I felt compelled to write this today as I think I have some wisdom to contribute to national discussion. This is probably complete hubris on my part, but that doesn't stop the rest of the bloggers out there, so why should I let it get in my way.
The impetus for this particular blog post is my recent viewing of "Confirmation" on HBO. I thought it was so well done that praise should be given for all participants. Kerry Washington did a superb job as Anita Hill and brought that moment before the Senate back to me almost completely intact. It seemed so real for me that I was brought back to the very day we who were alive witnessed it on the television. Wendell Pierce was also excellent as Clarence Thomas. I had a little problem with this particular actor as Justice Thomas because I have always loved Wendell Pierce since my first encounter with his work in "The Wire". I thought he was excellent in "Treme" and he is currently very enjoyable in "The Odd Couple". Because of these other associations, there were moments when I could only see the actor and not the character he portrayed.
Even given the above, I was transported back into time to the actual hearings themselves and the disgust I felt as the committee completely manhandled Professor Hill. It caused really deep feelings in me and I was amused by the endnotes that HBO tacked on showing the change in numbers of women in politics after these hearings. Actually my life, at the time of these hearings, was pretty full of responsibilities. I was a full time city mail carrier in Chicago at the time and I was completing my undergraduate degree in mathematics part time. I would attend classes in my mail carrier's uniform most of the time. Give that I was more than twice the age of the other students, I suppose I did stand out. Just a clarification, but I was in my late 40's and did not attempt to complete my degree until my children had mostly reached adulthood.
I remember sitting in a calculus class and I couldn't resist commenting to the student to my right who happened to be a little closer to my age than most of the others in the class. I mentioned that the hearings had brought back to me memories of the harassment I had suffered from male bosses and coworkers over the years. To my amazement this woman said she had never experienced any harassment. It was so rampant that I was stunned to know that this person had not experienced any. Was i just the victim of a lot of bad luck? Even as a letter carrier I had experienced harassment from school boys on the street who would yell out of their classrooms demeaning comments focused on my sexuality. What would their parents think? I wondered.
Another point made by Professor Hill was that she kept quiet about it because retaliation could ruin her career and her reputation. She also had difficulty explaining why she followed him from one job to another. Well ask any woman in a similar situation and the answer she gave was quite clear and it was clear by the way the committee treated her. She was making this up to get back at him because he didn't want to go out with her, she suffered from erotomania, and I become almost apoplectic as I revisit these accusations in my mind. When I have had to respond to comments in a similar vein I just become mute because the comments seem completely inane to me and the commenters cannot really believe those things. Especially if they know me at all.
Just personally I am not good at answering charges made completely on fictional grounds. I think I learned in grade school that to entertain answering these criticisms just offers them substance.
Yes, we have come far, I guess. I have had to go through so much sensitivity training that I could give the whole course myself. Of course, it was somewhat wasted on me as I would be the least likeliest person to harass a coworker. I guess I am slow to trust also, as all of the guarantees against retaliation never gave me enough confidence to report harassment in the workplace.
Tuesday, April 19, 2016
Wednesday, April 16, 2014
About Case-Control Studies
One step up from cross sectional studies, in terms of value of evidence in hypothesis testing, would be case control studies. These are studies where the comparison groups (case and control) are chosen for the outcome under study. Choosing where to find the subjects for both the group with the condition under study and that without the condition is critical. Sometimes the disease status is established with the use of laboratory tests or determination of a panel of experts. Many case control studies will take a sample from hospitalized patients, choosing those with the study condition and the non-case group from hospitalized subjects. These studies are retrospective with a backward direction to ascertain a related attribute or past event that is correlated with the disease under study. The research may have more than one comparison group.
The purpose of these studies is to discover a risk factor that might be correlated with the condition under study. One case control study will not prove that something is a risk factor. Care must be taken to identify any confounding factors that might be in the causal pathway. For example, there is a correlation between the use of alcohol and the use of tobacco. Depending on whether or not smoking is being investigated as a risk factor, it will be necessary to understand the use of alcohol in the two groups to determine if it is a risk factor or a confounding factor. This can be very difficult and statistics alone may not accomplish this. The analysis must involve critical thinking skills about the known or suspected risk factors and confounding factors.
