Hampshire school districts. Half the students surveyed (596) drank, but not regularly; 5 percent (59) were regular drinkers, and an additional 2 percent (19) were regular drinkers and had been drunk at least once. Reported alcohol use increased with both grade and age, and males drank more than females. The child's attitude toward drinking, perceived family attitudes towards drinking, the number of drinking friends, and self-perceived wrongdoing by the child were four factors strongly related to alcohol use. Increased alcohol use was also associated with experimental and current use of cigarettes, marijuana, and smokeless tobacco.     

Electronic cigarette and combustible cigarette use following a campus-wide ban: Prevalence of use and harm perceptions

Abstract

The current study examined changes in prevalence of e-cigarette use and perceptions of the harmfulness of e-cigarette and combustible cigarettes following a campus-wide tobacco ban. Undergraduate students completed surveys of tobacco use and perceived product harmfulness. Four samples were collected: in 2013 prior to the ban (n?=?792) and in fall 2014 (n?=?310), 2015 (n?=?208), and 2016 (n?=?417). E-cigarette use increased in the years following the ban (p?=?.01) while combustible cigarette use decreased from 2013 to 2016 (p?=?.02). Men were more likely than women to use both products (ps?<?.05). Students’ perceptions of the harmfulness of combustible and electronic cigarettes remained stable in the years following the ban (p?>?.05). This study is the first to examine the impact of including e-cigarettes in tobacco free policies. Combustible cigarette use declined, but e-cigarette use increased in the years following the e-cigarette ban. Prospective research is needed to understand the long-term impacts of e-cigarette bans.     

Fraternal birth order and ratio of heterosexual/homosexual feelings in women and men

Studies of the 2-3% of persons who identify as homosexual found men but not women had more older brothers than persons who identify as heterosexual. The present study investigated the birth order in the approximately 20% of men and women who anonymously report some homosexual feelings, few of whom identify as homosexual. The number of older brothers and sisters was investigated in seven cohorts: 319 male twins; and 49, 54, and 61 female and 66, 116, and 50 male medical students. Both women and men who anonymously reported homosexual feelings had a greater mean number of older brothers and sisters than did those who reported no homosexual feelings. The difference was stronger in relation to brothers than sisters. The birth order effect was not related to the strength of the subjects' degree of homosexual compared with heterosexual feelings. Its presence in women could not be accounted for by the widely accepted hypothesis that the birth order effect is due to a maternal immune reaction provoked only by male fetuses. The lack of relationship between the strength of the effect and degree of homosexual feelings in the men and women suggests the influence of birth order on homosexual feelings was not due to a biological, but a social process in the subjects studied. Investigating the neglected significant percentage of predominantly heterosexual men and women who anonymously report some homosexual feelings may aid in understanding the factors influencing sexual orientation, and identity.     

Book Reviews

Qualitative Sociology -     

Bayesian decision procedures for binary and continuous bivariate dose-escalation studies

In this paper, Bayesian decision procedures are developed for dose-escalation studies based on binary measures of undesirable events and continuous measures of therapeutic benefit. The methods generalize earlier approaches where undesirable events and therapeutic benefit are both binary. A logistic regression model is used to model the binary responses, while a linear regression model is used to model the continuous responses. Prior distributions for the unknown model parameters are suggested. A gain function is discussed and an optional safety constraint is included.     

A Generalized Loss Function for Process Optimization

The use of loss functions for measuring the undesirability associated with failure to achieve target values for manufacturing product characteristics is widespread in industry. This study presents a generalization of one of the most commonly used loss functions and compares the two functions based on five theoretical criteria. A simulation involving multiple probability distributions for a single product characteristic is used to compare the performance of the loss functions. An example from the manufacture of helicopter transmission gears is used to empirically demonstrate the superiority of the generalized loss function over the conventional loss function.