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Journal articles on the topic 'Actuarial scales'
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1
Elwood, Richard W. "Updating Probability in Sex Offender Risk Assessment." International Journal of Offender Therapy and Comparative Criminology 62, no. 7 (June 7, 2017): 2063–80. http://dx.doi.org/10.1177/0306624x17711880.
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Actuarial scales like the Static-99R are widely used to predict an individual’s risk of sexual recidivism. However, current actuarial scales only provide rates of detected sex offenses over 10-year follow-up and do not account for all recidivism risk factors. Therefore, some forensic evaluators extrapolate, adjust, or override recidivism rates derived from actuarial scales to predict the lifetime risk of committed offenses that accounts for external risk factors, those not addressed by the actuarial scales. However, critics contend that altering rates from actuarial scales degrades their predictive validity. This article makes the case for extrapolating risk for time of exposure and for evidence-based external risk factors. It proposes using odds ratios (ORs) from case-control studies to adjust predictions from follow-up cohort studies. Finally, it shows how evaluators can apply ORs and their margins of error to sex offender risk assessment.
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Hanson, R. Karl. "Assessing the Calibration of Actuarial Risk Scales." Criminal Justice and Behavior 44, no. 1 (December 21, 2016): 26–39. http://dx.doi.org/10.1177/0093854816683956.
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Assessing the predictive accuracy of actuarial risk assessment tools requires consideration of discrimination (the differences between recidivists and nonrecidivists) and calibration (the credibility of the recidivism rates associated with test scores or categories). Currently, there are no conventions for reporting calibration effect sizes for offender risk tools. This article explains one promising calibration effect size statistic (the Expected/Observed [E/O] index) and provides an illustrative example of how it can be calculated and interpreted. Briefly, the E/O index is the ratio of the expected number of recidivists to the observed number of recidivists. Guidance is provided for calculating the E/O index with fixed follow-up data as well as from survival data. This article also discusses alternative approaches to examining calibration and provides references to other studies using the E/O index to assess the calibration of offender risk scales.
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Cunningham, Mark D., Jon R. Sorensen, Mark P. Vigen, and S. O. Woods. "Correlates and Actuarial Models of Assaultive Prison Misconduct Among Violence-Predicted Capital Offenders." Criminal Justice and Behavior 38, no. 1 (October 27, 2010): 5–25. http://dx.doi.org/10.1177/0093854810384830.
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Correlates of prison violence and the classification accuracy of an actuarial model were examined from retrospective review of the disciplinary records of former death row inmates in Texas ( N = 111) who had been predicted to commit future violence at trial and subsequently obtained relief from their death sentences between 1989 and 2008. Correlates of “potentially” violent infractions included age (inversely), intellectual capability (inversely), prior violent crime arrest, and gun-only weapon used in murder (inversely). An actuarial scale constructed from the sample was modestly (area under the curve [AUC] = 0.690) associated with combined violence on death row and in the broader prison population, as were scales constructed previously from other samples (AUC = 0.609 to 0.656). Although AUCs for serious assaults in three models were relatively high (AUC = 0.799 to 0.831), low base rates result in these actuarial scales having high false positive rates (e.g., 76%) in identifying offenders who will commit serious prison assaults.
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Grys, D. J. Le. "Actuarial considerations on genetic testing." Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 352, no. 1357 (August 29, 1997): 1057–61. http://dx.doi.org/10.1098/rstb.1997.0085.
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In the UK the majority of life insurers employ relatively liberal underwriting standards so that people can easily gain access to life assurance cover. Up to 95%of applicants are accepted at standard terms. If genetic testing becomes widespread then the buying habits of the public may change. Proportionately more people with a predisposition to major types of disease may take life assurance cover while people with no predisposition may take proportionately less. A model is used to show the possible effect. However, the time–scales are long and the mortality of assured people is steadily improving. The change in buying habits may result in the rate of improvement slowing down. In the whole population, the improvement in mortality is likely to continue and could improve faster if widespread genetic testing results in earlier diagnosis and treatment. Life insurers would not call for genetic tests and need not see the results of previous tests except for very large sums assured. In the UK, life insurers are unlikely to change their underwriting standards and are extremely unlikely to bring in basic premium rating systems that give discounts on the premium or penalty points according to peoples' genetic profile. The implications of widespread genetic testing on medical insurance and some health insurance covers may be more extreme.
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GRANN, MARTIN, HENRIK BELFRAGE, and ANDERS TENGSTRÖM. "Actuarial Assessment of Risk for Violence." Criminal Justice and Behavior 27, no. 1 (February 2000): 97–114. http://dx.doi.org/10.1177/0093854800027001006.
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This article explores the predictive validity of two actuarial risk assessment instruments among mentally disordered offenders in Sweden: the historical part (H-10) of a historical, clinical, and risk management factors instrument (HCR-20) and the Violence Risk Appraisal Guide (VRAG). Actuarial scores were obtained retrospectively in two populations: one group of violent offenders with personality disorders and one with violent offenders diagnosed with schizophrenia. The predictive accuracy was evaluated with receiver operating characteristic analysis using a violent reconviction within 2 years from release or discharge as the criterion variable. Both scales fared better in the group of personality-disordered offenders than in the group of offenders with schizophrenia, and the H-10 fared better than the VRAG in both offender groups. The study found that historical data maintain a robust predictive validity in a population of personality-disordered offenders, whereas clinical and risk management factors may be of greater importance in offender populations in which major mental disorders are prevalent.
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Hanson, R. Karl, and David Thornton. "Improving risk assessments for sex offenders: A comparison of three actuarial scales." Law and Human Behavior 24, no. 1 (2000): 119–36. http://dx.doi.org/10.1023/a:1005482921333.
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Seto, Michael C. "Is More Better? Combining Actuarial Risk Scales to Predict Recidivism Among Adult Sex Offenders." Psychological Assessment 17, no. 2 (2005): 156–67. http://dx.doi.org/10.1037/1040-3590.17.2.156.
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Roberts, Caton F., Dennis M. Doren, and David Thornton. "Dimensions Associated with Assessments of Sex Offender Recidivism Risk." Criminal Justice and Behavior 29, no. 5 (October 2002): 569–89. http://dx.doi.org/10.1177/009385402236733.