Sometimes there are data sets out there that can be used to run analyses that have not been gathered for that purpose. If that is the case, the conclusions can be wildly inappropriate. When reliable investigators conduct case control studies they design them to obtain good information that will either provide a new avenue for hypothesis generation or that will confirm previous research. It is important to consider the statistical properties of the analysis that will be conducted with the gathered data. Did the study authors gather the data for the purpose identified in the publication? The use of sample size calculation will ensure the study is sized appropriately to detect a correlation for the risk factors with the condition under study.
To judge how much weight to put on information published from a case control study, it is important to critically analyze how the populations were identified. If it was self-reported by the subjects were there qualifying questions to determine the accuracy? If it was based on diagnosis by medical professionals, was this verified. Is it possible that some in the control group also had the condition but had not been diagnosed? Also, some thought should be given to the determination of the risk factors being studied. Would a reasonable person answer the questions truthfully? Can we believe self-report for these conditions? Was the control population biased? If hospital-based controls were used, were they appropriate? If determination of the disease status involved x-rays was the radiologist blinded?
It is not always easy to determine the answers to these questions when reading the results of a case control study analysis. This is where your critical thinking skills will help you out. Is it reasonable to believe that these determinations are unbiased? Are there other studies with similar results so the mass of evidence is in agreement? Many of the published research articles today are from case control studies. These are the appropriate design for many outcomes, especially those that are rare. These designs are also used where there is a long latent period or duration of expression. These studies are usually less expensive than cohort or cross-sectional studies and are subsequently the largest portion of published research, as a rule. As both the occurrence of disease and the risk factors occur in the past, it is difficult to determine which came first, which can make the observed association stronger than the actual association. Carefully done case control studies still contribute a lot of information in the study of diseases.
The purpose of these studies is to discover a risk factor that might be correlated with the condition under study. One case control study will not prove that something is a risk factor. Care must be taken to identify any confounding factors that might be in the causal pathway. For example, there is a correlation between the use of alcohol and the use of tobacco. Depending on whether or not smoking is being investigated as a risk factor, it will be necessary to understand the use of alcohol in the two groups to determine if it is a risk factor or a confounding factor. This can be very difficult and statistics alone may not accomplish this. The analysis must involve critical thinking skills about the known or suspected risk factors and confounding factors.
Sometimes there are data sets out there that can be used to run analyses that have not been gathered for that purpose. If that is the case, the conclusions can be wildly inappropriate. When reliable investigators conduct case control studies they design them to obtain good information that will either provide a new avenue for hypothesis generation or that will confirm previous research. It is important to consider the statistical properties of the analysis that will be conducted with the gathered data. Did the study authors gather the data for the purpose identified in the publication? The use of sample size calculation will ensure the study is sized appropriately to detect a correlation for the risk factors with the condition under study.
To judge how much weight to put on information published from a case control study, it is important to critically analyze how the populations were identified. If it was self-reported by the subjects were there qualifying questions to determine the accuracy? If it was based on diagnosis by medical professionals, was this verified. Is it possible that some in the control group also had the condition but had not been diagnosed? Also, some thought should be given to the determination of the risk factors being studied. Would a reasonable person answer the questions truthfully? Can we believe self-report for these conditions? Was the control population biased? If hospital-based controls were used, were they appropriate? If determination of the disease status involved x-rays was the radiologist blinded?
It is not always easy to determine the answers to these questions when reading the results of a case control study analysis. This is where your critical thinking skills will help you out. Is it reasonable to believe that these determinations are unbiased? Are there other studies with similar results so the mass of evidence is in agreement? Many of the published research articles today are from case control studies. These are the appropriate design for many outcomes, especially those that are rare. These designs are also used where there is a long latent period or duration of expression. These studies are usually less expensive than cohort or cross-sectional studies and are subsequently the largest portion of published research, as a rule. As both the occurrence of disease and the risk factors occur in the past, it is difficult to determine which came first, which can make the observed association stronger than the actual association. Carefully done case control studies still contribute a lot of information in the study of diseases.
Thursday, March 13, 2014
What Can We Learn From Cross-Sectional Studies?
