Equal Allocation Research Articles

The optimal co-insurance rate for outpatient drug expenses of Iranian health insured based on the data mining method

ObjectiveA more equal allocation of healthcare funds for patients who must pay high costs of care ensures the welfare of society. This study aimed to estimate the optimal co-insurance for outpatient drug costs for health insurance.SettingThe research population includes outpatient prescription claims made by the Health Insurance Organization that outpatient prescriptions in a timely manner in 2016, 2017, 2018, and 2019 were utilized to calculate the optimal co-insurance. The study population was representative of the research sample.DesignAt the secondary level of care, 11 features of outpatient claims were studied cross-sectionally and retrospectively using data mining. Optimal co-insurance was estimated using Westerhut and Folmer's utility model.ParticipantsOne hundred ninety-three thousand five hundred fifty-two individuals were created from 21 776 350 outpatient claims of health insurance. Because of cost-sharing, insured individuals in a low-income subsidy plan and those with refractory diseases were excluded.ResultsInsureds were divided into three classes of low, middle, and high risk based on IQR and were separated to three clusters using the silhouette coefficient. For the first, second, and third clusters of the low-risk class, the optimal co-insurance estimates are 0.81, 0.76, and 0.84, respectively. It was equal to one for all middle-class clusters and 0.38, 0.45, and 0.42, respectively, for the high-risk class. The insurer's expenses were altered by $3,130,463, $3,451,194, and $ 1,069,859 profit for the first, second, and third clusters, respectively, when the optimal co-insurance strategy is used for the low-risk class. For middle risks, it was US$29,239,815, US$13,863,810, and US$ 14,573,432 while for high risks, US$4,722,099, US$ 6,339,317, and US$19,627,062, respectively.ConclusionsThese findings can improve vulnerable populations' access to costly medications, reduce resource waste, and help insurers distribute funds more efficiently.

Personalised versus standard text message prompts for increasing trial participant response to telephone follow-up: an embedded randomised controlled retention trial

BackgroundImproving retention within randomised controlled trials is important. The effectiveness of different strategies can be assessed using a Study Within A Trial (SWAT). Previous research has shown personalised text message reminders improve clinic attendance rates; however, the results are mixed on improving postal questionnaire return. This SWAT aims to assess whether personalised text message reminders improve completion rates for scheduled telephone follow-ups.MethodsThis SWAT is a two-arm, multi-centre randomised controlled trial with equal allocation. The host trial was the Melatonin for Anxiety prior to General anaesthesia In Children trial (ISRCTN 18296119), where the child’s caregiver was to answer a scheduled telephone follow-up 14 days post-surgery; participants for the SWAT were therefore the caregiver. Text messages were sent 24–48 h before the scheduled call and the personalised version contained the first name of the caregiver which was omitted in the non-personalised version. The primary outcome was questionnaire completion rate, defined as the proportion of caregivers successfully contacted, and completed any of the questionnaires, over the telephone within the follow-up window (day 14 + 7 days).ResultsThe SWAT included 100 of the 110 (91%) participants randomised into the host trial. Randomisation within the SWAT was equal between non-personalised (n = 50) and personalised (n = 50) interventions. The overall questionnaire response rate was 73% with a difference between the two interventions of 68% in the non-personalised text message arm and 78% in the personalised text message arm. The adjusted absolute risk difference was 7.1% (95% confidence interval = −10.2%, 24.4%). There was no difference in either the time to response or the number of contact attempts between the two interventions.ConclusionsThere is some evidence that personalised text messages could be effective at increasing response rates when data is collected via telephone and in a population of caregivers for paediatric trial participants. However, similar SWATs have shown mixed results. Given the low-cost and low risks associated with personalising text message reminders, this SWAT could be implemented easily in other RCTs scheduling telephone follow-up appointments.Trial RegistrationISRCTN 18296119, SWAT 35 (MRC Northern Ireland Network for Trials Methodology Network).

