A Suggested Approach to Overcome California''s Inability to Permit Urban Resource Recovery Facilities

The premature political termination of the permit reviews of five urban resource recovery projects in California may indicate a deficiency in the process under which project health risk assessments are performed and policy biases of the public agencies that control the contents of the assessments. This article examines the permitting process that separates project health risk assessments from environmental impact reports and the anti-resource-recovery goals and policies of the state and local agencies that guide the preparation of project health risk assessments. Also examined are two independent studies made of the informational adequacy of the LANCER project documents. The article concludes that it is only by merging the risk assessment process with the environmental review process that control of the agencies can be loosened and project proponents be able to prepare project risk assessments for urban California resource recovery projects that will offer the projects any likelihood of being able to complete the permitting process.     

The Contrast Between Risk Assessment and Rules of Evidence in the Context of International Trade Disputes: Can the U.S. Experience Inform the Process?

Risk assessment provides a formalized process to evaluate human, animal, and ecological responses associated with exposure to environmental agents. The purpose of risk assessment is to answer two related questions.

• ? How likely is an (adverse) event to occur?
• ? If it does, how severe will the impact be?

In the United States, the science of risk assessment has evolved out of the necessity to make public health decisions in the face of scientific uncertainty. Its basic propositions have been established over the past three decades and its applications have impacted virtually every aspect of public health and environmental protection in many countries, including the United States. More recently, the World Trade Organization's (WTO) dispute‐settlement process has provided additional incentive for the reliance on risk assessments internationally through the requirement that member countries be able to provide scientific justification, based on a risk assessment, for public health and environmental regulatory measures that are challenged. The purpose of this article is to review the history of risk assessment in the United States, emphasizing the development of both its scientific and policy aspects, as one example of the development of institutional capacity for risk assessment. This article discusses the importance of the social, political, and economic contexts of risk assessment and risk management in shaping the approaches taken while highlighting the reality that the analytic or risk assessment part of the decision‐making process, in the absence of scientific data, can be completed only by inserting inferences, or policy judgments, which may differ among countries. This article recognizes these differences, and the consequent difference between risk assessment that incorporates public health protective assumptions and the rules of evidence that seek to answer questions of causality, and discusses implications for the WTO dispute‐settlement process. It further explores the value of country‐specific risk assessment guidelines to facilitate consistency within a country along with the appropriateness and feasibility of international risk assessment guidelines.     

隐匿价值、社群学习与知识付费动态定价

互联网知识付费中,知识产品价值对供需双方皆具有“隐匿性”。而网络社群作为产品体验信息的重要来源,在知识价值“显现化”过程中发挥着关键作用。基于此,本文将社群交互因素纳入知识付费两期动态定价博弈模型,深入探讨社群学习机制对最优定价策略的影响。模型分析发现：①最优社群价格存在上限阈值,以确保营造良好社群学习氛围。②最优市场价格依赖于知识成本、消费者参与收益和知识价值后验信念,与知识价值之间呈现“非线性”关系。③知识产品一般应采取渗透式定价方式,而消费者耐心程度、社群活跃度与社群交互效率对均衡价格具有重要影响。进一步福利分析表明,互联网社群学习情境将提升提供者收益。本文揭示了互联网知识交易定价的深层逻辑：社群学习引致的“策略效应”和“信息效应”重塑了消费者行为模式,进而倒逼提供者采取适应性动态定价机制。     

Better Negative than Positive? Evidence of a Bias for Negative Information about Possible Health Dangers

Do the results of a scientific study influence confidence in the study's validity and the magnitude of change in the resulting perceived danger of the health risk investigated? Findings from the three investigations reported here indicate that scientific results that confirm a danger (negative results) do affect confidence in a study's validity and resulting risk assessments differently than results indicating low risk (positive results). Findings of Study 1 revealed that research results indicating a health risk were more trusted than results indicating little health risk. This effect was independent of the credibility of the information source. Study 2 demonstrated that confidence in research results increased with an increasing indication of health risk. Study 3 showed that people have more confidence in the results of animal tests on a food additive indicating negative human health effects than in animal tests indicating that a food additive is harmless. The findings have important practical implications. The observed asymmetry between positive and negative research results may be one reason that people are afraid of many of the hazards they are faced with in modern society.     

Looking for Their Dick Vermeil: How Prior Performance Influences the Selection Decision

When replacing an executive, an organization is faced with the choice of either promoting someone internally or hiring an outsider. Prior research in the private sector supports the contention that poor performing organizations will be adaptive and seek an outsider in hopes of initiating change that will improve performance. Do public organizations behave similarly? We address this question in the context of public education and examine the superintendent hiring decisions in 491 school districts. We find that school boards make sophisticated assessments of the district’s performance and these assessments influence their selection decisions.     