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This research explored empirical dimensions of sex offender recidivism risk. Study 1 portrayed descriptive statistics and factor structure information concerning actuarial risk instruments and diagnoses derived from a sample of sex offenders being evaluated for civil commitment in Wisconsin. Study 2 used a sample from England and Wales to analyze the relationships between individual risk factors commonly found as items within actuarial scales. Factor structure results from Study 2 conceptually overlapped those found in the first sample, and variables developed from this factor structure predicted sexual reconviction as well. Results from these two studies are discussed in terms of separable components of risk for sexual recidivism and the roles those components may play in processes underlying sexual reoffense.
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Wilkie, A. D. "Some experiments with salary scales." Journal of the Institute of Actuaries 112, no. 1 (June 1985): 61–73. http://dx.doi.org/10.1017/s0020268100041986.
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1. Salary scales have been widely used in actuarial literature about pension schemes, but they do not seem to have been developed beyond the idea first introduced by Manly (1901) and used in a series of papers following this, including McGowan (1901), Manly (1902, 1903 and 1911), and M'Lauchlan (1908). King (1905), Bacon (1907) and M'Lauchlan (1914) discuss the construction of a salary scale from records of individual employees. King made some valuable observations on how a salary scale may change with time if the observed population is not a stationary one, for example, because the firm is growing or declining, which Bacon also commented on, and M'Lauchlan went into considerable detail about the separation of different grades. Thomas (1913) gave an example of an organization with six ranks, within each of which there was a salary scale, and showed explicit probabilities of promotion in each year of age. His development comes closest to what I shall discuss below. Text books on Life Contingencies, such as Jordan (1952), Hooker & Longley-Cook (1957) and most recently Neill (1977), have followed essentially the definition introduced by Manly, as also have papers and text books on pension funds, such as Porteous (1936), Marples (1948), Heywood & Marples (1950), Crabbe & Poyser (1953) and Lee (1973). Curiously Spurgeon (1922) does not mention salary scales, although his book was written after they had come into use.
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Mills, Jeremy F., Daryl G. Kroner, and Toni Hemmati. "The Measures of Criminal Attitudes and Associates (MCAA)." Criminal Justice and Behavior 31, no. 6 (December 2004): 717–33. http://dx.doi.org/10.1177/0093854804268755.
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Recent research has demonstrated that antisocial attitudes and antisocial associates are among the better predictors of antisocial behavior. This study tests the predictive validity of the Measures of Criminal Attitudes and Associates (MCAA) in a sample of adult male offenders. The MCAA comprises two parts: Part A is a quantified self-report measure of criminal friends, and Part B contains four attitude scales: Violence, Entitlement, Antisocial Intent, and Associates. The MCAA scales showed predictive validity for the outcomes of general and violent recidivism. In addition, the MCAA significantly improved the prediction of violent recidivism over an actuarial risk assessment instrument alone. Discussion centers on the contribution that antisocial attitudes and associates make to risk assessment.
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Douglas, Kevin S., Melissa Yeomans, and Douglas P. Boer. "Comparative Validity Analysis of Multiple Measures of Violence Risk in a Sample of Criminal Offenders." Criminal Justice and Behavior 32, no. 5 (October 2005): 479–510. http://dx.doi.org/10.1177/0093854805278411.
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This study compared the predictive validity of multiple indices of violence risk among 188 general population criminal offenders: Historical-Clinical-Risk Management-20 (HCR-20) Violence Risk Assessment Scheme, Violence Risk Appraisal Guide (VRAG), Violent Offender Risk Assessment Scale (VORAS), Hare Psychopathy Checklist-Revised (PCL-R), and Screening Version (PCL:SV). Several indices were related to violent recidivism with large statistical effect sizes: HCR-20 (Total, Clinical and Risk Management scales, structured risk judgments), VRAG, and behavioral scales of psychopathy measures. Multivariate analyses showed that HCR-20 indices were consistently related to violence and that the VRAG entered some analyses. Findings are inconsistent with a position of strict actuarial superiority, as HCR-20 structured risk judgments—an index of structured professional or clinical judgment—were as strongly related to violence.
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Bonta, James. "Offender Risk Assessment." Criminal Justice and Behavior 29, no. 4 (August 2002): 355–79. http://dx.doi.org/10.1177/0093854802029004002.
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During the past 20 years, there have been significant developments in the area of offender assessment. As a result, this knowledge has placed the field in a position to construct guidelines as to what should characterize useful and effective offender assessment instruments. The author’s suggestions as to what constitutes good assessment ranges from the noncontroversial (e.g., actuarial instruments) to the more contentious (e.g., lessening one’s reliance on static risk scales). Whether the reader agrees with the views expressed, it is hoped that the force of the empirical arguments will at least provoke some careful consideration rather than summarily dismissing them.
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Elwood, Richard W. "Defining Probability in Sex Offender Risk Assessment." International Journal of Offender Therapy and Comparative Criminology 60, no. 16 (July 28, 2016): 1928–41. http://dx.doi.org/10.1177/0306624x15587912.
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There is ongoing debate and confusion over using actuarial scales to predict individuals’ risk of sexual recidivism. Much of the debate comes from not distinguishing Frequentist from Bayesian definitions of probability. Much of the confusion comes from applying Frequentist probability to individuals’ risk. By definition, only Bayesian probability can be applied to the single case. The Bayesian concept of probability resolves most of the confusion and much of the debate in sex offender risk assessment. Although Bayesian probability is well accepted in risk assessment generally, it has not been widely used to assess the risk of sex offenders. I review the two concepts of probability and show how the Bayesian view alone provides a coherent scheme to conceptualize individuals’ risk of sexual recidivism.
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Brittain, Brian J., Leah Georges, and Jim Martin. "Examining the Predictive Validity of the Public Safety Assessment." Criminal Justice and Behavior 48, no. 10 (April 7, 2021): 1431–49. http://dx.doi.org/10.1177/00938548211005836.
