The "caring experience": testing the psychometric properties of the Caring Efficacy Scale

The purpose of the study was to undertake rigorous psychometric testing of the Caring Efficacy Scale in a sample of Registered Nurses. A cross-sectional survey of 2000 registered nurses was undertaken. The Caring Efficacy Scale was utilised to inform the psychometric properties of the selected items of the Caring Efficacy Scale. Cronbach’s Alpha identified reliability of the data. Exploratory Factor Analysis and Confirmatory Factor Analysis were undertaken to validate the factors. Confirmatory factor analysis confirmed the development of two factors; Confidence to Care and Doubts and Concerns. The Caring Efficacy Scale has undergone rigorous psychometric testing, affording evidence of internal consistency and goodness-of-fit indices within satisfactory ranges. The Caring Efficacy Scale is valid for use in an Australian population of registered nurses. The scale can be used as a subscale or total score reflective of self-efficacy in nursing. This scale may assist nursing educators to predict levels of caring efficacy.

Reliability and validity of query intent assessments

In most intent recognition studies, annotations of query intent are created post hoc by external assessors who are not the searchers themselves. It is important for the field to get a better understanding of the quality of this process as an approximation for determining the searcher's actual intent. Some studies have investigated the reliability of the query intent annotation process by measuring the interassessor agreement. However, these studies did not measure the validity of the judgments, that is, to what extent the annotations match the searcher's actual intent. In this study, we asked both the searchers themselves and external assessors to classify queries using the same intent classification scheme. We show that of the seven dimensions in our intent classification scheme, four can reliably be used for query annotation. Of these four, only the annotations on the topic and spatial sensitivity dimension are valid when compared with the searcher's annotations. The difference between the interassessor agreement and the assessor-searcher agreement was significant on all dimensions, showing that the agreement between external assessors is not a good estimator of the validity of the intent classifications. Therefore, we encourage the research community to consider using query intent classifications by the searchers themselves as test data.

Ultimate flexural limit states analysis of prestressed concrete sleeper

Railway is one of the most important, reliable and widely used means of transportation, carrying freight, passengers, minerals, grains, etc. Thus, research on railway tracks is extremely important for the development of railway engineering and technologies. The safe operation of a railway track is based on the railway track structure that includes rails, fasteners, pads, sleepers, ballast, subballast and formation. Sleepers are very important components of the entire structure and may be made of timber, concrete, steel or synthetic materials. Concrete sleepers were first installed around the middle of last century and currently are installed in great numbers around the world. Consequently, the design of concrete sleepers has a direct impact on the safe operation of railways. The "permissible stress" method is currently most commonly used to design sleepers. However, the permissible stress principle does not consider the ultimate strength of materials, probabilities of actual loads, and the risks associated with failure, all of which could lead to the conclusion of cost-ineffectiveness and over design of current prestressed concrete sleepers. Recently the limit states design method, which appeared in the last century and has been already applied in the design of buildings, bridges, etc, is proposed as a better method for the design of prestressed concrete sleepers. The limit states design has significant advantages compared to the permissible stress design, such as the utilisation of the full strength of the member, and a rational analysis of the probabilities related to sleeper strength and applied loads. This research aims to apply the ultimate limit states design to the prestressed concrete sleeper, namely to obtain the load factors of both static and dynamic loads for the ultimate limit states design equations. However, the sleepers in rail tracks require different safety levels for different types of tracks, which mean the different types of tracks have different load factors of limit states design equations. Therefore, the core tasks of this research are to find the load factors of the static component and dynamic component of loads on track and the strength reduction factor of the sleeper bending strength for the ultimate limit states design equations for four main types of tracks, i.e., heavy haul, freight, medium speed passenger and high speed passenger tracks. To find those factors, the multiple samples of static loads, dynamic loads and their distributions are needed. In the four types of tracks, the heavy haul track has the measured data from Braeside Line (A heavy haul line in Central Queensland), and the distributions of both static and dynamic loads can be found from these data. The other three types of tracks have no measured data from sites and the experimental data are hardly available. In order to generate the data samples and obtain their distributions, the computer based simulations were employed and assumed the wheel-track impacts as induced by different sizes of wheel flats. A valid simulation package named DTrack was firstly employed to generate the dynamic loads for the freight and medium speed passenger tracks. However, DTrack is only valid for the tracks which carry low or medium speed vehicles. Therefore, a 3-D finite element (FE) model was then established for the wheel-track impact analysis of the high speed track. This FE model has been validated by comparing its simulation results with the DTrack simulation results, and with the results from traditional theoretical calculations based on the case of heavy haul track. Furthermore, the dynamic load data of the high speed track were obtained from the FE model and the distributions of both static and dynamic loads were extracted accordingly. All derived distributions of loads were fitted by appropriate functions. Through extrapolating those distributions, the important parameters of distributions for the static load induced sleeper bending moment and the extreme wheel-rail impact force induced sleeper dynamic bending moments and finally, the load factors, were obtained. Eventually, the load factors were obtained by the limit states design calibration based on reliability analyses with the derived distributions. After that, a sensitivity analysis was performed and the reliability of the achieved limit states design equations was confirmed. It has been found that the limit states design can be effectively applied to railway concrete sleepers. This research significantly contributes to railway engineering and the track safety area. It helps to decrease the failure and risks of track structure and accidents; better determines the load range for existing sleepers in track; better rates the strength of concrete sleepers to support bigger impact and loads on railway track; increases the reliability of the concrete sleepers and hugely saves investments on railway industries. Based on this research, many other bodies of research can be promoted in the future. Firstly, it has been found that the 3-D FE model is suitable for the study of track loadings and track structure vibrations. Secondly, the equations for serviceability and damageability limit states can be developed based on the concepts of limit states design equations of concrete sleepers obtained in this research, which are for the ultimate limit states.

