bluuebunny/crossref_metadata_2025 huggingface dataset:
Multicultural Education: A Program To Benefit Our Students and Society
Authors: Bachman Jerry
Published: March 2007

If the profound changes in cultural assumptions needed to build a cre ative, peaceful, and productive multi cultural society are to occur, they must begin with those of us who are responsible for the education of tomorrow's citizens.
Preparing High Schools for Eighth Grade Students
Authors: Jett Daniel L. , Pulling Diane N. , Ross Janet
Published: March 2007

Principals spend a great deal of time preparing students for the transition to the high school. But how much is done to prepare the high school for the students?
Some Reflections on Doing the Principalship
Authors: Evans Dennis L.
Published: March 2007

Whatever the issue, the principal is the pivotal player in facilitating change or maintaining the status quo. The importance of this role is support ed by experience and research.
Service Learning and Curriculum Transfusion
Authors: Buchen Irving H.
Published: March 2007

Service learning need not be a short- term program. It can exhibit develop mental stages that parallel and feed into patterns of academic growth.
Alternative Learning: A Behavior Modification Plan For At-Risk Youth
Authors: Hoover John T.
Published: March 2007

Once students at very high risk of school failure are identified, what can be done to modify the risky behaviors they exhibit?
Using Technology To Create Safer Schools
Authors: Townley Arthur J. , Martinez Kenneth
Published: March 2007

Providing safe campuses must be a priority for all schools. The thoughtful use of technology can help school administrators to provide a safe cam pus where students can learn without fear of violence.
Restructuring the Assistant Principal's Role
Authors: Williams Fredonia B.
Published: March 2007

Assistant principals play an important role in developing and sustaining an effective school leadership team. This role becomes more productive for assistant principals when shared responsibilities and the team manage ment approach are emphasized.
Interdisciplinary Education— You Bet It Can Work!
Authors: Impson Patricia D. , Lynam Jolene M. , Reiter Robert L.
Published: March 2007

How can schools move forward to prepare students for the multifaceted world of the twenty-first century? This interdisciplinary model shows what can be done.
Using Interdisciplinary Block Programming for Underachieving Pupils
Authors: Embriano Anthony J. , Ryan Mark J.
Published: March 2007

New York City's Outreach Program addressed the challenge of educating students once labeled as dropouts by developing an interdisciplinary model of instruction designed to accommodate their academic and affective needs.
The Interview: What Candidates For Administrative Positions Should Know and Do
Authors: Pigford Aretha B.
Published: March 2007

An interview is your opportunity to sell a product about which you have the most knowledge—yourself. Your challenge is to ensure that everything about that product conveys a powerful, positive message.
Should Site-Based Committees Be Involved in the Campus Staffing Process?
Authors: Holman Linda Jean
Published: March 2007

Site-based decision making can help schools better meet the needs of students through increased ownership and empowerment. Selecting teachers and principals may be the most critical area of authority in which the school can participate.
Making a Difference in School Climate, Counseling Services, and Student Success
Authors: Killin Terry E. , Williams Rhonda L.
Published: March 2007

After 12 years of involvement with advisory programs in a variety of for mats, the authors are convinced of their benefits—including positive school climate, students learning to solve peer conflicts, and students with enhanced self-esteem.
It's Not Easy Being Green: Mentoring for the First Year Principal
Authors: Wilmore Elaine L.
Published: March 2007

When new principals take up the job, it helps to have a plan and a friend. The Texas A&M Management Profile program assesses and develops beginners and aspiring candidates.
Block Scheduling: A Means To Improve School Climate
Authors: Buckman Daniel C. , King Bonnie Besten , Ryan Sheila
Published: March 2007

The two Orlando, Fla., high schools described in this article are working toward providing success for all stu dents by implementing restructuring plans generated by their own school communities.
The Hybrid Schedule: Scheduling to the Curriculum
Authors: Boarman Gerald L. , Kirkpatrick Barbara S.
Published: March 2007

A series of experiments with single and double mod scheduling led to a highly flexible schedule that meets the needs of the teachers and students at this large suburban school.
High Tech High: Cruising on the Internet
Authors: Wilson Thomas F.
Published: March 2007

When students at Eagan High School pass their "driver's exam," it can take them much farther than half a tank of gas in the family mini-van, and there's no age minimum.
A Mentoring Program for New Teachers: Ensuring Success
Authors: Harris Sandra
Published: March 2007

Principals can play a pivotal role in ensuing the survival and success of first-year teachers by providing a mentor program.
Asking the Right Questions: Successful University Consultation in Public Schools
Authors: Ramirez-Smith Christina , Sprague Marsha M.
Published: March 2007

University professors can provide successful consultation to schools by learning to work effectively with administrators to remove roadblocks that prevent effective inservice. The questions suggested here may focus both university faculty members and school administrators on outcomes that meet participants' expectations.
Tech Prep/School-to-Work: Preparing Students for Life Beyond High School
Authors: Black Karl
Published: March 2007

