Adaptive methods for Bayesian time-to-event point-of-care clinical trials

Point-of-care clinical trials are randomized clinical trials designed to maximize pragmatic design features. The goal is to integrate research into standard care such that the burden of research is minimized for patient and physician, including recruitment, randomization and study visits. When possible, these studies employ Bayesian adaptive methods and data collection through the medical record. Due to the passive and adaptive nature of these trials, a number of unique challenges may arise over the course of a study. In this dissertation, adaptive methodology for Bayesian time-to-event clinical trials is developed and evaluated for studies with limited censoring. Use of a normal approximation to the study parameter likelihood is proposed for trials in which the likelihood is not normally distributed and assessed with respect to frequentist type I and II errors. A previously developed method for choosing a normal prior distribution for analysis is applied with modifications to allow for adaptive randomization. This method of prior selection in conjunction with the normal parameter likelihood is used to estimate future data for the purpose of prediction of study success. A previously published method for future event estimation is modified to allow for adaptive randomization and inclusion of prior information. Accuracy of this method is evaluated against final study numbers under a range of study designs and parameter likelihood assumptions. With these future estimates, we predict study conclusions by calculating predicted probabilities of study outcome and compare them to actual study conclusions. Reliability of this method is evaluated considering prior distribution choice, study design, and use of an incorrect likelihood for analysis. The normal approximation to non-normally distributed data performs well here and is reliable when the underlying likelihood is known. The choice of analytic prior distribution agrees with previously published results when equal allocation is forced, but changes depending on the severity of adaptive allocation. Performance of event estimation and prediction vary, but can provide reliable estimates after only 25 subjects have been observed. Analysis and prediction can reliably be carried out in point-of-care studies when care is taken to ensure assumptions are reasonable

Quality of Health Care for Children and Adolescents: A Chartbook

Contains 40 charts and analyses that represent the current state of pediatric health care. Provides practical guidance and recommendations for policymakers, health care professionals, and patient advocates

Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

INDUSTRY LOCATION MODELING: EXTENSIONS OF THE PLAINS ECONOMIC TARGETING SYSTEM

Community/Rural/Urban Development, Industrial Organization,

Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives

Reviews the structure, prevalence, measurement issues, perception, and impact of current quality incentive programs, and discusses how much and under what circumstances they will improve quality of care. Includes descriptions of select programs

Value for money in the English NHS: Summary of the evidence

The extent to which the English National Health Service secures value for money for taxpayers has become a central issue of political and public debate. Questions include: how much expenditure growth has been made available to the NHS? on what has that money been spent? what improvements in the volume and quality of health care have been secured? and what are the implications for productivity? There has been a flurry of research activity designed to address these and similar questions. This report seeks to bring together this research in a concise format and draws some tentative conclusions about recent productivity changes in the NHS. It finds that there is considerable evidence of growth in both the volume and quality of NHS activity. However, this has not in general kept pace with the growth in expenditure. On most measures, therefore, NHS productivity is either static or declining. However, the report highlights a large number of unresolved methodological issues that make it hard to draw any definitive conclusions. We conclude that the measurement of NHS productivity change makes an important contribution to national debate. However, there remains considerable scope for improving both the data and the methods underlying current estimates.

Community Owned Renewable Energy in North Coast NSW Social Housing

This study assesses the feasibility of implementing community owned renewable energy (CORE) technology in social housing units in North Coast NSW. I completed this study by conducting interviews with three renewable energy policy experts to ascertain the current state of renewable energy and CORE in NSW. Second, I conducted four interviews with separate social housing unit employees/residents to understand their interpretation of current barriers to implementing renewable energy in the social housing and if any of the units currently have any renewable energy technology or energy efficiency programs in place. After finishing this assessment, I did a comparative analysis with the barriers to CORE determined by academics and the barriers identified by social housing unit employee/resident interviews. This showed the significance of the capital and information barriers, as both academic and non-academic sources cited these as reasons against implementation of renewable energy. After deciding the most significant barriers, I assessed unique benefits of CORE over standard renewable energy technology that can address these barriers. These benefits include the economic and social benefits of CORE, such as financing structures that enable high investment returns, possibility of donation based funding, community engagement, centralized location of renewable energy technology and ability for greater social cohesion. Understanding these benefits show the potential opportunities of CORE over standard renewable energy that social housing units should consider for future implementation. The study shows the importance of innovating solutions as a way to connect low-access and vulnerable populations to renewable energy technology. As household and electricity costs continue to affect the North Coast NSW region, devising creative ways to address these impacts are essential to promote equity in achieving environmental sustainability. Therefore, if these barriers are addressed, CORE has the potential to be an effective way to transition social housing units to renewable energy and reduce their ecological footprint substantially

Sexual Violence and Armed Conflict: Complex Dynamics of Re-Victimization

This article first examines two types of causes of sexual violence in armed conflict: systemic, or more distant causes, and more proximate, or situational causes, including the role of runaway norms. In the second part, the article draws from a phase model of conflict to understand the new wars and the types of sexual violence that they entail in different stages of conflict. One of the important contributions of this model is to highlight the multiple situations and ways women and the girl child especially (and sometimes others in society, including men and boys, though this is typically underreported) are at risk of sexual violence. It also shows how that risk leads to re-victimization throughout the cycle of conflict for many sexual assault survivors. In addition, it helps elucidate the complexity of victimhood, as many victims are also forced to commit atrocities. The conclusions draw the relevance of these insights for thinking about policymaking to prevent sexual violence in armed conflicts, to identity perpetrators versus victims, and assist the survivors during and in the aftermath of conflict

A Biblical course of study for the daily instruction of juniors

https://place.asburyseminary.edu/ecommonsatsdissertations/2185/thumbnail.jp