Classifying Mouse Movements and Providing Help in Web Surveys

Survey administrators go to great lengths to make sure survey questions are easy to understand for a broad range of respondents. Despite these efforts, respondents do not always understand what the questions ask of them. In interviewer-administrated surveys, interviewers can pick up on cues from the respondent that suggest they do not understand or know how to answer the question and can provide assistance as their training allows. However, due to the high costs of interviewer administration, many surveys are moving towards other survey modes (at least for some respondents) that do not include costly interviewers, and with that a valuable source for clarification is gone. In Web surveys, researchers have experimented with providing real-time assistance to respondents who take a long time to answer a question. Help provided in such a fashion has resulted in increased accuracy, but some respondents do not like the imposition of unsolicited help. There may be alternative ways to provide help that can refine or overcome the limitations to using response times. This dissertation is organized into three separate studies that each use a set of independently collected data to identify a set of indicators survey administrators can use to determine when a respondent is having difficulty answering a question and proposes alternative ways of providing real-time assistance that increase accuracy as well as user satisfaction. The first study identifies nine movements that respondents make with the mouse cursor while answering survey questions and hypothesizes, using exploratory analyses, which movements are related to difficulty. The second study confirms use of these movements and uses hierarchical modeling to identify four movements which are the most predictive. The third study tests three different of providing unsolicited help to respondents: text box, audio recording, and chat. Accuracy and respondent satisfaction are evaluated for each mode. There were no differences in accuracy across the three modes, but participants reported a preference for receiving help in a standard text box. These findings allow survey designers to identify difficult questions on a larger scale than previously possible and to increase accuracy by providing real-time assistance while maintaining respondent satisfaction

The effect of stratification on wind-driven, cross-shelf circulation and transport on the inner continental shelf

Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at the Massachusetts Institute of Technology and the Woods Hole Oceanographic Institution June 2012Observations from a three-year field program on the inner shelf south of Martha's Vineyard, MA and a numerical model are used to describe the effect of stratification on inner shelf circulation, transport, and sediment resuspension height. Thermal stratification above the bottom mixed layer is shown to cap the height to which sediment is resuspended. Stratification increases the transport driven by cross-shelf wind stresses, and this effect is larger in the response to offshore winds than onshore winds. However, a one-dimensional view of the dynamics is not sufficient to explain the relationship between circulation and stratification. An idealized, cross-shelf transect in a numerical model (ROMS) is used to isolate the effects of stratification, wind stress magnitude, surface heat flux, cross-shelf density gradient, and wind direction on the inner shelf response to the cross-shelf component of the wind stress. In well mixed and weakly stratified conditions, the cross-shelf density gradient can be used to predict the transport efficiency of the cross-shelf wind stress. In stratified conditions, the presence of an along-shelf wind stress component makes the inner shelf response to cross-shelf wind stress strongly asymmetric.This work was supported through National Science Foundation grant no. OCE-0548961, the WHOI Academic Programs Office, and the WHOI Coastal Ocean Institute

Profits v. Purpose: Hybrid Companies and the Charitable Dollar

Social entrepreneurship -- a catch-all term meaning harnessing business practices for social good -- has attracted people who want to “do well while doing good” for decades. Advocates of the idea have succeeded in blurring the boundaries among legal ownership types and inspired nonprofit/for-profit joint ventures, public-private partnerships, and the widespread privatization of traditional government functions and activities. The most recent manifestation of this trend is the creation of hybrid non-profit/for-profit firms. In the United States, the Low-Profit Limited Liability Company (L3C) is growing, and there are similar firms in the United Kingdom and Canada. In this paper we address the narrow, legal justifications for L3Cs in the U.S., as well as the broader justifications for hybrid organizations. We then identify four types of problems raised by the L3C and, perhaps to a lesser extent, other models: 1) their internal, legal incoherence; 2) the risk to charitable assets and potential for inappropriate use of tax subsidies; 3) the problematic assumption that for-profits are more efficient than nonprofit or government alternatives; and 4) the potentially inappropriate use of government imprimatur. However, recognizing the increasing and unyielding limits on the ability of nonprofits to raise capital, we concede that L3Cs may well offer a valuable route to capital while avoiding conversions to for-profit ownership