Pacific Grove High School has developed career paths in business, arts and communications, and hospitality to help students succeed in life as well as in high school.
Career Quest and the Changing Workplace: Career Paths in Dothan, Alabama
Authors: Sasser Jack , Woodham James
Published: March 2007

With the active involvement of the community, the Dothan (Ala.) public schools have been restructured to meet the needs of all students. Involvement has been the key to success, and multiple input has strength ened the program and gained the support of the entire community.
Supporting the Success of The Aspiring and Beginning School Leader
Authors: Ginty Edwin F.
Published: March 2007

Beginning building administrators and those who aspire to this role should be supported and encouraged by members of the school com munity as they deal with the challenges and tough issues of building administration. Their success is critical to the excellence of tomorrow's schools and students.
Regaining and Maintaining Control of School Business Functions And Activities
Authors: Hayes Eugene M.
Published: March 2007

Taking control of your school's business functions requires the courage and the willingness to make changes, developing and sharing your vision, taking the initiative and responsibility, constantly learning, being flexible and innovative, utilizing technology, and reevaluating how you use and organize your resources.
Why Do So Many High Achieving High School Students Dislike School?
Authors: LoVette Otis K. , Jacob Shirley
Published: March 2007

A recent survey found that high ability students were often bored at school but not at home. If students do not perceive a valued purpose to their school assignments they may see the work as boring and irrel evant. What can principals do to help teachers challenge all students?
Keeping the Vision: A Student- Centered School for Excellence
Authors: Conner Nancy , Krajewski Bob
Published: March 2007

Milwaukee's Washington High School is a dynamic institution whose culture is in the "process of becoming." While the understandably complex process of becoming is neither unique nor magic, the con tinuing development of their work culture is worth sharing. This is their story.
A Journey Through Change: The Woodbridge Senior High School Story
Authors: White Pamela P. , Hardebeck Mary Ann
Published: March 2007

Culture develops gradually over time; it cannot be mandated through a series of calculated events. Real change in the work place involving the way things are done, however, can evolve when "people's behavior is influenced less by direct leadership and more by commitment to shared values" (Brandt, 1992b).
Learning Styles in the High School: A Novel Approach
Authors: Callan Roger John
Published: March 2007

High school teachers traditionally are reticent to adopt learning styles teaching techniques. There is, however, a painless and effective way to help students learn new and difficult material with a minimum of teacher input. With the effectiveness of such an approach, teachers may be more interested in using these techniques in their classrooms.
A South African Assistant Principal Takes a Look at Some U.S. Schools
Authors: Thomas Leonard R.
Published: March 2007

While studying in Philadelphia on a Fulbright Scholarship last year, the author spent a semester observing elementary, middle level, and high school classes in this large urban school district. These are some of his impressions of school life in the eastern part of the United States.
A Letter to a Newly Appointed Principal: Ten Tips for Making the Grade
Authors: Skelly Kevin
Published: March 2007

New principals may find that the school and the community will judge them by the way they act during the early days of their appointment. Some hints from a principal who is no Longer entirely a beginner may help smooth the path.
What Is the Role of the Middle Level Assistant Principal, And How Should It Change?
Authors: Porter Jeffery J.
Published: March 2007

Who is the middle school assistant principal? How has the role of middle level assistant principal changed? Why has this position largely been overlooked as a significant force in middle level edu cation ? What can be done to ensure that the importance of the middle level assistant principal's position is fully recognized?
Never Again Would We Be the Same: The Oklahoma City Bombing
Authors: Mathers Kent
Published: March 2007

A terrorist attack on the Alfred P. Murrah Federal Building in Oklahoma City showed the nation that no area of the country was free from the possibility of violence or terrorism. This author describes the day and the aftermath of the tragedy.
Seven Assumptions of a Solution-Focused Conversational Leader
Authors: Paull Robert C. , McGrevin Carol Z.
Published: March 2007

How can we consistently create effective conversations in our interac tions with students, teachers, parents, and community members? How can we listen compassionately to stakeholder concerns white trans forming these concerns into actions that lead to solutions? What assumptions should we maintain to move conversations from com ptaints about kids, parents, teachers, and schools to conversations that produce results?
A Very Different Kind of Teacher Education Program: Professional Development Schools
Authors: Dodd Anne Wescott
Published: March 2007

Because the only prediction we can safely make about the 21st century is that it will be characterized by constant change, educators are faced with the challenge of preparing students to cope with the unknown as well as the known. This task requires a very different kind of teacher education program.
The Principal and the School Psychologist: Partners for Students
Authors: Murray Barbara A.
Published: March 2007

Prevention is more effective (and less costly) than reaction. The school psychologist, who is trained in such prevention strategies, holds a wealth of information that, properly utilized, can be among the princi pal's greatest assets.
Social Studies Education for The 21st Century
Authors: Laffey Martharose
Published: March 2007