Building an augmented map for road risk assessment

Recent road safety statistics show that the decades-long fatalities decreasing trend is stopping and stagnating. Statistics further show that crashes are mostly driven by human error, compared to other factors such as environmental conditions and mechanical defects. Within human error, the dominant error source is perceptive errors, which represent about 50% of the total. The next two sources are interpretation and evaluation, which accounts together with perception for more than 75% of human error related crashes. Those statistics show that allowing drivers to perceive and understand their environment better, or supplement them when they are clearly at fault, is a solution to a good assessment of road risk, and, as a consequence, further decreasing fatalities. To answer this problem, currently deployed driving assistance systems combine more and more information from diverse sources (sensors) to enhance the driver's perception of their environment. However, because of inherent limitations in range and field of view, these systems' perception of their environment remains largely limited to a small interest zone around a single vehicle. Such limitations can be overcomed by increasing the interest zone through a cooperative process. Cooperative Systems (CS), a specific subset of Intelligent Transportation Systems (ITS), aim at compensating for local systems' limitations by associating embedded information technology and intervehicular communication technology (IVC). With CS, information sources are not limited to a single vehicle anymore. From this distribution arises the concept of extended or augmented perception. Augmented perception allows extending an actor's perceptive horizon beyond its "natural" limits not only by fusing information from multiple in-vehicle sensors but also information obtained from remote sensors. The end result of an augmented perception and data fusion chain is known as an augmented map. It is a repository where any relevant information about objects in the environment, and the environment itself, can be stored in a layered architecture. This thesis aims at demonstrating that augmented perception has better performance than noncooperative approaches, and that it can be used to successfully identify road risk. We found it was necessary to evaluate the performance of augmented perception, in order to obtain a better knowledge on their limitations. Indeed, while many promising results have already been obtained, the feasibility of building an augmented map from exchanged local perception information and, then, using this information beneficially for road users, has not been thoroughly assessed yet. The limitations of augmented perception, and underlying technologies, have not be thoroughly assessed yet. Most notably, many questions remain unanswered as to the IVC performance and their ability to deliver appropriate quality of service to support life-saving critical systems. This is especially true as the road environment is a complex, highly variable setting where many sources of imperfections and errors exist, not only limited to IVC. We provide at first a discussion on these limitations and a performance model built to incorporate them, created from empirical data collected on test tracks. Our results are more pessimistic than existing literature, suggesting IVC limitations have been underestimated. Then, we develop a new CS-applications simulation architecture. This architecture is used to obtain new results on the safety benefits of a cooperative safety application (EEBL), and then to support further study on augmented perception. At first, we confirm earlier results in terms of crashes numbers decrease, but raise doubts on benefits in terms of crashes' severity. In the next step, we implement an augmented perception architecture tasked with creating an augmented map. Our approach is aimed at providing a generalist architecture that can use many different types of sensors to create the map, and which is not limited to any specific application. The data association problem is tackled with an MHT approach based on the Belief Theory. Then, augmented and single-vehicle perceptions are compared in a reference driving scenario for risk assessment,taking into account the IVC limitations obtained earlier; we show their impact on the augmented map's performance. Our results show that augmented perception performs better than non-cooperative approaches, allowing to almost tripling the advance warning time before a crash. IVC limitations appear to have no significant effect on the previous performance, although this might be valid only for our specific scenario. Eventually, we propose a new approach using augmented perception to identify road risk through a surrogate: near-miss events. A CS-based approach is designed and validated to detect near-miss events, and then compared to a non-cooperative approach based on vehicles equiped with local sensors only. The cooperative approach shows a significant improvement in the number of events that can be detected, especially at the higher rates of system's deployment.