Profits v. Purpose: Hybrid Companies and the Charitable Dollar

Social entrepreneurship -- a catch-all term meaning harnessing business practices for social good -- has attracted people who want to “do well while doing good” for decades. Advocates of the idea have succeeded in blurring the boundaries among legal ownership types and inspired nonprofit/for-profit joint ventures, public-private partnerships, and the widespread privatization of traditional government functions and activities. The most recent manifestation of this trend is the creation of hybrid non-profit/for-profit firms. In the United States, the Low-Profit Limited Liability Company (L3C) is growing, and there are similar firms in the United Kingdom and Canada. In this paper we address the narrow, legal justifications for L3Cs in the U.S., as well as the broader justifications for hybrid organizations. We then identify four types of problems raised by the L3C and, perhaps to a lesser extent, other models: 1) their internal, legal incoherence; 2) the risk to charitable assets and potential for inappropriate use of tax subsidies; 3) the problematic assumption that for-profits are more efficient than nonprofit or government alternatives; and 4) the potentially inappropriate use of government imprimatur. However, recognizing the increasing and unyielding limits on the ability of nonprofits to raise capital, we concede that L3Cs may well offer a valuable route to capital while avoiding conversions to for-profit ownership

Inner-shelf response to cross-chelf wind stress : the importance of the cross-shelf density gradient in an idealized numerical model and field observations

Author Posting. © American Meteorological Society, 2014. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 44 (2014): 86–103, doi:10.1175/JPO-D-13-075.1.This study investigates the effects of horizontal and vertical density gradients on the inner-shelf response to cross-shelf wind stress by using an idealized numerical model and observations from a moored array deployed south of Martha’s Vineyard, Massachusetts. In two-dimensional (no along-shelf variation) numerical model runs of an initially stratified shelf, a cross-shelf wind stress drives vertical mixing that results in a nearly well-mixed inner shelf with a cross-shelf density gradient because of the sloping bottom. The cross-shelf density gradient causes an asymmetric response to on- and offshore wind stresses. For density increasing offshore, an offshore wind stress drives a near-surface offshore flow and near-bottom onshore flow that slightly enhances the vertical stratification and the cross-shelf circulation. An onshore wind stress drives the reverse cross-shelf circulation reducing the vertical stratification and the cross-shelf circulation. A horizontal Richardson number is shown to be the nondimensional parameter that controls the dependence of the wind-driven nondimensional cross-shelf transport on the cross-shelf density gradient. Field observations show the same empirical relationship between the horizontal Richardson number and transport fraction as the model predicts. These results show that it is the cross-shelf rather than vertical density gradient that is critical to predicting the inner-shelf cross-shelf transport driven by a cross-shelf wind stress.This work was funded by Ocean Sciences Division of the National Science Foundation Grant OCE-0548961 and by the Woods Hole Oceanographic Institution through the Academic Programs Office and the Coastal Ocean Institute. Data central to this study were provided by the Martha’s Vineyard Coastal Observatory, which is funded by WHOI and the Jewett/EDUC/Harrison Foundation.2014-07-0

The effect of wind direction on cross-shelf transport on an initially stratified inner shelf

Cross-shelf and along-shelf wind stresses both independently have been shown to drive transport across the inner shelf. We investigate how the circulation and density fields respond to simultaneous cross- and along-shelf wind forcing using a set of model experiments on an initially stratified inner shelf. For all wind directions with a downwelling along-shelf component, the inner shelf is unstratified and the cross-shelf wind dominates transport. For wind directions with an upwelling along-shelf component, the inner shelf can be stratified and the transition from inner to midshelf occurs over a wide swath of shelf. In this transition region, the effects of the cross- and along-shelf wind stresses are not separable, because the response to each component is tied to the other by the density field on which they both act. A consequence of this asymmetry is that offshore transport occurs for more compass directions, and more strongly than onshore transport, making offshore transport more likely under variable wind conditions in the field, even if the average wind stress were near zero. These model results demonstrate a strongly asymmetric directional dependence of wind-driven, cross-shelf transport on the inner shelf. Field observations from the inner shelf of Martha\u27s Vineyard, Massachusetts, substantiate both the directional dependence and magnitude of the transport predicted by the model

Transitions from Telephone Surveys to Self-Administered and Mixed-Mode Surveys: AAPOR Task Force Report