The primary purpose of social studies is to help young people develop the ability to make informed and reasoned decisions for the public good as citizens of a culturally diverse, democratic society in an inter dependent world.
Improving Secondary School Discipline by Involving Students In the Process
Authors: Furtwengler Willis J.
Published: March 2007

What might happen if students shared responsibility for improving aspects of their classroom instruction and learning activities? Potential benefits are suggested by the improvement in 17 schools that formed a community of learners and leaders.
Performance-Based Evaluation and The School Library Media Specialist
Authors: Taylor Joie , Bryant Miles
Published: March 2007

Evaluation is a fact of life for any teacher. If evaluation is to be an effective tool for improving one's work, however, it must make sense. One group of educators who feel that customary evaluation practices do not make sense are library media specialists, who frequently indi cate they are not evaluated at all or are evaluated in a manner that does not accurately reflect what they do.
Curriculum Mapping and Instructional Supervision
Authors: Clough Dick B. , James Terry L. , Witcher Ann E.
Published: March 2007

The primary purpose of curriculum mapping is to have a written record of what is being taught in the classroom. White the lesson plan docu ments what a teacher intends to teach, the curriculum map logs what is actually taught.
lgebra for the Twenty-First Century: New Vision
Authors: Burrill Gail
Published: March 2007

Algebra is important for everyone. It provides a way to represent a sit uation so it can be analyzed carefully. In the new algebra classroom, students will be talking and listening to each other as they learn to understand problems and devise solutions. Teachers will organize tasks to help students discover that the use of symbols allows them to con trol data and use them to produce answers to real questions.
Principal Leadership: A Primary Factor in School-Based Management And School Improvement
Authors: Delaney Jerome G.
Published: March 2007

There are two schools of thought on school-based management. One views it as a positive and successful vehicle of school improvement. The other argues that it has been minimally successful with respect to school improvement and the results do not justify all the time, energy, and effort expended in operationalizing the concept.
The Multiple Menu Model: A Successful Marriage for Integrating Content and Process
Authors: Renzulli Joseph S.
Published: March 2007

The curriculum-writing experiences of teachers have not always been positive. Without a comprehensive framework for curriculum develop ment the hours of toil often result in a hybrid conglomeration of activi ties that does little to enhance the teaching and learning process in any meaningful way. Here is a brief overview of a model that invites teach ers who want to write curriculum into the process of curriculum design.
Trends in Environmental Influences Upon the Intellectual Development Of Young People
Authors: Williams Wendy M.
Published: March 2007

Most school administrators, teachers, and parents are concerned about our society's negative influences on children's intellectual develop ment. There is widespread worry about the impact of television, movies, video games, computer games, and other related activities. How do these environmental factors affect young people's intellectual development?
Using Technology To Upgrade The Principal's Role as Instructional Leader
Authors: Kaufman Cathy C.
Published: March 2007

For school principals, an ongoing challenge in the evolution of technology is the cost/benefit ratio—how to get the most from each expenditure, how to structure the environment to equitably serve the largest number of students, how to effectively match software designs with curriculum goals, and how to motivate and equip teachers to link technological capacities with improved student learning.
Strategies for Teaching in a Block-of-Time Schedule
Authors: Hackmann Donald G. , Schmitt Donna M.
Published: March 2007

Secondary schools throughout the nation are fashioning creative alter natives to traditional six and seven-period days, in the form of block- of-time schedules. Although varying tremendously in format, block-of- time schedules have an overarching commonality: They significantly depart from the traditional 45 to 55-minute class period.
An Invitation to Innovation: Rethinking the High School Day
Authors: Winn Deanna D. , Menlove Ronda , Zsiray Stephen W.
Published: March 2007

How do we use time? Do current schedules recognize the importance of time and its relationship to learning? As high schools change, is there a conscious examination of how to structure time during the school day or are we trying to force innovative and successful ways of educating students into a rigid and unexamined structure?
Coming Out of the Clouds: Safe Landings for Technology Initiatives
Authors: Cohen Fredric , Camhi Shari L.
Published: March 2007

Every school district faces a challenge when formulating a technology plan. If a district fails to accept the challenge fully because the condition of the environment is uncertain, it may short-change students, fail to promote learning, and shatter the confidence of schools and community members. But how does a district know what steps to take?
A Schoolwide Discipline Plan That Empowers Teachers and Gives Principals Time for Instructional Leadership
Authors: Borelli Jan
Published: March 2007

How can you develop and implement a schoolwide discipline program that empowers teachers and turns administrators back into instructional leaders; develop a faculty advisory that assists the principal in leading the school instead of "hounding" the principal; and develop leadership in teachers and students to improve the climate for teach ing and learning in your school?
The Secondary School Assistant Principal as Education Leader: The New York City Experience
Authors: Golden Lester
Published: March 2007

All across the United States, education and schools are being restruc tured in the hope that school systems can better provide for the needs of students. Restructuring not only entails designing a curriculum, creating state-of-the-art school plants, and developing new educa tional programs and procedures, it also involves taking a look at the roles school supervisors play in preparing school staff members to do a more effective job.
Winding Down the School Year: A Checklist for Principals
Authors: Findley Dale , Findley Beverly
Published: March 2007