Risk Communication in the Real World

Rigorous health risk assessments of site-specific projects are generally little understood by nontechnical decision makers and the public and often appear to them to obfuscate a straightforward answer to their fundamental question: “Is the project safe?” The focus on risk, usually out of context of benefits, deprives the reader of the opportunity to make a fully informed decision on the proposal. While the risk assessment tools may need to be refashioned, confidence in the analytical process can be improved, partly through more citizen involvement, as well as through more effective communication of the conservatism of the assumptions, the thoroughness of the process, and the significance of the results in comparison to other commonly accepted involuntary exposures and risks.     

The Power of Perception: Health Risk Attributed to Air Pollution in an Urban Industrial Neighbourhood

This paper describes a multi-stakeholder process designed to assess the potential health risks associated with adverse air quality in an urban industrial neighborhood. The paper briefly describes the quantitative health risk assessment conducted by scientific experts, with input by a grassroots community group concerned about the impacts of adverse air quality on their health and quality of life. In this case, rather than accept the views of the scientific experts, the community used their powers of perception to advantage by successfully advocating for a professionally conducted community health survey. This survey was designed to document, systematically and rigorously, the health risk perceptions community members associated with exposure to adverse air quality in their neighborhood. This paper describes the institutional and community contexts within which the research is situated as well as the design, administration, analysis, and results of the community health survey administered to 402 households living in an urban industrial neighborhood in Hamilton, Ontario, Canada. These survey results served to legitimate the community's concerns about air quality and to help broaden operational definitions of health. In addition, the results of both health risk assessment exercises served to keep issues of air quality on the local political agenda. Implications of these findings for our understanding of the environmental justice process as well as the ability of communities to influence environmental health policy are discussed.     

Do Interactions Between Environmental Chemicals and the Human Microbiome Need to Be Considered in Risk Assessments?

One of the most dynamic and fruitful areas of current health‐related research concerns the various roles of the human microbiome in disease. Evidence is accumulating that interactions between substances in the environment and the microbiome can affect risks of disease, in both beneficial and adverse ways. Although most of the research has concerned the roles of diet and certain pharmaceutical agents, there is increasing interest in the possible roles of environmental chemicals. Chemical risk assessment has, to date, not included consideration of the influence of the microbiome. We suggest that failure to consider the possible roles of the microbiome could lead to significant error in risk assessment results. Our purpose in this commentary is to summarize some of the evidence supporting our hypothesis and to urge the risk assessment community to begin considering and influencing how results from microbiome‐related research could be incorporated into chemical risk assessments. An additional emphasis in our commentary concerns the distinct possibility that research on chemical–microbiome interactions will also reduce some of the significant uncertainties that accompany current risk assessments. Of particular interest is evidence suggesting that the microbiome has an influence on variability in disease risk across populations and (of particular interest to chemical risk) in animal and human responses to chemical exposure. The possible explanatory power of the microbiome regarding sources of variability could reduce what might be the most significant source of uncertainty in chemical risk assessment.     

The importance of data warehouses for physician executives

Soon, most physicians will begin to learn about data warehouses and clinical and financial data about their patients stored in them. What is a data warehouse? Why are we seeing their emergence in health care only now? How does a hospital, or group practice, or health plan acquire or create a data warehouse? Who should be responsible for it, and what sort of training is needed by those in charge of using it for the edification of the sponsoring organization? I'll try to answer these questions in this article.     

Innovation communities' contributions throughout firms’ innovation processes: An outdoor sports industry case study

Although it is crucial for firms to select openness patterns and strategies to involve innovation communities more effectively, the literature treats innovation communities as homogeneous. However, organizations may mobilize various innovation communities, including external and/or internal members. Similarly, little is known about how firms may involve those different types of innovation community during the distinct phases of their innovation processes. In this context, our main research questions are: For what contributions do companies solicit innovation communities? Do these contributions vary in content and intensity depending on the community and the phase of the innovation process? We distinguish between three types of innovation community (user, practice, and epistemic) and use a dynamic approach, considering four innovation process phases (opportunity recognition, search for solutions, development, and diffusion). The multicase study design includes three iconic firms from the outdoor sports industry and relies on archival data, observations, and 31 semidirective interviews with members of their innovation teams. Our results first show the important involvement of innovation communities during the innovation process. They also highlight the complementary use of those communities to manage their contributions, alongside their dark sides, better. Finally, we emphasize the crucial contribution of internal communities of practice in the firms’ open innovation strategies.     