Steady-state statistical properties and implementation of randomization designs with maximum tolerated imbalance restriction for two-arm equal allocation clinical trials.

In recent decades, several randomization designs have been proposed in the literature as better alternatives to the traditional permuted block design (PBD), providing higher allocation randomness under the same restriction of the maximum tolerated imbalance (MTI). However, PBD remains the most frequently used method for randomizing subjects in clinical trials. This status quo may reflect an inadequate awareness and appreciation of the statistical properties of these randomization designs, and a lack of simple methods for their implementation. This manuscript presents the analytic results of statistical properties for five randomization designs with MTI restriction based on their steady-state probabilities of the treatment imbalance Markov chain and compares them to those of the PBD. A unified framework for randomization sequence generation and real-time on-demand treatment assignment is proposed for the straightforward implementation of randomization algorithms with explicit formulas of conditional allocation probabilities. Topics associated with the evaluation, selection, and implementation of randomization designs are discussed. It is concluded that for two-arm equal allocation trials, several randomization designs offer stronger protection against selection bias than the PBD does, and their implementation is not necessarily more difficult than the implementation of the PBD.

Operation and control of compact offshore combined cycles for power generation

Gas turbines are the main means for generating power in offshore installations. To increase energy efficiency, and thus reduce CO2 emissions, a steam bottoming cycle can be added to produce additional power by recovering surplus heat from the gas turbine exhaust. Due to space constraints, this solution is not widespread for offshore power generation. To enable deployment, the system must be compact and be able to provide varying power demands. In this paper, we analyze the operation and control problem for such compact combined cycles, consisting of two gas turbines and one steam bottoming cycle. We analyze the steady-state performance of the combined cycle with respect to efficiency and CO2 emissions for two control strategies for coordinating the power setpoint of the two gas turbines. Equal load allocation of the gas turbines showed a higher thermal efficiency and lower emissions compared to keeping one gas turbine close to nominal and letting the second one handle load variations. The main controlled variables for the steam bottoming cycle are the superheated steam pressure and temperature. We implement decentralized control strategies based on standard PID-controllers and nonlinear feedforward. Due to reduced throttle losses, sliding pressure shows higher efficiency and lower CO2 emissions compared to keeping a constant steam pressure, which conversely provides a better temperature dynamic response and may be necessary with highly varying power demand.

Life cycle assessment of a novel production route for scandium recovery from bauxite residues

Scandium (Sc) has various technological applications, but the concentrations of Sc in ores are low. Both, the mining of low concentrated Sc and the production of industrial-grade Sc are a heavy burden on the environment. Bauxite residue (BR) from alumina production represents one of the major sources of Sc in Europe (Ochsenkühn-Petropulu et al., 1994). The goal of this study is to assess the environmental impacts from cradle to gate of a novel production route developed in the Scandium Aluminium Europe project (SCALE) to extract Sc at concentrations <100 ppm from BR, to concentrate and upgrade it to pure ScF3 and Sc2O3 and ultimately to refine it to an aluminium scandium master alloy with 2 % Sc mass fraction (AlSc2 %). Results show that the global warming potential (GWP), measured in CO2-eq per kg Sc2O3, generated with the novel route is about half the GWP of the state-of-the-art Sc2O3 production from rare earth tailings when applying equal allocation principles. The initial process step to dissolve BR and extract Sc consumes elevated amounts of acid and energy and is responsible for at least 80 % of the route’s total environmental impact. The amount of the generated filter cake (FC) is equal to the amount of the BR input and is a potential resource for cement clinker production. The ecotoxicological study indicates that both FC and BR are slightly ecotoxic.

The Safety and Effectiveness of Telemedicine for Cancer-Related Colostomy Care in the Early Stage of Discharge: A Prospective, Randomized, Single-Center Study.