Understanding and measuring information security culture in developing countries : case of Saudi Arabia

The purpose of the current study was to develop a measurement of information security culture in developing countries such as Saudi Arabia. In order to achieve this goal, the study commenced with a comprehensive review of the literature, the outcome being the development of a conceptual model as a reference base. The literature review revealed a lack of academic and professional research into information security culture in developing countries and more specifically in Saudi Arabia. Given the increasing importance and significant investment developing countries are making in information technology, there is a clear need to investigate information security culture from developing countries perspective such as Saudi Arabia. Furthermore, our analysis indicated a lack of clear conceptualization and distinction between factors that constitute information security culture and factors that influence information security culture. Our research aims to fill this gap by developing and validating a measurement model of information security culture, as well as developing initial understanding of factors that influence security culture. A sequential mixed method consisting of a qualitative phase to explore the conceptualisation of information security culture, and a quantitative phase to validate the model is adopted for this research. In the qualitative phase, eight interviews with information security experts in eight different Saudi organisations were conducted, revealing that security culture can be constituted as reflection of security awareness, security compliance and security ownership. Additionally, the qualitative interviews have revealed that factors that influence security culture are top management involvement, policy enforcement, policy maintenance, training and ethical conduct policies. These factors were confirmed by the literature review as being critical and important for the creation of security culture and formed the basis for our initial information security culture model, which was operationalised and tested in different Saudi Arabian organisations. Using data from two hundred and fifty-four valid responses, we demonstrated the validity and reliability of the information security culture model through Exploratory Factor Analysis (EFA), followed by Confirmatory Factor Analysis (CFA.) In addition, using Structural Equation Modelling (SEM) we were further able to demonstrate the validity of the model in a nomological net, as well as provide some preliminary findings on the factors that influence information security culture. The current study contributes to the existing body of knowledge in two major ways: firstly, it develops an information security culture measurement model; secondly, it presents empirical evidence for the nomological validity for the security culture measurement model and discovery of factors that influence information security culture. The current study also indicates possible future related research needs.

Validation of a new tool to measure responsiveness and structure in the feeding context : the Authoritative Feeding Practices Questionnaire

How mothers interact with their toddlers around food lays the foundations for healthy eating and healthy weight gain in later life. This research involving 467 Australian first-time mothers of 2-year-old children resulted in the development of a new self-report tool, the Authoritative Feeding Practices Questionnaire, assessing maternal responsive feeding and mealtime structure. Secondary analysis of the NOURISH randomised controlled trial included theory-driven item selection, confirmatory factor analysis, evaluation of psychometric properties and construct validation. The result is a brief, reliable and valid new tool for evaluating the maternal feeding practices that support children to become healthy, independent eaters.

