Incremental Sampling Methodology: Applications for Background Screening Assessments

This article presents the findings from a numerical simulation study that was conducted to evaluate the performance of alternative statistical analysis methods for background screening assessments when data sets are generated with incremental sampling methods (ISMs). A wide range of background and site conditions are represented in order to test different ISM sampling designs. Both hypothesis tests and upper tolerance limit (UTL) screening methods were implemented following U.S. Environmental Protection Agency (USEPA) guidance for specifying error rates. The simulations show that hypothesis testing using two‐sample t ‐tests can meet standard performance criteria under a wide range of conditions, even with relatively small sample sizes. Key factors that affect the performance include unequal population variances and small absolute differences in population means. UTL methods are generally not recommended due to conceptual limitations in the technique when applied to ISM data sets from single decision units and due to insufficient power given standard statistical sample sizes from ISM.     

Family violence in gambling help-seeking populations

Elevated rates of family violence among treatment-seeking problem gamblers compared to general population estimates have been reported in Spain, Canada and Australia. This study examined the occurrence of family violence among 454 problem gambling help-seeking clients (370 gamblers, 84 affected others) recruited through 3 national gambling treatment services in New Zealand. Measures used were the Problem Gambling Severity Index, and a modified version of the HITS Scale which assessed physical, emotional, verbal and sexual abuse. Past-year family violence among gamblers in this sample was 46.8% for victimization, 41.2% for perpetration and 55.0% for any form of family violence. Among affected others the occurrence was 65.5% for victimization, 57.1% for perpetration and 71.4% for any form of violence. The most common type of violence was verbal intimate partner violence. Affected others and women gamblers reported higher rates of violence victimization and perpetration. These findings underscore the importance of screening gambling help-seeking clients for family violence, and the development of prevention and treatment programmes to address violence in this population, with particular attention to affected others and women gamblers. Future research should assess coercive control and the gendered nature of family violence among problem gambling help-seekers.     

Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.     

Responding to the call: a conceptual model for kinship care assessment

Kinship care has become an important care option worldwide. However, in many jurisdictions, child welfare services use traditional foster care assessment systems. The assessment of the kinship home poses particular challenges. The initial assessment of the kinship home, enabling emergency placements, provides a child‐centred perspective. However, agencies frequently fail to meet the designated time frame for completion of the assessment/approval process. Such failures require the development of different conceptual models for kinship care service delivery, especially for assessments. This paper builds on earlier work on assessment models, drawing on the international literature and the author's involvement and research on kinship care in Ireland. The usability of the proposed model needs to be evaluated across different legislative, policy and practice contexts internationally.     

Using In Vitro High‐Throughput Screening Data for Predicting Benzo[k]Fluoranthene Human Health Hazards

Today there are more than 80,000 chemicals in commerce and the environment. The potential human health risks are unknown for the vast majority of these chemicals as they lack human health risk assessments, toxicity reference values, and risk screening values. We aim to use computational toxicology and quantitative high‐throughput screening (qHTS) technologies to fill these data gaps, and begin to prioritize these chemicals for additional assessment. In this pilot, we demonstrate how we were able to identify that benzo[k]fluoranthene may induce DNA damage and steatosis using qHTS data and two separate adverse outcome pathways (AOPs). We also demonstrate how bootstrap natural spline‐based meta‐regression can be used to integrate data across multiple assay replicates to generate a concentration–response curve. We used this analysis to calculate an in vitro point of departure of 0.751 μM and risk‐specific in vitro concentrations of 0.29 μM and 0.28 μM for 1:1,000 and 1:10,000 risk, respectively, for DNA damage. Based on the available evidence, and considering that only a single HSD17B4 assay is available, we have low overall confidence in the steatosis hazard identification. This case study suggests that coupling qHTS assays with AOPs and ontologies will facilitate hazard identification. Combining this with quantitative evidence integration methods, such as bootstrap meta‐regression, may allow risk assessors to identify points of departure and risk‐specific internal/in vitro concentrations. These results are sufficient to prioritize the chemicals; however, in the longer term we will need to estimate external doses for risk screening purposes, such as through margin of exposure methods.     

The Optimal Allocation Combination for the One-Sided Sequential Screening Procedure Based on the Individual Misclassification Error

In this article, the expected total costs of three kinds of quality cost functions for the one-sided sequential screening procedure based on the individual misclassification error are obtained, where the expected total cost is the sum of the expected cost of inspection, the expected cost of rejection, and the expected cost of quality. The computational formulas for three kinds of expected total costs are derived when k screening variables are allocated into r stages. The optimal allocation combination is determined based on the criterion of minimum expected total cost. At last, we give one example to illustrate the selection of the optimal allocation combination for the sequential screening procedure.     

Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)

Several colorectal cancer (CRC) screening models have been developed describing the progression of adenomas to CRC. Currently, there is increasing evidence that serrated lesions can also develop into CRC. It is not clear whether screening tests have the same test characteristics for serrated lesions as for adenomas, but lower sensitivities have been suggested. Models that ignore this type of colorectal lesions may provide overly optimistic predictions of the screen‐induced reduction in CRC incidence. To address this issue, we have developed the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model that includes the adenoma‐carcinoma pathway and the serrated pathway to CRC as well as characteristics of colorectal lesions. The model structure and the calibration procedure are described in detail. Calibration resulted in 19 parameter sets for the adenoma‐carcinoma pathway and 13 for the serrated pathway that match the age‐ and sex‐specific adenoma and serrated lesion prevalence in the COlonoscopy versus COlonography Screening (COCOS) trial, Dutch CRC incidence and mortality rates, and a number of other intermediate outcomes concerning characteristics of colorectal lesions. As an example, we simulated outcomes for a biennial fecal immunochemical test screening program and a hypothetical one‐time colonoscopy screening program. Inclusion of the serrated pathway influenced the predicted effectiveness of screening when serrated lesions are associated with lower screening test sensitivity or when they are not removed. To our knowledge, this is the first model that explicitly includes the serrated pathway and characteristics of colorectal lesions. It is suitable for the evaluation of the (cost)effectiveness of potential screening strategies for CRC.     

The roller-coaster of experiences: becoming the parent of a deaf child

When early testing indicates a hearing loss, parents find themselves on a roller-coaster of experiences leaving little time or space for reflection. This study is based on interviews with families in the Flemish region of Belgium, one of the earliest in the world to introduce universal neonatal screening for hearing loss. Starting from a phenomenological approach, we explore parents’ accounts of their experiences in order to uncover the meanings of early parenting of a child identified with a label. Soon after birth, these parents encounter a different world in which intertwined discourses construct parenthood with a deaf child. During the process of becoming a parent, representations of deafness as impairment were omnipresent. In contrast to a medical and technological perspective that insists on the need to intervene as fast as possible, it is argued that the private and social implications of rapid intervention require explicit consideration.