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The purpose of this study was to examine the predictive validity of the Public Safety Assessment (PSA), an actuarial pretrial assessment instrument, administered to 15,931 individuals in Volusia County, Florida, between 2016 and 2017. A series of logistic regression models analyzed the influence of the PSA’s risk scores for Failure to Appear (FTA) and New Criminal Activity (NCA), as well as gender, race, and the length of time spent in pretrial custody on incidents of failure to appear and new pretrial arrest. The findings suggest that while both the FTA and NCA scales predicted pretrial failure fairly well, the variation explained by the models suggest that there is much that we do not understand about predicting pretrial failure to appear and new pretrial arrest, indicating the need for further research and refinement of pretrial assessment instruments.
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Lehmann, Robert J. B., David Thornton, L. Maaike Helmus, and R. Karl Hanson. "Developing Nonarbitrary Metrics for Risk Communication." Criminal Justice and Behavior 43, no. 12 (July 9, 2016): 1661–87. http://dx.doi.org/10.1177/0093854816651656.
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Nominal risk categories for actuarial risk assessment information should be grounded in nonarbitrary, evidence-based criteria. The current study presents numeric indicators for interpreting one such tool, the Risk Matrix 2000, which is widely used to assess the recidivism risk of sexual offenders. Percentiles, risk ratios, and 5-year recidivism rates are presented based on an aggregated sample ( N = 3,144) from four settings: England and Wales, Scotland, Germany, and Canada. The Risk Matrix 2000 Sex, Violence, and Combined scales showed moderate accuracy in assessing the risk of sexual, non-sexual violent, and violent recidivism, respectively. Although there were some differences across samples in the distributions of risk categories, relative increases in recidivism for ascending risk categories were remarkably consistent. Options for presenting percentiles, risk ratios, and absolute recidivism estimates in applied evaluations are offered, with discussion of the advantages, disadvantages, and limitations of these risk communication metrics.
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Kohrt, Holbrook, Brit Turnbull, G. Laport, D. Miklos, J. Shizuru, L. Johnston, S. Arai, et al. "Outcomes Following Allogeneic Hematopoietic Cell Transplantation (HCT) Using Non-Myeloablative Conditioning with Total Lymphoid Irradiation (TLI) and Anti-Thymocyte Globulin (ATG) Confirm a Low Incidence of Graft Versus Host Disease (GVHD) with Retained Anti-Tumor Activity." Blood 112, no. 11 (November 16, 2008): 3310. http://dx.doi.org/10.1182/blood.v112.11.3310.3310.
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Abstract We recently translated a murine model of bone marrow transplantation that protected against GVHD yet retained graft anti-tumor reactions to a clinical study of 37 patients using TLI and ATG conditioning with HLA matched related and unrelated donors, and showed a marked reduction in the incidence of acute GVHD (Lowsky et al., NEJM2005; 353:1321–31). We now report the clinical outcomes following transplantation of a larger set of patients using the same TLI and ATG regimen. One hundred and eleven consecutive patients with hemato-lymphoid malignancies (64 with lymphoid malignancies and 47 with myeloid malignancies) received G-CSF mobilized grafts from HLA matched related (60), unrelated (45) or 1-allele mismatched (6) donors. Of the 64 patients with lymphoid malignancies, 17 (27%) were in complete remission (CR), and 47 (73%) were in partial remission (PR) or were with progressive disease (PD) at the start of the transplant regimen. Of these 64 patients 59 (92%) had advanced stage disease and 32 (50%) had disease relapse after a prior autologous transplant. Of the 47 patients with myeloid malignancies 26 (55%) were in a first CR, 10 (21%) in a second CR and 11 (24%) were beyond second CR or were with residual disease at the start of TLI and ATG conditioning. One hundred and seven (96%) patients achieved multilineage donor hematopoietic cell engraftment within 28 days after HCT, while 4 (4%) patients had primary graft failure. All patients were monitored for manifestations of acute GVHD (aGVHD) with standard scoring scales during the first 100 days after transplantation. The cumulative incidence of clinically significant aGVHD grades II–IV was 2% and 11% for recipients of grafts from related and unrelated donors, respectively. All cases of aGVHD were treated to resolution except in one patient. One hundred and two (92%) patients survived beyond 100 days who were evaluated for the development of chronic GVHD. The cumulative risk for extensive chronic GVHD at three years was 27% with no difference in risk for recipients of related and unrelated grafts. Among the 64 patients with lymphoid malignancies, the follow-up for the first enrolled patient was 2252 days and for the last patient 360 days; 20 of these patients died of which 14 were from relapse of disease. Of the 47 patients in PR or with stable disease at the start of TLI and ATG 30 (64%) converted to a CR of which only 7 patients had any evidence of acute or chronic GVHD. The K-M actuarial EFS according to status of disease at the start of TLI and ATG is shown in figure 1a. For the 47 patients with myeloid malignancies, the period of observation the first and last patient was 2229 and 369 days, respectively; 24 of the 25 patient deaths were due to disease relapse. The K-M actuarial EFS stratified according to status of disease at the start of TLI and ATG is shown in figure 1b. The non-relapse mortality at 1 year for recipients of related and unrelated grafts is 3% and 7%, respectively. These data confirm that TLI and ATG conditioning is well tolerated and associated with low incidences of non-relapse mortality and of acute and chronic GVHD. The high incidence of conversion from PR to CR and the relatively low incidence of disease progression in this group of patients with advanced stage disease suggest the presence of retained graft anti-tumor activity. Figure 1a. Actuarial event free survival among patients with lymphoid malignancies startified by disease status at transplantation, n = 64. Figure 1b. Actuarial event free survival among patients with myeloid malignancies startified by disease status at transplantation, n = 47. Figure 1a. Actuarial event free survival among patients with lymphoid malignancies startified by disease status at transplantation, n = 64. . / Figure 1b. Actuarial event free survival among patients with myeloid malignancies startified by disease status at transplantation, n = 47.
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Thomson, Lindsay, Michelle Davidson, Caroline Brett, Jonathan Steele, and Rajan Darjee. "Risk Assessment in Forensic Patients with Schizophrenia: The Predictive Validity of Actuarial Scales and Symptom Severity for Offending and Violence over 8 – 10 Years." International Journal of Forensic Mental Health 7, no. 2 (January 2008): 173–89. http://dx.doi.org/10.1080/14999013.2008.9914413.