Validity and reliability of 3-minute nutrition screening (3-MinNS)performed by nurses on oncology and surgical patients

Background Nutrition screening is usually administered by nurses. However, most studies on nutrition screening tools have not used nurses to validate the tools. The 3-Minute Nutrition Screening (3-MinNS) assesses weight loss, dietary intake and muscle wastage, with the composite score of each used to determine risk of malnutrition. The aim of the study was to determine the validity and reliability of 3-MinNS administered by nurses, who are the intended assessors. Methods In this cross sectional study, three ward-based nurses screened 121 patients aged 21 years and over using 3-MinNS in three wards within 24 hours of admission. A dietitian then assessed the patients’ nutritional status using Subjective Global Assessment within 48 hours of admission, whilst blinded to the results of the screening. To assess the reliability of 3-MinNS, 37 patients screened by the first nurse were re-screened by a second nurse within 24 hours, who was blinded to the results of the first nurse. The sensitivity, specificity and best cutoff score for 3-MinNS were determined using the Receiver Operator Characteristics Curve. Results The best cutoff score to identify all patients at risk of malnutrition using 3-MinNS was three, with sensitivity of 89% and specificity of 88%. This cutoff point also identified all (100%) severely malnourished patients. There was strong correlation between 3-MinNS and SGA (r=0.78, p<0.001). The agreement between two nurses conducting the 3-MinNS tool was 78.3%. Conclusion 3-Minute Nutrition Screening is a valid and reliable tool for nurses to identify patients at risk of malnutrition.

The structured and practical approach in development of decision support system for consultant selection in public sector infrastructure project

Nowadays, most of the infrastructure development projects undertaken are complex in nature. Practically, public clients who do not have a good understanding of the design and management may suffer severe losses, especially for infrastructure projects. There is a need for luring the right consultant to secure client's investment in infrastructure developments. Throughout the project life cycle, consultants play vital role from the inception to completion stage of a project. A few studies in Malaysia show that infrastructure projects involving irrigation and drainage have experience problems such as poor workmanship, delay and cost overrun due to the consultant's inability or the client incompetence of recruiting consultants in time. This highlights the need of aided decision making and an efficient system to select the best consultant by using Decision Support System (DSS). On the other hand, recent trends reveal that most DSS in construction only concentrate on decision model development. These models are impractical and unused as they are complicated or difficult for laymen such as project managers to utilize. Thus, this research attempts to develop an efficient DSS for consultant selection namely consultDeSS. Driven by the motivation and research aims, this study deployed Design Science Research Methodology (DSRM) dominant with a combination of case studies at the Malaysian Department of Irrigation and Drainage (DID). Two real projects involving irrigation and drainage infrastructure were used to design, implement and evaluate the artefact. The 3-tier consultDeSS was revised after the evaluation and the design was significantly improved based on user feedback. By developing desirable tools that fit client's needs will enhance the productivity and minimize conflict within groups and organisations. The tool is more usable and efficient compared to previous studies in construction. Thus, this research has demonstrated a purposeful artefact with a practical and valid structured development approach that is applicable in a variety of problems in construction discipline.

Food and Brisbane households : dietary, social and health consequences of food insecurity

