A modified random-effect procedure for combining risk difference in sets of 2×2 tables from clinical trials

Summary Meta-analyses of sets of clinical trials often combine risk differences from several 2×2 tables according to a random-effects model. The DerSimonian-Laird random-effects procedure, widely used for estimating the populaton mean risk difference, weights the risk difference from each primary study inversely proportional to an estimate of its variance (the sum of the between-study variance and the conditional within-study variance). Because those weights are not independent of the risk differences, however, the procedure sometimes exhibits bias and unnatural behavior. The present paper proposes a modified weighting scheme that uses the unconditional within-study variance to avoid this source of bias. The modified procedure has variance closer to that available from weighting by ideal weights when such weights are known. We studied the modified procedure in extensive simulation experiments using situations whose parameters resemble those of actual studies in medical research. For comparison we also included two unbiased procedures, the unweighted mean and a sample-size-weighted mean; their relative variability depends on the extent of heterogeneity among the primary studies. An example illustrates the application of the procedures to actual data and the differences among the results. This research was supported by Grant HS 05936 from the Agency for Health Care Policy and Research to Harvard University.     

A Cost–Benefit Analysis of a Family Systems Intervention for Managing Pediatric Chronic Illness

Despite recent increases of psychosocial programs for pediatric chronic illness, few studies have explored their economic benefits. This study investigated the costs–benefits of a family systems‐based, psychosocial intervention for pediatric chronic illness (MEND: Mastering Each New Direction). A quasi‐prospective study compared the 12‐month pre–post direct and indirect costs of 20 families. The total cost for program was estimated to $5,320. Families incurred $15,249 less in direct and $15,627 less in indirect costs after MEND. On average, medical expenses reduced by 86% in direct and indirect costs, for a cost–benefit ratio of 0.17. Therefore, for every dollar spent on the program, families and their third payers saved approximately $5.74. Implications for healthcare policy and reimbursements are discussed.     

Short Break and Respite Services for Disabled Children in England: Comparing Children's and Parents' Perspectives of Their Impact on Children

Researchers, health and social care workers often seek to understand the perspectives of children; but gathering views directly from children can present difficulties. Parents are often asked to provide accounts of children's feelings or opinions on the assumption that their proxy reports are accurate and unproblematic. This qualitative thematic analysis of open‐question responses from 352 parents and 73 disabled children examines their accounts of the impact of short break services on disabled children. Participants' perspectives differed; children tended to describe immediate outcomes such as enjoying activities and participation; parents acknowledged these, but focused on longer term developmental outcomes for children.     

Does the road to muscle rejuvenation go through Notch?

The capacity of skeletal muscles to repair and regenerate declines during aging in humans, and this decline may lead to muscle loss and frailty. Conboy et al. show that injured muscles of aging mice are defective in Notch signaling, because up-regulation of the Notch ligand, Delta-1, is impaired. Delta-1 promotes proliferation of the satellite cells that repair damaged muscles, and Conboy et al. show that experimental activation of Notch signaling is sufficient to reverse the age-related decline in muscle regenerative capacity. Extension of these important findings to humans could lead to the development of new therapeutic approaches to maintain muscle function during aging.     

The good life for children: Do we really care about the trends?

How do we know if Australian children and young people are having a ‘good life‘? What about their lives compared to children and young people in other countries? To answer these questions, the Australian Research Alliance for Children and Youth (ARACY) produced a Report Card to compare Australian average, Indigenous Australian average, and international or Organisation for Economic Co‐operation and Development (OECD) average for a number of measures of child and youth wellbeing. The ARACY Report Card shows that Australian results are average when compared to other OECD countries in most areas of child and youth wellbeing. Most importantly for nearly all indicators, Indigenous Australian children fare substantially less well than the Australian average and the majority of children in other countries. It is argued that community attitudes and behaviours toward children and young people, and our society's focus on wealth creation, are detrimental to children's and young people's wellbeing. The need for a better balance between economic progress and a socially and environmentally sustainable society is discussed, along with a strategy to better meet the emotional needs of children and young people.     

Income, Environmental Disamenity, and Toxic Releases

The literature argues that income growth leads to increased demand for environmental quality and thus reduction in pollution. Using a utility theoretic model, we hypothesize that the income–pollution relationship should depend on the level of disamenity of the pollutant. We proxy for disamenity using the toxicity of releases. For counties in the United States, the functional relationship between income and releases depends on the level of disamenity: the form is more concave for more toxic releases. We find that environmental improvements occur at lower levels of per capita income for more toxic pollutants.     

Electronics: The new revolution

Electronics has produced a succession of remarkable accomplishments within the lifetime of living men. Yet, new developments in the field are so vast and exciting that they may be viewed as the advent of an Electronic Revolution comparable to the Industrial Revolution.     

Robustness of Approaches to ROC Curve Modeling under Misspecification of the Underlying Probability Model

A variety of statistical regression models have been proposed for the comparison of ROC curves for different markers across covariate groups. Pepe developed parametric models for the ROC curve that induce a semiparametric model for the market distributions to relax the strong assumptions in fully parametric models. We investigate the analysis of the power ROC curve using these ROC-GLM models compared to the parametric exponential model and the estimating equations derived from the usual partial likelihood methods in time-to-event analyses. In exploring the robustness to violations of distributional assumptions, we find that the ROC-GLM provides an extra measure of robustness.     

Effects of censoring on the robustness of exponential-based confidence intervals for median lifetime

Statistical procedures for constructing confidence intervals for median lifetime often rest on a distributional assumption for failure times.This paper explores the interplay between censoring levels and robustness for two construction procedures based on exponential lifetime, subject to general right-censoring. Data are simulated from nearby Weibull distributions. As expected, the simulations indicate that when the exponential assumption is not satisfied, observed coverage by the confidence intervals may differ substantially from the specified coverage level. The marked improvement in the robustness properties of the intervals as the level of censoring increases suggests questions for future research.     

Rebates, inventories, and intertemporal price discrimination

We demonstrate that universally redeemed rebates can increase manufacturer profits by reducing the incentives of downstream retailers to hoard inventories when optimal wholesale prices vary predictably over time. By bypassing retailers and making direct contracts with buyers, the manufacturer can increase the variations in effective prices paid by consumers without concomitantly creating larger incentives for retailers to hold inventories. During profitable, high-demand periods, manufacturer revenues are ordinarily constrained by'competition'from retailer inventories, thus limiting profits. However, by selectively offering rebates to consumers while maintaining high wholesale prices, low-demand periods can be accommodated without inducing retailer hoarding.