Meaningful Benchmarks Research Articles

Understanding community-based participatory research through a social movement framework: a case study of the Kahnawake Schools Diabetes Prevention Project

BackgroundA longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP).MethodsThis research uses a case study design layered on a movement-building evaluation framework, which allows progress to be tracked over time. Data collection strategies included document (scientific and organizational) review (n = 51) and talking circles with four important community stakeholder groups (n = 24).ResultsFindings provide an innovative and chronological perspective of the evolution of KSDPP as seen through a social movement lens, and identify intermediate outcomes associated with different dimensions of movement building achieved by the project over time (mobilization, leadership, vision and frames, alliance and partnerships, as well as advocacy and action strategies). It also points to areas of improvement for KSDPP in building its potential for action.ConclusionWhile this study’s results are directly relevant and applicable to the local context of KSDPP, they also highlight useful lessons and conclusions for the planning and evaluation of other long-standing and sustainable CBPR initiatives. The conceptual framework provides meaningful benchmarks to track evidence of progress in the context of CBPR. Findings from the study offer new ways of thinking about the evaluation of CBPR projects and their progress by drawing on frameworks that guide other forms of collective action.

Network‐Based Approaches for Pathway Level Analysis

Identification of impacted pathways is an important problem because it allows us to gain insights into the underlying biology beyond the detection of differentially expressed genes. In the past decade, a plethora of methods have been developed for this purpose. The last generation of pathway analysis methods are designed to take into account various aspects of pathway topology in order to increase the accuracy of the findings. Here, we cover 34 such topology-based pathway analysis methods published in the past 13 years. We compare these methods on categories related to implementation, availability, input format, graph models, and statistical approaches used to compute pathway level statistics and statistical significance. We also discuss a number of critical challenges that need to be addressed, arising both in methodology and pathway representation, including inconsistent terminology, data format, lack of meaningful benchmarks, and, more importantly, a systematic bias that is present in most existing methods. © 2018 by John Wiley & Sons, Inc.

Establishing meaningful benchmarks: the development of a formative feedback tool for advanced laparoscopic suturing.

Time and accuracy are commonly used metrics to assess laparoscopic skills in a simulated environment. However, they do not provide trainees with meaningful information about how to improve their skills. The objective of this study was to provide preliminary validity evidence for the creation a formative feedback tool (FFT) for advanced laparoscopic suturing skills. Videotapes of senior surgical residents (PGY3-5; SRs) and minimally invasive surgeons (MIS) performing 3 advanced laparoscopic suturing tasks were analyzed: needle handling (NH), suturing under tension (UT), and continuous suturing (CS). A FFT was created based on a grounded theory analysis of interviews with MIS surgeons about the key technical aspects of each task. The FFT was used to assess the videotaped performances of SRs and MIS surgeons by two blinded independent raters. The FFT is composed of three parts: NH contains 10 items, UT 18, and CS 20. Each item was classified according to seven key surgical principles: depth perception, safety, bimanual dexterity, exposure, tissue handling, instrument manipulation, and forward planning. The videotaped performance of SR and MIS surgeons was graded on a 3-point Likert scale ("does well," "needs some improvement," and "does poorly") and scores were calculated as a sum of the points. ICCs for all three tasks were high (NH 0.90, UT 0.87, and CS 0.90). FFT score correlated strongly with combined time and accuracy measurements for UT (0.82, p<0.01) and CS (0.81, p<0.01), and moderately for NH (0.65, p<0.01). MIS surgeons performed significantly better than SRs on UT (p=0.02) and CS (p=0.05), while scores on NH were similar (p=0.57). A comprehensive tool for providing feedback about advanced laparoscopic suturing skills was developed. The FFT demonstrates evidence for validity as a measure of suturing skills and experience, and provides meaningful information to trainees about how to improve their skills and engage in more deliberate and efficient practice.