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Hatchett, Gregory T. "Does Psychopathology Predict Counseling Duration?" Psychological Reports 93, no. 1 (August 2003): 175–85. http://dx.doi.org/10.2466/pr0.2003.93.1.175.
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Many university counseling centers have adopted case management policies in an effort to conserve limited resources. Fearing that students with more severe problems will consume too many clinical resources, many counseling centers have decided to refer such students to external agencies or providers for mental health services. However, this fear might be unwarranted because empirical research has not shown a substantial relationship between psychopathology and counseling duration. This investigation examined whether a new treatment-planning inventory, the Butcher Treatment Planning Inventory, might be useful for better understanding the relationships between various problem areas and counseling duration. Participants were new clients (students and staff members) at a university counseling center in the southeastern USA. Professional staff members and graduate students in counselor education, clinical psychology, and clinical social work provided counseling services to the participants. Lower scores on several scales predicted counseling duration. In other words, clients with lower scores on these scales (representing less psychopathology) attended more counseling sessions than clients with greater psychopathology. Therapists' background also predicted counseling duration; clients who worked with either a professional staff member or graduate student in counselor education attended more sessions than clients who worked with a graduate student in clinical psychology. The results of this study, combined with previous research, suggest that measures of psychopathology are not very useful for identifying which clients will complete long-term counseling. Until better information becomes available, actuarial tables remain the most efficient means for predicting counseling duration.
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Chin, Eu Gene, Erin M. Buchanan, Chad Ebesutani, and John Young. "Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales?" Psychological Reports 122, no. 4 (June 22, 2018): 1550–75. http://dx.doi.org/10.1177/0033294118783508.
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The 21-item Depression, Anxiety, and Stress Scales (DASS-21) is a self-report measure that is easy to administer, quick to score, and is freely available. Widely used in diverse settings and populations, confirmatory factor analytic evidence has accumulated for a bifactor model underlying this multidimensional measure. Studies employing an exploratory bifactor approach to more closely examine its underlying structure and inter-relations of factors, however, have been scarce. This is unfortunate because confirmatory techniques often employ indirect ways of handling model misspecification, whereas exploratory methods enable more direct approaches. Moreover, more precise approaches to modeling an exploratory bifactor structure have not been examined with the DASS-21. Based on several large samples of undergraduate students in the United States, the first two parts of the paper (Studies 1 and 2) utilized both exploratory ( M = 19.7 years of age) and confirmatory factor analytic methods ( M = 19.7 years of age) following those presented by contemporary multidimensional modeling theorists. Building upon these results, the third part of the paper (Study 3; M = 20.0 years of age) examined sensitivity-/specificity-related indices to provide cut-off score recommendations for a revised DASS-21 instrument based on a newly identified and supported bifactor structure. Implications of these results are discussed in terms of taxonomy, challenges inherent in multidimensional modeling, and potential use of the revised DASS-21 measure as a component of an actuarial decision-making strategy to inform clinical referrals.
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Hølmebakk, T., and A. Nesbakken. "Surgery for Pilonidal Disease." Scandinavian Journal of Surgery 94, no. 1 (March 2005): 43–46. http://dx.doi.org/10.1177/145749690509400111.
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Background and Aims: Surgery for pilonidal disease carries a considerable risk of complications, recurrence, and cosmetic sequelae. The present study evaluates the four procedures performed in our institution. Material and Methods: Operations from 1999 through 2002 were retrospectively assessed. Cosmetic result and overall satisfaction were reported on visual analogue scales. Results: Seventy-three procedures were performed in 71 patients: excision with open granulation in nine; excision and primary suture in 25; rhomboid plasty in 23; and lay-open in 16 patients. Infections were as frequent after rhomboid plasty (40 %) as after excision and primary suture (43 %). Nineteen recurrences (26 %) were observed during a median follow-up of 20 months, and the estimated five-year actuarial recurrence rate was 44 %. Recurrence occurred in 1/9 (11 %) after excision with granulation, in 4/23 (17 %) after excision and suture, in 5/25 (20 %) after rhomboid plasty, and in 9/16 patients (56 %) after lay-open. The cosmetic result was satisfactory only in 22/53 (42 %) patients; the result was poor in 16/53 (30 %) patients. Conclusion: Results after surgery for pilonidal disease are modest and should be compared to conservative management in a randomised trial.
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Brouillette-Alarie, Sébastien, Jean Proulx, and R. Karl Hanson. "Three Central Dimensions of Sexual Recidivism Risk: Understanding the Latent Constructs of Static-99R and Static-2002R." Sexual Abuse 30, no. 6 (February 9, 2017): 676–704. http://dx.doi.org/10.1177/1079063217691965.
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The most commonly used risk assessment tools for predicting sexual violence focus almost exclusively on static, historical factors. Consequently, they are assumed to be unable to directly inform the selection of treatment targets, or evaluate change. However, researchers using latent variable models have identified three dimensions in static actuarial scales for sexual offenders: Sexual Criminality, General Criminality, and a third dimension centered on young age and aggression to strangers. In the current study, we examined the convergent and predictive validity of these dimensions, using psychological features of the offender (e.g., antisocial traits, hypersexuality) and recidivism outcomes. Results indicated that (a) Sexual Criminality was related to dysregulation of sexuality toward atypical objects, without intent to harm; (b) General Criminality was related to antisocial traits; and (c) Youthful Stranger Aggression was related to a clear intent to harm the victim. All three dimensions predicted sexual recidivism, although only General Criminality and Youthful Stranger Aggression predicted nonsexual recidivism. These results indicate that risk tools for sexual violence are multidimensional, and support a shift from an exclusive focus on total scores to consideration of subscales measuring psychologically meaningful constructs.
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Starke, Robert M., David J. McCarthy, Ching-Jen Chen, Hideyuki Kano, Brendan McShane, John Lee, David Mathieu, et al. "Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium." Journal of Neurosurgery 132, no. 1 (January 2020): 114–21. http://dx.doi.org/10.3171/2018.8.jns181467.
