Model free audit methodology for bias evaluation of tumour progression in oncology

Many oncology studies incorporate a blinded independent central review (BICR) to make an assessment of the integrity of the primary endpoint, progression free survival. Recently, it has been suggested that, in order to assess the potential for bias amongst investigators, a BICR amongst only a sample of patients could be performed; if evidence of bias is detected, according to a predefined threshold, the BICR is then assessed in all patients, otherwise, it is concluded that the sample was sufficient to rule out meaningful levels of bias. In this paper, we present an approach that adapts a method originally created for defining futility bounds in group sequential designs. The hazard ratio ratio, the ratio of the hazard ratio (HR) for the treatment effect estimated from the BICR to the corresponding HR for the investigator assessments, is used as the metric to define bias. The approach is simple to implement and ensures a high probability that a substantial true bias will be detected. In the absence of bias, there is a high probability of accepting the accuracy of local evaluations based on the sample, in which case an expensive BICR of all patients is avoided. The properties of the approach are demonstrated by retrospective application to a completed Phase III trial in colorectal cancer. The same approach could easily be adapted for other disease settings, and for test statistics other than the hazard ratio. Copyright © 2015 John Wiley & Sons, Ltd.     

Union wage differentials and the effects of industry and local union density: Evidence from the 1980s

This study finds that the real union-nonunion wage differential has declined only slightly since 1985, a period of falling unionism. The study also finds that, in contrast to earlier research, local (geographic) union density positively affects union and nonunion wages. This paper has benefited from discussions with Bill Even and Barry Hirsch. The research support of the School of Business Administration Research Committee is greatly appreciated.     

Training teachers to safeguard children: developing a consistent approach

Earlier work on the preparation of student teachers to deal with child protection concerns had indicated that initial teacher training (ITT) providers were often struggling to determine what to include on the subject and who should provide the input, as well as coping with the difficulty of trying to fit it into an overfull curriculum. In an attempt to support this work, the National Society for the Prevention of Cruelty to Children (NSPCC) developed a course for this group of students. Although an evaluation indicated the need for the materials to be redrafted, the views of both those involved in the exercise and a subsequent survey of ITT providers not only contributed to the redraft but also to the debate around the most effective approach to training professionals to protect children and young people. Copyright © 2005 John Wiley & Sons, Ltd.     

Further notes on record taking and making in maternity care: The case of South Asian descent women

This paper draws on data from a small-scale ethnographic study of the delivery of maternity care to South Asian descent women in a hospital in Southern England during 1988. Stereotyped views of these women which related to their customs and culture as well as their typification as patients were commonly expressed by staff, particularly midwives. The paper examines the role of medical records and record making in stereotyping Asian women: the ways in which stereotyped views of women may affect the record making process; and how that process itself may reinforce and create stereotypes. The utility of records for ‘rate production’ purposes is also discussed. The focus of the paper is the creation of a woman's maternity records which occurs in the antenatal clinic. The transformation of stigmatised views of a client into ‘facts’ about a client is common among bureaucrats, in this setting health service staff. This process affects the client's future encounters with the bureaucracy. In medical settings records (ie the case notes) help to create, transmit and reify negative stereotypes of health service users. These stereotypes can affect the kind of care given to individual patients.     

The small ministry with the large reach: Using relationships to extend organisational capacity

Abstract

The Ministry of Pacific Island Affairs is charged with identifying the aspirations and needs of Pacific people residing in Aotearoa/New Zealand, providing high quality policy advice to governments and their ministries, and with advising ministries on how these might be achieved. With a large, dispersed client population, a small staff and limited resources, this represents a major task for the Ministry. However, the Ministry has been able to deliver these by forming a network of co‐operative relationships with both its communities and the other ministries and agencies charged with formulating policy and delivering services to the communities. But limited resources prevent the Ministry mediating each of these relationships on a continuing basis.

This paper focuses on the ways in which the Ministry of Pacific Island Affairs went about forming and using a web of “partnerships” with Pacific communities, social policy agencies, and service providers to overcome some of the challenges which a small ministry with limited resources faces. This paper attempts to show how a larger web of relationships became central to the Ministry's community development mission.

The Ministry formed and nurtured a series of local partnerships between communities’ representatives and the ministries which deliver local programs. The arrangements free the Ministry to monitor the relationships and the performance of the ministries and agencies. Previously, we have described the organisational model as an apogāleveleve, or spider web, in which the web is a series of defined relationships created and maintained by the “centre” for a specific purpose: obtaining the best possible outcomes for constituent communities. Each operative relationship is connected via the centre, and mediated by the centre, which also monitors the performance of the system as a whole and moves to repair damage anywhere it occurs to ensure that the web as a whole continues to deliver outcomes. The network of co‐operative relationships, or partnerships, has made it possible for the Ministry to achieve significant results relatively quickly with limited resources.