Identification and validation of clinically meaningful benchmarks in the 12-item Multiple Sclerosis Walking Scale

Background: The 12-item Multiple Sclerosis Walking Scale (12-MSWS) is a validated questionnaire which assessed walking function; it has been widely adopted in multiple sclerosis (MS) clinical research. Objective: Identify and validate clinically meaningful 12-MSWS benchmarks in MS. Methods: Cross-sectional study of 159 MS patients permitted identification of clinically meaningful 12-MSWS benchmarks based on their relationship to real-life anchors. Identified 12-MSWS benchmarks were then validated in a second population of 96 subjects using measures of ambulation, cognition, and patient-reported outcomes. Results: 12-MSWS score of 0–24.99 was associated with working outside the home and assistance-free mobility; 25–49.99 was associated with gait disability and difficulty doing housework; 50–74.99 was associated with unemployment, government healthcare, cane use, and difficulty performing instrumental activities of daily living (IADLs); and 75–100 was associated with change in occupation due to walking, mobility impairment requiring bilateral assistance, and inability to perform IADLs. During the validation step, strong linear associations were identified between 12-MSWS benchmarks and other MS-related disability outcome measures, including ambulatory and non-ambulatory measures. Conclusion: We have identified clinically meaningful 12-MSWS benchmarks which define four groups differentiated by increasing levels of mobility impairment and associated loss of functional independence. These data provide insight into how 12-MSWS translate to meaningful functional limitations in MS.

‘Dangerous Targets’ revisited: Old dangers in new contexts plague marine protected areas

Abstract The use of targets to provide measurable objectives and benchmarks for management, conservation, and restoration of ecosystems is commonplace. In the marine and coastal realms, targets have been successful in setting sustainable limits to fisheries harvests, thresholds for pollutants, and recommended amounts of representative habitat included in marine protected area (MPA) networks. Quantifiable targets can dissuade governments from making dubious claims about investments in ocean protection that sound impressive but cannot be verified. Examples are presented where protection targets have been used successfully for marine management, and instances where measurable and meaningful benchmarks serve to allow tracking of true progress. However, the setting of targets can also be a double‐edged sword. In some cases, targets have proven useful, but in many instances, interventions made to fulfil targets not only give a false illusion of progress or even success, they present opportunity costs that impede further conservation. Some of these issues were raised in the 2003 article ‘Dangerous Targets?: Unresolved issues and ideological clashes around marine protected areas’ that appeared in Aquatic Conservation: Marine and Freshwater Ecosystems. Since its publication, the article's warnings about how targets can sometimes be dangerous and counter‐productive have led to intense debate among scientists and policy‐makers alike, and the paper has been cited in more than 500 publications. Yet today, more than a dozen years after the first ‘Dangerous Targets' publication, new targets are driving more MPA designations and conservation strategies than ever before, and the ‘dangerous’ aspects of target setting have been largely ignored. This paper discusses old ‘dangers' in the context of new developments in marine conservation, including the lingering problem of having simplistic metrics drive marine policies, and the unintended result that can often occur when outputs (percentage of area under MPA designation) do not align with true outcomes of effective management and conservation. Newly emerging ‘dangers’ in letting areal targets (percentage of area under MPA designation) drive MPA designations are also discussed, including how the rush to fulfil obligations to protect a certain proportion of area is taking place in planning, separate from broader level, and potentially more holistic, marine spatial planning (MSP). The paper suggests five recommendations that would allow policy‐makers to use targets more effectively, including: (1) increase transparency in planning, especially around specific goals and objectives of MPA establishment; (2) use time‐based areal targets when representativity is a goal of the protected area strategy; (3) use MPAs when spatial protections are the best solution to the management challenge; (4) design MPAs with intrinsic performance goals, and use performance‐based metrics in subsequent evaluation of MPAs; and (5) embed MPA planning into broader policy frameworks, including MSP. These five recommendations are oriented toward multilateral institutions, governments, and non‐governmental organizations, suggesting concrete ways to utilize target‐setting to their best advantage, in order to fight the downward spiral of degradation affecting marine and coastal environments worldwide. Copyright © 2016 John Wiley &amp; Sons, Ltd.

Identifying clinically meaningful benchmarks for gait improvement after total hip arthroplasty.

