When Things Go Wrong in the Clinic: How to Prevent and Respond to Serious Student Misconduct

This article documents the types of misconduct that students commit, explores why serious misconduct occurs, examines whether such conduct can be anticipated and reduced by prescreening and monitoring potentially problematic students, and suggests how misconduct might be addressed once it occurs. The authors\u27 analysis thus encompasses both legal obligations and pedagogical considerations, and it takes account of the differing perspectives of clinical professors, law school administrators, and bar examiners. The authors operate from a student centered perspective that emphasizes the support and development of law students. This article is prescriptive, therefore, in the extent to which it emphasizes preventive actions and constructive responses. The purpose of this article is not to prescribe how a clinical professor should deal with any particular instance of misconduct, but rather to empower clinical professors to deal thoughtfully with such situations by providing them with helpful information and an analytic framework

Dimension reduction and shrinkage methods for high dimensional disease risk scores in historical data

Abstract Background Multivariable confounder adjustment in comparative studies of newly marketed drugs can be limited by small numbers of exposed patients and even fewer outcomes. Disease risk scores (DRSs) developed in historical comparator drug users before the new drug entered the market may improve adjustment. However, in a high dimensional data setting, empirical selection of hundreds of potential confounders and modeling of DRS even in the historical cohort can lead to over-fitting and reduced predictive performance in the study cohort. We propose the use of combinations of dimension reduction and shrinkage methods to overcome this problem, and compared the performances of these modeling strategies for implementing high dimensional (hd) DRSs from historical data in two empirical study examples of newly marketed drugs versus comparator drugs after the new drugs’ market entry—dabigatran versus warfarin for the outcome of major hemorrhagic events and cyclooxygenase-2 inhibitor (coxibs) versus nonselective non-steroidal anti-inflammatory drugs (nsNSAIDs) for gastrointestinal bleeds. Results Historical hdDRSs that included predefined and empirical outcome predictors with dimension reduction (principal component analysis; PCA) and shrinkage (lasso and ridge regression) approaches had higher c-statistics (0.66 for the PCA model, 0.64 for the PCA + ridge and 0.65 for the PCA + lasso models in the warfarin users) than an unreduced model (c-statistic, 0.54) in the dabigatran example. The odds ratio (OR) from PCA + lasso hdDRS-stratification [OR, 0.64; 95 % confidence interval (CI) 0.46–0.90] was closer to the benchmark estimate (0.93) from a randomized trial than the model without empirical predictors (OR, 0.58; 95 % CI 0.41–0.81). In the coxibs example, c-statistics of the hdDRSs in the nsNSAID initiators were 0.66 for the PCA model, 0.67 for the PCA + ridge model, and 0.67 for the PCA + lasso model; these were higher than for the unreduced model (c-statistic, 0.45), and comparable to the demographics + risk score model (c-statistic, 0.67). Conclusions hdDRSs using historical data with dimension reduction and shrinkage was feasible, and improved confounding adjustment in two studies of newly marketed medications

Compilation and review engagements : essential questions and answers

https://egrove.olemiss.edu/aicpa_guides/1524/thumbnail.jp

Awareness, Accuracy, and Predictive Validity of Self-reported Cholesterol in Women

Background: Although current guidelines emphasize the importance of cholesterol knowledge, little is known about accuracy of this knowledge, factors affecting accuracy, and the relationship of self-reported cholesterol with cardiovascular disease (CVD). Methods: The 39,876 female health professionals with no prior CVD in the Women’s Health Study were asked to provide self-reported and measured levels of total and high-density lipoprotein (HDL) cholesterol. Demographic and cardiovascular risk factors were considered as determinants of awareness and accuracy. Accuracy was evaluated by the difference between reported and measured cholesterol. In addition, we examined the relationship of self-reported cholesterol with incident CVD over 10 years. Results: Compared with women who were unaware of their cholesterol levels, aware women (84%) had higher levels of income, education, and exercise and were more likely to be married, normal in weight, treated for hypertension and hypercholesterolemia, nonsmokers, moderate drinkers, and users of hormone therapy. Women underestimated their total cholesterol by 9.7 mg/dL (95% CI: 9.2–10.2); covariates explained little of this difference (R$^2$ < .01). Higher levels of self-reported cholesterol were strongly associated with increased risk of CVD, which occurred in 741 women (hazard ratio 1.23/40 mg/dL cholesterol, 95% CI: 1.15–1.33). Women with elevated cholesterol who were unaware of their level had particularly increased risk (HR=1.88, P < .001) relative to aware women with normal measured cholesterol. Conclusion: Women with obesity, smoking, untreated hypertension, or sedentary lifestyle have decreased awareness of their cholesterol levels. Self-reported cholesterol underestimates measured values, but is strongly related to CVD. Lack of awareness of elevated cholesterol is associated with increased risk of CVD