There has been an exponential growth in the use of telemedicine services to provide clinical care. However, the safety and effectiveness of telemedicine in cancer-related colostomy care during the early stages of discharge remain unclear. This study aimed to support that the safety and effectiveness of telemedicine in cancer-related colostomy care were not inferior to those of outpatient care. This was a prospective randomized noninferiority study. A total of 76 consecutive patients who underwent cancer-related colostomy stoma were enrolled and randomly divided into a telemedicine group or an outpatient group with an equal allocation ratio (1:1). The outpatient group was provided in-person interview mode colostomy care, whereas the telemedicine group was provided video interview mode colostomy care. The stoma-related complications, self-care ability, and quality of life reflected the safety and effectiveness of colostomy care in the early stages of discharge. The incidence of stoma-related complications within two weeks and one month after discharge was not significantly different between the two groups (p 2-weeks = 0.772 and p 1-month = 0.760). The mean NCI-CTCAE score for stoma-related complications was less than level 2. The ESCA and C-COH-QOL-OQ scores were not significantly different between the telemedicine and outpatient groups at two weeks and one month after discharge (all p > 0.05). The results revealed that the safety and effectiveness of telemedicine for cancer-related colostomies in the early stages of discharge were not inferior to those of outpatient care alone.

Effects of an intervention combining physical activity and components of Amygdala and Insula Retraining (AIR) on sleep and working memory among older male adults

&lt;sec&gt;&lt;title&gt;Background&lt;/title&gt;&lt;p&gt;Older individuals are at a particular risk of sleep disorders, a loss of cognitive and emotional control, and a poor quality of life. Pharmaceutical therapy for these conditions is commonplace but has not been particularly effective, and relatively little research exists for their treatment using non-pharmacological approaches. The effectiveness of Physical Activity plus selected components of Amygdala and Insula Retraining (PAAIR) was tested to improve sleep quality, depression, working memory, and emotion regulation among older males.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Methods&lt;/title&gt;&lt;p&gt;This was a parallel, randomized control trial. The study was conducted in-person among 40 older Iranian men (&lt;italic&gt;M&lt;/italic&gt;&lt;sub&gt;age&lt;/sub&gt;: 65.78, &lt;italic&gt;SD&lt;/italic&gt; = 2.41). The participants were randomly assigned with equal allocation to either the PAAIR or a control condition. Both interventions were conducted in-person over 12 weeks. The participants met twice weekly for 45-minute sessions at a local elderly training and rehabilitation center. All participants completed measurements for sleep quality, depressive symptoms, working memory, and emotion regulation at baseline, 12 weeks (immediately after the intervention), and 8 weeks later.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Results&lt;/title&gt;&lt;p&gt;Among the 36 individuals who finished the study, their sleep quality, working memory, and emotion regulation improved, and their depressive symptoms were reduced from baseline to 12 weeks (post-intervention) and 8 weeks later; these effects were seen even more so for the PAAIR group compared to the control group, with large to extremely large effect sizes.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Conclusion&lt;/title&gt;&lt;p&gt;The findings suggest that PAAIR has the potential to enhance sleep quality, cognitive function, and emotion regulation and reduce depressive symptoms among older men, thus contributing to their quality of life and mental health.&lt;/p&gt;&lt;/sec&gt;

