Sustainable Pedagogy

As faculty at a STEM university, each of us honor our commitment to sustainability in unique ways. While the juxtaposition of humanities and engineering may seem odd, the two fields are in fact deeply related and deeply committed to sustainable pedagogy. In this panel, each professor discusses her/his classroom space as a place of sustainable practices. For Dr. Brown and Dr. Mitchell, their honors course series introduces students to some of the key sustainability concerns societies are facing today, the various interpretations and applications of sustainability, the role of technology in addressing sustainability issues, and the ethical principles relevant for attending to these concerns. As future engineers, scientists, resource managers, designers, and professionals, the class asks students to take seriously the development and application of technology and the need to routinely make decisions that have ethical implications for the health and welfare of others, society, and the natural environment. In Dr. Silverman’s Environmental Communication course, students study the sustainability of our current food production system. By examining topics such as meat production, food waste, local food, and food deserts, students come to understand food is not just an issue of the physical environment but also a political, economic, and social issue that effects the sustainability of humanity as a whole. Throughout the semester, students participate in community engagement projects and learn first-hand how they can be part of the change needed and what that change looks like

Methods for the Sequential Parallel Comparison Design

Sequential parallel comparison design (SPCD) has been proposed to increase the likelihood of success of clinical trials, especially trials with a possibly high placebo effect. SPCD is conducted with two stages, and subjects are randomized into three groups: (1) placebo in both periods, (2) placebo in the first period and active therapy in the second period, and (3) active therapy in both periods. Efficacy analysis of the study data includes all data from stage 1 and all placebo non-responding subjects from stage 2. Each stage is analyzed separately then the data are pooled to yield a single p-value. We first describe methods to use in a trial where we combine SPCD with the group sequential approach. We examine how to increase the sample size and adjust the design parameters during an interim analysis to increase power; these design parameters include allocation proportion to placebo in stage 1 of SPCD and weight of stage 1 data in the overall efficacy test statistic. Next, we develop new methods for SPCD with binary and time-to-event outcomes. These methods allow us to analyze SPCD stage-wise using the model of interest with adjustment for covariates. We show that under certain conditions the covariance between the estimated treatment effects in the two periods of SPCD is 0 under both null and alternative hypotheses. We also show that the stage-wise test statistics are uncorrelated under the null hypothesis. As a result, we can omit covariance in the construction of the overall test statistic and the confidence interval for the weighted sum of treatment effects. We develop framework and implementation of SPCD using permutation tests and bootstrap hypothesis testing. This approach allows the flexibility to use SPCD with any outcome. We examine two variations of permutation tests and three variations of the bootstrap. We show that the overall permutation as well as the stage-wise permutation test preserve type I error. Additionally, the bootstrap that maintains the original stage 1 group sample sizes and the stage-wise bootstrap also preserve type I error. The stage-wise permutation test and bootstrap make it easy to evaluate SPCD data with popular software.Doctor of Philosoph

Performance-based fi nancing at the Global Fund to Fight AIDS, Tuberculosis and Malaria: an analysis of grant ratings and funding, 2003–12

Background Performance-based fi nancing can be used by global health funding agencies to improve programme performance and thus value for money. The Global Fund to Fight AIDS, Tuberculosis and Malaria was one of the fi rst global-health funders to deploy a performance-based fi nancing system. However, its complex, multistep system for calculating and paying on grant ratings has several components that are subjective and discretionary. We aimed to test the association between grant ratings and disbursements, an indication of the extent to which incentives for performance are transmitted to grant recipients. Methods We obtained publicly available data for 508 Global Fund grants from 2003 to 2012 with performance ratings and corresponding disbursements, merged with other datasets that contained data for relevant country characteristics. We used regression analysis to identify predictors of grant disbursements in phase 2 (typically the latter 3 of 5 years of a grant), using two dependent variables: whether a grant had any phase-2 disbursements, and the phase-2 disbursement amount. In a separate analysis, we also investigated the predictors of grant performance ratings. Findings Grant performance rating in phase 1 was positively associated with having any disbursements in phase 2, but no association was seen between phase-1 ratings and phase-2 disbursement amounts. Further more, performance ratings are not replicable by external observers, both because subjective and discretionary decisions are made in the generation of performance measures and because the underlying data are not available. Interpretation The Global Fund’s present performance-based funding system does not adequately convey incentives for performance to recipients, and the organisation should redesign this system to explicitly link a portion of the funds to a simple performance measure in health coverage or outcomes, measured independently and robustly

Value-based tiered pricing for universal health coverage : an idea worth revisiting

The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those

Defining the Incremental Utility of Prostate Multiparametric Magnetic Resonance Imaging at Standard and Specialized Read in Predicting Extracapsular Extension of Prostate Cancer

AbstractMultiparametric magnetic resonance imaging (mpMRI) is increasingly used in staging early prostate cancer (PCa) but remains heavily reader-dependent. We aim to define the incremental utility of mpMRI over clinical parameters in determining the pathologic extracapsular extension (pECE) of PCa interpreted in a standard radiologic setting and when further over-read by a specialized reader. We retrospectively reviewed 120 men with clinically localized PCa undergoing mpMRI and radical prostatectomy. We obtained radiologic prediction of pECE from standard radiologic reports (standard read) and by a specialized reader blinded to clinical and pathologic findings (specialized read). We determined the incremental benefit of standard read and specialized read by sequential addition to a baseline clinical parameters-only logistic regression model predicting pECE. The sensitivity and specificity of standard read were 77% and 44%, respectively, whereas those of specialized read were 86% and 81%. The positive likelihood ratio was 1.7 at baseline, 1.7 adding standard read, and 6.5 adding specialized read. The negative likelihood ratio was 0.6 at baseline, 0.5 adding standard read, and 0.1 adding specialized read. Standard read modestly improved prediction of pECE, whereas specialized read improved it moderately.Patient summaryThe incremental benefit of mpMRI over clinical information is small but increases to moderate with a specialized second opinion. This second opinion may be useful when considering active surveillance, nerve-sparing surgery, or focal therapy

A mixed methods investigation of how young adults in Virginia received, evaluated, and responded to COVID-19 public health messaging

The purpose of this study was to investigate how young adults in Virginia received, evaluated, and responded to messages related to the coronavirus/COVID-19, a major disruptor of our time, and to understand how and when these messages influenced behavior. This was a sequential explanatory mixed methods study, including an online survey (quantitative) and virtual focus groups (qualitative). We surveyed a convenience sample of 3,694 Virginia residents by distributing a link to complete the survey online. Only data from18-24 year old adults (n=207) were included in the analysis for this study. Focus group participants were recruited from the survey participants as well as from a college-level introductory health class. Most (83%) young adult respondents reported national science and health organizations as a trusted source for COVID-19 information and over 50% of respondents reported getting information from state/local health departments (72%), healthcare professionals (71%), and online news sources (51%). Focus group participants emphasized social media as an additional major source of COVID-19 information. Focus group data revealed that young adults struggled with deciphering contradictory messaging, had a mix of logical and emotional reasons for deciding whether to adhere to guidelines, had a desire for consistent, fact-based public health messaging at the national level. The findings from this study underscore the importance of consistent, positive public health messaging in a public health crisis