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Changing approaches of prosecutors towards juvenile repeated sex-offenders: A Bayesian evaluation
Dipankar Bandyopadhyay,Debajyoti Sinha,Stuart Lipsitz,Elizabeth Letourneau
Statistics , 2010, DOI: 10.1214/09-AOAS295
Abstract: Existing state-wide data bases on prosecutors' decisions about juvenile offenders are important, yet often un-explored resources for understanding changes in patterns of judicial decisions over time. We investigate the extent and nature of change in judicial behavior toward juveniles following the enactment of a new set of mandatory registration policies between 1992 and 1996 via analyzing the data on prosecutors' decisions of moving forward for youths repeatedly charged with sexual violence in South Carolina. To analyze this longitudinal binary data, we use a random effects logistic regression model via incorporating an unknown change-point year. For convenient physical interpretation, our models allow the proportional odds interpretation of effects of the explanatory variables and the change-point year with and without conditioning on the youth-specific random effects. As a consequence, the effects of the unknown change-point year and other factors can be interpreted as changes in both within youth and population averaged odds of moving forward. Using a Bayesian paradigm, we consider various prior opinions about the unknown year of the change in the pattern of prosecutors' decision. Based on the available data, we make posteriori conclusions about whether a change-point has occurred between 1992 and 1996 (inclusive), evaluate the degree of confidence about the year of change-point, estimate the magnitude of the effects of the change-point and other factors, and investigate other provocative questions about patterns of prosecutors' decisions over time.
Hospital Surgical Volume, Utilization, Costs and Outcomes of Retroperitoneal Lymph Node Dissection for Testis Cancer
Hua-yin Yu,Nathanael D. Hevelone,Sunil Patel,Stuart R. Lipsitz,Jim C. Hu
Advances in Urology , 2012, DOI: 10.1155/2012/189823
Abstract: Objectives. Retroperitoneal lymph node dissection (RPLND) outcomes for testis cancer originate mostly from single-center series. We characterized population-based utilization, costs, and outcomes and assessed whether higher volume affects outcomes. Methods and Materials. Using the US Nationwide Inpatient Sample from 2001–2008, we identified 993 RPLND and used propensity score methods to assess utilization, costs, and inpatient outcomes based on hospital surgical volume. Results. 51.6% of RPLND were performed at hospitals where there were two or fewer cases per year. RPLND was more commonly performed at large urban teaching hospitals, where men were younger, more likely to be white and earning incomes exceeding the 50th percentile (all ). Higher hospital volumes were associated with fewer complications and more routine home discharges (all ). However, higher volume hospitals had more transfusions ( ) and incurred $1,435 more in median costs ( ). Limitations include inability to adjust for tumor characteristics and absence of outpatient outcomes. Conclusions. Sociodemographic differences exist between high versus low volume RPLND hospitals. Although higher volume hospitals had more transfusions and higher costs, perhaps due to more complex cases, they experienced fewer complications. However, most RPLND are performed at hospitals where there were two or fewer cases per year. 1. Introduction Testis cancer is the most common malignancy among US men aged 18–34 years. The overall incidence of germ cell tumors has risen since 1973, and the annual increase in the incidence of nonseminomatous germ cell tumors (NSGCT-) has been 2% per year [1, 2]. Retroperitoneal lymph node dissection (RPLND) is used for the treatment of men with stage I NSGCT, low volume stage II disease, and in the postchemotherapy setting to eradicate residual mass. However, RPLND utilization has decreased since 1988 due to the increased use of surveillance and primary chemotherapy [3]. Due to the relative low incidence of testis cancer compared with other genitourinary malignancies, most reports of RPLND use and outcomes originate from high volume tertiary referral centers, and there is an absence of population-based RPLND outcomes data. While testis cancer mortality and RPLND use rates have been reported from the U.S. Surveillance Epidemiology and End Results (SEER) cancer registry [3], there is currently no way to link pathologic data to nationally representative administrative datasets such as Medicare, due to the age limitation of this patient population. Moreover, while volume outcomes
Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia
Jonathan M Spector, Jonathan Reisman, Stuart Lipsitz, Priya Desai, Atul A Gawande
BMC Pregnancy and Childbirth , 2013, DOI: 10.1186/1471-2393-13-43
Abstract: Health workers in Africa and Asia were surveyed using a web-based questionnaire. A list of essential childbirth-related health technologies was drawn from World Health Organization guidelines for preventing and managing complications associated with the major causes of maternal and newborn mortality globally. Demographic data describing each birth center were obtained and health workers reported on the availability of essential childbirth-related health technologies at their centers. Comparison analyses were conducted using Rao-Scott chi-square test statistics.Health workers from 124 birth centers in 26 African and 15 Asian countries participated. All facilities exhibited gaps in the availability of essential childbirth-related health technologies. Availability was significantly reduced in birth centers that had lower birth volumes and those from lower income countries. On average across all centers, health workers reported the availability of 18 of 23 essential childbirth-related health technologies (79%; 95% CI, 74%, 84%). Low-volume facilities suffered severe shortages; on average, these centers reported reliable availability to 13 of 23 technologies (55%; 95% CI, 39%, 71%).Substantial gaps exist in the availability of essential childbirth-related health technologies across health sector levels in Africa and Asia. Strategies that facilitate reliable access to vital health technologies in these regions are an urgent priority.
