Integrating ethical enquiry and health technology assessment: limits and opportunities for efficiency and equity

This paper aims at discussing some contributions, limitations and opportunities that efficiency and equity studies could make to form a better understanding of ethical issues involved in health technology assessment (HTA). Prenatal detection of Down syndrome is used as a case study for further discussions regarding efficiency and equity, as well as other ethical principles including beneficence, non-maleficence and autonomy. The development and use of adequate methods and the need for context appraisal are two imperative issues in this field of knowledge. The analysis of ethical implications in HTA should account for both. Economic evaluation methodologies have great potential in the assessment of some key ethical principles such as efficiency and equity but are of limited use concerning other fundamental principles. Social and individual values play a prominent role in this respect.     

Maximum Likelihood Inference for Log-linear Models Subject to Constraints of Double Monotone Dependence

To model an hypothesis of double monotone dependence between two ordinal categorical variables A and B usually a set of symmetric odds ratios defined on the joint probability function is subject to linear inequality constraints. Conversely in this paper two sets of asymmetric odds ratios defined, respectively, on the conditional distributions of A given B and on the conditional distributions of B given A are subject to linear inequality constraints. If the joint probabilities are parameterized by a saturated log-linear model, these constraints are nonlinear inequality constraints on the log-linear parameters. The problem here considered is a non-standard one both for the presence of nonlinear inequality constraints and for the fact that the number of these constraints is greater than the number of the parameters of the saturated log-linear model.This work has been supported by the COFIN 2002 project, references 2002133957_002, 2002133957_004. Preliminary findings have been presented at SIS (Società Italiana di Statistica) Annual Meeting, Bari, 2004.     

Exploring the Hierarchical Structure of Pacific Identity and Wellbeing

To understand outcomes for Pacific peoples in New Zealand we need to further our psychological knowledge of the relationship between Pacific identity and wellbeing. We map the hierarchical organization of Pacific identity and wellbeing using a novel top-down factor analytic approach applied to the Pacific Identity and Wellbeing Scale (PIWBS; N = 586). Analyses indicated that Pacific identity experiences were organized within two broad dimensions reflecting Identity Engagement and Cultural Wellbeing. Critically, our analysis showed that Religious Centrality and Embeddedness emerged jointly from these dual broad domains. Religious identification provides a bridging link between identity and wellbeing for Pacific peoples. Identifying the relationships of Pacific identity and wellbeing factors, and how religious identification emerges jointly from these two broad domains, provides valuable information in how the Pacific self may be cognitively organized and may assist in future research directions in this area. We assert that this general statistical model provides broad conceptual insights into how Pacific peoples experience their identity and culture, and how this relates to various social indicators of health and wellbeing at a broad, theoretical level. In particular, we offer a conceptual analysis of possible insights from our hierarchical model of identity and wellbeing for understanding Pacific suicide in New Zealand.     

External Information Model in a Compositional Perspective: Evaluation of Campania Adolescents’ Preferences in the Allocation of Leisure-Time

Social Indicators Research - The study of preferences of leisure-time activities provides important information on the characteristics and inclinations of specific demographics. Modeling these data...     

Effects of demography and urbanization on stress and body condition in urban white-tailed deer

Urban Ecosystems - White-tailed deer (Odocoileus virginianus) are becoming increasingly common in urban environments. How they respond to potential changes (i.e. increased human interactions,...     

Remittance behaviours of foreigners in Italy

This article investigates the determinants of remittance behaviours among foreigners in Italy and intends to gain a better understanding of the temporal pattern of remittances. The analysis is based on data from the 2009 “Italian Statistics on Income and Living Conditions of Households with Foreigners”. The decisions on whether to remit and how much to remit are separately yet simultaneously estimated using a zero‐inflated beta regression model. The findings reveal that remittances are driven by a mix of altruistic and self‐interest motives that may persist for many years. Many covariates included in the model have a different effect on the propensity to remit and on the relative amount of remittances. We find some evidence that the average propensity to remit follows an M‐shaped trajectory over time. However, the model specification including only time and time squared proves that the inverted‐U shape trajectory, well‐established in the literature, still remains a better choice in terms of parsimoniousness and flexibility. Among those who remit, time since migration does not have any significant effect on the normalized amount remitted.     

Negotiating the Lines of Contention: Counterframing and Boundary Work in the School of the Americas Debate1

Counterframing scholars typically identify counterframes that interpretively distinguish arguments among opponents. This approach assumes that counterframing strategy centers on directly countering the claims of protesters. In my in‐depth examination of the ongoing debate between protesters and officials of the former School of the Americas, I identify a form of counterframing that agrees with and embraces the moral alternatives implicit in accusers’ claims. I bring boundary construction theory into conversation with counterframing analysis to expand understanding of how framing and counterframing strategies revolve around the competition for common, moral resources. I explain that in the movement to close the School of the Americas, protesters’ claims have served as moral boundaries against which the targeted institution has redefined its objectives and programs. I introduce the concept of “boundary negotiation” to argue that counterframing strategy and success lie in the negotiation of moral boundaries called into question by social movements. I outline defensive and offensive modes of boundary negotiation and identify boundary negotiation as a mechanism driving the link between counterframing and demobilization.     

Operational challenges in adaptive design implementation

Implementation of adaptive clinical trial designs raises challenges with regard to the processes by which accruing trial data is analyzed, reviewed, and acted upon. In line with current monitoring conventions, it should be viewed that inappropriate knowledge of interim results can raise concerns regarding maintaining trial integrity and interpretability of results. Here we discuss issues related to these processes in adaptive trials, and point out distinctions versus other more familiar monitoring situations. One topic involves the composition of the group of individuals who will have access to interim results in order to recommend adaptations. We discuss operational models for data review by this group; one question addressed is whether in adaptive trials a role in this process for a representative of the study sponsor could at times be warranted, and might be justified if adequate protections are in place. Another issue involves whether adaptations made based upon interim data can convey to observers an amount of information about the results, which could rise to a level of concern. We consider whether different types of adaptations might be more or less problematic with regard to this issue, and recommend steps that might be considered to mitigate this concern.