I have become a little frustrated lately with the
barrage of inaccurate statements that are posted all over the Internet. The
statements that I find the most frustrating are those that purport to cite
medical research and then have attention grabbing headlines that are phrased to
excite peoples' fears about their environment. Many times they will quote
an article from a respected journal but will somehow misconstrue the actual
intent of that article. In any case, it has driven me to this. I
want to begin a discussion here of the types of epidemiological evidence and help
you learn how to judge how much belief you could reasonably attach to a study
that might be cited in one of the articles. I thought I would begin at
the bottom of the ladder, so to speak, of weight of evidence. Today's
posting will discuss cross-sectional studies.
First, as you probably know, a cross-sectional
study is like taking a snapshot on a particular day. Our
national census is cross-sectional in that you report your address on the first
day of April of census year. It doesn't matter where you resided the day
before or where you are moving to the next day. It is only for that day.
When a cross-sectional analysis is performed you are only looking at the
characteristics that apply for the date and time the evidence is gathered.
This means that both the outcome and the exposure are from the same time
period.
There are a lot of questions you should ask
yourself about this type of analysis. For example, if you were trying to
make an inference about a long-term exposure, you would need to have a window
of exposure to justify the connection between exposure and outcome. It might
also help if you could quantify the exposure. The classic example is the father
of modern epidemiology John Snow. He deduced the cause of the Broad St. cholera
epidemic was water from a particular well. He removed the pump handle and
the epidemic subsided.
If you are looking at a highly stable
population where nobody moves in or out the error induced by people moving
around is minimal. If your population is going through an upheaval of any
kind in which there is migration of populations, from the rural areas to the
cities, for example, any exposure that is focused on urban population might be
biased due to what is basically an inaccurately measured exposure. So you
can ask yourself questions about the population stability where the
cross-sectional analysis subjects are situated. Also, the outcome might
be associated with the place the subjects live. If you are doing a cross
sectional study in Rochester, MN, where the Mayo Clinic is located, there are
some outcomes that will show up differently here if people can move to
Rochester, MN, to be treated for the particular disease you are researching.
I know this can sound very complicated and when I
first began my graduate program I almost threw my hands up in the air when
these questions arose because they just seemed insurmountable. That is
why these types of studies should be carefully done and all of these questions
addressed. So it would be expected any issue that would make
cross-sectional studies invalid or biased should be addressed in the article publishing
these results.
If you doubt these biases were adequately
addressed, you can see what direction the analysis results would be biased in
the worst case. If you are satisfied the investigators dealt adequately
with these possible biases, the next question would be, what does it all mean?
The evidence gathered in cross-sectional studies is of value to generate
hypotheses for studies to be conducted that would provide better evidence.
What those studies could be is the subject for another day.
Saturday, January 25, 2014
Borgen-- Is it the Best TV Show about politics, ever?
Well if it isn't, please let me know what is. I just started watching the third and final season and only now realize how deep my mourning period since I watched the last episode of Season 2 was. I am like a five year old on Xmas morning. I want to keep watching, but I want to have more episodes to anticipate.
When the West Wing was at its best there was a similar feeling. Only then I wished very hard that Bartlett was our real president. Birgitte Nyborg is a Danish politician and the Danish system of government is not like the American system in many key concepts. Birgitte Nyborg was Prime Minister for Seasons 1 and 2 and we were able to see the many ways consensus was reached in the Danish system. We also were witness to how real compromise could work and everyone could still go home and get a good night's sleep.
But it is not just the idealism that deserves high praise, it is the detail with which these characters deal with their humanity in all of its many facets. The actors perform with the highest quality and demonstrate humanity and complexity. Yet they find ways to lose and come back and try again. It is breathtakingly beautiful in the execution.
When the West Wing was at its best there was a similar feeling. Only then I wished very hard that Bartlett was our real president. Birgitte Nyborg is a Danish politician and the Danish system of government is not like the American system in many key concepts. Birgitte Nyborg was Prime Minister for Seasons 1 and 2 and we were able to see the many ways consensus was reached in the Danish system. We also were witness to how real compromise could work and everyone could still go home and get a good night's sleep.