There are no established benchmarks for gait mechanics after total hip arthroplasty (THA). This study sought to identify minimum clinically important postoperative (MCIP) or minimum clinically important improvement (MCII) values for self-selected walking speed, sagittal plane dynamic hip range of motion (HROM) (peak flexion-peak extension) and peak hip adduction moments measured during quantitative gait analysis. Preoperative and 1-year postoperative data collected during quantitative gait analysis, along with Harris Hip Scores (HHS), for 145 subjects were collected from a motion analysis data repository. The MCIP (or MCII) was defined as the 75th percentile mark on a plot of the cumulative percent of subjects with HHS ≥ 80 versus the postoperative value (or change) in the respective variable. 95% confidence intervals (CI) were calculated. Logistic regression was used to test the association of age, sex, BMI, and preoperative HHS with benchmarks. The MCIP of speed was 1.34 m/s (95%CI 1.30, 1.37); MCII was 0.32 (0.30, 0.35) m/s. The HROM MCIP was 30.0° (29.4°, 30.7°); MCII was 13.3° (12.1°, 14.8°). The adduction moment MCIP was 4.2% Body Weight × Height (4.0, 4.4); MCII was 0.87 (0.57, 1.17) % Body Weight × Height. Women were more likely to achieve MCII for HROM and MCIP for adduction moment (ORs 2.4-11.6, p ≤ 0.031). Lower BMI predicted HROM and adduction moment MCIPs (ORs 0.85-0.88, p ≤ 0.015). Lower preoperative HHS predicted speed, HROM and adduction moment MCIIs (ORs 0.95-0.97, p ≤ 0.012). With further validation, clinically-relevant gait benchmarks can enhance efforts to improve THA outcomes.

Predictive modeling and threshold scores for care seeking among women with urinary incontinence: The short forms of the Pelvic Floor Distress Inventory and Urogenital Distress Inventory.

To further the interpretability of the Pelvic Floor Distress Inventory (PFDI-20) and Urogenital Distress Inventory (UDI-6) by (i) evaluating the ability of these measures to distinguish between women with urinary incontinence who do and do not seek care, (ii) defining PFDI-20 and UDI-6 threshold scores above which women with urinary incontinence seek care, and (iii) developing a predictive model for incontinence care seeking. An observational study was conducted with two groups of women with urinary incontinence: 256 who had not sought care and 90 seeking initial care at a tertiary center. Sample sizes were based upon the prevalence of care seeking for urinary incontinence and the number of potential predictors for care seeking. Wilcoxon rank-sum tests, receiver operating characteristics, and multivariable logistic regression were use to achieve the study aims. Women with urinary incontinence who sought care had higher median PFDI-20 and UDI-6 scores compared to non-care seekers (73.96 vs. 16.67, P < 0.0001, and 41.67 vs. 8.33, P < 0.0001). A PFDI-20 score of 33.33 (83.33% sensitivity and 79.30% specificity) had very good discriminatory accuracy in distinguishing care and non-care seekers (AUC 0.886 ± 0.019 [95%CI 0.8518, 0.9254] P < 0.0001). A UDI-6 score of 25.00 (83.33% sensitivity and 83.59% specificity) had excellent discriminatory accuracy in distinguishing care and non-care seekers (AUC 0.9025 ± 0.0190 [95%CI 0.8653, 0.9398] P < 0.0001). A multivariable predictive model accurately identified 82.4% of care and non-care seekers. A PFDI-20 score of 33.33 and UDI-6 score of 25.00 provide meaningful benchmarks for care seeking among women with urinary incontinence. Neurourol. Urodynam. 35:949-954, 2016. © 2015 Wiley Periodicals, Inc.

Development of multinational definitions of minimal clinically important improvement and patient acceptable symptomatic state in osteoarthritis.

The ability to interpret scores from patient-reported outcome measures at the individual patient level depends on the availability of valid, clinically meaningful benchmarks of response and state attainment. The goal was to develop multinational estimates for minimal clinically important improvement (MCII) and patient acceptable symptomatic state (PASS). A multinational sample of patients with osteoarthritis (OA) was evaluated before and 4 weeks after treatment with nonsteroidal antiinflammatory drugs. Patients completed either the Western Ontario and McMaster Osteoarthritis Index (WOMAC) numerical rating scale 3.1 (hip and knee OA) or the Australian/Canadian Index (AUSCAN) numerical rating scale 3.1 (hand OA) before and after treatment. Patients rated the clinical importance of their response to treatment and their satisfaction with the health state achieved, from which multinational MCII and PASS estimates were calculated for both the WOMAC and AUSCAN indices. A total of 609 patients from 7 countries participated in the study. MCII and PASS estimates varied slightly by instrument and subscale. Absolute (percentage) change for MCII ranged 6-9 (10% to 17%) for WOMAC and 4-9 (8% to 15%) for AUSCAN. PASS estimates ranged 39-48 for WOMAC and 38-45 for AUSCAN. Some between-country variation was observed in MCII and PASS. Preliminary multinational estimates for MCII and PASS have been developed for several countries. Further research is required to evaluate the robustness, temporal consistency, and age- and sex-dependency of the preliminary estimates as well as their generalizability to other countries, languages, cultures, regions, and other condition-specific outcome measures.

