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Washington has abandoned the assumptions and certain of the limitations of proxy warfare.
However, when considered in the context of the lack of direct cost measurements, the limitations of proxy cost measures, and the prevalence of quasi-experimental designs, it is difficult to know what level of confidence to place in that finding.
We used the more extensive and rigorous modified PROMIS methodology in an attempt to overcome some of the inherent limitations of proxy measures and to accomplish much of the work of establishing valid and reliable items prospectively, rather than depending entirely on retrospective testing of measures.
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Although we acknowledge the limitations of mixing proxy with self-reported responses, on balance we adopted the position that it was better to include proxy reports for those unable to self-complete our questionnaire than to exclude them from the study altogether, which would lead to a biased sample.
Enriching the observational record will go some way to eliminating, or at the very least mitigating, the biases and limitations of each proxy (Gergis and Fowler 2009; Jones and Mann 2004).
The limitations of this proxy have been discussed elsewhere, 4 5 including that, especially in European countries with colonial histories such as Scotland, many of the elderly were born abroad, and substantial proportions (often 50% or more) of resident ethnic minority populations are not born abroad.
Possible issues affecting the sensitivity and specificity of the psychological autopsy include factors related to the method of assessment per se and limitations of the proxy-based interview procedure [ 6].
Even though proxies still report more limitations, the magnitude of proxy response bias was very small.
A second limitation of using proxy measures is illustrated by the conflict of explicit cost measures and proxy measures within the same study.
A third limitation of using proxy measures is related to the inconsistent relationship between process measures correlated with adverse events and the actual rates of those adverse events.
These findings contribute to an increasing body of evidence that shows that the classification of water sources as improved or unimproved is inadequate to measure access to safe water and that highlights the limitations of using this proxy alone.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com