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OBJECTIVEIn this multicenter study, the authors reviewed the results obtained in patients who underwent Gamma Knife radiosurgery (GKRS) for dural arteriovenous fistulas (dAVFs) and determined predictors of outcome.METHODSData from a cohort of 114 patients who underwent GKRS for cerebral dAVFs were compiled from the International Gamma Knife Research Foundation. Favorable outcome was defined as dAVF obliteration and no posttreatment hemorrhage or permanent symptomatic radiation-induced complications. Patient and dAVF characteristics were assessed to determine predictors of outcome in a multivariate logistic regression analysis; dAVF-free obliteration was calculated in a competing-risk survival analysis; and Youden indices were used to determine optimal radiosurgical dose.RESULTSA mean margin dose of 21.8 Gy was delivered. The mean follow-up duration was 4 years (range 0.5–18 years). The overall obliteration rate was 68.4%. The postradiosurgery actuarial rates of obliteration at 3, 5, 7, and 10 years were 41.3%, 61.1%, 70.1%, and 82.0%, respectively. Post-GRKS hemorrhage occurred in 4 patients (annual risk of 0.9%). Radiation-induced imaging changes occurred in 10.4% of patients; 5.2% were symptomatic, and 3.5% had permanent deficits. Favorable outcome was achieved in 63.2% of patients. Patients with middle fossa and tentorial dAVFs (OR 2.4, p = 0.048) and those receiving a margin dose greater than 23 Gy (OR 2.6, p = 0.030) were less likely to achieve a favorable outcome. Commonly used grading scales (e.g., Borden and Cognard) were not predictive of outcome. Female sex (OR 1.7, p = 0.03), absent venous ectasia (OR 3.4, p < 0.001), and cavernous carotid location (OR 2.1, p = 0.019) were predictors of GKRS-induced dAVF obliteration.CONCLUSIONSGKRS for cerebral dAVFs achieved obliteration and avoided permanent complications in the majority of patients. Those with cavernous carotid location and no venous ectasia were more likely to have fistula obliteration following radiosurgery. Commonly used grading scales were not reliable predictors of outcome following radiosurgery.
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Meleth, S., L. Allen, E. Kvale, R. Meredith, S. Spencer, M. Heslin, L. Nabell, J. Posey, and E. Partridge. "A qualitative study of exceptional survivors of cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e17522-e17522. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e17522.
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e17522 Background: An exceptional survivor of cancer is an individual who has outlived actuarial predictions for his/her particular form of cancer or experienced a complete regression. This pilot study was designed to determine if there were any biological, psychosocial, cultural or lifestyle characteristics exceptional survivors of cancer that can be measured and transferred through interventions to other cancer patients. Methods: The sample consisted of 21 survivors of cancer who were identified by oncologists at UAB as exceptional survivors. The study gathered qualitative data through semi-structured interviews and two validated scales measuring resilience, sense of coherence. A new cancer ‘catastrophizing’ scale based on the pain catastrophizing scale (PCS) was tested for its concordance with the two validated scales. The diagnosis and treatment information on these patients was collected through a questionnaire completed by the patient's oncologist. Results: Eight oncologists referred twenty-five patients to the study. Twenty-one patients agreed to participate. A unifying theme across all patient interviews was a deep spiritual connection with a supreme being. Praying for healing, intercessory prayer, and seeking guidance through faith with respect to best treatment options were common. The patients verbalized faith in physicians and were willing to seek more experimental treatments largely due to their spirituality. In general, the survivors were highly resilient as measured by the resilience scale and had a high sense of coherence as measured by the sense of coherence scale. They were also unlikely to conceptualize the diagnosis as a ‘catastrophe’ as measured by the new cancer catastrophizing scale. Conclusions: This study provides preliminary evidence of a relationship between spirituality and exceptional survivorship. Findings suggest exceptional survivors may be more willing to participate in clinical trials than other populations of cancer patients. Future studies should prospectively follow cancer patients to ascertain the temporal nature of the association between spirituality and exceptional survivorship. No significant financial relationships to disclose.
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Cohen-Inbar, Or, Robert M. Starke, Hideyuki Kano, Gregory Bowden, Paul Huang, Rafael Rodriguez-Mercado, Luis Almodovar, et al. "Stereotactic radiosurgery for cerebellar arteriovenous malformations: an international multicenter study." Journal of Neurosurgery 127, no. 3 (September 2017): 512–21. http://dx.doi.org/10.3171/2016.7.jns161208.
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OBJECTIVECerebellar arteriovenous malformations (AVMs) represent the majority of infratentorial AVMs and frequently have a hemorrhagic presentation. In this multicenter study, the authors review outcomes of cerebellar AVMs after stereotactic radiosurgery (SRS).METHODSEight medical centers contributed data from 162 patients with cerebellar AVMs managed with SRS. Of these patients, 65% presented with hemorrhage. The median maximal nidus diameter was 2 cm. Favorable outcome was defined as AVM obliteration and no posttreatment hemorrhage or permanent radiation-induced complications (RICs). Patients were followed clinically and radiographically, with a median follow-up of 60 months (range 7–325 months).RESULTSThe overall actuarial rates of obliteration at 3, 5, 7, and 10 years were 38.3%, 74.2%, 81.4%, and 86.1%, respectively, after single-session SRS. Obliteration and a favorable outcome were more likely to be achieved in patients treated with a margin dose greater than 18 Gy (p < 0.001 for both), demonstrating significantly better rates (83.3% and 79%, respectively). The rate of latency preobliteration hemorrhage was 0.85%/year. Symptomatic post-SRS RICs developed in 4.5% of patients (n = 7). Predictors of a favorable outcome were a smaller nidus (p = 0.0001), no pre-SRS embolization (p = 0.003), no prior hemorrhage (p = 0.0001), a higher margin dose (p = 0.0001), and a higher maximal dose (p = 0.009). The Spetzler-Martin grade was not found to be predictive of outcome. The Virginia Radiosurgery AVM Scale score (p = 0.0001) and the Radiosurgery-Based AVM Scale score (p = 0.0001) were predictive of a favorable outcome.CONCLUSIONSSRS results in successful obliteration and a favorable outcome in the majority of patients with cerebellar AVMs. Most patients will require a nidus dose of higher than 18 Gy to achieve these goals. Radiosurgical and not microsurgical scales were predictive of clinical outcome after SRS.