But it is not just the idealism that deserves high praise, it is the detail with which these characters deal with their humanity in all of its many facets. The actors perform with the highest quality and demonstrate humanity and complexity. Yet they find ways to lose and come back and try again. It is breathtakingly beautiful in the execution.
Thursday, September 12, 2013
Musings and Thought-provoking Citations
I found this collection of quotes and thoughts recently. I had collected and disseminated these to my children around 1990. At the time I attributed these to the original authors when I knew who originally published it. I find these are still thought provoking more than twenty years later.
On Contentment: It is the capacity to accept what one cannot avoid. " one can live magnificently in this world if one knows how to work and how to love, to work for the person one loves, and to love one's work."--Leo Tolstoy
New Directions:
I want to travel as far as I can go,
I want to reach the joy that's in my soul,
And change the limitations that I know,
And feel my mind and spirit grow;
I want to live, exist, "to be"
And hear the truths inside of me.
The essence of greatness is the ability to choose personal fulfillment in circumstances where others choose madness.
Feelings are not just emotions that happen to you. Feelings are reactions you choose to have. If you are in charge of your own emotions, you don't have to choose self-defeating reactions.
You alone control what enters your head as thought.
You make yourself unhappy because of the thoughts you have about the people or things in your life.
A thought becomes a belief when you've worked on it repeatedly, not when you simply try it once and use your initial inability as the rationale for giving up.
Taking charge of yourself involves more than simply trying on new thoughts for size. It requires a determination to be happy, and to challenge and destroy each and every thought that creates a self-immobilizing unhappiness in you.
Self-worth cannot be verified by others. You are worthy because you say it is so. If you depend on others for your values it is other-worth.
Love: the ability and willingness to allow those that you care for to be what they choose for themselves, without any insistence that they satisfy you.
Complaining is the refuge of those who have no self-reliance.
Complaining about yourself is a useless activity and one which keeps you from effectively living your life. It encourages self-pity and immobilizes you in your efforts at giving and receiving love.
If you notice things in yourself that you dislike, rather than complaining you can actively set about taking the necessary corrective steps.
On Forgiveness:
While forgiving may seem to be a generous, magnanimous thing to do, it is also self-serving in a very real sense. Forgiving promotes good fellowship, it strengthens ties with family and friends, and best of all, it is good for one's blood pressure, digestive system and general health.
When we hate our enemies we give them power over us.. power over our sleep, our appetites and our happiness. They would dance with joy if they knew how much they were upsetting us. Our hate is not hurting them at all, but it is turning our own days and nights into a hellish turmoil.
"The more people who believe something, the more apt it is to be wrong, while the one who is right often has to stand alone"...Kierkegaard.
This only appears to get more true as time goes by,
Half the trouble in the world comes from people being cheerful when they should be concerned.
I just read that teaching relaxation to surgical patients may not be doing them any favor. It appears patients are better able to deal with surgical tensions if they are anxious.
"one is rarely lucky enough to be hated for oneself alone."
We may hate a person because he reminds us of someone we feared and disliked when younger, or because we see in him some gross caricature of what we find repugnant in ourself, or because he symbolizes an attitude that seems to threaten us.
"Once you have a clearly defined sense of direction and values, you will find harmony, a balance of giving and receiving. Soon you recognize the destruction that is inseparable from yielding to extremes." Marietta Hartley
On Dreams:
If travel occurs in one's dreams, it can mean a suppressed longing to get away from the boredom of life and to expand one's horizons of experience.
"There are too many of them in the world lately, the hopeful ladies who married grown-up boy children and soon lost all hope. They are the secretaries and nurses and switchboard people, the store clerks, schoolteachers, cab drivers, and Avon ladies. They lead the singles life. Lots of laughs and lots of barren mornings. Skilled sex, mod conversations and all heartaches carefully concealed. They are not ardent libbers, yet at the same time they are not looking for some man to 'take care'. God knows they are expert in taking care of themselves. They just want a grown-up man to share their life with, each of them taking care. But there are one hell of a lot more grown-up ladies than grown-up men." Travis McGee in The Dreadful Lemon Sky by John D. McDonald.