AGREEMENTS ON TRANSBOUNDARY WATER BODIES: STATE AND PROSPECTS OF DEVELOPMENT

The article deals with the regulation of transboundary water bodies on the basis of multilateral and bilateral agreements of the Republic of Kazakhstan with the countries of Central Asia, the Russian Federation and the People's Republic of China. The main purpose of the study is to analyze the existing international agreements regulating the issues of joint use of transboundary water bodies and to develop proposals to address issues related to insufficient volume of incoming water. With the collapse of the Soviet Union and the destruction of the unified system of regulation of the water industry, surface waters ceased to be considered internal water bodies, and acquired a transboundary character requiring comprehensive international legal regulation. Particular attention to transboundary water bodies is due to the high dependence of Kazakhstan on neighboring countries forming more than 40 km3 out of 100 km3 of the total long-term flow of rivers and temporary watercourses. Of the existing 8 water management basins of the country, only the Nura-Sarysu basin does not have transboundary water bodies. A decrease in the volume of water can have a negative impact on industrial production, utilities and agriculture of the country. The adoption of preventive measures and the conclusion of transparent agreements with neighboring countries will avoid catastrophic consequences for the country's economy and human life. In this regard, the authorized state bodies represented by the Ministry of Ecology and Natural Resources, as well as the Ministry of Foreign Affairs, need to actively use dialogue platforms within the framework of regional organizations and signed agreements to build the potential of relations between neighboring countries to address issues of equal water allocation. The comparative legal method was used as the main research method, which allowed analyzing the existing interstate agreements. The results of the study indicate a large amount of work done between neighboring countries, however, modern global challenges encourage countries to defend a tougher position that meets national interests, which in turn is not always beneficial for downstream countries.

The role of between‐group competition in children's within‐group merit‐based resource allocation

AbstractThe present study tested how 5‐ to 6‐year‐old and 7‐ to 8‐year‐old children allocate with in‐group collaborators according to merit in the context of external between‐group competition. Children (N = 310) first were asked to collaborate with a high‐ or low‐merit partner to complete an intergroup game in the form of competition (further divided into win and lose conditions) or noncompetition. Afterward, they were asked to allocate, reason about, and express their expected allocations toward the in‐group collaborator. We found that 5–6‐year‐olds allocated meritoriously with collaborators in the first‐party context. In contrast, 7–8‐year‐olds were affected by external between‐group competition. Specifically, compared with the noncompetitive condition, 7–8‐year‐olds conducted equal or roughly equal allocations with the in‐group collaborator and referenced Equality and Affiliation more frequently in the win and lose conditions. Furthermore, both 5–6‐year‐olds and 7–8‐year‐olds expected teachers to allocate meritoriously across the win, lose and noncompetitive conditions, indicating that they realized that social norms require them to make allocations based on merit rather than social relationships. The findings suggest that with age, children weighed the moral concerns of merit and the social concerns of in‐group harmony when determining the allocation of resources.

The Implementation of Inter- Agency Task Force Guidelines in School Settings and Its Effect to Students’ Learning at Davao Central College

Aims: It examines the extent of integration of the guidelines in the school setting and their impact on students. The study aims to determine the level of implementation of Inter-Agency Task Force in the different alert level in school setting and its effect to the student’s learners in their physiological, socio-emotional, and mental well-being.&#x0D; Study Design: Descriptive Research Study.&#x0D; Place and Duration of Study: Davao Central College (DCC) students of the school year 2022-2023.&#x0D; Methodology: The study focuses to post-evaluate the implementation of Inter-Agency Task Force Guidelines and its effect to students of Davao Central College in terms of the alert level implemented in the region and its effects to the physiological, socio-emotional, and mental well-being of the students. The study involved 300 students from different year levels, equal allocations were used to obtain number of samples across the different year level. The questionnaire was undergone content validation by three validators experts. There The findings revealed that students' perceptions play a crucial role in assessing the effectiveness of the guidelines. Continuous support, reinforcement of social distancing practices, and ongoing evaluation are essential for a safe and effective learning environment. While the guidelines positively affect students' physical and socio-emotional well-being.&#x0D; Results: The level of implementation of IATF guidelines, categorized into Level 1, Level 2, and Level 3. The SD values for all three levels are relatively similar, ranging from 0.90 to 0.92, indicating a moderate level of variation in student responses within each level. The overall category mean is 4.04, reflecting the average perception of students across all levels. Additionally, the overall SD of 0.82 indicates relatively low variation in student responses, suggesting a consistent perception of the overall level of implementation of the IATF guidelines as high. The effects of the implementation of IATF guidelines on students. The standard deviation (SD) values range from 0.88 to 0.97, indicating a moderate level of variation in student responses within each aspect. The overall category mean is 3.85, representing the average perception of students regarding the effects of the implementation of IATF guidelines across all aspects. Additionally, the overall SD of 0.83 suggests relatively low variation in student responses, indicating a consistent perception of the overall effects as high. In terms of the Physiological Aspect, there is a significant positive relationship between the implementation of IATF guidelines (Level 1, Level 2, Level 3) and its effects, with r-values ranging from 0.595 to 0.680. This indicates that as the implementation of the guidelines increases, there is a corresponding increase in the positive effects on students' physiological well-being. The p-values of 0.000 indicate that these relationships are statistically significant.&#x0D; Conclusion: Students' perceptions reveal the effectiveness of implemented guidelines, emphasizing the need for continuous support, reinforced of social distancing. Importantly the study showcases Davao Central College as an exemplar of law-abiding institution, exemplified by its unwavering commitment to adhering to the IATF guidelines within the school setting. The diligent and consistent compliance demonstrated by DCC establishes it as a model for other institutions to emulate. As a future research, they can use this as references if there are crisis that related for the health safety of the students and its implementation.

