Background:Effective, scalable strategies to improve maternal, fetal, and newborn health and reduce preventable morbidity and mortality are urgently needed in low- and middle-income countries. Building on the successes of previous checklist-based programs, the World Health Organization (WHO) and partners led the development of the Safe Childbirth Checklist (SCC), a 28-item list of evidence-based practices linked with improved maternal and newborn outcomes. Pilot-testing of the Checklist in Southern India demonstrated dramatic improvements in adherence by health workers to essential childbirth-related practices (EBPs). The BetterBirth Trial seeks to measure the effectiveness of SCC impact on EBPs, deaths, and complications at a larger scale.
Methods: This matched-pair, cluster-randomized controlled, adaptive trial will be conducted in 120 facilities across 24 districts in Uttar Pradesh, India. Study sites, identified according to predefined eligibility criteria, were matched by measured covariates before randomization. The intervention, the SCC embedded in a quality improvement program, consists of leadership engagement, a 2-day educational launch of the SCC, and support through placement of a trained peer “coach” to provide supportive supervision and real-time data feedback over an 8-month period with decreasing intensity. A facility-based childbirth quality coordinator is trained and supported to drive sustained behavior change after the BetterBirth team leaves the facility. Study participants are birth attendants and women and their newborns who present to the study facilities for childbirth at 60 intervention and 60 control sites. The primary outcome is a composite measure including maternal death, maternal severe morbidity, stillbirth, and newborn death, occurring within 7 days after birth. The sample size (n = 171,964) was calculated to detect a 15% reduction in the primary outcome. Adherence by health workers to EBPs will be measured in a subset of births (n = 6000). The trial will be conducted in close collaboration with key partners including the Governments of India and Uttar Pradesh, the World Health Organization, an expert Scientific Advisory Committee, an experienced local implementing organization (Population Services International, PSI), and frontline facility leaders and workers
Discussion: If effective, the WHO Safe Childbirth Checklist program could be a powerful health facilitystrengthening intervention to improve quality of care and reduce preventable harm to women and newborns, with millions of potential beneficiaries.
Trial registration: BetterBirth Study Protocol dated: 13 February 2014; ClinicalTrials.gov: NCT02148952; Universal Trial Number: U1111-1131-5647.
Data are being collected on human behaviour in cities such as London, New York, Singapore and Shanghai, with a view to meeting city dwellers' needs more effectively. Incorporating decision-making theory into analyses of the data from these 'urban observatories' would yield further valuable information.
The vast majority of social science research presently uses small (MB or GB scale) data sets. These fixed-scale data sets are commonly downloaded to the researcher's computer where the analysis is performed locally, and are often shared and cited with well-established technologies, such as the Dataverse Project (see Dataverse.org), to support the published results. The trend towards Big Data -- including large scale streaming data -- is starting to transform research and has the potential to impact policy-making and our understanding of the social, economic, and political problems that affect human societies. However, this research poses new challenges in execution, accountability, preservation, reuse, and reproducibility. Downloading these data sets to a researcher’s computer is infeasible or not practical; hence, analyses take place in the cloud, require unusual expertise, and benefit from collaborative teamwork and novel tool development. The advantage of these data sets in how informative they are also means that they are much more likely to contain highly sensitive personally identifiable information. In this paper, we discuss solutions to these new challenges so that the social sciences can realize the potential of Big Data.
The accuracy of U.S. Social Security Administration (SSA) demographic and financial forecasts is crucial for the solvency of its Trust Funds, other government programs, industry decision making, and the evidence base of many scholarly articles. Because SSA makes public little replication information and uses qualitative and antiquated statistical forecasting methods, fully independent alternative forecasts (and the ability to score policy proposals to change the system) are nonexistent. Yet, no systematic evaluation of SSA forecasts has ever been published by SSA or anyone else --- until a companion paper to this one (King, Kashin, and Soneji, 2015a). We show that SSA's forecasting errors were approximately unbiased until about 2000, but then began to grow quickly, with increasingly overconfident uncertainty intervals. Moreover, the errors are all in the same potentially dangerous direction, making the Social Security Trust Funds look healthier than they actually are. We extend and then attempt to explain these findings with evidence from a large number of interviews we conducted with participants at every level of the forecasting and policy processes. We show that SSA's forecasting procedures meet all the conditions the modern social-psychology and statistical literatures demonstrate make bias likely. When those conditions mixed with potent new political forces trying to change Social Security, SSA's actuaries hunkered down trying hard to insulate their forecasts from strong political pressures. Unfortunately, this otherwise laudable resistance to undue influence, along with their ad hoc qualitative forecasting models, led the actuaries to miss important changes in the input data. Retirees began living longer lives and drawing benefits longer than predicted by simple extrapolations. We also show that the solution to this problem involves SSA or Congress implementing in government two of the central projects of political science over the last quarter century:  promoting transparency in data and methods and  replacing with formal statistical models large numbers of qualitative decisions too complex for unaided humans to make optimally.