Distributed video coding: Assessing the HEVC upgrade

In the distributed video coding (DVC) context, predictive Intra coding plays an important role not only as one of the most meaningful (low encoding complexity) benchmarks but also as the adopted coding mode for the so-called key frames used in the most popular DVC architectures. While the first DVC codecs adopted the H.263 Intra codec to play this role, it became clear around 2005 that the (standard) Intra coding reference codec had evolved and should become the H.264/AVC Intra codec, which has been used since then by the DVC literature. However, while DVC solutions have been evolving since those times, also predictive video coding has evolved and a new predictive video coding standard has recently emerged, the High Efficiency Video Coding (HEVC) standard. To acknowledge this evolution and be fair with the predictive coding technology, the improved DVC solutions should now integrate and be compared with the improved and more relevant HEVC standard and not anymore with the H.264/AVC 10-year-old standard. In this context, this paper proposes to upgrade the DVC tools and benchmarking by adopting the HEVC Intra codec to take the role that the H.264/AVC Intra standard was previously playing. To assess the impact of this inevitable upgrade, an advanced, representative DVC solution has been adopted and its performance assessed and compared in the context of the H.264/AVC and HEVC standard frameworks. The compression efficiency and computational complexity experiments performed allow concluding that upgrading DVC solutions with HEVC Intra coding allows strengthening the DVC positioning in the video coding landscape. This conclusion highlights how the experiments performed in this paper are critical to define the new DVC status quo.

A comprehensive overview of methodologies and performance evaluation frameworks in 3D mesh segmentation

3D mesh segmentation has become a crucial part of many applications in 3D shape analysis. In this paper, a comprehensive survey on 3D mesh segmentation methods is presented. Analysis of the existing methodologies is addressed taking into account a new categorization along with the performance evaluation frameworks which aim to support meaningful benchmarks not only qualitatively but also in a quantitative manner. This survey aims to capture the essence of current trends in 3D mesh segmentation.

Reconstructing the world trade multiplex: the role of intensive and extensive biases.

In economic and financial networks, the strength of each node has always an important economic meaning, such as the size of supply and demand, import and export, or financial exposure. Constructing null models of networks matching the observed strengths of all nodes is crucial in order to either detect interesting deviations of an empirical network from economically meaningful benchmarks or reconstruct the most likely structure of an economic network when the latter is unknown. However, several studies have proved that real economic networks and multiplexes topologically differ from configurations inferred only from node strengths. Here we provide a detailed analysis of the world trade multiplex by comparing it to an enhanced null model that simultaneously reproduces the strength and the degree of each node. We study several temporal snapshots and almost 100 layers (commodity classes) of the multiplex and find that the observed properties are systematically well reproduced by our model. Our formalism allows us to introduce the (static) concept of extensive and intensive bias, defined as a measurable tendency of the network to prefer either the formation of extra links or the reinforcement of link weights, with respect to a reference case where only strengths are enforced. Our findings complement the existing economic literature on (dynamic) intensive and extensive trade margins. More generally, they show that real-world multiplexes can be strongly shaped by layer-specific local constraints.