Effect of economic inequality on generosity: A social norm perspective.

Economic inequality has been found to reduce individuals' generosity in western contexts. However, whether this effect is cross-culturally consistent and its internal mechanism remain unclear, as well as how to mitigate this impact. Hence, we explored whether and why economic inequality may erode generosity in a sample of Chinese adults from the social norm perspective and introduced the equal allocation norm to mitigate this effect. Four online studies were conducted: two were correlational (Study 1: n = 300; Study 2: n = 568) and two were experimental (Study 3: n = 289; Study 4: n = 500). Results showed that economic inequality predicted less generosity in the dictator game, and perceived unequal allocation norm accounted for this effect. Moreover, introducing the equal allocation norm could buffer this negative effect. Findings suggest economic inequality impairs generosity, and making the equal allocation norm more salient may guide people to act more generously.

Energy Aware Task Allocation for Semi-Asynchronous Mobile Edge Learning

This paper extends the paradigm of "mobile edge learning (MEL)" by designing an energy-aware optimal task allocation scheme for training a machine learning (ML) model in a semi-asynchronous manner across multiple learners connected via the resource-constrained wireless edge network. The tasks are allocated such that the local dataset size selected at each learner ensures completion within a given global delay constraint and a local maximum energy consumption limit. Hence, the designed method is heterogeneity aware (HA) because it offers a trade-off between resource consumption and MEL performance by directly relating the time and energy consumption to the heterogeneous communication/computational capabilities of learners. Because the resulting optimization is an NP-hard quadratically-constrained integer linear program (QCILP), a two-step suggest-and-improve (SAI) solution is proposed. The proposed HA semi-asynchronous (HA-Asyn) approach is compared against the HA synchronous (HA-Sync) scheme and the heterogeneity unaware (HU) synchronous/asynchronous (HU-Sync/Asyn) equal batch allocation schemes. Results from a system of 20 learners tested for various completion time and energy consumption constraints show that the proposed HA-Asyn method works better than the HU-Sync/Asyn approaches and can even provide gains of up-to 25% compared to the HA-Sync scheme.

Tri-objective Stochastic Model to Optimize Location and Sizing of Scooter Battery Swapping Station

The optimal locations and sizing of scooter Battery Swap Stations (BSSs) can promote the use of battery-swapping scooters to make cities more environmentally sustainable. Few studies investigated the optimal allocation of BSSs for scooters, especially for tri-objective optimization. Hence, this study presents the proposed Stochastic Tri-objective Grid-based Scooter BSS Allocation Model (STGSBSSAM) based on our previous studies. STGSBSSAM used ModelBuilder to semi-automatically perform data pre-processing and display the layout of the allocation of BSSs. Thus, deep learning algorithm was used to detect the flow of traffic and compensate the insufficiency of data. Also, different from our previous studies, the time slots of battery swapping demands were assumed to be highly correlated with the hourly traffic flow of different land-use types.Based on the results, STGSBSSAM could better allocate BSSs. Also, the rule of equal allocation was better than the rule of inverse distance in terms of the battery allocation rule. Meanwhile, in order to make the optimized allocation of scooters beneficial, the investigation could be made into the three objectives as a whole. The actual allocation of BSSs also indirectly validated the effectiveness of this STGSBSSAM methodology.

