Quality adjusted survival analysis: A neglected application of the quality of well-being scale

Abstract

Background In survival analysis, those who are alive are statistically coded as 1.0 while those who are dead are coded as 0.0. Since everyone who remains alive is given the same score, a person confined to bed with an irreversible coma is alive and is counted the same as someone who is active and asymtomatic. The Quality of Well-being (QWB) scale defines levels of wellness on the continuum between death and optimum function and integrates morbidity and mortality into the same number. This paper demonstrates the effect of including mortality in QWB estimates for male adults with HIV infection.

Method This study involves follow-up of a cohort of 386 male adults participating in the San Diego HIV Neurobehavioral Research Center (HNRC). Patients were evaluated using the QWB at enrollment and at six month intervals. All patients were classified into three stages of HIV disease according to the Center for Disease Control (CDC) classification: CDC IV (symptomatic HIV disease), CDC II or III (asymptomatic infection) and uninfected male controls.

Results QWB scores were calculated with and without mortality included for men in each CDC class who completed a one year (N = 148) or two year follow-up (N = 60). At each evaluation, there were significant differences among CDC classes and inclusion of deaths increased the variance accounted for by CDC class at each evaluation.

Conclusions HIV infection has significant impacts upon both morbidity and mortality. Survival analysis captures only the mortality dimension, while quality adjusted survival analysis using the QWB includes both dimensions. We propose quality adjusted survival analysis as a more sensitive method for assessing outcome in HIV disease and other health conditions.     

Children's understanding of interpretation

The prevailing view in the study of children's developing theories of mind is that the 4-year-old's newfound understanding of false belief is the single developmental milestone marking entry into an adult “folk psychology.” We argue instead that there are at least two such watershed events. Children first develop a “copy theory” that equates the mind with a recording device capable of producing either faithful or flawed representations of reality and according to which mental states are determined entirely by the flow of information into the mind. Only later, in the early school years, do children come to appreciate, as do adults, that the mind itself can contribute to the content of mental states. This later-arriving “Interpretive Theory of Mind” allows an appreciation of the capacity for constructively interpreting and misinterpreting reality. The main finding from the six studies reported here is that children who otherwise demonstrate a clear understanding that beliefs can be false (and so deserve to be credited with a theory of mind), can nevertheless fail to appreciate even the most basic aspects of interpretation: that despite exposure to precisely the same information, two persons can still end up holding sharply different opinions about what is the self-same reality. What these studies reveal is that an interpretive theory of mind is different from, and later arriving than, an appreciation of the possibility of false belief, and contrary to competing claims, this interpretive theory actually makes its first appearance during, but not before, the early school years.     

Retrieval processes that produce interference in modified forced-choice recognition tests

Recognition can suffer if the retrieval cues activate more than one trace (e.g., for Flower A and Flower A′). We found evidence for two retrieval processes by examining interference effects in forcedchoice tests (e.g., Did you see Flower A or Flower A″?). Experiment 1 provided evidence of a problem in discriminating between temporally and contextually similar traces that were formed in the study phase. A competitor (Flower A′) interfered more if it was shown in the study phase rather than in the test phase. Experiments 2 and 3 found evidence for a blocking process in recognizing pairs of words (child—apple). A competitor interfered more if it was recent, shown at test rather than at study. This pattern occurred regardless of whether the competitor was similar to the target (child—orange) or dissimilar to it (child—truck). The importance of a particular retrieval process may depend on an item’s representation as well as on the retrieval cues.     

Cyber- and face-to-face bullying: who crosses over?

A total of 3956 children aged 12–13 years who completed the Longitudinal Study of Australian Children (LSAC Wave 5) were studied about their experiences of traditional face-to-face bullying and cyberbullying in the last month. In terms of prevalence, sixty percent of the sample had been involved in traditional bullying as the victim and/or the offender whereas eight percent had been involved in cyberbullying as victim and/or offender. The vast majority (95 %) of those involved in cyberbullying were also involved in traditional bullying. Children involved in both traditional bullying and cyberbullying were compared with those involved in only traditional bullying. Boys were more likely to be involved in both types of bullying than girls. Children with friends involved in delinquent activities and who did not have trustworthy and supportive friends were more likely to bully both traditionally and in cyberspace. Computer proficiency and use did not differentiate children who had crossed over from those who had not, although computer use for socializing purposes had some predictive value in identifying those children who crossed over. The study reflects the value of school interventions for children as they approach adolescence, covering both traditional bullying and cyberbullying, and targeting social relationships in order to teach children how to manage them safely and intelligently.     