Telephone surveys have been a ubiquitous method of collecting survey data, but the environment for telephone surveys is changing. Many surveys are transitioning from telephone to self-administration or combinations of modes for both recruitment and survey administration. Survey organizations are conducting these transitions from telephone to mixed modes with only limited guidance from existing empirical literature and best practices. This article summarizes findings by an AAPOR Task Force on how these transitions have occurred for surveys and research organizations in general. We find that transitions from a telephone to a selfadministered or mixed-mode survey are motivated by a desire to control costs, to maintain or improve data quality, or both. The most common mode to recruit respondents when transitioning is mail, but recent mixedmode studies use only web or mail and web together as survey administration modes. Although early studies found that telephone response rates met or exceeded response rates to the self-administered or mixed modes, after about 2013, response rates to the self-administered or mixed modes tended to exceed those for the telephone mode, largely because of a decline in the telephone mode response rates. Transitioning offers opportunities related to improved frame coverage and geographic targeting, delivery of incentives, visual design of an instrument, and cost savings, but challenges exist related to selecting a respondent within a household, length of a questionnaire, differences across modes in use of computerization to facilitate skip patterns and other questionnaire design features, and lack of an interviewer for respondent motivation and clarification. Other challenges related to surveying youth, conducting surveys in multiple languages, collecting nonsurvey data such as biomeasures or consent to link to administrative data, and estimation with multiple modes are also prominent

The role of lumbar puncture in children with suspected central nervous system infection

BACKGROUND: The use of the lumbar puncture in the diagnosis of central nervous system infection in acutely ill children is controversial. Recommendations have been published but it is unclear whether they are being followed. METHODS: The medical case notes of 415 acute medical admissions in a children's hospital were examined to identify children with suspected central nervous system infection and suspected meningococcal septicaemia. We determined whether lumbar punctures were indicated or contraindicated, whether they had been performed, and whether the results contributed to the patients' management. RESULTS: Fifty-two children with suspected central nervous system infections, and 43 with suspected meningococcal septicaemia were identified. No lumbar punctures were performed in patients with contraindications, but only 25 (53%) of 47 children with suspected central nervous system infection and no contraindications received a lumbar puncture. Lumbar puncture findings contributed to the management in 18 (72%) of these patients, by identifying a causative organism or excluding bacterial meningitis. CONCLUSION: The recommendations for undertaking lumbar punctures in children with suspected central nervous system infection are not being followed because many children that should receive lumbar punctures are not getting them. When they are performed, lumbar puncture findings make a useful contribution to the patients' management

HIV-1 infection among women in Israel, 2010–2018

Introduction Although women comprise 33% of the HIV-1-carriers in Israel, they have not previously been considered a risk group requiring special attention. Immigration waves from countries in Africa and in East Europe may have changed the local landscape of women diagnosed with HIV-1. Here, we aimed to assess viral and demographic characteristics of HIV-1-positive women identified in Israel between 2010 and 2018. Methods All > 16 year-old, HIV-1-infected women, diagnosed in Israel in 2010–2018, (n = 763) registered in the National HIV reference laboratory were included in this cross-sectional study. Demographic and clinical characteristics were extracted from the database. Viral subtypes and transmitted drug resistance mutations (TDRM) were determined in 337 (44.2%) randomly selected samples collected from treatment-naive women. Results Median age at diagnosis was 38 years. Most (73.3%) women were immigrants from the former Soviet Union (FSU) (41.2%, 314) or sub-Saharan Africa (SSA) (32.2%, 246) and carried subtype A (79.7%) or C (90.3%), respectively. Only 11.4% (87) were Israeli-born women. Over the years, the prevalence of women from SSA decreased while that of women from FSU increased significantly (p < 0.001). The median CD4+ cell count was 263 cells/mm3, and higher (391 cells/mm3) in Israeli-born women. TDRM were identified in 10.4% of the tested samples; 1.8, 3 and 7.1% had protease inhibitors (PI), nucleotide reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) TDRM, respectively. The prevalence of women with NNRTI TDRM significantly increased from 4.9% in 2010–2012 to 13.3% in 2016–2018. Israeli-born women had the highest prevalence (16.3%) of NNRTI TDRM (p = 0.014). NRTI A62 (5.6%), NNRTI E138 and K103 (5.6 and 4.2%, respectively) were the most prominent mutated sites. Conclusions Most HIV-1-positive women diagnosed in Israel in 2010–2018 were immigrants, with the relative ratio of FSU immigrants increasing in recent years. The high proportion of women diagnosed with resistance mutations, particularly, the yearly increase in the frequency of NNRTI mutations, support the national policy of resistance testing at baseline

Toward a 21st-century health care system: Recommendations for health care reform

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage. 8. Create a health coverage board with broad stakeholder representation to determine and periodically update the affordable standard benefit package available through state or regional insurance exchanges