Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI)

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Estimation in multi-path change-point problems

The current literature deals with the change-point problem only in the context of the obser¬vation of a single sequence. In this paper, inference will be based on the observation of TV sequences of random variables, each sequence containing one change-point. This extension allows the effective use of bootstrap and empirical Bayes methods, both of which are not feasible in the single-path context. Two classes of these “multi-path” change-point problems are considered. If the change-point is assumed to occur at the the same position in each sequence, then the terminology “fixed-tau multi-path change-point” will be used. In other cases, one may expect the change-point to occur at random positions in each sequence, according to some distribution, a “random-tau multi-path change-point” problem. Examples and simulations are given.     

Bayesian optimal design for changepoint problems

We investigate Bayesian optimal designs for changepoint problems. We find robust optimal designs which allow for arbitrary distributions before and after the change, arbitrary prior densities on the parameters before and after the change, and any log‐concave prior density on the changepoint. We define a new design measure for Bayesian optimal design problems as a means of finding the optimal design. Our results apply to any design criterion function concave in the design measure. We illustrate our results by finding the optimal design in a problem motivated by a previous clinical trial. The Canadian Journal of Statistics 37: 495–513; 2009 © 2009 Statistical Society of Canada     

Bayesian demography: projecting the Iraqi Kurdish population, 1977-1990

"Projecting populations that have sparse or unreliable data, such as those of many developing countries, presents a challenge to demographers. The assumptions that they make to project data-poor populations frequently fall into the realm of ?educated guesses', and the resulting projections, often regarded as forecasts, are valid only to the extent that the assumptions on which they are based reasonably represent the past or future, as the case may be. These traditional projection techniques do not incorporate a demographer's assessment of uncertainty in the assumptions. Addressing the challenges of forecasting a data-poor population, we project the Iraqi Kurdish population using a Bayesian approach. This approach incorporates a demographer's uncertainty about past and future characteristics of the population in the form of elicited prior distributions."     

Screening and Brief Intervention for Tobacco Use by Student Health Providers on College Campuses

Abstract

Objective: This study assessed college students’ reports of tobacco screening and brief intervention by student health center providers. Participants: Participants were 3,800 students from 8 universities in North Carolina. Methods: Web-based survey of a stratified random sample of undergraduates. Results: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. Conclusions: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.     

Development and Validation of a Tool to Improve Physician Identification of Elder Abuse: The Elder Abuse Suspicion Index (EASI)©

ABSTRACT

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Isotonic estimation of the intensity of a nonhomogeneous Poisson process: The multiple realization setup

In the 1950s Brunk and Van Eeden each obtained maximum-likelihood estimators of a finite product of probability density functions under partial or complete ordering of their parameters. Their results play an important role in the general theory of inference under order restrictions and lead to an isotonic estimator of the intensity of a nonhomogeneous Poisson process. Here an elementary derivation of the maximum likelihood estimator (m.l.e.) for the intensity of a nonhomogeneous Poisson process is given when several (possibly censored) realizations are available. Boswell obtained the m.l.e. based on a single realization as well as a conditional m.l.e. under the same conditions. An example is given to show that in the multirealization setup a conditional m.l.e. may not exist; the proofs are, we believe, new and elementary. An illustrative application is given.     

Locked into gambling: anticipatory regret as a motivator for playing the National Lottery

Four hundred and eighty-five people were asked about their intentions to play the National Lottery in England a week prior to the introduction of a new midweek draw. We predicted that those people who played the Saturday game with a regular set of numbers would be more inclined to play the new midweek game than those who had not established a routine of using the same set of numbers. We further predicted that their motivation to play would derive from a feeling of 'anticipatory regret'—a sense that they would find it intolerable to discover their regular numbers had been drawn when they hadn't purchased a ticket. Results supported both of these predictions, and an interpretation of the data is given in terms of the circumstances most likely to trigger such counterfactual reasoning.     

Date fighting experiences among college students: are they associated with other health-risk behaviors?

OBJECTIVE: The authors examined the clustering of health-risk behaviors among college students who reported date fight involvement. PARTICIPANTS AND METHODS: The authors administered a Web-based survey to a stratified random sample of 3,920 college students from 10 universities in North Carolina. RESULTS: Among men, 5.6% reported date fight victimization, and 1% reported date fight perpetration. Victimization among men was associated with (1) first drink at age 15 years or younger, (2) a recent threat of violence by someone who had been drinking, (3) smoking, (4) amphetamine use, and (5) older age. Among women, 6.7% reported date fight victimization, which was associated with (1) older age, (2) assault from a student who had been drinking, (3) sex with 2 or more persons, (4) consumption of alcohol in high school, (5) illegal drug use, (6) nonsexual assault requiring medical treatment, and (7) living off campus. Of the women, 4.2% reported date fight perpetration, which was associated with (1) minority race/ethnicity, (2) older age, (3) frequency of sexual intercourse, and (4) alcohol and marijuana use. CONCLUSIONS: Date fight experiences were associated with multiple health-risk behaviors among this sample of college students.     

2009–2010 Seasonal Influenza Vaccination Coverage Among College Students From 8 Universities in North Carolina

Abstract

Objective: The authors sought to describe the 2009–2010 seasonal influenza vaccine coverage of college students. Participants: A total of 4,090 college students from 8 North Carolina universities participated in a confidential, Web-based survey in October–November 2009. Methods: Associations between self-reported 2009–2010 seasonal influenza vaccination and demographic characteristics, campus activities, parental education, and e-mail usage were assessed by bivariate analyses and by a mixed-effects model adjusting for clustering by university. Results: Overall, 20% of students (range 14%–30% by university) reported receiving 2009–2010 seasonal influenza vaccine. Being a freshman, attending a private university, having a college-educated parent, and participating in academic clubs/honor societies predicted receipt of influenza vaccine in the mixed-effects model. Conclusions: The self-reported 2009–2010 influenza vaccine coverage was one-quarter of the 2020 Healthy People goal (80%) for healthy persons 18 to 64 years of age. College campuses have the opportunity to enhance influenza vaccine coverage among its diverse student populations.