"Robust standard errors" are used in a vast array of scholarship to correct standard errors for model misspecification. However, when misspecification is bad enough to make classical and robust standard errors diverge, assuming that it is nevertheless not so bad as to bias everything else requires considerable optimism. And even if the optimism is warranted, settling for a misspecified model, with or without robust standard errors, will still bias estimators of all but a few quantities of interest. The resulting cavernous gap between theory and practice suggests that considerable gains in applied statistics may be possible. We seek to help researchers realize these gains via a more productive way to understand and use robust standard errors; a new general and easier-to-use "generalized information matrix test" statistic that can formally assess misspecification (based on differences between robust and classical variance estimates); and practical illustrations via simulations and real examples from published research. How robust standard errors are used needs to change, but instead of jettisoning this popular tool we show how to use it to provide effective clues about model misspecification, likely biases, and a guide to considerably more reliable, and defensible, inferences. Accompanying this article is open source software that implements the methods we describe.
The financial stability of four of the five largest U.S. federal entitlement programs, strategic decision making in several industries, and many academic publications all depend on the accuracy of demographic and financial forecasts made by the Social Security Administration (SSA). Although the SSA has performed these forecasts since 1942, no systematic and comprehensive evaluation of their accuracy has ever been published by SSA or anyone else. The absence of a systematic evaluation of forecasts is a concern because the SSA relies on informal procedures that are potentially subject to inadvertent biases and does not share with the public, the scientific community, or other parts of SSA sufficient data or information necessary to replicate or improve its forecasts. These issues result in SSA holding a monopoly position in policy debates as the sole supplier of fully independent forecasts and evaluations of proposals to change Social Security. To assist with the forecasting evaluation problem, we collect all SSA forecasts for years that have passed and discover error patterns that could have been---and could now be---used to improve future forecasts. Specifically, we find that after 2000, SSA forecasting errors grew considerably larger and most of these errors made the Social Security Trust Funds look more financially secure than they actually were. In addition, SSA's reported uncertainty intervals are overconfident and increasingly so after 2000. We discuss the implications of these systematic forecasting biases for public policy.
Large errors in flu prediction were largely avoidable, which offers lessons for the use of big data.
In February 2013, Google Flu Trends (GFT) made headlines but not for a reason that Google executives or the creators of the flu tracking system would have hoped. Nature reported that GFT was predicting more than double the proportion of doctor visits for influenza-like illness (ILI) than the Centers for Disease Control and Prevention (CDC), which bases its estimates on surveillance reports from laboratories across the United States ( 1, 2). This happened despite the fact that GFT was built to predict CDC reports. Given that GFT is often held up as an exemplary use of big data ( 3, 4), what lessons can we draw from this error?
The social sciences are undergoing a dramatic transformation from studying problems to solving them; from making do with a small number of sparse data sets to analyzing increasing quantities of diverse, highly informative data; from isolated scholars toiling away on their own to larger scale, collaborative, interdisciplinary, lab-style research teams; and from a purely academic pursuit to having a major impact on the world. To facilitate these important developments, universities, funding agencies, and governments need to shore up and adapt the infrastructure that supports social science research. We discuss some of these developments here, as well as a new type of organization we created at Harvard to help encourage them -- the Institute for Quantitative Social Science. An increasing number of universities are beginning efforts to respond with similar institutions. This paper provides some suggestions for how individual universities might respond and how we might work together to advance social science more generally.
Existing research on the extensive Chinese censorship organization uses observational methods with well-known limitations. We conducted the first large-scale experimental study of censorship by creating accounts on numerous social media sites, randomly submitting different texts, and observing from a worldwide network of computers which texts were censored and which were not. We also supplemented interviews with confidential sources by creating our own social media site, contracting with Chinese firms to install the same censoring technologies as existing sites, and—with their software, documentation, and even customer support—reverse-engineering how it all works. Our results offer rigorous support for the recent hypothesis that criticisms of the state, its leaders, and their policies are published, whereas posts about real-world events with collective action potential are censored.
We offer the first large scale, multiple source analysis of the outcome of what may be the most extensive effort to selectively censor human expression ever implemented. To do this, we have devised a system to locate, download, and analyze the content of millions of social media posts originating from nearly 1,400 different social media services all over China before the Chinese government is able to find, evaluate, and censor (i.e., remove from the Internet) the large subset they deem objectionable. Using modern computer-assisted text analytic methods that we adapt to and validate in the Chinese language, we compare the substantive content of posts censored to those not censored over time in each of 85 topic areas. Contrary to previous understandings, posts with negative, even vitriolic, criticism of the state, its leaders, and its policies are not more likely to be censored. Instead, we show that the censorship program is aimed at curtailing collective action by silencing comments that represent, reinforce, or spur social mobilization, regardless of content. Censorship is oriented toward attempting to forestall collective activities that are occurring now or may occur in the future --- and, as such, seem to clearly expose government intent.