Best-practice benchmarking using clustering methods: Application to energy regulation

Data envelopment analysis (DEA) is widely used as a benchmarking tool for improving productive performance of decision making units (DMUs). The benchmarks produced by DEA are obtained as a side-product of computing efficiency scores. As a result, the benchmark units may differ from the evaluated DMU in terms of their input–output profiles and the scale size. Moreover, the DEA benchmarks may operate in a more favorable environment than the evaluated DMU. Further, DEA is sensitive to stochastic noise, which can affect the benchmarking exercise. In this paper we propose a new approach to benchmarking that combines the frontier estimation techniques with clustering methods. More specifically, we propose to apply some clustering methods to identify groups of DMUs that are similar in terms of their input–output profiles or other observed characteristics. We then rank DMUs in the descending order of efficiency within each cluster. The cluster-specific efficiency rankings enable the management to identify not only the most efficient benchmark, but also other peers that operate more efficiently within the same cluster. The proposed approach is flexible to combine any clustering method with any frontier estimation technique. The inputs of clustering and efficiency analysis are user-specified and can be multi-dimensional. We present a real world application to the regulation of electricity distribution networks in Finland, where the regulator uses the semi-nonparametric StoNED method (stochastic non-parametric envelopment of data). StoNED can be seen as a stochastic extension of DEA that takes the noise term explicitly into account. We find that the cluster-specific efficiency rankings provide more meaningful benchmarks than the conventional approach of using the intensity weights obtained as a side-product of efficiency analysis.

Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort

The aim of this analysis was to identify Young Mania Rating Scale (YMRS) meaningful benchmarks for clinicians (severity threshold, minimal clinically significant difference [MCSD]) using the Clinical Global Impressions Bipolar (CGI-BP) mania scale, to provide a clinical perspective to randomized clinical trials (RCTs) results. We used the cohort of patients with acute manic/mixed state of bipolar disorders (N = 3459) included in the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. A receiver-operating characteristic analysis was performed on randomly selected patients to determine the YMRS optimal severity threshold with CGI-BP mania score ≥ "Markedly ill" defining severity. The MCSD (clinically meaningful change in score relative to one point difference in CGI-BP mania for outcome measures) of YMRS, was assessed with a linear regression on baseline data. At baseline, YMRS mean score was 26.4 (±9.9), CGI-BP mania mean score was 4.8 (±1.0) and 61.7% of patients had a score ≥ 5. The optimal YMRS severity threshold of 25 (positive predictive value [PPV] = 83.0%; negative predictive value [NPV] = 66.0%) was determined. In this cohort, a YMRS score of 20 (typical cutoff for RCTs inclusion criteria) corresponds to a PPV of 74.6% and to a NPV of 77.6%, meaning that the majority of patients included would be classified as severely ill. The YMRS minimal clinically significant difference was 6.6 points.

Methods and approaches in the topology-based analysis of biological pathways

The goal of pathway analysis is to identify the pathways significantly impacted in a given phenotype. Many current methods are based on algorithms that consider pathways as simple gene lists, dramatically under-utilizing the knowledge that such pathways are meant to capture. During the past few years, a plethora of methods claiming to incorporate various aspects of the pathway topology have been proposed. These topology-based methods, sometimes referred to as “third generation,” have the potential to better model the phenomena described by pathways. Although there is now a large variety of approaches used for this purpose, no review is currently available to offer guidance for potential users and developers. This review covers 22 such topology-based pathway analysis methods published in the last decade. We compare these methods based on: type of pathways analyzed (e.g., signaling or metabolic), input (subset of genes, all genes, fold changes, gene p-values, etc.), mathematical models, pathway scoring approaches, output (one or more pathway scores, p-values, etc.) and implementation (web-based, standalone, etc.). We identify and discuss challenges, arising both in methodology and in pathway representation, including inconsistent terminology, different data formats, lack of meaningful benchmarks, and the lack of tissue and condition specificity.

Benchmarking airports from a managerial perspective

Benchmarking airports is currently popular both in the academic literature and in practice but has proved rather problematic due to the heterogeneity inherent in any reasonably sized dataset. Most studies either treat the airport production technology as a black box, or separate the terminal and airside activities, assessing them individually. In this article we analyze airports as a single unit due to the direct complementarities, thus avoiding the artificial separation of inputs. Using data envelopment analysis (DEA), we open the black box in which a network describes the production process, thus demonstrating the sequential effects that separate final from intermediate outputs, including those under partial managerial control and those that are known to be non-discretionary. To further improve the benchmarking process, we identify appropriate peers for a case study of 43 European airports over 10 years, through a restricted reference mechanism according to pre-defined characteristics. Compared to basic DEA models, the results of the proposed structure provide more meaningful benchmarks with comparable peer units and target values that are potentially achievable in the medium term. By identifying each unit's individual reference set, unique outliers influence the performance measurement less severely than occurs under basic DEA. In addition, the formulations produce an implementation path that moves the airport towards the Pareto frontier gradually, taking into account the regulatory and business environment in which the unit is located.