Every principal is aware of the importance of being prepared to open school in the fall. Equally important, but not so obvious, is the process of closing one school year in preparation for the next. The following checklist may help.
Service Learning: A Process To Connect Learning and Living
Authors: Kinsley Carol W.
Published: March 2007

Service learning is a way to help our young people grow individually and as members of society. It is about helping our young people grow up to understand the connection between living and learning, what it means to be a adult, what it means to live as a citizen in a free and "civil" society, and what it means to live as a truly compassionate and caring human being.
What Research Tells Us About Designing Service Learning Programs
Authors: Shumer Robert
Published: March 2007

Service learning is growing in popularity. More and more schools and districts are beginning such programs or expanding existing ones. Developing quality initiatives need not feel like a shot in the dark, though. A good research base can help to inform the process and ensure a greater likelihood for success.
When Problems Arise at School: How Schools and Parents Can Work Together
Authors: Hartman Diane M. , Chesley Gary
Published: March 2007

We want all students to enjoy school and to experience greater academ ic achievement and social development each year. We hope all parents can enjoy an ideal relationship with their chitd's school where all prob lems are minor and are handled quickly and with goodwill. It does indeed take a partnership among teachers, parents, and administrators to guide students successfully through their education.
Helping Teachers Integrate Internet Resources into the Curriculum
Authors: Land Michael
Published: March 2007

You're on the Internet! Now what? Most teachers want and need a view of the Internet based on what is already familiar to them—lesson plans, activities, materials. Here is one view of the Internet for the middle level or high school administrator who is interested in assist ing his or her faculty to integrate the resources of the Internet into the curriculum.
Providing Diversity in Middle Level World Language Study in Massachusetts
Authors: VonVillas Barbara A.
Published: March 2007

The Massachusetts Education Reform Bill of 1993 supports the devel opment and implementation of curriculum frameworks in all major dis ciplines, including world languages. The department of education has implemented a statewide assessment system that provides proficiency benchmarks at Grade 10. As a result, districts have been reviewing their curricula and expanding their programs whenever possible to meet the needs of students faced with proficiency exams.
The 4 x 4 Block Scheduling Model: What Do Teachers Have To Say About It?
Authors: Hurley J. Casey
Published: March 2007

High school leaders need to explore both the advantages and disadvantages of the 4 x 4 schedule. If this innovation is implemented without discussion of how to ensure rigor while using time flexibly, it may be sabotaged by those who fear the disadvantages and question the advantages. This article and its companion piece examine what teach ers and students think about the block schedule.
A Study of Teacher Beliefs on the Efficacy of Block Scheduling
Authors: Staunton Jim
Published: March 2007

Unless there is a clear picture of instructional practices under altered bell schedules, restructuring efforts may stall as a result of disappointment and disaffection by staff members who see them as merely another wave of change that will soon disappear. Unless teachers embrace the concepts of change that follow restructuring instructional time, we face the possibility of failure.
What Do Teachers in California Have To Say About Block Scheduling?
Authors: Staunton Jim , Adams Teresa
Published: March 2007

In California, schools have experimented with a number of block schedules that afford teachers more time with students in longer blocks that alternate by day of the week. A survey of teacher attitudes regarding block scheduling revealed that teachers believe block scheduling offers opportunities to try new teaching strategies and vary the usual classroom routine.
Bridge: A Program Designed To Ease the Transition from the Middle Level to the High School
Authors: Hernández Sheets Rosa , Izard-Baldwin Gloria , Atterberry Patricia
Published: March 2007

The Bridge program provides all ninth graders at Ingraham High School with access to the educational opportunities available through a variety of activities that promote academic achievement, responsibility, school spirit, fellowship, acceptance, and empowerment.
Meaning and Information: A Perspective on Donald M. MacKay
Authors: Soloski John
Published: March 2007

The purpose of this paper is to explore some of the ideas presented in Donald MacKay's Information, Mechanism and Meaning, a collection of selected papers written by MacKay, most of which were presented to various scientific confer ences in the 1950s and 7960s. This paper also examines MacKay's ideas in relation to some of the ideas of Lee Thayer and William Stephenson.
Communication, Law and Morals: Notes Toward a Study of Responsibility and Mass Communication
Authors: Hardt Hanno
Published: March 2007

... journalists, by the nature of their profession, may have a special communicative function to fulfill, and their work should undergo a careful examination along with considerations of their audiences, who are integral parts of a developing theory of responsibility.
Daily Newspapers and Social Accountability
Authors: Slade Clyde Melvin
Published: March 2007

The corporate press came to view the First Amend ment as a two-edged sword. The provision that "Congress shall make no law " leaves the newspaper free from government control and allows it to pursue its own perception of social responsibility unchallenged by all. But it also insists that "Congress shall make a lot of laws" to foster its privileged status.
Television Spectacle and the Internationalization of Sport
Authors: Whannel Garry
Published: March 2007

