Coalition for a Healthier Community: Lessons learned and implications for future work

The Coalition for a Healthier Community (CHC) initiative was implemented to improve the health and well-being of women and girls. Underpinning CHC is a gender-based focus that uses a network of community partners working collaboratively to generate relevant behavior change and improved health outcomes. Ten programs are trying to determine whether gender-focused system approaches are cost-effective ways to address health disparities in women and girls. Programs implemented through coalitions made up of academic institutions, public health departments, community-based organizations, and local, regional, and national organizations, are addressing health issues such as domestic violence, cardiovascular disease prevention, physical activity, and healthy eating. Although these programs are ongoing, they have made significant progress. Key factors contributing to their early success include a comprehensive needs assessment, robust coalitions, the diversity of populations targeted, programs based on findings of the needs assessments, evaluations taking into consideration the effect of gender, and strong academic–community partnerships. A noteworthy impact of these programs has been their ability to shape and impact public, social, and health policies at the state and local levels. However, there have been challenges associated with the implementation of such a complex program. Lessons learned are discussed in this paper.     

An approximation of logarithmic functions in the regression setting

We consider a method of moments approach for dealing with censoring at zero for data expressed in levels when researchers would like to take logarithms. A Box–Cox transformation is employed. We explore this approach in the context of linear regression where both dependent and independent variables are censored. We contrast this method to two others, (1) dropping records of data containing censored values and (2) assuming normality for censored observations and the residuals in the model. Across the methods considered, where researchers are interested primarily in the slope parameter, estimation bias is consistently reduced using the method of moments approach.     

蒙特卡罗方法及其在辐射剂量计算中的应用

概述了蒙特卡罗方法的产生与发展,阐述了蒙特卡罗方法的基本特点,最后就蒙特卡罗方法在辐射剂量计算上的应用进行了讨论。     

Low dose risk estimation via simultaneous statistical inferences

Summary.  The paper develops and studies simultaneous confidence bounds that are useful for making low dose inferences in quantitative risk analysis. Application is intended for risk assessment studies where human, animal or ecological data are used to set safe low dose levels of a toxic agent, but where study information is limited to high dose levels of the agent. Methods are derived for estimating simultaneous, one-sided, upper confidence limits on risk for end points measured on a continuous scale. From the simultaneous confidence bounds, lower confidence limits on the dose that is associated with a particular risk (often referred to as a bench-mark dose ) are calculated. An important feature of the simultaneous construction is that any inferences that are based on inverting the simultaneous confidence bounds apply automatically to inverse bounds on the bench-mark dose.     

Benchmark Analysis: Shopping with Proper Confidence

We discuss the issue of using benchmark doses for quantifying (excess) risk associated with exposure to environmental hazards. The paradigm of low-dose risk estimation in dose-response modeling is used as the primary application scenario. Emphasis is placed on making simultaneous inferences on benchmark doses when data are in the form of proportions, although the concepts translate easily to other forms of outcome data.     

Predictive Bayesian Microbial Dose-Response Assessment Based on Suggested Self-Organization in Primary Illness Response: Cryptosporidium parvum

The probability of illness caused by very low doses of pathogens cannot generally be tested due to the numbers of subjects that would be needed, though such assessments of illness dose response are needed to evaluate drinking water standards. A predictive Bayesian dose-response assessment method was proposed previously to assess the unconditional probability of illness from available information and avoid the inconsistencies of confidence-based approaches. However, the method uses knowledge of the conditional dose-response form, and this form is not well established for the illness endpoint. A conditional parametric dose-response function for gastroenteric illness is proposed here based on simple numerical models of self-organized host-pathogen systems and probabilistic arguments. In the models, illnesses terminate when the host evolves by processes of natural selection to a self-organized critical value of wellness. A generalized beta-Poisson illness dose-response form emerges for the population as a whole. Use of this form is demonstrated in a predictive Bayesian dose-response assessment for cryptosporidiosis. Results suggest that a maximum allowable dose of 5.0 x 10(-7) oocysts/exposure (e.g., 2.5 x 10(-7) oocysts/L water) would correspond with the original goals of the U.S. Environmental Protection Agency Surface Water Treatment Rule, considering only primary illnesses resulting from Poisson-distributed pathogen counts. This estimate should be revised to account for non-Poisson distributions of Cryptosporidium parvum in drinking water and total response, considering secondary illness propagation in the population.     

Predicting body fat using weight–height indices

While body fat is the most accurate measure of obesity, its measurement requires special equipment that can be costly and time consuming to operate. Attention has thus typically focused on the easier to calculate body mass index (BMI). However, the ability of BMI to accurately identify obesity has been increasingly questioned. This paper focuses attention on whether more general body mass indices are appropriate measures of body fat. Using a data set of body fat, height, and weight measurements, general models are estimated which nest a wide variety of weight–height indices as special cases. In the absence of a race and gender categorisation, the conventional BMI was found to be the appropriate index with which to predict body fat. When such a categorisation was made, however, the BMI was never selected as the appropriate index. In general, predicted female body fat was some 10 kg higher than that of a male of identical build and predicted % body fat was over 11 percentage points higher, but age effects were smaller for females. Considerable racial differences in predicted body fat were found for males, but such differences were less marked for females. The implications of this finding for interpreting recent research on the effect of obesity on health, society, and economic factors are considered.     

Bootstrap Estimation of Benchmark Doses and Confidence Limits with Clustered Quantal Data

The benchmark dose (BMD) is an exposure level that would induce a small risk increase (BMR level) above the background. The BMD approach to deriving a reference dose for risk assessment of noncancer effects is advantageous in that the estimate of BMD is not restricted to experimental doses and utilizes most available dose-response information. To quantify statistical uncertainty of a BMD estimate, we often calculate and report its lower confidence limit (i.e., BMDL), and may even consider it as a more conservative alternative to BMD itself. Computation of BMDL may involve normal confidence limits to BMD in conjunction with the delta method. Therefore, factors, such as small sample size and nonlinearity in model parameters, can affect the performance of the delta method BMDL, and alternative methods are useful. In this article, we propose a bootstrap method to estimate BMDL utilizing a scheme that consists of a resampling of residuals after model fitting and a one-step formula for parameter estimation. We illustrate the method with clustered binary data from developmental toxicity experiments. Our analysis shows that with moderately elevated dose-response data, the distribution of BMD estimator tends to be left-skewed and bootstrap BMDL s are smaller than the delta method BMDL s on average, hence quantifying risk more conservatively. Statistically, the bootstrap BMDL quantifies the uncertainty of the true BMD more honestly than the delta method BMDL as its coverage probability is closer to the nominal level than that of delta method BMDL. We find that BMD and BMDL estimates are generally insensitive to model choices provided that the models fit the data comparably well near the region of BMD. Our analysis also suggests that, in the presence of a significant and moderately strong dose-response relationship, the developmental toxicity experiments under the standard protocol support dose-response assessment at 5% BMR for BMD and 95% confidence level for BMDL.