Evaluation of program success for programs with multiple trials in binary outcomes

A late‐stage clinical development program typically contains multiple trials. Conventionally, the program's success or failure may not be known until the completion of all trials. Nowadays, interim analyses are often used to allow evaluation for early success and/or futility for each individual study by calculating conditional power, predictive power and other indexes. It presents a good opportunity for us to estimate the probability of program success (POPS) for the entire clinical development earlier. The sponsor may abandon the program early if the estimated POPS is very low and therefore permit resource savings and reallocation to other products. We provide a method to calculate probability of success (POS) at an individual study level and also POPS for clinical programs with multiple trials in binary outcomes. Methods for calculating variation and confidence measures of POS and POPS and timing for interim analysis will be discussed and evaluated through simulations. We also illustrate our approaches on historical data retrospectively from a completed clinical program for depression. Copyright © 2015 John Wiley & Sons, Ltd.     

逆层次分析法——复杂经济社会系统评价问题的新方法探索

逆层次分析法(AAHP)是为解决层次分析法(AHP)权重重要性概念内涵模糊不清的理论缺陷,通过明确界定各种分析权重的内涵以及它们之间的内在联系而提出的一种处理复杂经济社会系统评价决策问题的新方法。从权重内涵的明确性、目标与方案之间的关联性和评价模型的科学严谨性三方面来看,AAHP突出强调的是系统因素权重估计的可行性、合理性与可靠性,系统主体目标策略控制与方案的关联性和决策方案复合优选排序权重计算的科学性。     

Clinical outcomes for women who had continuity of care experiences with midwifery students

BackgroundPre-registration midwifery students in Australia are required to engage in a minimum of ten continuity of care experiences (CoCE). Students recruit and gain consent of each woman to provide CoCE under direct supervision of a registered health professional, usually a midwife. Clinical outcomes for women who had CoCE with a midwifery student placed in a continuity of midwifery care (CMC) or fragmented models are rarely reported.Aims1. analyse clinical outcomes for women experiencing CMC with CoCE by students; 2. analyse clinical outcomes for women in a fragmented care model with CoCE by students; and 3. compare clinical outcomes according to women’s primary model of care.MethodsStudents undertaking a Bachelor of Midwifery program at one Australian university recorded clinical outcomes for women experiencing CoCE during pregnancy [n = 5972] and labour and birth [n = 3933] in an e-portfolio. A retrospective, cohort design compared student recorded maternal data with National Core Maternity Indicators and Queensland Perinatal Data.ResultsMidwifery students providing CoCE reported better or equal clinical outcomes for women compared to population data. Women receiving CoCE had reduced likelihood of tobacco smoking after 20 weeks of pregnancy, episiotomy, and third and fourth degree tears.ConclusionsClinical outcomes for women in fragmented models of care and receiving CoCE by undergraduate, pre-registration midwifery students are equal to or better than State data across 12 variables. CoCE should be offered to all women early in their pregnancy to ensure optimal benefits. Acknowledging midwifery students’ potential to make positive impacts on women’s clinical outcomes may prompt more health services to reconceptualise and foster CoCE.     

LGBT Health in the Midlands: A Rural/Urban Comparison of Basic Health Indicators

Research into the health and wellbeing of rural lesbian, gay, bisexual, and transgender (LGBT) populations is limited. A community-based participatory research (CBPR) approach was used to develop an online survey for LGBT Nebraskans. The 770 participants replied to an array of questions on social determinants of health and basic health outcomes. Only significant differences in having health insurance were found between urban and rural participants. Social determinants of health were explored. Results of this study suggest that regional culture may be more salient to health for lesbian, gay, bisexual, and transgender persons living in the Midwest than rural or urban residence.     

Foster Carer Strain and its Impact on Parenting and Placement Outcomes for Adolescents

Drawing on recently completed research funded by the Departmentof Health, this article examines the extent of strain on thefoster carers of adolescents, its influence on parenting practicesand the overall impact on placement outcomes. The research find­ingsshow that foster-carers’ parenting capacity was markedlyreduced in a number of specific areas when they had experienceda high number of stressful life events in the six months priorto the young person’s arrival or were under considerablestrain during the placement. Conduct problems, hyperactivityand violent behaviour by the young people increased carer strain,as did contact difficulties with the children’s families.Problems in contacting social workers were linked to elevatedstrain, whilst strain was lessened when carers received helpfrom friends or from local professionals. Signifi­cantlyhigher disruption rates were experienced by strained carersand these placements were also less beneficial to the youngpeople.     

Using the 'Looking After Children' dimensions to collect aggregate data on well-being

The Department of Health has funded the development of a set of schedules for collating information on and monitoring the progress of children looked after by local authorities. An additional aspiration underlying official encouragement of the use of these ‘Looking After Children’ (LAC) materials was that they would provide aggregate data to feed into national and local policy and planning. Progress on this aim has been slow, in part because instruments designed to aid practice in individual cases have not adapted easily to the hoped for dual role, and in part because completion rates have been patchy and often poor. This paper describes an action research project designed to use the children's reviewing system to collect aggregate data on the LAC dimensions of well‐being. It comments on the viability of this method of aggregate data collection as well as locating the information on a cohort of 96 children in the context of other studies, and debates about whether the state can be a ‘good parent’.     

信息不对称与人的经济行为

信息不对称及其经济效应是信息经济学研究的中心问题,本文依据信息经济学和行为科学理论,从现实经济生活出发,系统地阐述了信息不对称的内涵,论证了信息不对称的必然性,探讨了信息不对称条件下交易双方的经济行为,提出了信息不对称条件下卖方(或代理方)违规败德行为的函数式,最后讨论了信息不对称造成的经济后果,提出了解决这一问题的思路。     

不对称信息下风险投资家与风险企业家之间的委托代理问题研究

风险投资体系以多重激励和不对称信息为特征,风险投资的三方利益主体之间存在着双重委托-代理关系,有效控制代理风险是风险投资高效运作的基本前提。本文基于信息经济学原理,分析了风险投资家与风险企业家之间代理风险的成因,并从委托人的角度讨论了风险治理的原则和投资契约的构造。     

Gender,Family Structure,and Adolescents’ Primary Confidants

Using data from the National Longitudinal Survey of Youth 1997 (N = 4,190), this study examined adolescents’ reports of primary confidants. Results showed that nearly 30% of adolescents aged 16 – 18 nominated mothers as primary confidants, 25% nominated romantic partners, and 20% nominated friends. Nominating romantic partners or friends was related to increased risk‐taking behaviors, supporting the attachment notion that shifting primary confidants to peers in adolescence may reflect premature autonomy from parents. Tendencies to prefer romantic partners over parents varied by gender and family structure, which were greater for those from single‐father families and girls from mother‐stepfather families, but less for those from single‐mother families and boys from mother‐stepfather families, compared with their counterparts from two‐biological‐parent families.     

西方信贷融资担保理论

西方信贷融资担保理论认为作为融资中介机构的银行和借款者之间在履行信贷融资担保过程中存在一定的交易成本。这种交易成本直接影响贷款利率水平。在信息不对称的信贷市场中，贷款利率和担保要求对于不同风险偏好的款者会产生逆向选择效应，并且可能会引发道德风险。担保对于借款者的品质又具有信号和传递作用，这有利于贷款者更好地进行风险控制。借贷双方在长期业务交往中建立起来的信贷关系本身就是一种担保资源，它既能够产生关系借款者品质的信息，也有利于缓解信贷市场的信息不对称问题。