BACKGROUND: Prediction models and prognostic scores have been increasingly popular in both clinical practice and clinical research settings, for example to aid in risk-based decision making or control for confounding. In many medical fields, a large number of prognostic scores are available, but practitioners may find it difficult to choose between them due to lack of external validation as well as lack of comparisons between them.METHODS: Borrowing methodology from network meta-analysis, we describe an approach to Multiple Score Comparison meta-analysis (MSC) which permits concurrent external validation and comparisons of prognostic scores using individual patient data (IPD) arising from a large-scale international collaboration. We describe the challenges in adapting network meta-analysis to the MSC setting, for instance the need to explicitly include correlations between the scores on a cohort level, and how to deal with many multi-score studies. We propose first using IPD to make cohort-level aggregate discrimination or calibration scores, comparing all to a common comparator. Then, standard network meta-analysis techniques can be applied, taking care to consider correlation structures in cohorts with multiple scores. Transitivity, consistency and heterogeneity are also examined.RESULTS: We provide a clinical application, comparing prognostic scores for 3-year mortality in patients with chronic obstructive pulmonary disease using data from a large-scale collaborative initiative. We focus on the discriminative properties of the prognostic scores. Our results show clear differences in performance, with ADO and eBODE showing higher discrimination with respect to mortality than other considered scores. The assumptions of transitivity and local and global consistency were not violated. Heterogeneity was small.CONCLUSIONS: We applied a network meta-analytic methodology to externally validate and concurrently compare the prognostic properties of clinical scores. Our large-scale external validation indicates that the scores with the best discriminative properties to predict 3 year mortality in patients with COPD are ADO and eBODE.
Worldwide, an increasing number of students seek private supplementary tutoring, known as ‘shadow education.’ Various studies report social class differences in the use of shadow education. High-SES families may invest in shadow education as a form of concerted cultivation, seeking to improve their children’s school achievement. In this study, we apply meta-analytic structural equation modeling to explore relationships between parental education, income, and the use of shadow education across nations and educational contexts. We find robust relationships between parental education, income and the use of shadow education. Moreover, we assess a mediating role of shadow education in the relationship between SES and achievement. Shadow education appears to fulfill a competitive function for privileged families who seek to secure advantage in educational competition. We conclude that educational research, particularly research concerned with inequality of opportunities, needs to take account of the progressively prominent position of shadow education in the educational landscape.
Internet technology offers a lot of new opportunities for the dissemination of information, sharing of support and consultation of professionals. Innovating professionals from multiple disciplines have begun to exploit the new opportunities for parenting support. The studies presented in this book are meant to deepen our insights in the subject of online parenting support and investigate the feasibility to use single session email consultation to empower parents. This publication includes: - A systematic review of 75 studies on online parenting support. - A meta-analytic review of 12 studies on online tools to improve parenting. - A content analysis of 129 parenting questions and responses in single session email consultation. - An analysis and validation study of the newly developed Guiding the Empowerment Process model. - An evaluation study of the effects of single session email consultation on parental empowerment. The results of this research indicate that the Internet is not only a source of information, but it can also be an instrument for support and training, aiming to improve parental competencies.
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