(This is a shortened version of a paper given at the Conference on The Third World. Development or Crisis, in Penang, Malaysia, in November 1984, and the author would like to thank the Consumers Association of Penang for permission to reproduce it here )
How to find French business information
Authors: Norton Robert
Published: March 2007

Introduces and evaluates the leading sources of French business information. Covers business directories, statistics & economic forecasts; business periodicals & indexing services; on-line databases; publishers; booksellers; market research organisations and literature; associations and international sources.
How to find German business information
Authors: Dunning Peter
Published: March 2007

Evaluates the major sources of West German business information, including directories, statistics, market research organisations, periodicals and newspapers, and online databases.
How to find Italian business information
Authors: Cucchi Luisa
Published: March 2007

Evaluates the major sources of Italian business information, including directories, statistics, market research organisations and online databases.
Print
Authors: Tagg Lawrence
Published: March 2007

The 1988 Investors Companion to the Top 100 UK Companies, published by Financial Times Business Information Limited, 7th Floor, 50-64 Broadway, London SW1H 0DB. Tel. 01-799 2002. £15.95, ISBN 185334 012X.

Keyguide to Information Sources in Business Ethics by Francis P. McHugh, published by Mansell Publishing Limited, Artillery House, Artillery Row, London SW1P 1RT. Tel. 01-222 7676. £28.00, ISBN 0 720118492.

The Counties and Regions of the UK: Economic, Industrial and Social Trends in Local Authority Areas, compiled by David Mort, University of Warwick Business Information Service, published by Gower Publishing Company Limited, Gower House, Croft Road, Aldershot, Hampshire GU11 3HR. Tel. 0252 331551. £27.50, ISBN 0 566 02755 0.
Business intelligence: developing a prototype in-house database
Authors: Self Richard J
Published: March 2007

When the requirements are clearly defined, a prototype system is easy to construct. Defining the require ments for a Business Intelligence System is far more difficult and is dependent on the unique needs of each organisation. This paper reviews some of the key issues of Business Intelligence operations and their impact on the definition of a Business Intelligence system. The impact of the current, rapid developments in com puting technology on the choices available for developing a system is briefly considered. A short overview of the prototyping approach to system development is given. This is followed by a summary of the current Rolls- Royce approach to developing an in-house prototype system.
Perception of Quantitative Information for Treatment Decisions
Authors: Feldman-Stewart Deb , Kocovski Nancy , McConnell Beth A. , Brundage Michael D. , Mackillop William J.
Published: March 2007

The study was designed to determine which formats for displaying quantities, such as probabilities of treatment risks and benefits, are perceived most accurately and easily by patients. Accuracy and speed of processing were compared for six different presentation formats: pie charts, vertical bars, horizontal bars, numbers, systematic ovals, and random ovals. Quantities were used in two tasks: a choice task that required larger/smaller judgments and an estimate task that required more precise evaluation. The impacts of blue-yellow color and of a treatment-decision context on performance in the two tasks were also investigated. The study included four experiments. Taken together the results suggest that the formats best for making a choice differ from those best for estimating the size of an amount. For making a choice, vertical bars, horizontal bars, numbers, and systematic ovals were equally well perceived; pie charts and random ovals caused slower and less accurate performances. For estimating, numbers led to the most accurate estimates, followed by systematic ovals. The other four formats led to the least accurate estimates. Color and context did not alter which formats were best. Key words: decision making; quantitative information presentation; questionnaire format. (Med Decis Making 2000;20:228-238)
A New Scale for Assessing Perceptions of Chance
Authors: Woloshin Steven , Schwartz Lisa M. , Byram Stephanie , Fischhoff Baruch , Welch H. Gilbert
Published: March 2007

Background. Clinicians and researchers often wish to know how patients perceive the likelihoods of health risks. Little work has been done to develop and validate scales and formats to measure perceptions of event probabilities, particularly low probabilities (i.e., <1%). Objective. To compare a new visual analog scale with three benchmarks in terms of validity and reliability. Design. Survey with retest after approximately two weeks. Respondents estimated the probabilities of six events with the new scale, which featured a "magnifying glass" to represent probabilities between 0 and 1% on a logarithmic scale. Participants estimated the same probabilities on three benchmarks: two linear visual analog scales (one labeled with words, one with numbers) and a "1 in x" scale. Subjects. 100 veterans and family members and 107 university faculty and students. Measures. For each scale, the authors assessed: 1) validity—the correlation between participants' direct rankings (i.e., numbering them from 1 to 6) and scale-derived rankings of the relative probabilities of six events; 2) test-retest reliability— the correlation of responses from test to retest two weeks later; 3) usability (missing/ incorrect responses, participant evaluation). Results. Both the magnifier and the two linear scales outperformed the "1 in x" scale on all criteria. The magnifier scale performed about as well as the two linear visual analog scales for validity (correlation between direct and scale-derived rankings = 0.72), reliability (test-retest correlation = 0.55), and usability (2% missing or incorrect responses, 65% rated it easy to use). 62% felt the magnifier scale was a "very good or good" indicator of their feelings about chance. The magnifier scale facilitated expression of low-probability judgments. For example, the estimated chance of parenting sextuplets was orders of magnitude lower on the magnifier scale (median perceived chance 10 5) than on its linear counterpart (10-2). Participants' assessments of high-probability events (e.g., chance of catching a cold in the next year) were not affected by the presence of the magnifier. Conclusions. The "1 in x" scale performs poorly and is very difficult for people to use. The magnifier scale and the linear number scale are similar in validity, reliability, and usability. However, only the magnifier scale makes it possible to elicit perceptions in the low-probability range (<1%). Key words: patient perceptions; perception measurement scale. (Med Decis Making 2000;20:298-307)
Estimating Diagnostic Test Accuracy Using a "Fuzzy Gold Standard"
Authors: Phelps Charles E. , Hutson Alan
Published: March 2007