Background & Aims: Access to sufficient amounts of safe and culturally-acceptable foods is a fundamental human right. Food security exists when all people, at all times, have physical, social, and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. Food insecurity therefore occurs when the availability or access to sufficient amounts of nutritionally-adequate, culturally-appropriate and safe foods, or, the ability to acquire such foods in socially-acceptable ways, is limited. Food insecurity may result in significant adverse effects for the individual and these outcomes may vary between adults and children. Among adults, food insecurity may be associated with overweight or obesity, poorer self-rated general health, depression, increased health-care utilisation and dietary intakes less consistent with national recommendations. Among children, food insecurity may result in poorer self or parent-reported general health, behavioural problems, lower levels of academic achievement and poor social outcomes. The majority of research investigating the potential correlates of food insecurity has been undertaken in the United States (US), where regular national screening for food insecurity is undertaken using a comprehensive multi-item measurement. In Australia, screening for food insecurity takes place on a three yearly basis via the use of a crude, single-item included in the National Health Survey (NHS). This measure has been shown to underestimate the prevalence of food insecurity by 5%. From 1995 – 2004, the prevalence of food insecurity among the Australian population remained stable at 5%. Due to the perceived low prevalence of this issue, screening for food insecurity was not undertaken in the most recent NHS. Furthermore, there are few Australian studies investigating the potential determinants of food insecurity and none investigating potential outcomes among adults and children. This study aimed to examine these issues by a) investigating the prevalence of food insecurity among households residing in disadvantaged urban areas and comparing prevalence rates estimated by the more comprehensive 18-item and 6-item United States Department of Agriculture (USDA) Food Security Survey Module (FSSM) to those estimated by the current single-item measure used for surveillance in Australia and b) investigating the potential determinants and outcomes of food insecurity, Methods: A comprehensive literature review was undertaken to investigate the potential determinants and consequences of food insecurity among developed countries. This was followed by a cross-sectional study in which 1000 households from the most disadvantaged 5% of Brisbane areas were sampled and data collected via mail-based survey (final response rate = 53%, n = 505). Data were collected for food security status, sociodemographic characteristics (household income, education, age, gender, employment status, housing tenure and living arrangements), fruit and vegetable intakes, meat and take-away consumption, presence of depressive symptoms, presence of chronic disease and body mass index (BMI) among adults. Among children, data pertaining to BMI, parent-reported general health, days away from school and activities and behavioural problems were collected. Rasch analysis was used to investigate the psychometric properties of the 18-, 10- and 6-item adaptations of the USDA-FSSM, and McNemar's test was used to investigate the difference in the prevalence of food insecurity as measured by these three adaptations compared to the current single-item measure used in Australia. Chi square and logistic regression were used to investigate the differences in dietary and health outcomes among adults and health and behavioural outcomes among children. Results were adjusted for equivalised household income and, where necessary, for indigenous status, education and family type. Results: Overall, 25% of households in these urbanised-disadvantaged areas reported experiencing food insecurity; this increased to 34% when only households with children were analysed. The current reliance on a single-item measure to screen for food insecurity may underestimate the true burden among the Australian population, as this measure was shown to significantly underestimate the prevalence of food insecurity by five percentage points. Internationally, major potential determinants of food insecurity included poverty and indicators of poverty, such as low-income, unemployment and lower levels of education. Ethnicity, age, transportation and cooking and financial skills were also found to be potential determinants of food insecurity. Among Australian adults in disadvantaged urban areas, food insecurity was associated with a three-fold increase in experiencing poorer self-rated general health and a two-to-five-fold increase in the risk of depression. Furthermore, adults from food insecure households were twoto- three times more likely to have seen a general practitioner and/or been admitted to hospital within the previous six months, compared to their food secure counterparts. Weight status and intakes of fruits, vegetables and meat were not associated with food insecurity. Among Australian households with children, those in the lowest tertile were over 16 times more likely to experience food insecurity compared to those in the highest tertile for income. After adjustment for equivalised household income, children from food insecure households were three times more likely to have missed days away from school or other activities. Furthermore, children from food insecure households displayed a two-fold increase in atypical emotions and behavioural difficulties. Conclusions: Food insecurity is an important public health issue and may contribute to the burden on the health care system through its associations with depression and increased health care utilisation among adults and behavioural and emotional problems among children. Current efforts to monitor food insecurity in Australia do not occur frequently and use a tool that may underestimate the prevalence of food insecurity. Efforts should be made to improve the regularity of screening for food insecurity via the use of a more accurate screening measure. Most of the current strategies that aim to alleviate food insecurity do not sufficiently address the issue of insufficient financial resources for acquiring food; a factor which is an important determinant of food insecurity. Programs to address this issue should be developed in collaboration with groups at higher risk of developing food insecurity and should incorporate strategies to address the issue of low income as a barrier to food acquisition.