We marshal discoveries about human behavior and learning from social science research and show how they can be used to improve teaching and learning. The discoveries are easily stated as three social science generalizations: (1) social connections motivate, (2) teaching teaches the teacher, and (3) instant feedback improves learning. We show how to apply these generalizations via innovations in modern information technology inside, outside, and across university classrooms. We also give concrete examples of these ideas from innovations we have experimented with in our own teaching.
The American system of higher education is under attack by political, economic, and educational forces that threaten to undermine its business model, governmental support, and operating mission. The potential changes are considerably more dramatic and disruptive than what we've already experienced. Traditional colleges and universities urgently need a coherent, thought-out response. Their central role in ensuring the creation, preservation, and distribution of knowledge may be at risk and, as a consequence, so too may be the spectacular progress across fields we have come to expect as a result.
Symposium contributors include Henry E. Brady, John Mark Hansen, Gary King, Nannerl O. Keohane, Michael Laver, Virginia Sapiro, and Maya Sen.
We discuss a method for improving causal inferences called "Coarsened Exact Matching'' (CEM), and the new "Monotonic Imbalance Bounding'' (MIB) class of matching methods from which CEM is derived. We summarize what is known about CEM and MIB, derive and illustrate several new desirable statistical properties of CEM, and then propose a variety of useful extensions. We show that CEM possesses a wide range of desirable statistical properties not available in most other matching methods, but is at the same time exceptionally easy to comprehend and use. We focus on the connection between theoretical properties and practical applications. We also make available easy-to-use open source software for R and Stata which implement all our suggestions.
In the election for President of the United States, the Electoral College is the body whose members vote to elect the President directly. Each state sends a number of delegates equal to its total number of representatives and senators in Congress; all but two states (Nebraska and Maine) assign electors pledged to the candidate that wins the state's plurality vote. We investigate the effect on presidential elections if states were to assign their electoral votes according to results in each congressional district,and conclude that the direct popular vote and the current electoral college are both substantially fairer compared to those alternatives where states would have divided their electoral votes by congressional district.
The financial viability of Social Security, the single largest U.S. Government program, depends on accurate forecasts of the solvency of its intergenerational trust fund. We begin by detailing information necessary for replicating the Social Security Administration’s (SSA’s) forecasting procedures, which until now has been unavailable in the public domain. We then offer a way to improve the quality of these procedures due to age-and sex-specific mortality forecasts. The most recent SSA mortality forecasts were based on the best available technology at the time, which was a combination of linear extrapolation and qualitative judgments. Unfortunately, linear extrapolation excludes known risk factors and is inconsistent with long-standing demographic patterns such as the smoothness of age profiles. Modern statistical methods typically outperform even the best qualitative judgments in these contexts. We show how to use such methods here, enabling researchers to forecast using far more information, such as the known risk factors of smoking and obesity and known demographic patterns. Including this extra information makes a sub¬stantial difference: For example, by only improving mortality forecasting methods, we predict three fewer years of net surplus, $730 billion less in Social Security trust funds, and program costs that are 0.66% greater of projected taxable payroll compared to SSA projections by 2031. More important than specific numerical estimates are the advantages of transparency, replicability, reduction of uncertainty, and what may be the resulting lower vulnerability to the politicization of program forecasts. In addition, by offering with this paper software and detailed replication information, we hope to marshal the efforts of the research community to include ever more informative inputs and to continue to reduce the uncertainties in Social Security forecasts.
Amelia II is a complete R package for multiple imputation of missing data. The package implements a new expectation-maximization with bootstrapping algorithm that works faster, with larger numbers of variables, and is far easier to use, than various Markov chain Monte Carlo approaches, but gives essentially the same answers. The program also improves imputation models by allowing researchers to put Bayesian priors on individual cell values, thereby including a great deal of potentially valuable and extensive information. It also includes features to accurately impute cross-sectional datasets, individual time series, or sets of time series for diﬀerent cross-sections. A full set of graphical diagnostics are also available. The program is easy to use, and the simplicity of the algorithm makes it far more robust; both a simple command line and extensive graphical user interface are included.
When respondents use the ordinal response categories of standard survey questions in different ways, the validity of analyses based on the resulting data can be biased. Anchoring vignettes is a survey design technique intended to correct for some of these problems. The anchors package in R includes methods for evaluating and choosing anchoring vignettes, and for analyzing the resulting data.
We highlight common problems in the application of random treatment assignment in large scale program evaluation. Random assignment is the defining feature of modern experimental design. Yet, errors in design, implementation, and analysis often result in real world applications not benefiting from the advantages of randomization. The errors we highlight cover the control of variability, levels of randomization, size of treatment arms, and power to detect causal effects, as well as the many problems that commonly lead to post-treatment bias. We illustrate with an application to the Medicare Health Support evaluation, including recommendations for improving the design and analysis of this and other large scale randomized experiments.