Socioeconomic disparity in mortality and the burden of cardiovascular disease: analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study

Although socioeconomic inequality in cardiovascular health has long been a public health focus, the differences in cardiovascular-disease burden and mortality between people with different socioeconomic statuses has yet to be adequately addressed. We aimed to assess the effects of socioeconomic status, measured via three socioeconomic-status indicators (ie, education, occupation, and household wealth and a composite socioeconomic-status disparity index, on mortality and cardiovascular-disease burden (ie, incidence, mortality, and admission to hospital) in China. For this analysis, we used data from the Prospective Urban Rural Epidemiology (PURE)-China cohort study, which enrolled adults aged 35-70 years from 115 urban and rural areas in 12 provinces in China between Jan 1, 2005, and Dec 31, 2009. Final follow-up was on Aug 30, 2021. Indicators of socioeconomic status were education, occupation, and household wealth; these individual indicators were also used to create an integrated socioeconomic-status index via latent class analysis. Standard questionnaires administered by trained researchers were used to obtain baseline data and were supplemeted by physical measurements. The primary outcomes were all-cause mortality, cardiovascular-disease mortality, non-cardiovascular-disease mortality, major cardiovascular disease, and cardiovascular-disease admission to hospital. Hazard ratios (HRs) and average marginal effects were used to assess the association between the primary outcomes and socioeconomic status. Of 47 931 participants enrolled in the PURE-China study, 47 278 (98·6%) had complete information on sex and follow-up. After excluding 1189 (2·5%) participants with missing data on education, household wealth, and occupation at baseline, 46 089 participants were included in this analysis. Median follow-up was 11·9 years (IQR 9·5-12·6); 26 860 (58·3%) of 46 089 participants were female and 19 229 (41·7%) were male. Having no or primary education, unskilled occupation, or being in the lowest third of household wealth was associated with a higher risk of all-cause mortality, cardiovascular-disease mortality, non-cardiovascular-disease mortality, major cardiovascular disease, and cardiovascular-disease admission to hospital compared with having higher education, a professional or managerial occupation, or more household wealth. After adjustment for confounders, people categorised as having low integrated socioeconomic status based on the index had a higher risk of all-cause mortality (HR 1·65 [95% CI 1·42-1·92]), cardiovascular-disease mortality (2·19 [1·68-2·85]), non-cardiovascular disease mortality (1·43 [1·18-1·72]), major cardiovascular disease (1·43 [1·27-1·61]) and cardiovascular-disease admission to hospital (1·14 [1·01-1·28]) compared with people categorised as having high integrated socioeconomic status. Socioeconomic-status inequalities in mortality and cardiovascular-disease outcomes exist in China. Targeted policies of equal health-care resource allocation should be promoted to equitably benefit people with fewer years of education and less household wealth. Funding sources are listed at the end of the Article.

The effect of competition on children's merit-based resource allocation: The difference between interpersonal and intergroup competition.

Competition usually exists in groups in everyday interactions, but how children allocate according to competition outcomes (e.g., merit-based allocation) after intergroup competition and the difference in children's allocations of rewards between interpersonal and intergroup competition remain unclear. Children aged 3-8 years were asked to complete interpersonal or intergroup competitive games and were further asked to allocate rewards between themselves and their partners (Study 1) or between their group and the other group (Studies 2 and 3) and to reason about their decisions. We found that after interpersonal competition, children tended to conduct merit-based allocations when they won but were more inclined to conduct equal allocations when they lost; after intergroup competition, children were more inclined to make equal allocations regardless of whether they won or lost, only less than half of children followed meritorious principles. However, children conducted more merit-based allocations with age after both interpersonal and intergroup competitions. In addition, children showed less bias towards their own side after intergroup competition than after interpersonal competition. Finally, they demonstrated an earlier proclivity towards being influenced by winning outcomes than by losing outcomes after interpersonal competition, whereas a converse tendency was found after intergroup competition.