This study uses Monte Carlo methods to analyze the consequences of having a criterion standard ("gold standard") that contains some error when analyzing the accuracy of a diagnostic test using ROC curves. Two phenomena emerge: 1) When diagnostic test errors are statistically independent from inaccurate ("fuzzy") gold standard (FGS) errors, estimated test accuracy declines. 2) When the test and the FGS have statistically dependent errors, test accuracy can become overstated. Two methods are proposed to eliminate the first of these errors, exploring the risk of exacerbating the second. Both require a probabilistic (rather than binary) gold-standard statement (e.g., probability that each case is abnormal). The more promising of these, the "two-truth" method, selectively eliminates those cases where the gold standard is most ambiguous (probability near 0.5). When diagnostic test and FGS errors are independent, this approach can eliminate much of the downward bias caused by FGS error, without meaningful risk of overstating test accuracy. When the test and FGS have dependent errors, the resultant upward bias can cause test accuracy to be overstated, in the most extreme cases, even before the offsetting "two-truth" approach is employed. Key words: ROC curves; diagnostic test accuracy; technology assessment. (Med Decis Making 1995;15:44-57)
You Can Lead a Horse to Water-Improving Physicians' Knowledge of Probabilities May Not Affect Their Decisions
Authors: Poses Roy M. , Cebul Randall D. , Wigton Robert S.
Published: March 2007

Objectives. To determine whether improving physicians' judgments of the probability of streptococcal pharyngitis for patients with sore throats would affect their use of antibiotics and affect the variation in such use. Design. Post-hoc retrospective analysis of data previously collected as part of a controlled trial. Settings. University student health services in Penn sylvania and Nebraska. Patients. Sequential patients with pharyngitis seen before and after the time clinicians received either an experimental educational intervention designed to improve probabilistic diagnostic judgments (at the Pennsylvania site) or a control intervention, a standard lecture (at the Nebraska site). The clinician-subjects were the primary case physicians practicing at either site. Measurements. Clinical variables prospectively recorded by the clinicians, probability assessments, and treatment decisions. Results. At the experi mental site, despite marked decreases in clinicians' overestimations of disease probability after the intervention, the proportion of patients prescribed antibiotics showed a trend toward increasing: 100/290 (34.5%) pre-intervention, 90/225 (40%) post-intervention. The interven tion did not decrease practice variation between individual doctors. Univariable and multi variable analyses showed no major change in the relationships between clinical variables and treatment decisions after the intervention. At the control site there was no major change in probability judgments or treatment decisions after the intervention. Conclusions. Teaching physicians to make better judgments of disease probability may not alter their treatment decisions. Key words: knowledge; probability; decision making; pharyngitis diagnosis. (Med Decis Making 1995;15:65-75)
Comparison of "Accelerated" Tissue Plasminogen Activator with Streptokinase for Treatment of Suspected Myocardial Infarction
Authors: Kellett John , Clarke John
Published: March 2007

Purpose. A computerized decision analysis, based on the results of published clinical trials, assessed the risks, benefits, and costs of different thrombolytic regimens for suspected myocardial infarction (MI) throughout the likely range of clinical circumstances. Data source. Medline search and articles' bibliographies. Study selection. All studies reporting efficacy and side effects of thrombolysis. Data analysis. Life-expectancy outcomes of thrombolytic therapies for possible MI modeled by decision analysis. Results. The analysis allows a clinician to estimate the benefits, risks, and relative costs of thrombolytic therapies throughout the likely range of individual clinical circumstances. When applied, for example, to the average patient in ISIS-2, estimated gains are 150 quality-adjusted days of life (QALDs) from treatment with streptokinase (SK) and 255 QALDs with "accelerated" tPA (tPA). tPA costs $1,686 more than SK, taking into account the cost of lifelong care of the extra strokes incurred. Nevertheless, the chances of stroke above which thrombolysis is not preferred are 5.0% for SK and 8.0% for tPA, with tPA remaining the preferred treatment for six hours after symptom onset; thereafter, SK is marginally preferred, but at much lower cost. Both regimens are beneficial in older patients provided the chances of MI and death are "average" or greater. Conclusion. Where the chances of MI and death are known, decision analysis can be a useful bedside tool to guide thrombolytic therapy and subsequently, if needed, to review and defend the treatment decisions made. Key words: decision analysis; thrombolytic therapy; myocardial infarction; streptokinase; tissue plasminogen activator. (Med Decis Making 1995;15:297-310)
Tradeoffs between Quality and Quantity of Life
Authors: Stiggelbout Anne M. , De Haes J.C.J.M. , Kiebert Gwendoline M. , Kievit Job , Leer Jan-Willem H.
Published: March 2007