Observed and Expected Outcomes in Transfer and Nontransfer Patients With a Hip Fracture

Hospitals and providers that accept transfer patients risk lower ratings on publically reported quality measures that are inadequately adjusted for infirmity and complexity. We compared the outcomes of transferred patients and nontransferred patients after treatment of a hip fracture and sought to determine if expected outcomes based on an expansion of All Patient Refined-Diagnosis Related Groups (APR-DRGs) norms are accurately adjusted for transfer status. Retrospective cohort study. Tertiary care referral center. Four hundred six consecutive patients 65 years and older who received operative treatment of an acute hip fracture. Patients who were transferred from another acute care hospital or a skilled nursing facility before treatment were classified as transfer patients (n = 123), and all other patients were nontransfer patients (n = 283). Groups were compared with respect to in-hospital mortality, length of stay (LOS), excess days over the geometric mean length of stay (GMLOS), and readmission rate as well as expected length of stay (Exp LOS) and expected mortality (Exp Mort) based on APR-DRG norms and additional adjustment for transfer status. Transfer patients had significantly greater LOS (10.2 vs 9.6 days; P < 0.05), Exp LOS (9.7 vs 7.7 days; P < 0.001), Exp Mort (0.07 vs 0.03; P = 0.004), and excess days over the GMLOS (4.1 vs 3.3 days; P = 0.025) than nontransfer patients, near-significant greater in-hospital mortality (9.8 vs 4.9%; P = 0.069), and similar readmission rates. The differences in LOS and Exp LOS were nonsignificant in both transfer (P = 0.49) and nontransfer patients (P = 0.10). Patients 65 years and older transferred to a tertiary care facility for treatment of an acute hip fracture have worse outcome than nontransfer patients. Unadjusted data such as in-hospital mortality may be misleading, but risk adjustment using the APR-DRG methodology and additional correction for transfer status may provide meaningful benchmarks.

The Rush to Atrial Septal Defect Closure: Is the Introduction of Percutaneous Closure Driving Utilization?

Surgical repair of isolated atrial septal defect (ASD) and patent foramen ovale (PFO) has been largely supplanted by percutaneous closure. Whether the perceived benefit of percutaneous closure has lowered thresholds for intervention and thus increased overall utilization rates is unknown. We sought to determine nationwide trends in the use of percutaneous compared with surgical closure and their respective outcomes over an 18-year period. Using the Nationwide Inpatient Sample and International Classification of Diseases, Ninth Revision, procedure and diagnosis codes, we identified all ASD/PFO closures performed from 1988 to 2005. National estimates and their standard deviations were calculated. Logistic regression analysis identified determinants of closure type. We identified 15,482 secundum ASD/PFO closures between 1988 and 2005, yielding a national estimate of 79,841 cases. Of these, 5,495 (national estimate, 27,554 +/- 2,526) were percutaneous, 10,278 (national estimate, 53,710 +/- 1,451) were surgical. The ASD/PFO closures per capita increased dramatically from 1.08 per 100,000 population in 1988 to 2.59 per 100,000 population in 2005, an increase of 139%. When analyzed by closure type, surgical closure increased by only 24% (from 0.86 per 100,000 population in 1988 to 1.07 per 100,000 in 2005) whereas percutaneous closure increased by 3,475% (from 0.04 per 100,000 population in 1988 to 1.43 per 100,000 in 2005). A marked shift in repair type occurred in 2001. Estimated mortality rates remained near 1% for both closure types over time. Nationwide utilization of ASD/PFO repair has increased over time, largely attributable to the dramatic rise in percutaneous closure. Despite the substantial increase in utilization, mortality has remained constant. In the absence of meaningful benchmarks, prospective studies comparing outcomes and criteria for surgical versus percutaneous closure are needed to determine whether the increased rates of ASD closure are justified.