Consent for Research Involving Spanish- and English-Speaking Latinx Adults With Schizophrenia.

Latinxs are vastly underrepresented in mental health research; one of many contributing factors may be complexities in the research consent process, including language preferences. We examined determinants of comprehension of research consent procedures and tested the effects of a preconsent research schema condition among 180 adults with schizophrenia (60 Latinx-English and 60 Latinx-Spanish preference, and 60 non-Latinx White). Participants were randomly assigned (equal allocation) to an educational session regarding clinical research concepts and processes (schema condition) or to an attention control. Following a subsequent simulated consent procedure for a hypothetical drug trail, comprehension of consent disclosures was measured with 2 standard measures. One-way ANOVAs showed significant medium effect size differences between ethnicity/language groups on both measures of comprehension (η2s = 0.066-0.070). The Latinx-Spanish group showed lower comprehension than non-Latinx White participants; differences between the 2 Latinx groups did not reach statistical significance. Group differences were not statistically significant after adjusting for differences in education, or on scores from structured measures of acculturation, health literacy, or research literacy. Two-way ANOVAs showed no significant main effects for consent procedure on either comprehension measure (Ps > .369; partial η2s < 0.006) and no significant group-by-consent interactions (Ps > .554; partial η2s < 0.008). Although the preconsent procedure was not effective, the results suggest health and research literacy may be targets for reducing disparities in consent comprehension. The onus is on researchers to improve communication of consent information as an important step to addressing health care disparities.

Balancing the Objectives of Statistical Efficiency and Allocation Randomness in Randomized Controlled Trials

Various restricted randomization procedures are available to achieve equal (1:1) allocation in a randomized clinical trial. However, for some procedures, there is a nonnegligible probability of imbalance in the final numbers which may result in an underpowered study. It is important to assess such probability at the study planning stage and make adjustments in the design if needed. In this article, we perform a quantitative assessment of the tradeoff between randomness, balance, and power of restricted randomization designs targeting equal allocation. First, we study the small-sample performance of biased coin designs with known asymptotic properties and identify a design with an excellent balance–randomness tradeoff. Second, we investigate the issue of randomization-induced treatment imbalance and the corresponding risk of an underpowered study. We propose two risk mitigation strategies: increasing the total sample size or fine-tuning the biased coin parameter to obtain the least restrictive randomization procedure that attains the target power with a high, user-defined probability for the given sample size. Additionally, we investigate an approach for finding the most balanced design that satisfies a constraint on the chosen measure of randomness. Our proposed methodology is simple and yet generalizable to more complex settings, such as trials with stratified randomization and multi-arm trials with possibly unequal randomization ratios.

Meaning-centered pain coping skills training for patients with metastatic cancer: Protocol for a randomized controlled efficacy trial