Simple Methods of Determining Confidence Intervals for Functions of Estimates in Published Results
Garrett Fitzmaurice, Stuart Lipsitz, Sundar Natarajan, Atul Gawande, Debajyoti Sinha, Caprice Greenberg, Edward Giovannucci
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0098498
Abstract: Often, the reader of a published paper is interested in a comparison of parameters that has not been presented. It is not possible to make inferences beyond point estimation since the standard error for the contrast of the estimated parameters depends upon the (unreported) correlation. This study explores approaches to obtain valid confidence intervals when the correlation is unknown. We illustrate three proposed approaches using data from the National Health Interview Survey. The three approaches include the Bonferroni method and the standard confidence interval assuming (most conservative) or (when the correlation is known to be non-negative). The Bonferroni approach is found to be the most conservative. For the difference in two estimated parameter, the standard confidence interval assuming yields a 95% confidence interval that is approximately 12.5% narrower than the Bonferroni confidence interval; when the correlation is known to be positive, the standard 95% confidence interval assuming is approximately 38% narrower than the Bonferroni. In summary, this article demonstrates simple methods to determine confidence intervals for unreported comparisons. We suggest use of the standard confidence interval assuming if no information is available or if the correlation is known to be non-negative.
Vida y subjetividad: Los Descartes de Michel Henry
T?3picos , 2006,
Abstract: with the cogito ergo sum, descartes has intended to offer a safe ground for the construction of scientific knowledge. nevertheless, the problematic thus posed has totally forgotten, as heidegger points out, to elucidate the sense of the being of this sum. it can be said that the whole work of michel henry constitutes a deeply original attempt to raise the question of the ego sum on a truthfully ontological context. hence, his meditation on descartes work and project takes up a central and permanent place in his work. henry discovers to us in l′essence de la manifestation (1964) and in phénoménologie du corps (1965) a descartes whose project, based unreflectively on an intuitionist procedure, identifies truth with evidence and thus predetermines his investigation as an impossible attempt to exhibit the grounding under light, which is impossible, given that the grounding, the being of the ego - henry states-, is invisible. this is what descartes has understood, according to henry's "généalogie de la psychanalyse" (1985): the being of the sum is not a "that" which may be given by a vision but a "how" that reveals itself without any mediation as pathos: the appearing of life to itself in the immanence of its affectivity.
Vida y subjetividad: Los Descartes de Michel Henry
Mario Lipsitz
T?3picos , 2006,
Abstract: Con el ego cogito sum, Descartes ha buscado ofrecer un suelo seguro para la edificación del conocimiento científico. Sin embargo, la problemática así instaurada ha olvidado totalmente, como se ala Heidegger, elucidar el sentido de ser de ese sum. Puede decirse que toda la obra de Michel Henry constituye una tentativa profundamente original de plantear la cuestión del ego sum sobre un contexto verdaderamente ontológico. Es en esta medida que su meditación sobre la obra y el proyecto cartesiano ocupa un lugar central y permanente. Henry nos descubre en L′essence de la Manifestation (1964) y en Phénoménologie du Corps un Descartes cuyo proyecto, basado irreflexivamente sobre un procedimiento intuicionista identifica verdad con evidencia y predetermina así su investigación como una imposible tentativa de exhibir el fundamento bajo la luz. Imposible, pues el fundamento, afirma Henry, el ser del ego, es invisible. Esto es lo que ha comprendido el Descartes al que nos abre Henry en su "Généalogie de la Psychanalyse" (1985): el ser del sum no es un "qué" susceptible de ser dado por un ver sino un "como" que se revela sin mediación a sí mismo como pathos: el aparecerse a si de la vida en la inmanencia de su afectividad. With the cogito ergo sum, Descartes has intended to offer a safe ground for the construction of scientific knowledge. Nevertheless, the problematic thus posed has totally forgotten, as Heidegger points out, to elucidate the sense of the being of this sum. It can be said that the whole work of Michel Henry constitutes a deeply original attempt to raise the question of the ego sum on a truthfully ontological context. Hence, his meditation on Descartes work and project takes up a central and permanent place in his work. Henry discovers to us in L′essence de la Manifestation (1964) and in Phénoménologie du Corps (1965) a Descartes whose project, based unreflectively on an intuitionist procedure, identifies truth with evidence and thus predetermines his investigation as an impossible attempt to exhibit the grounding under light, which is impossible, given that the grounding, the being of the ego - Henry states-, is invisible. This is what Descartes has understood, according to Henry's "Généalogie de la Psychanalyse" (1985): the being of the sum is not a "that" which may be given by a vision but a "how" that reveals itself without any mediation as pathos: the appearing of life to itself in the immanence of its affectivity.