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Nout, Remi A., Lonneke V. van de Poll-Franse, Marnix L. M. Lybeert, Carla C. Wárlám-Rodenhuis, Jan J. Jobsen, Jan Willem M. Mens, Ludy C. H. W. Lutgens, Betty Pras, Wim L. J. van Putten, and Carien L. Creutzberg. "Long-Term Outcome and Quality of Life of Patients With Endometrial Carcinoma Treated With or Without Pelvic Radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) Trial." Journal of Clinical Oncology 29, no. 13 (May 1, 2011): 1692–700. http://dx.doi.org/10.1200/jco.2010.32.4590.
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PurposeTo determine the long-term outcome and health-related quality of life (HRQL) of patients with endometrial carcinoma (EC) treated with or without pelvic radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) trial.Patients and MethodsBetween 1990 and 1997, 714 patients with stage IC grade 1 to 2 or IB grade 2 to 3 EC were randomly allocated to pelvic external-beam radiotherapy (EBRT) or no additional treatment (NAT). HRQL was evaluated with the Short Form 36-Item (SF-36) questionnaire; subscales from the European Organisation for Research and Treatment of Cancer (EORTC) PR25 module for bowel and bladder symptoms and the OV28 and CX24 modules for sexual symptoms; and demographic questions. Analysis was by intention-to-treat.ResultsMedian follow-up was 13.3 years. The 15-year actuarial locoregional recurrence rates were 5.8% for EBRT versus 15.5% for NAT (P < .001), and 15-year overall survival was 52% versus 60% (P = .14). Of the 351 patients confirmed to be alive with correct address, 246 (70%) returned the questionnaire. Patients treated with EBRT reported significant (P < .01) and clinically relevant higher rates of urinary incontinence, diarrhea, and fecal leakage leading to more limitations in daily activities. Increased symptoms were reflected by the frequent use of incontinence materials after EBRT (day and night use, 42.9% v 15.2% for NAT; P < .001). Patients treated with EBRT reported lower scores on the SF-36 scales “physical functioning” (P = .004) and “role-physical” (P = .003).ConclusionEBRT for endometrial cancer is associated with long-term urinary and bowel symptoms and lower physical and role-physical functioning, even 15 years after treatment. Despite its efficacy in reducing locoregional recurrence, EBRT should be avoided in patients with low- and intermediate-risk EC.
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Akimoto, T., K. Hiroyuki, K. Shirai, K. Harada, T. Ebara, K. Ito, T. Yamamoto, and T. Nakano. "HDR brachytherapy combined with hypofractionated EBRT for intermediate-high risk prostate cancer." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 14655. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.14655.
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14655 Background: To report on biochemical outcome and late complication in pts with localized prostate cancer (LPC) treated with HDR-brachytherapy (HDR-BT) combined with hypofractionated EBRT. Methods: From 06/2000 to 12/2004, 108 pts with intermediate (37 pts.) or high-risk (63 pts.) LPC were treated with hypofractionated EBRT (3 Gy × 17 fr., thrice a week) followed by HDR-BT (5 Gy × 5; 9 pts, 7 Gy × 3; 15 pts, 9 Gy × 2; 76 pts). HDR-BT was administered a week after the completion of the hypofractionated EBRT. The planning target volume was defined as the prostate gland with a 5-mm margin all around, and the planning was conducted based on CT images. Biologically effective doses (BED) to the prostate was between 83–84 Gy. All patient received androgen ablation. Acute and late toxicities were scored according to the EORTC/RTOG morbidity grading scales. Median follow-up duration was 27 months from HDR-BT and 39 months from initiation of androgen ablation. Results: All pts completed treatment. The 5-year actuarial PSA relapse-free survival rates for intermediate and high-risk pts were 100% and 93% respectively. Acute genitourinary (GU) toxicity was 64% in grade 0–1, 31% in grade 2 and 6% in grade 3. Urethral stricture developed in 3%, with a median time from the completion of HDR brachytherapy to the occurrence of 22 months (19–26 months). Ten pts had grade 2 rectal bleeding, with a median time from the completion of HDR brachytherapy to the occurrence of 11 months (7–14 months). No pts developed grade 3 or more severe rectal complication. The incidence of acute and late toxicity did not differ according to the fractionation schema of HDR-BT. Conclusion: Our data demonstrate the successful feasibility of HDR-BT combined with hypofractionated EBRT as a safe method for escalating the total dose to the prostate without significant increasing risk of acute and late GU and rectal toxicities. No significant financial relationships to disclose.
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Lowsky, Robert, Keith Stockerl-Goldstein, Ginna Laport, David Miklos, Sally Arai, Judith Shizuru, Laura Johnston, Karl Blume, Robert Negrin, and Samuel Strober. "Clinical Outcomes Following Allogeneic Hematopoietic Cell Transplantation (HCT) Using Nonmyeloablative Host Conditioning with Total Lymphoid Irradiation and Anti-Thymocyte Globulin Confirm a Low Incidence of Graft Versus Host Disease (GVHD) and Retained Graft Anti-Tumor Activity." Blood 108, no. 11 (November 16, 2006): 603. http://dx.doi.org/10.1182/blood.v108.11.603.603.