"Life, as we find it, is too hard for us; it entails too much pain, too many disappointments, impossible tasks. We cannot do without palliative remedies. There are perhaps three of these means: Powerful diversions of interest, which lead us to care little about out miseries; substitutive gratifications, which lessen it; and intoxicating substances, which make us insensitive to it. Something of this kind is indispensable." Sigmund Freud.
"Life was probably no different in the Stone Age or the Renaissance than it is in the computer age. Such "diversions" as painting on the cave walls or painting by the numbers, or 'substitutive gratifications' like Christians vs. lions in the Colosseum, or the Raiders vs. the Eagles in the Super Bowl, were and are never the real answer. The closes thing to a panacea has been the use of intoxicating substances." Joseph Pursch.
It is impossible to feel the equal of someone who has been awake longer than you.
Whereas people don't mind loving others for the love of God or humanity, no one wants to be loved only because of a general, undiscriminating love. (See Kurt Vonnegut's God Bless You , Mr. Rosewater. )
The world seems more cheerful if, when we wake up in the morning, we find we are no longer alone and that there is another human being beside us in the half-dark." Vincent Van Gogh
"Life is a banquet and most poor suckers are starving to death." Auntie Mame.
On Contentment: It is the capacity to accept what one cannot avoid. " one can live magnificently in this world if one knows how to work and how to love, to work for the person one loves, and to love one's work."--Leo Tolstoy
New Directions:
I want to travel as far as I can go,
I want to reach the joy that's in my soul,
And change the limitations that I know,
And feel my mind and spirit grow;
I want to live, exist, "to be"
And hear the truths inside of me.
The essence of greatness is the ability to choose personal fulfillment in circumstances where others choose madness.
Feelings are not just emotions that happen to you. Feelings are reactions you choose to have. If you are in charge of your own emotions, you don't have to choose self-defeating reactions.
You alone control what enters your head as thought.
You make yourself unhappy because of the thoughts you have about the people or things in your life.
A thought becomes a belief when you've worked on it repeatedly, not when you simply try it once and use your initial inability as the rationale for giving up.
Taking charge of yourself involves more than simply trying on new thoughts for size. It requires a determination to be happy, and to challenge and destroy each and every thought that creates a self-immobilizing unhappiness in you.
Self-worth cannot be verified by others. You are worthy because you say it is so. If you depend on others for your values it is other-worth.
Love: the ability and willingness to allow those that you care for to be what they choose for themselves, without any insistence that they satisfy you.
Complaining is the refuge of those who have no self-reliance.
Complaining about yourself is a useless activity and one which keeps you from effectively living your life. It encourages self-pity and immobilizes you in your efforts at giving and receiving love.
If you notice things in yourself that you dislike, rather than complaining you can actively set about taking the necessary corrective steps.
On Forgiveness:
While forgiving may seem to be a generous, magnanimous thing to do, it is also self-serving in a very real sense. Forgiving promotes good fellowship, it strengthens ties with family and friends, and best of all, it is good for one's blood pressure, digestive system and general health.
When we hate our enemies we give them power over us.. power over our sleep, our appetites and our happiness. They would dance with joy if they knew how much they were upsetting us. Our hate is not hurting them at all, but it is turning our own days and nights into a hellish turmoil.
"The more people who believe something, the more apt it is to be wrong, while the one who is right often has to stand alone"...Kierkegaard.
This only appears to get more true as time goes by,
Half the trouble in the world comes from people being cheerful when they should be concerned.
I just read that teaching relaxation to surgical patients may not be doing them any favor. It appears patients are better able to deal with surgical tensions if they are anxious.
"one is rarely lucky enough to be hated for oneself alone."
We may hate a person because he reminds us of someone we feared and disliked when younger, or because we see in him some gross caricature of what we find repugnant in ourself, or because he symbolizes an attitude that seems to threaten us.
"Once you have a clearly defined sense of direction and values, you will find harmony, a balance of giving and receiving. Soon you recognize the destruction that is inseparable from yielding to extremes." Marietta Hartley
On Dreams:
If travel occurs in one's dreams, it can mean a suppressed longing to get away from the boredom of life and to expand one's horizons of experience.