The patient's perspective is of prime concern in weighing the benefits and side effects of oncologic treatment. Little is known about patients' preferences and attitudes. The authors developed a short questionnaire to assess patient attitudes concerning trade offs between quality of life and length, or quantity, of life (the QQ Questionnaire). The questionnaire turned out to be feasible for use in various groups of cancer patients. In a factor analysis, the questionnaire was shown to consist of two factors, a Q(uality) and a L(ength) factor. Values of Cronbach's α for the Q and L scales (consisting of four items each) were 0.68 and 0.79, respectively. Younger patients and patients who have children assigned relatively more importance to striving for prolonged survival. Contrary to our expectation, no association was found between scores on the two scales and time tradeoff utility scores. The QQ Questionnaire can be used in research settings to study patient attitudes and the stability and determinants of patients' pref erences. Key words: oncology; quality of life; side effects; patient preferences; health state utilities. (Med Decis Making 1996;16:184-192)
The Relationship between Descriptive and Valuational Quality-of-life Measures in Patients with Intermittent Claudication
Authors: Bosch Johanna L. , Hunink Maria G.M.
Published: March 2007

The study objective was to assess the relationship between descriptive and valuational quality-of-life measures in patients with intermittent claudication. In telephone inter views, 68 patients completed a questionnaire consisting of a descriptive health status measure (RAND 36-Item Health Survey 1.0), and several valuational measures (stan dard gamble, time tradeoff, rating scale, and McMaster health utility index). All mea sures demonstrated reduced quality of life in the patients. Scores on the RAND-36 dimensions correlated moderately well with the rating scale and McMaster health utility index (R = 0.37-0.67) but less well with the standard gamble and the time tradeoff (R = 0.10-0.46). Multiple regression analysis demonstrated that 28% of the variance in the time-tradeoff values and 14% of the variance of the standard-gamble utilities could be explained by the best combination of RAND dimensions. These results suggest that answers to descriptive health-status questions cannot reliably predict standard-gamble utilities or time-tradeoff values. Key words: quality of life; health status; utility assess ment ; peripheral vascular diseases; intermittent claudication. (Med Decis Making 1996;16:217-225)
Decision-theoretic Refinement Planning in Medical Decision Making
Authors: Haddawy Peter , Doan Anhai , Kahn Charles E.
Published: March 2007

Decision-theoretic refinement planning is a new technique for finding optimal courses of action. The authors sought to determine whether this technique could identify optimal strategies for medical diagnosis and therapy. An existing model of acute deep venous thrombosis of the lower extremities was encoded for analysis by the decision-theoretic refinement planning system (DRIPS). The encoding represented 6,206 possible plans. The DRIPS planner used artificial intelligence techniques to elimmate 5,150 plans (83%) from consideration without examining them explicitly. The DRIPS system identified the five strategies that minimized cost and mortality. The authors conclude that decision- theoretic planning is useful for examining large medical-decision problems. Key words: decision-theoretic refinement planning; diagnosis; treatment; DRIPS ; acute deep venous thrombosis ; artificial intelligence. (Med Decis Making 1996;16:315-325)
Finding the Optimal Multiple-test Strategy Using a Method Analogous to Logistic Regression
Authors: Richards Robert J. , Hammitt James K. , Tsevat Joel
Published: March 2007

Finding the optimal strategy among a battery of tests may be cumbersome for decision- analytic models. The authors present a method of examining multiple test combinations that is based on a modified Bayes' formula analogous to logistic regression. They examined all 16 combinations of four tests used to diagnose hepatolenticular degen eration. The four tests examined were: serum ceruloplasmin level, 24-hour urinary copper excretion, free serum copper level, and liver biopsy copper concentration. They also simulated the diagnostic workup of the disease for a hypothetical cohort of 15,000 patients at risk. Assuming the disutilities of false positives and false negatives to be equal, and considering sensitivity analysis of test characteristics, the following test combinations were found to be optimal for making the diagnosis at a prior probability of disease equal to 0.05: positive serum ceruloplasmin and 24-hour urinary copper excretion, combined with either positive liver biopsy or free serum copper (or both). The strategies obtained by the modified Bayes' formula were the same as those found using the simulated data set with a standard logistic-regression software package. The logistic model's diagnostic accuracy is 0.98 as measured by the area under the re ceiver operating characteristic curve. The optimal strategy for diagnosing hepatolentic ular degeneration vanes with the prior probability of disease. For prior probabilities of 0.05, 0.25, and 0.9, and the optimal strategy, model sensitivities are 0.801, 0.880, and 0.997, and model specificities are 0.991, 0.985, and 0.814, respectively. The new method provides a convenient alternative to decision trees when examining multiple diagnostic tests. Key words: hepatolenticular degeneration; logistic models; sensitivity and specificity; simulation; diagnosis, differential. (Med Decis Making 1996;16:367- 375)
The importance of Perspective in the Measurement of Quality-adjusted Life Years
Authors: Richardson Jeff , Nord Erik
Published: March 2007