A generalized linear mixed model for longitudinal binary data with a marginal logit link function
Michael Parzen,Souparno Ghosh,Stuart Lipsitz,Debajyoti Sinha,Garrett M. Fitzmaurice,Bani K. Mallick,Joseph G. Ibrahim
Statistics , 2011, DOI: 10.1214/10-AOAS390
Abstract: Longitudinal studies of a binary outcome are common in the health, social, and behavioral sciences. In general, a feature of random effects logistic regression models for longitudinal binary data is that the marginal functional form, when integrated over the distribution of the random effects, is no longer of logistic form. Recently, Wang and Louis [Biometrika 90 (2003) 765--775] proposed a random intercept model in the clustered binary data setting where the marginal model has a logistic form. An acknowledged limitation of their model is that it allows only a single random effect that varies from cluster to cluster. In this paper we propose a modification of their model to handle longitudinal data, allowing separate, but correlated, random intercepts at each measurement occasion. The proposed model allows for a flexible correlation structure among the random intercepts, where the correlations can be interpreted in terms of Kendall's $\tau$. For example, the marginal correlations among the repeated binary outcomes can decline with increasing time separation, while the model retains the property of having matching conditional and marginal logit link functions. Finally, the proposed method is used to analyze data from a longitudinal study designed to monitor cardiac abnormalities in children born to HIV-infected women.
Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program
Jonathan M. Spector, Priya Agrawal, Bhala Kodkany, Stuart Lipsitz, Angela Lashoher, Gerald Dziekan, Rajiv Bahl, Mario Merialdi, Matthews Mathai, Claire Lemer, Atul Gawande
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0035151
Abstract: Background Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes. Methods and Findings A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes. Conclusions Introduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.
Development of a Charting Method to Monitor the Individual Performance of Surgeons at the Beginning of Their Career
Antoine Duclos, Matthew J. Carty, Jean-Louis Peix, Cyrille Colin, Stuart R. Lipsitz, Jean-Louis Kraimps, Fabrice Menegaux, Fran?ois Pattou, Fréderic Sebag, Nicolas Voirin, Sandrine Touzet, Stéphanie Bourdy, Jean-Christophe Lifante, CATHY Study Group
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0041944
Abstract: Background Efforts to provide a valid picture of surgeons’ individual performance evolution should frame their outcomes in relation to what is expected depending on their experience. We derived the learning curve of young thyroidectomy surgeons as a baseline to enable the accurate assessment of their individual outcomes and avoid erroneous conclusions that may derive from more traditional approaches. Methods Operative time and postoperative recurrent laryngeal nerve palsy of 2006 patients who underwent a thyroidectomy performed by 19 young surgeons in five academic hospitals were monitored from April 2008 to December 2009. The database was randomly divided into training and testing datasets. The training data served to determine the expected performance curve of surgeons during their career and factors influencing outcome variation using generalized estimating equations (GEEs). To simulate prospective monitoring of individual surgeon outcomes, the testing data were plotted on funnel plots and cumulative sum charts (CUSUM). Performance charting methods were utilized to present outcomes adjusted both for patient case-mix and surgeon experience. Results Generation of performance curves demonstrated a gradual reduction in operative time from 139 (95% CI, 137 to 141) to 75 (71 to 80) minutes, and from 15.7% (15.1% to 16.3%) to 3.3% (3.0% to 3.6%) regarding the nerve palsy rate. Charts interpretation revealed that a very young surgeon had better outcomes than expected, whereas a more experienced surgeon appeared to be a poor performer given the number of years that he had already spent in practice. Conclusions Not considering the initial learning curve of surgeons exposes them to biased measurement and to misinterpretation in assessing their individual performance for thyroidectomy. The performance chart represents a valuable tool to monitor the outcome of surgeons with the expectation to provide safe and efficient care to patients.
Discussion Article: Disciplinary Boundaries for Creativity  [PDF]
Stuart Rowlands
Creative Education (CE) , 2011, DOI: 10.4236/ce.2011.21007
Abstract: Creativity is a very topical issue and indeed a political one. For example, the very notion of ‘little c creativity’ seems to be a reflection of the requirements of what could be described as a ‘Post-Fordist’ economy. However, the call to develop creativity in education is largely based on the idea of creativity as the production of novel ideas. The central argument of this article is that creativity cannot be seen purely in terms of novel ideas but that it is intrinsically bound with the teaching of the academic disciplines. It is within the context of creativity in the sense of transforming the disciplines that two paradoxes are discussed. The first paradox is that the truly creative act is not the preserve of the genius but the potential for the whole of humanity. Secondly, creativity involves both thinking within the constraints of the discipline and challenging those constraints. This implies the need for students to engage in meta-discourse, involving the nature and history of the subject-matter taught.
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