BackgroundP-curve has been proposed as a statistical test of evidential value. The distributions of sets of statistically significant p-values are tested for skewness. P-curves of true effects are right-skewed, with greater density at lower p-values than higher p-values. Analyses of null effects result in a flat or left-skewed distribution. The accuracy of p-curve has not been tested using published research analyses of a null effect. We examined whether p-curve accurately rejects a set of significant p-values obtained for a nonexistent effect.MethodsHomeopathic ultramolecular dilutions are medicinal preparations with active substances diluted beyond Avogadro’s number. Such dilute mixtures are unlikely to contain a single molecule of an active substance. We tested whether p-curve accurately rejects the evidential value of significant results obtained in placebo-controlled clinical trials of homeopathic ultramolecular dilutions.ResultsP-curve accurately rejected the evidential value of significant results obtained in placebo-controlled clinical trials of ultramolecular dilutions. Robustness testing using alternate p-values yielded similar results.ConclusionOur results suggest that p-curve can accurately detect when sets of statistically significant results lack evidential value.
Background: Inappropriate sleep duration has been showed to be associated with increased suicidality among high school students in the United States. An association between inappropriate sleep duration and general depressive symptoms among this population has not been reported.
Objective● Describe the diverse determinants of national health and how they are compositely graded in health care system rankings.● Articulate intrinsic reasons why equity should not be subsumed within other evaluative categories.● Design an equity-limited ratings framework for limiting maximum ratings of inequitible healthcare systems.IntroductionHealthcare systems are often evaluated using comparative health care rankings. Simulations have shown that maximally inequitable health care systems can perform well in published, influential health care system rankings by excelling in non-equity categories1, resulting in highly ranked yet grossly inequitable healthcare systems. Recently, despite below average equity rankings, the healthcare systems of Australia and New Zealand ranked among the top four in The Commonwealth Fund’s international comparative study Mirror, Mirror 20172. Equity rankings should logically limit non-equity rankings given the insignificance of healthcare system improvements to those lacking adequate healthcare coverage. We analyzed whether an equity-limited ranking methodology would limit overall rankings for significantly inequitable healthcare systems while maintaining the general findings of the Commonwealth Fund study.MethodsWe reanalyzed The Commonwealth Fund’s 2017 international health care system comparison using a modified, equity-limited methodology. For each country, maximum non-equity domain summary scores were limited to the equity domain summary score. Countries were ranked using the mean of the five domain-specific performance scores. Overall rankings were compared to the original rankings.ResultsSeven of eleven countries had an overall rank change in the equity-limited model. Countries with above average overall ratings but poor equity ratings had the greatest changes in overall rank. Australia’s overall ranking decreased from second to seventh, thereby matching its equity ranking of seventh. New Zealand changed from fourth to eighth overall, matching its equity ranking as well. Other changes were less significant, with changes of only one overall rank position. Notably, the bottom three countries and the top country were unchanged.ConclusionsEquity-limited ranking methodologies can prevent inequitable health care systems from attaining high overall ratings. Such equity-limited rankings are logical considering the diminished significance of health care system improvements to those lacking adequate health coverage. Methodologies that incorporate equity limits should be used to produce fairer rankings that respect the dignity and rights of all individuals.References1. Reisman S, Blumenkranz Z. Comparative health care system rankings can obscure maximal inequities: A simulation study.Society for Public Health Education (SOPHE) 69th Annual Conference. 2018, June.2. Schneider EC, Sarnak DO, Squires D, Shah A, Doty MM. Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. The Commonwealth Fund. 2017, July.
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