Scaling instruments for the measurement of quality-adjusted life years (QALYs) incor porate either a personal or an impersonal perspective on the benefits of a health intervention and either do or do not incorporate considerations of equity. This paper sets out three hypotheses concerning perspective and equity: 1) that more equally distributed benefits will be preferred to less equally distributed benefits; 2) that the preference value elicited for a health benefit will be greater when the respondent to a QALY questionnaire is a potential beneficiary; and 3) that, by comparison with personal preferences, individuals will be more concerned with the quantity than the quality of life in other people. These hypotheses were tested using two existing instruments and two other instruments that were created for this study. Results gave no support to the third hypothesis; some support to the first hypothesis, and strong support for the sec ond hypothesis. It is concluded that perspective can significantly alter the values in corporated in a QALY instrument. The policy implications of the results are twofold. First, they give some support to the view that distributional consequences of health programs are of importance to the population and that they should be included in the evaluation of any health program. Second, they indicate that an evaluation should consider whether the health-state values to be obtained should incorporate an imper sonal perspective reflecting the purely "social" judgment of a health planner or a per spective reflecting self-interest. Key words: quality-adjusted life years; scaling instru ments ; equity; preferences; policy. (Med Decis Making 1997;17:33-41)
A Cost-Effectiveness Analysis of the Orphan Drug Cysteamine in the Treatment of Infantile Cystinosis
Authors: Soohoo Nelson , Schneider Jerry A. , Kaplan Robert M.
Published: March 2007

Objective. Cysteamine is a recently licensed orphan drug used to treat the inherited metabolic disease cystinosis. The drug delays the onset of renal failure in cystinotic patients and may provide many other significant health benefits. This study examined the cost-effectiveness of the administration of cysteamine to cystinotic patients prior to end-stage renal disease (ESRD). Method. Decision-tree analysis and cost-effectiveness analysis. Cost data were estimated from current clinical charges and Medicare public-access reports. Life expectancy outcomes were derived from both published and unpublished clinical studies and from the U.S. Renal Data System. Results. Cysteamine therapy can extend the life of kidneys and delay renal transplantation, thereby increasing life expectancy for patients with cystinosis. Patients receiving cysteamine therapy prior to renal failure have lifetime-treatment drug costs of $234,000, in comparison with $238,000 for those who are not medicated. Costs of cysteamine therapy are offset by savings associated with delaying transplantation and costs of dialysis. Conclusions. Use of the orphan drug cysteamine both improves health outcomes and reduces health care costs for patients with cystinosis. Key words: cystinosis; cysteamine ; decision analysis; cost-effectiveness. (Med Decis Making 1997;17:193-198)
Dollars May Not Buy as Many QALYs as We Think:
Authors: Fryback Dennis G. , Lawrence William F.
Published: March 2007

The scale of health state quality that should be used to compute quality-adjusted life years (QALYs) ranges from 0 (death) to 1.0 (excellent health); this is called the "Q" scale. But many cost-utility analyses (CUAs) in the literature use the upper anchor of the scale to denote only the absence of the particular health condition under investigation, and weight the disease state proportional to this endpoint; these are called "q" scales. Computations using q-scale health-state weights ignore the fact that the average patient is still subject to chronic and acute conditions comorbid with the condition being analyzed; the absence of a particular condition is not in general the same as excellent health, i.e., the Q scale is longer than a q scale. CUAs based on q scales yield 'qALYs." Incremental $/qALY ratios are generally lower than $/QALY ratios; in the example presented, $/qALY must be inflated by about 15% to yield $/QALY. Other CUAs correctly weight disease states using the Q scale, but erroneously assign a quality weight of 1.0 to absence of the disease in the CUA computations. The results of such analyses are called "NP-QALYs," as the correction factor to compute QALYs is not a simple proportional adjustment. The authors suggest that analysts doing cost-utility analyses without access to primary data from treated patients use average age-specific health-related quality-of-life weights from population-based studies to represent the state of not having a particular disease. Consumers of CUAs should closely examine the nature of the QALYs in any published analyses before making decisions based on their results. Key words: QALY; quality-adjusted life years; utility; quality-of-life assessment; cost-utility analysis; cost-effectiveness methodology. (Med Decis Making 1997;17:276-284)