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Abstract Murine models of HCT established that nonablative conditioning using low doses of irradiation targeted to lymphoid tissues (TLI) and depletive anti-T cell antibodies protects against GVHD by skewing residual host T cell subsets to favor regulatory natural killer T cells that suppress GVHD by polarizing donor T cells toward secretion of non-inflammatory cytokines such as IL-4. We recently translated the murine protocol to a clinical study of 37 patients (pts) using nonmyeloablative TLI and ATG host conditioning with HLA matched related (MRD) and unrelated (URD) donors, and showed a marked reduction in the incidence of acute GVHD (aGVHD) while retaining graft anti-tumor activity (Lowsky et al., NEJM2005; 353). We now report the clinical outcomes following HCT of a larger set of pts using the same TLI and ATG regimen. Seventy consecutive pts with hemato-lymphoid malignancies (46 with lymphoid malignancies and 24 with acute leukemias) received MRD (38) or URD (32) G-CSF mobilized HCT. Of the 46 pts with lymphoid malignancies, 40 (87%) had advanced stage disease, 25 (54%) had relapsed after a prior autologous transplant, 31 (67%) were in partial remission (PR) at the start of the allogeneic transplant regimen, 6 (13%) had progressive disease (PD) and 9 (20%) were in a complete remission (CR). Of the 24 pts with acute leukemia 13 (54%) were in a first CR, 8 (33%) in second CR or beyond, and 3 (13%) were not in remission at the start of the transplant regimen. Sixty-eight of the 70 (97%) pts achieved multilineage donor cell engraftment within 56 days post transplantation. All pts were monitored for manifestations of aGVHD using standard scoring scales during the first 100 days after transplantation. Among the 38 recipients of an MRD graft aGVHD was grade 0 in 36 (95%) pts and grade I in 2 (5%) pts. Among the 32 pts that received grafts from an URD aGVHD was scored as grade 0 in 24 (75%) pts, grade I in 5 (16%) pts, grade II in 2 (6%) pts, and grade III in 1 (3%). All cases of aGVHD were treated to resolution. Thirty-seven of 38 (97%) pts with grafts from a MRD survived more than 100 days and were at risk for chronic GVHD (cGVHD). Among these, 26 (70%) had no cGVHD, 4 (11%) had limited cGVHD and 7 (19%) extensive cGVHD. Twenty-eight pts with grafts from URDs were at risk for cGVHD; 19 (68%) had no cGVHD, 3 (11%) had limited cGVHD and 6 (21%) had extensive cGVHD. Among the 46 transplant recipients with lymphoid malignancies, the follow-up ranged from 1674 to 197 days; 12 of these patients died and six were from disease relapse. The Kaplan-Meier (K-M) actuarial event free survival (EFS) at 3 years is 43%. EFS for patients that relapsed with lymphoma after failing a prior autologous transplant (n=25) was not different compared to patients that did not have a prior autologous transplant (n=21) as 6 events occured in both groups. The period of observation for the 24 pts with acute leukemia ranged from 190 to 1631 days; 10 of 11 pts died from disease relapse. The K-M actuarial EFS at 3 years is 50%. These data confirm the low incidence of acute and chronic GVHD using the TLI and ATG regimen in patients receiving grafts from MRD and URD. The low incidence of disease relapse in this group of patients with high-risk disease demonstrates the retention of graft anti-tumor activity.
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Guix, B., J. Bartrina, I. Henriquez, R. Serrate, P. Palombo, J. Vendrell, and J. Tello. "Combined treatment image guided-intensity modulated radiotherapy (IG-IMRT) plus high-dose rate brachytherapy (HDR) and hormonotherapy (HT) as treatment for high-risk prostate cancer: Five-year result of a phase II study." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 15571. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.15571.
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15571 Background: To report early and late toxicity and preliminary biochemical outcome in 345 patients with high-risk (Gleason >=7; PSA>20 or T2c-T3) clinically localized prostate cancer treated with combined high-dose-rate brachytherapy and IMRT (IMRT-HDR) to the prostate and seminal vesicles with 24–36 months of hormononal treatment (goserelin+bicalutamide) (HT). Methods: Between 12/1999 and 10/2003, 345 patients with PSA>20, Gleason score>6 and/or T2c-T3 N0 M0 prostate cancer were treated with IG-IMRT followed by HDR implant to the prostate and HT. Patients were randomly assigned to receive HT for 24 (group 1, 172 patients) or 36 months (group 2, 173 patients). Acute and late toxicities were scored by the EORTC/RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. PSA failure was defined as nadir +2.0 ng/ml. Results: All patients completed treatment. One patient included in the group 1 and none of the group 2 experienced grade 3 rectal toxicity (rectal ulcer). Seven patients in each group (4.0%) developed acute Grade 2 urinary symptoms, and none experienced urinary retention. No patient (0%) developed Grade 4 rectal complications or grade 3 or 4 urinary complications. With a median follow-up of 44 months, the 5-year actuarial PSA relapse-free survival rates for the whole group of patients was 95.7 %. No statistical differences between group 1 and 2 patients were found. Conclusions: High-dose IG-IMRT+HDR and HT was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute and late rectal and urinary complications were significantly low, compared with what has been observed with high-dose conventional, 3D-conformal or IMRT-only. Short-term PSA control rates seem to be at least comparable to those achieved with 3D-EBRT or IMRT. Both treatment regimes were very effective. Longer follow-up is needed to know if better PSA control rate are achieved with longer HT. No significant financial relationships to disclose.
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Guix, B., J. Bartrina, J. Tello, L. Quinzanos, and T. Lacorte. "Dose escalation by high-dose 3D-conformal radiotherapy (HD-3D-CRT) or low-dose 3D-conformal radiotherapy plus HDR brachytherapy (LD-3D-CRT+HDR-B) for intermediate- or high-risk prostate cancer: Early results of a prospective comparative trial." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 5118. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.5118.