Dengue or Kokobera? A case report from the top end of the Northern Territory

In early April 1998, the Centre for Disease Control in Darwin was notified of a possible case of dengue which appeared to have been acquired in the Northern Territory. Because dengue is not endemic to the Northern Territory, locally acquired infection has significant public health implications, particularly for vector identification and control to limit the spread of infection. Dengue IgM serology was positive on two occasions, but the illness was eventually presumptively identified as Kokobera infection. This case illustrates the complexity of interpreting flavivirus serology. Determining the cause of infection requires consideration of the clinical illness, the incubation period, the laboratory results and vector presence. Waiting for confirmation of results, before the institution of the public health measures necessary for a true case of dengue, was ultimately justified in this case. This is a valid approach in the Northern Territory, but may not be applicable to areas of Australia with established vectors for dengue. Commun Dis Intell 1998;22:105-107.

Beginning inference in fourth grade : exploring variation in measurement

This paper addresses one of the foundational components of beginning infernce, namely variation, with 5 classes of Year 4 students undertaking a measurement activity using scaled instruments in two contexts: all students measuring one person's arm span and recording the values obtained, and each student having his/her own arm span measured and recorded. The results included documentation of students' explicit appreciation of the variety of ways in which varitation can occur, including outliers, and their ability to create and describe valid representations of their data.

Publicly verifiable ciphertexts

In many applications, where encrypted traffic flows from an open (public) domain to a protected (private) domain, there exists a gateway that bridges the two domains and faithfully forwards the incoming traffic to the receiver. We observe that indistinguishability against (adaptive) chosen-ciphertext attacks (IND-CCA), which is a mandatory goal in face of active attacks in a public domain, can be essentially relaxed to indistinguishability against chosen-plaintext attacks (IND-CPA) for ciphertexts once they pass the gateway that acts as an IND-CCA/CPA filter by first checking the validity of an incoming IND-CCA ciphertext, then transforming it (if valid) into an IND-CPA ciphertext, and forwarding the latter to the recipient in the private domain. “Non-trivial filtering'' can result in reduced decryption costs on the receivers' side. We identify a class of encryption schemes with publicly verifiable ciphertexts that admit generic constructions of (non-trivial) IND-CCA/CPA filters. These schemes are characterized by existence of public algorithms that can distinguish between valid and invalid ciphertexts. To this end, we formally define (non-trivial) public verifiability of ciphertexts for general encryption schemes, key encapsulation mechanisms, and hybrid encryption schemes, encompassing public-key, identity-based, and tag-based encryption flavours. We further analyze the security impact of public verifiability and discuss generic transformations and concrete constructions that enjoy this property.

Plaintext awareness in identity-based key encapsulation

The notion of plaintext awareness ( PA ) has many applications in public key cryptography: it offers unique, stand-alone security guarantees for public key encryption schemes, has been used as a sufficient condition for proving indistinguishability against adaptive chosen-ciphertext attacks ( IND-CCA ), and can be used to construct privacy-preserving protocols such as deniable authentication. Unlike many other security notions, plaintext awareness is very fragile when it comes to differences between the random oracle and standard models; for example, many implications involving PA in the random oracle model are not valid in the standard model and vice versa. Similarly, strategies for proving PA of schemes in one model cannot be adapted to the other model. Existing research addresses PA in detail only in the public key setting. This paper gives the first formal exploration of plaintext awareness in the identity-based setting and, as initial work, proceeds in the random oracle model. The focus is laid mainly on identity-based key encapsulation mechanisms (IB-KEMs), for which the paper presents the first definitions of plaintext awareness, highlights the role of PA in proof strategies of IND-CCA security, and explores relationships between PA and other security properties. On the practical side, our work offers the first, highly efficient, general approach for building IB-KEMs that are simultaneously plaintext-aware and IND-CCA -secure. Our construction is inspired by the Fujisaki-Okamoto (FO) transform, but demands weaker and more natural properties of its building blocks. This result comes from a new look at the notion of γ -uniformity that was inherent in the original FO transform. We show that for IB-KEMs (and PK-KEMs), this assumption can be replaced with a weaker computational notion, which is in fact implied by one-wayness. Finally, we give the first concrete IB-KEM scheme that is PA and IND-CCA -secure by applying our construction to a popular IB-KEM and optimizing it for better performance.