BackgroundMany patients with advanced cancer describe pain as a debilitating symptom that greatly interferes with daily activities and enjoyment of life. Psychosocial interventions can improve cancer-related pain but rarely address spiritual concerns (e.g., loss of meaning, peace), which can influence the pain experience for those facing life-threatening illness. To address these needs, we systematically developed and pilot tested a novel psychosocial intervention called Meaning-Centered Pain Coping Skills Training (MCPC). In this randomized controlled trial, we aim to determine MCPC's efficacy for reducing pain interference (primary outcome) and improving secondary outcomes. We will also estimate MCPC's cost-effectiveness. Method/DesignPatients (target N = 210) with advanced solid tumor malignancies (Stage IV) and clinically-elevated pain interference will be enrolled and block randomized with equal allocation to MCPC + enhanced usual care or enhanced usual care alone. MCPC's four, videoconferenced, 45–60 min weekly sessions will be individually delivered by trained study therapists. Primary (pain interference) and secondary (pain severity, anxiety and depressive symptoms, pain self-efficacy, social support, spiritual well-being) patient-reported outcomes will be assessed at baseline, and 8-weeks (primary endpoint) and 12-weeks after baseline. ConclusionOur MCPC intervention is the first to systematically address the biopsychosocial-spiritual aspects of pain in patients with advanced cancer. If MCPC demonstrates efficacy, next steps will involve hybrid efficacy-effectiveness and implementation work to broaden access to this brief, manualized, remotely-delivered intervention, with the goal of reducing suffering in patients with life-threatening illness.

CORPORATE SOCIAL RESPONSIBILITY IMPACT ON THE PERFORMANCE OF PRIVATE SECTOR EDUCATION

Private-sector educational entities require strong corporate strategies. To be effective in a globally competitive world, the Corporate Social Responsibility Approach must be embraced. This research examined corporate social responsibility in the district of Peshawar, Khyber Pakhtunkhwa, and its effect on secondary schools in the private sector. Primary nature research and data were collected through a five-point Likert scale questionnaire distributed to private sector high school teachers to get the data about the impact of corporate social responsibility on organizations’ performance. The questionnaire was fielded to private sector secondary school teachers in order to get data about the impact of corporate social responsibility on the performance of secondary schools. The population of the study was 184 registered private sector secondary schools (140 boys and 44 girls) which included 900 teachers (who taught to class 10th students during the session 2017-18) in district Peshawar. A sample of 280 teachers (140 male and 140 female) in 70 private sector secondary schools (35 for boys and 35 for girls) were selected through equal allocation sampling formula. Mean, Standard Deviation and t-test were applied for analyzing the data. The Pearson’s correlation r was used to evaluate the variable effects. The result from the data indicated that all the four aspects of CSR have positive significant impact on the performance of secondary schools.

Comparing the effectiveness of extracorporeal shockwave therapy and myofascial release therapy in chronic pelvic pain syndrome: study protocol for a randomized controlled trial

BackgroundChronic prostatitis/chronic pelvic pain syndrome is a highly prevalent syndrome. Previous studies showed that extracorporeal shockwave therapy and myofascial release therapy could improve the quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Theoretically, combined therapy with extracorporeal shockwave therapy and myofascial release therapy will likely have significant advantages in treating CP/CPPS. We, therefore, present a protocol for conducting a well-designed randomized controlled trial to compare the efficacy and safety of each therapy.MethodsThe proposed study will be a three-group randomized control trial (RCT) design that includes 150 participants from Zhongda Hospital Affiliated to Southeast University, with equal allocation of participants to the three intervention groups. The study duration will be 8 weeks, which includes a 4-week treatment period and a 4-week follow-up period. The primary outcome will be the changes in surface electromyography (sEMG) assessment and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). The secondary outcomes will include the changes in three-dimensional quantification, shear wave elastography (SWE), and sympathetic skin response (SSR) testing. Assessments will be conducted before the intervention (T0), before the 5th intervention (T1), immediately after the 8th intervention (T2), and the 4th week after the end of the 8th intervention (T3).DiscussionThis trial will compare the differences in efficacy between single extracorporeal shockwave therapy, single myofascial release therapy, and combined therapy to select the most appropriate treatment option for patients with CP/CPPS. The possible pathogenesis of CP/CPPS would also be analyzed by comparing the intercorrelation between each objective and subjective measurement (NIH-CPSI score, sEMG, SWE, SSR).Trial registrationThe name of the registry: Extracorporeal Shockwave and Myofascial Release Therapy in Chronic Pelvic Pain Syndrome.Registration number: NCT05659199. Date of registration: December 2022.