Role of gender in depressive disorder outcome for individual and group cognitive–behavioral treatment

Gender in cognitive-behavioral therapy (CBT) for outcome for depression has been inadequately examined in previous research. Thirty-five men and 55 women diagnosed with a depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) completed individual CBT at an outpatient community mental health clinic and 56 men and 105 women completed group CBT. Depression severity was measured before treatment and at endpoint using the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) along with secondary outcomes of anxiety (Beck Anxiety Inventory; Beck, Epstein, Brown, & Steer, 1988) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Endicott, Nee, Harrison, & Blumenthal, 1993). Men and women demonstrated equivalent pretreatment and posttreatment illness severity, a comparable gradient of improvement on outcomes, and attainment of clinically meaningful benchmarks.

In search of a benchmark: A proposed standard efficiency rating for air medical billing services

As CEO of more than one air ambulance company in my 23 years in this business, I did not have a clue how well my billing service performed, whether it was in-house or outsourced. This was not because I was not interested or did not make the effort, but because there were no readily available benchmarks and no process for meaningful comparisons with other programs and services. There still are very few meaningful benchmarks, but perhaps we can begin to create them. The Billing Efficiency Rating (BER), proposed here, might at least be a step in this direction. Without benchmarks, without the ability to know how well your accounts receivable are being managed, or how well they could be managed, there is little doubt most air ambulance companies leave a great deal of money on the table—for many companies we are talking millions of dollars. That seems a good reason to try.

Which Industries Are the Best Employers for Women? An Application of a New Equal Employment Opportunity Index

Abstract: This paper introduces and proposes a policy application for a new Equal Employment Opportunity (EEO) Index. The index is comprised of multiple measures of employers' human resource management outcomes and is designed to reflect employers' systemic EEO efforts. The index is applied to industry data from the Current Population Survey, and the tenets of Total Quality Management (TQM) theory are used for interpretation of results. It is found that the mining/construction industry provides a relatively inhospitable climate for women in the form, primarily, of a high degree of gender-related occupational segregation. The financial industry demonstrated the overall greatest gains for women during the 1990s. Closer examination of these industries with very good and very poor outcomes highlights the importance of addressing of industry performance on the index. JEL classification: J71, J78, J31, M11 Key words: discrimination, Total Quality Management, glass ceiling, occupational segregation, gender wage differentials The purpose of this paper is to demonstrate how policy makers can make use of a new Equal Employment Opportunity (EEO) Index to evaluate various industries' employment environments for women. An industry application of the EEO Index identifies gender disparities in employment outcomes across industries. Firms operating in poorly-performing industries might be slated for greater enforcement efforts by agencies such as the Equal Employment Opportunity Commission (EEOC) and the Office of Federal Contract Compliance Programs (OFCCP). In addition, policy makers may choose to direct training and other assistance to poorly-performing industry groups to assist them in improving their EEO performance. The impetus behind the use of a single index to measure and compare the experience of female workers is multi-faceted. First, a comprehensive index permits assessment of systemic employment discrimination. Employers' human resource management activities (e.g., compensation, recruitment, and evaluation of workers) are inter-related systems that should be designed and evaluated together (Becker, Huselid, and Ulrich 2001). This suggests that pay, hiring, and promotion outcomes should also be assessed together. The EEO Index in this paper allows distinct human resource management activities to be evaluated as a system. Relatedly, race and gender employment discrimination often go hand-in-hand, and the EEO Index provides a means to consider the systemic employment experience across multiple groups. Second, summarizing an employer's EEO performance in a single index provides a common measure with which to compare the performance of different employers and industries, and it allows quantification and tracing of EEO progress over time. This search for a common index that describes the overall employment experience from the perspective of women and/or minorities is similar to the long-standing search by development economists for a single index to quantify, compare, and trace over time the social development of a country. (1) Third, the single EEO Index used in this paper serves as a more reliable and valid indicator of women's work experiences than previously available because it is rooted firmly in anti-discrimination laws such as Title VII of the Civil Rights Act of 1964, which prohibits discrimination in any employment decision. There are no other existing measures that capture women's work experiences so systematically, or that provide such meaningful benchmarks such as the EEO performance of other industries or EEO performance over time. Variation in the EEO Index across industries will be interpreted within the framework of Total Quality Management (TQM) (Latzko and Sanders, 1995). In part, theories of TQM suggest that there will exist some random or common variation in industries' EEO performances that occur as part of the economic system in which they operate, and there will exist some assignable or special causes of variation that are attributable to particular industries (Stevenson, 2002, chs. …