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5118 Background: To report early and late toxicity and preliminary biochemical outcome in 445 patients with intermediate- or high-risk clinically localized prostate cancer treated with either HD-3D-CRT or with LD-3D-CRT+HDR-B. Methods: Between December 1999 and October 2005, 445 patients (pts) with PSA'10, Gleason score'6 and/or T2b-T3 N0 M0 prostate cancer entered the study. Pts were assigned to one of the two treatment groups: 76 Gy HD-3D-CRT to the prostate in 38 fractions (group 1; 223 patients) or 46 Gy LD-3D-CRT+ 16 Gy HDR-B given in 2 fractions of 8 Gy (group 2, 222 patients). Both groups were well balanced taking into account patient's as well as tumors’ characteristics. Toxicities were scored by the EORTC /RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. Results: All pts completed treatment. None pts included in the group 1 or 2 experienced grade 3 rectal toxicity. 28 pts of group 1 (12.5%) and 6 pts of group 2 (2.7%) developed grade 2 rectal toxicity (rectal bleeding or urgency). 15 pts in group 1 (6.7%) and 3 pts in group 2 (1.3%) developed grade 1 rectal bleeding (less than 2 times/week). In group 1 and 2, 81.8%and 95,9% of pts were free from rectal reactions respectively (p < 0.005). 19 pts in each group developed acute Grade 2 urinary symptoms (mainly dysuria), and none experienced urinary retention. No pts (0%) developed Grade 3 or 4 rectal or urinary complications. With a mean follow-up of 55 months, the 5-year actuarial PSA relapse-free survival rates for intermediate- and high-risk group 1 pts were 92 and 91 % respectively and 97 and 96 % for group 2 pts (p < 0.06). Conclusions: High-dose 3D-EBRT +HDR brachytherapy is a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute and late rectal and urinary complications were significantly reduced with the combined treatment, compared with what was observed with high-dose conventional, 3D-CRT. Short-term PSA control rates tends to be better with in the HDR-boosted patients as spected by higher effective-dose. No significant financial relationships to disclose.
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Zhang, Yanwei. "BAYESIAN ANALYSIS OF BIG DATA IN INSURANCE PREDICTIVE MODELING USING DISTRIBUTED COMPUTING." ASTIN Bulletin 47, no. 3 (July 6, 2017): 943–61. http://dx.doi.org/10.1017/asb.2017.15.
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AbstractWhile Bayesian methods have attracted considerable interest in actuarial science, they are yet to be embraced in large-scaled insurance predictive modeling applications, due to inefficiencies of Bayesian estimation procedures. The paper presents an efficient method that parallelizes Bayesian computation using distributed computing on Apache Spark across a cluster of computers. The distributed algorithm dramatically boosts the speed of Bayesian computation and expands the scope of applicability of Bayesian methods in insurance modeling. The empirical analysis applies a Bayesian hierarchical Tweedie model to a big data of 13 million insurance claim records. The distributed algorithm achieves as much as 65 times performance gain over the non-parallel method in this application. The analysis demonstrates that Bayesian methods can be of great value to large-scaled insurance predictive modeling.
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Shakil, M., and M. Ahsanullah. "Some inferences on the distribution of the Demmel condition number of complex Wishart matrices." Special Matrices 5, no. 1 (January 26, 2017): 127–38. http://dx.doi.org/10.1515/spma-2017-0011.
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Abstract In recent years, many researchers have studied the distributions of the Demmel (or the scaled) condition numbers (DCN) of complex Wishart matrices. In this paper, several new distributional properties of the distribution of the Demmel condition number of complex Wishart matrices are presented. The limiting distributions of the standardized extreme order statistics are given. Since the truncated distributions arise in practical statistics where the ability of record observations is limited to a given threshold or within a specified range, there has been a great interest, in recent years, in the characterizations of probability distributions by truncated moments. Before a particular probability distribution model is applied to fit the realworld data, it is necessary to confirm whether the given continuous probability distribution satisfies the underlying requirements by its characterization. Therefore, in this paper, some characterizations of the distribution of DCN are also shown. We hope that the findings of this paper will be quite useful in many fields of pure and applied sciences, such as, probability, statistics, multivariate statistics, linear algebra, operator algebra theory, actuarial science, physics, wireless communications, and polarimetric synthetic aperture radar (PolSAR), among others.
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Helmus, L. Maaike. "Estimating the probability of sexual recidivism among men charged or convicted of sexual offences: Evidence-based guidance for applied evaluators." Sexual Offending: Theory, Research, and Prevention 16 (June 15, 2021). http://dx.doi.org/10.5964/sotrap.4283.
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Risk assessment is routinely applied in forensic decision-making. Although relative risk information from risk scales is robust across diverse samples and settings, estimates of the absolute probability of sexual recidivism are not. Nonetheless, absolute recidivism estimates are still necessary in some evaluations. This paper summarizes research and offers guidance on evidence-based practices for assessing the probability of recidivism, organized largely around questions commonly asked in court. Overall, estimating the probability of sexual recidivism is difficult and should be undertaken with humility and circumspection. That being said, research favours empirical-actuarial risk tools for this task, more structured scales, and the use of multiple scales. Professional overrides of risk scale results should not be used under any circumstances. Paradoxically, however, professional judgement is still required in some circumstances. Risk scales do not consider all relevant risk factors, but the added value of external risk factors reaches a point of diminishing returns and may or may not be incremental (or worse, can degrade accuracy). There are reasons actuarial risk scales may both underestimate recidivism (e.g., undetected offending, short follow-ups) and overestimate recidivism (e.g., inclusion of sex offences not of interest in some referral questions, data on declining crime and recidivism rates, newer studies demonstrating overestimation of recidivism). Given all these considerations and the need for humility, in the absence of exceptional circumstances, I would not deviate too far from empirical estimates.
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Hilton, N. Zoe, and L. Maaike Helmus. "Using Graphs in Sexual Violence Risk Communication: Benefits May Depend on the Risk Metric." Sexual Abuse, August 17, 2020, 107906322095119. http://dx.doi.org/10.1177/1079063220951191.
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Actuarial scales provide a relatively objective and reliable assessment of individuals’ risk of recidivism. Recent research has explored how graphs can improve quantitative risk communication. We tested whether graphs can improve understanding and perception of sexual violence risk when matched with risk metric. Participants ( N = 676) were recruited from Amazon’s MTurk platform and read a brief description of a man convicted of a sexual offense, including results of a fictional sexual recidivism risk scale. In Study 1, absolute risk of recidivism enabled participants to distinguish between individuals with relatively high and low risk of sexual recidivism. In Study 2, this distinction was enhanced by adding a graph, especially when percentiles were communicated. Risk ratios increased perceived risk. Objective numeracy increased understanding and reduced perceived risk. We recommend that risk communication assumes limited statistical numeracy, and further research with practitioners to test the effect of graphs and risk metrics on forensic/judicial decisions.