Thymidylate synthase expression and outcome of patients receiving pemetrexed for advanced nonsquamous non-small-cell lung cancer in a prospective blinded assessment phase II clinical trial

INTRODUCTION In retrospective analyses of patients with nonsquamous non-small-cell lung cancer treated with pemetrexed, low thymidylate synthase (TS) expression is associated with better clinical outcomes. This phase II study explored this association prospectively at the protein and mRNA-expression level. METHODS Treatment-naive patients with nonsquamous non-small-cell lung cancer (stage IIIB/IV) had four cycles of first-line chemotherapy with pemetrexed/cisplatin. Nonprogressing patients continued on pemetrexed maintenance until progression or maximum tolerability. TS expression (nucleus/cytoplasm/total) was assessed in diagnostic tissue samples by immunohistochemistry (IHC; H-scores), and quantitative reverse-transcriptase polymerase chain reaction. Cox regression was used to assess the association between H-scores and progression-free/overall survival (PFS/OS) distribution estimated by the Kaplan-Meier method. Maximal χ analysis identified optimal cutpoints between low TS- and high TS-expression groups, yielding maximal associations with PFS/OS. RESULTS The study enrolled 70 patients; of these 43 (61.4%) started maintenance treatment. In 60 patients with valid H-scores, median (m) PFS was 5.5 (95% confidence interval [CI], 3.9-6.9) months, mOS was 9.6 (95% CI, 7.3-15.7) months. Higher nuclear TS expression was significantly associated with shorter PFS and OS (primary analysis IHC, PFS: p < 0.0001; hazard ratio per 1-unit increase: 1.015; 95%CI, 1.008-1.021). At the optimal cutpoint of nuclear H-score (70), mPFS in the low TS- versus high TS-expression groups was 7.1 (5.7-8.3) versus 2.6 (1.3-4.1) months (p = 0.0015; hazard ratio = 0.28; 95%CI, 0.16-0.52; n = 40/20). Trends were similar for cytoplasm H-scores, quantitative reverse-transcriptase polymerase chain reaction and other clinical endpoints (OS, response, and disease control). CONCLUSIONS The primary endpoint was met; low TS expression was associated with longer PFS. Further randomized studies are needed to explore nuclear TS IHC expression as a potential biomarker of clinical outcomes for pemetrexed treatment in larger patient cohorts. © 2013 by the International Association for the Study of Lung Cancer.

Shrinkage empirical likelihood estimator in longitudinal analysis with time-dependent covariates-application to modeling the health of Filipino children

The method of generalized estimating equations (GEE) is a popular tool for analysing longitudinal (panel) data. Often, the covariates collected are time-dependent in nature, for example, age, relapse status, monthly income. When using GEE to analyse longitudinal data with time-dependent covariates, crucial assumptions about the covariates are necessary for valid inferences to be drawn. When those assumptions do not hold or cannot be verified, Pepe and Anderson (1994, Communications in Statistics, Simulations and Computation 23, 939–951) advocated using an independence working correlation assumption in the GEE model as a robust approach. However, using GEE with the independence correlation assumption may lead to significant efficiency loss (Fitzmaurice, 1995, Biometrics 51, 309–317). In this article, we propose a method that extracts additional information from the estimating equations that are excluded by the independence assumption. The method always includes the estimating equations under the independence assumption and the contribution from the remaining estimating equations is weighted according to the likelihood of each equation being a consistent estimating equation and the information it carries. We apply the method to a longitudinal study of the health of a group of Filipino children.