"There are too many of them in the world lately, the hopeful ladies who married grown-up boy children and soon lost all hope. They are the secretaries and nurses and switchboard people, the store clerks, schoolteachers, cab drivers, and Avon ladies. They lead the singles life. Lots of laughs and lots of barren mornings. Skilled sex, mod conversations and all heartaches carefully concealed. They are not ardent libbers, yet at the same time they are not looking for some man to 'take care'. God knows they are expert in taking care of themselves. They just want a grown-up man to share their life with, each of them taking care. But there are one hell of a lot more grown-up ladies than grown-up men." Travis McGee in The Dreadful Lemon Sky by John D. McDonald.
"Life, as we find it, is too hard for us; it entails too much pain, too many disappointments, impossible tasks. We cannot do without palliative remedies. There are perhaps three of these means: Powerful diversions of interest, which lead us to care little about out miseries; substitutive gratifications, which lessen it; and intoxicating substances, which make us insensitive to it. Something of this kind is indispensable." Sigmund Freud.
"Life was probably no different in the Stone Age or the Renaissance than it is in the computer age. Such "diversions" as painting on the cave walls or painting by the numbers, or 'substitutive gratifications' like Christians vs. lions in the Colosseum, or the Raiders vs. the Eagles in the Super Bowl, were and are never the real answer. The closes thing to a panacea has been the use of intoxicating substances." Joseph Pursch.
It is impossible to feel the equal of someone who has been awake longer than you.
Whereas people don't mind loving others for the love of God or humanity, no one wants to be loved only because of a general, undiscriminating love. (See Kurt Vonnegut's God Bless You , Mr. Rosewater. )
The world seems more cheerful if, when we wake up in the morning, we find we are no longer alone and that there is another human being beside us in the half-dark." Vincent Van Gogh
"Life is a banquet and most poor suckers are starving to death." Auntie Mame.
Thursday, May 24, 2012
Back with more thoughts from the fog
It has been a while since I posted here. The time has been taken up with too many things I thought I needed to do. It occurred to me that these are my choices and I think I need to choose again. I am not laughing enough. So I decided to streamline the number of things I think I "should" do. So I am cutting back to essentials. I culled my bookcase by looking up the Amazon reviews for the books on my bookshelves. If it was a 3.7 or less and there were at least 100 reviews, they were boxed up for donation someplace still to be determined. This was a great exercise as it whetted my appetite for some really high ranking books. I think there is a 4.8 rated book in my immediate future. As soon as I finish the latest Ann Patchett I am currently reading. Now if only there was a reviewer who could help me go through my closet. I try being honest with myself, but too much honesty just make me want to pull the blankets up over my head in the morning. I hope to put together some extra time in my day so I can let play and mirth back into my life. Spending an hour once in a while watching cute kittens cavort sounds like good medicine if you believe "Laughter is the Best Medicine." A cute basket of kittens probably packs enough preventive medicine to ward of the Black Death. So here's to streamlining my life and breathing new sources of merriment into the spaces that previously were filled with chores.
Monday, November 22, 2010
Children of Divorce Have a Higher Risk of Stroke?
Okay, this is too much. What good did these researchers perform by investigating this link? These stroke-prone individuals cannot go back and ask their parents not to get a divorce so they won't be at risk of stroke. Could these researchers have used their resources to investigate other risk factors so we could all think about implementing strategies to reduce our risk of stroke? I think so. If not, perhaps they could do research in another field. I wonder, did they control for the number of divorces their parents had?
I am really upset by this news. Not because an association was found, but because an association that no one understands and no one can reduce was supposedly found. Now someone else will have to do more research to refute it. (or repudiate it, as Ms Palin would have it.)
Picture a Cathy AAaaaargh! here.
Here is the article that ignited my ire:
http://healthland.time.com/2010/11/22/do-kids-of-divorce-have-strokes-more-often/
I am really upset by this news. Not because an association was found, but because an association that no one understands and no one can reduce was supposedly found. Now someone else will have to do more research to refute it. (or repudiate it, as Ms Palin would have it.)
Picture a Cathy AAaaaargh! here.
Here is the article that ignited my ire:
http://healthland.time.com/2010/11/22/do-kids-of-divorce-have-strokes-more-often/
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