PubMed · 3668467
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R Madeley. 1987. Postneonatal mortality.. https://doi.org/10.1136/jech.41.1.85
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OBJECTIVE: To determine to what extent institutions carrying out in vitro fertilisation can reasonably be ranked according to their live birth rates. DESIGN: Retrospective analysis of prospectively collected data on live birth rate after in vitro fertilisation. SETTING: 52 clinics in the United Kingdom carrying out in vitro fertilisation over the period April 1994 to March 1995. MAIN OUTCOME MEASURE: Estimated adjusted live birth rate for each clinic; their rank and its associated uncertainty. RESULTS: There were substantial and significant differences between the live birth rates of the clinics. There was great uncertainty, however, concerning the true ranks, particularly for the smaller clinics. Only one clinic could be confidently ranked in the bottom quarter according to this measure of performance. Many centres had substantial changes in rank between years, even though their live birth rate did not change significantly. CONCLUSIONS: Even when there are substantial differences between institutions, ranks are extremely unreliable statistical summaries of performance and change in performance, particularly for smaller institutions. Any performance indicator should always be associated with a measure of sampling variability.
Growth of the human population has been underway for thousands of years and was never a problem until recently. It is now expanding exponentially, and today global population stands at nearly 6 billion with 97 million being added each year. Currently, overpopulation has led to serious social and environmental problems such as poverty, overcrowded slums, crime, terrorism, pollution of air and water, and depletion of the protective ozone layer. Warnings were sounded, but few listened. The enthusiasm once generated for solving the problem of too many people was short-lived. The press with puzzling abrogation of its responsibility to the public managed to allay all fears of population overgrowth. Two U.S. presidents welcomed such growth as a stimulus to economic development. Although modern contraceptives are safe, effective, and widely available, more are badly needed, but none are in the pipeline. Research is being hampered by hostile attitudes and by the high cost in time and money of bringing a new contraceptive to an uncertain market with the added threat of litigation. At the present rate of growth, the population will double in the next century. This is believed to be beyond the carrying capacity of our planet. Corrective measures by man or nature need to be undertaken.
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