Socioeconomic status, blood pressure progression, and incident hypertension in a prospective cohort of female health professionals

Aims The aim of this study was to examine the association between socioeconomic status, blood pressure (BP) progression, and incident hypertension. Methods and results We included 27 207 female health professionals free of hypertension and cardiovascular disease at baseline. Participants were classified into five education and six income categories. The main outcome variables were BP progression at 48 months of follow-up and incident hypertension during the entire study period. At 48 months, 48.1% of women had BP progression. The multivariable adjusted relative risks [95% confidence intervals (CIs)] for BP progression were 1.0 (referent), 0.96 (0.92-1.00), 0.92 (0.88-0.96), 0.90 (0.85-0.94), and 0.84 (0.78-0.91) (P for trend <0.0001) across increasing education categories and 1.0 (referent), 1.01 (0.94-1.08), 0.99 (0.93-1.06), 0.97 (0.91-1.04), 0.96 (0.90-1.03), and 0.89 (0.83-0.96) across increasing income categories (P for trend = 0.0001). During a median follow-up of 9.8 years, 8248 cases of incident hypertension occurred. Multivariable adjusted hazard ratios (95% CI) were 1.0 (referent), 0.92 (0.86-0.99), 0.85 (0.79-0.92), 0.87 (0.80-0.94), and 0.74 (0.65-0.84) (P for trend <0.0001) across increasing education categories and 1.0 (referent), 1.07 (0.95-1.21), 1.07 (0.95-1.20), 1.06 (0.94-1.18), 1.04 (0.93-1.16), and 0.93 (0.82-1.06) (P for trend 0.08) across increasing income categories. In joint analyses, education but not income remained associated with BP progression and incident hypertension. Conclusion Socioeconomic status, as determined by education but not by income, is a strong independent predictor of BP progression and incident hypertension in wome

Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials

Objective To evaluate the effect of vitamin E supplementation on incident total, ischaemic, and haemorrhagic stroke

Synegies Between Visible/Near-Infrared Imaging Spectrometry and the Thermal Infrared in an Urban Environment: An Evaluation of the Hyperspectral Infrared Imager (HYSPIRI) Mission

A majority of the human population lives in urban areas and as such, the quality of urban environments is becoming increasingly important to the human population. Furthermore, these areas are major sources of environmental contaminants and sinks of energy and materials. Remote sensing provides an improved understanding of urban areas and their impacts by mapping urban extent, urban composition (vegetation and impervious cover fractions), and urban radiation balance through measures of albedo, emissivity and land surface temperature (LST). Recently, the National Research Council (NRC) completed an assessment of remote sensing needs for the next decade (NRC, 2007), proposing several missions suitable for urban studies, including a visible, near-infrared and shortwave infrared (VSWIR) imaging spectrometer and a multispectral thermal infrared (TIR) instrument called the Hyperspectral Infrared Imagery (HyspIRI). In this talk, we introduce the HyspIRI mission, focusing on potential synergies between VSWIR and TIR data in an urban area. We evaluate potential synergies using an Airborne Visible/Infrared Imaging Spectrometer (AVIRIS) and MODIS-ASTER (MASTER) image pair acquired over Santa Barbara, United States. AVIRIS data were analyzed at their native spatial resolutions (7.5m VSWIR and 15m TIR), and aggregated 60 m spatial resolution similar to HyspIRI. Surface reflectance was calculated using ACORN and a ground reflectance target to remove atmospheric and sensor artifacts. MASTER data were processed to generate estimates of spectral emissivity and LST using Modtran radiative transfer code and the ASTER Temperature Emissivity Separation algorithm. A spectral library of common urban materials, including urban vegetation, roofs and roads was assembled from combined AVIRIS and field-measured reflectance spectra. LST and emissivity were also retrieved from MASTER and reflectance/emissivity spectra for a subset of urban materials were retrieved from co-located MASTER and AVIRIS pixels. Fractions of Impervious, Soil, Green Vegetation (GV) and Non-photosynthetic Vegetation (NPV), were estimated using Multiple Endmember Spectral Mixture Analysis (MESMA) applied to AVIRIS data at 7.5, 15 and 60 m spatial scales. Surface energy parameters, including albedo, vegetation cover fraction, broadband emissivity and LST were also determined for urban and natural land-cover classes in the region. Fractions were validated using 1m digital photography