Risk Perception: Using Conditional Versus General Base Rates for Risk Communication1

In general, people judge their chance of experiencing a health risk as being less than the general base rate because of their favorable status on risk factors (e.g., history of stroke). Presenting base rates for high and low risk groups (conditional base rates) were hypothesized to lessen people's tendency to adjust downward from the base rate because risk factors are included in conditional base rates (CBRs). Young (M= 19 years) and older women (M= 46 years) were presented with either a general base rate (GBR) or CBRs for high‐ and low‐risk groups for 5 health risks. The CBR groups were significantly less likely to adjust their probability judgments from the base rate for the risk group that they believed applied to them (e.g., smoker vs. nonsmoker). The CBR effect was replicated in a second experiment in which women (M = 19 years) were informed of either a GBR, a CBR for a high‐risk group, or a CBR for a low‐risk group. The findings suggest that people might estimate subjective probabilities by considering both the base rate for a health risk and self‐assessments on risk factors. Biases about one's status on risk factors, however, may limit people's identification with relevant risk groups and warrant further investigation.     

Attitudes,leprechauns and neutrinos: The ontology of behavioral science

Conclusion Although the historical dispute between introspective psychology and ontological behaviorism encourages the belief that attitudes do not exist, this belief is misguided. Even the Hacking test, suggested by someone with grave doubts about behavioral science, supports the claim that attitudes are just as real as neutrinos. Nevertheless, the progress of a science of attitudes may be severely limited by the influence of exogenous factors, factors including normative beliefs about how we should treat the people to whom attitudes are attributed. In so far as these beliefs prevent scientists from experimenting on people and their institutions, particle physics has resources unavailable to survey research. Thus a serious examination of behavioral science leads to some surprising conclusions as to which sciences are the hard ones and which ones are simply easier.Thanks are due to a number of people, particularly to Ted Jelen for invaluable advice and encouragement and editorial assistance and to Paul Teller, Dorothy Grover and my colleagues in the Indiana Philosophical Association for helpful and insightful comments. Research for this paper was supported by Faculty Development of DePauw University and the Humanities Division of Illinois Benedictine College.     

Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly

Can direct change in state of consciousness through specific mental techniques extend human life and reverse age-related declines? To address this question, 73 residents of 8 homes for the elderly (mean age = 81 years) were randomly assigned among no treatment and 3 treatments highly similar in external structure and expectations: the Transcendental Meditation (TM) program, mindfulness training (MF) in active distinction making, or a relaxation (low mindfulness) program. A planned comparison indicated that the "restful alert" TM group improved most, followed by MF, in contrast to relaxation and no-treatment groups, on paired associate learning; 2 measures of cognitive flexibility; mental health; systolic blood pressure; and ratings of behavioral flexibility, aging, and treatment efficacy. The MF group improved most, followed by TM, on perceived control and word fluency. After 3 years, survival rate was 100% for TM and 87.5% for MF in contrast to lower rates for other groups.     

The Picture Arrangement subtest of the WAIS as an index of social egocentrism: A comparative study of normal and emotionally disturbed children

This study describes a measure of social egocentrism based on a procedural variation in the Picture Arrangement subtest of the Wechsler Adult Intelligence Scale, compares this procedure with other previously proposed measures of egocentricity, and reports an application of this measure in the comparative study of 30 normal and emotionally disturbed children. The results of this comparison indicate that institutionalized children are sharply differentiated from their better adjusted peers in their ability to take roles or perspectives other than their own.Thanks are extended the children and staff of the children's service of the Menninger Foundation for their help and support in the completion of this study.