Improving Causal Inferences in Risk Analysis

Recent headlines and scientific articles projecting significant human health benefits from changes in exposures too often depend on unvalidated subjective expert judgments and modeling assumptions, especially about the causal interpretation of statistical associations. Some of these assessments are demonstrably biased toward false positives and inflated effects estimates. More objective, data‐driven methods of causal analysis are available to risk analysts. These can help to reduce bias and increase the credibility and realism of health effects risk assessments and causal claims. For example, quasi‐experimental designs and analysis allow alternative (noncausal) explanations for associations to be tested, and refuted if appropriate. Panel data studies examine empirical relations between changes in hypothesized causes and effects. Intervention and change‐point analyses identify effects (e.g., significant changes in health effects time series) and estimate their sizes. Granger causality tests, conditional independence tests, and counterfactual causality models test whether a hypothesized cause helps to predict its presumed effects, and quantify exposure‐specific contributions to response rates in differently exposed groups, even in the presence of confounders. Causal graph models let causal mechanistic hypotheses be tested and refined using biomarker data. These methods can potentially revolutionize the study of exposure‐induced health effects, helping to overcome pervasive false‐positive biases and move the health risk assessment scientific community toward more accurate assessments of the impacts of exposures and interventions on public health.     

Improving patient and community well-being

There are great gaps in the well-being of patients and communities. But there are numerous practice and community tools and opportunities that can successfully close these gaps. The health care professional is an often overlooked and underutilized resource and leader to positively influence the health of the community and patient. Physicians and health care professionals are in the health care field to maintain and increase the well-being of their patients and communities through disease prevention and health promotion at the practice level. This article argues that combining a community-level public health approach with the traditional practice level approach is more likely to achieve well-being for both individual patients and the community.     

Vulnerability,Risk Perception,and Health Profile of Marginalized People Exposed to Multiple Built‐Environment Stressors in Worcester,Massachusetts: A Pilot Project

Millions of low‐income people of diverse ethnicities inhabit stressful old urban industrial neighborhoods. Yet we know little about the health impacts of built‐environment stressors and risk perceptions in such settings; we lack even basic health profiles. Difficult access is one reason (it took us 30 months to survey 80 households); the lack of multifaceted survey tools is another. We designed and implemented a pilot vulnerability assessment tool in Worcester, Massachusetts. We answer: (1) How can we assess vulnerability to multiple stressors? (2) What is the nature of complex vulnerability—including risk perceptions and health profiles? (3) How can findings be used by our wider community, and what lessons did we learn? (4) What implications arise for science and policy? We sought a holistic picture of neighborhood life. A reasonably representative sample of 80 respondents captured data for 254 people about: demographics, community concerns and resources, time‐activity patterns, health information, risk/stress perceptions, and resources/capacities for coping. Our key findings derive partly from the survey data and partly from our experience in obtaining those data. Data strongly suggest complex vulnerability dominated by psychosocial stress. Unexpected significant gender and ethnic disease disparities emerged: notably, females have twice the disease burden of males, and white females twice the burden of females of color (p < 0.01). Self‐reported depression differentiated by gender and age is illustrative. Community based participatory research (CBPR) approaches require active engagement with marginalized populations, including representatives as funded partners. Complex vulnerability necessitates holistic, participatory approaches to improve scientific understanding and societal responses.     

Improving Risk Assessment Calculations for Traditional Foods Through Collaborative Research with First Nations Communities

As industrial development is increasing near northern Canadian communities, human health risk assessments (HHRA) are conducted to assess the predicted magnitude of impacts of chemical emissions on human health. One exposure pathway assessed for First Nations communities is the consumption of traditional plants, such as muskeg tea (Labrador tea) (Ledum/Rhododendron groenlandicum) and mint (Mentha arvensis). These plants are used to make tea and are not typically consumed in their raw form. Traditional practices were used to harvest muskeg tea leaves and mint leaves by two First Nations communities in northern Alberta, Canada. Under the direction of community elders, community youth collected and dried plants to make tea. Soil, plant, and tea decoction samples were analyzed for inorganic elements using inductively coupled plasma‐mass spectrometry. Concentrations of inorganic elements in the tea decoctions were orders of magnitude lower than in the vegetation (e.g., manganese 0.107 mg/L in tea, 753 mg/kg in leaves). For barium, the practice of assessing ingestion of raw vegetation would have resulted in a hazard quotient (HQ) greater than the benchmark of 0.2. Using measured tea concentrations it was determined that exposure would result in risk estimates orders of magnitude below the HQ benchmark of 0.2 (HQ = 0.0049 and 0.017 for muskeg and mint tea, respectively). An HHRA calculating exposure to tea vegetation through direct ingestion of the leaves may overestimate risk. The results emphasize that food preparation methods must be considered when conducting an HHRA. This study illustrates how collaboration between Western scientists and First Nations communities can add greater clarity to risk assessments.     

Historical Relationship Between Performance Assessment for Radioactive Waste Disposal and Other Types of Risk Assessment

This article describes the evolution of the process for assessing the hazards of a geologic disposal system for radioactive waste and, similarly, nuclear power reactors, and the relationship of this process with other assessments of risk, particularly assessments of hazards from manufactured carcinogenic chemicals during use and disposal. This perspective reviews the common history of scientific concepts for risk assessment developed until the 1950s. Computational tools and techniques developed in the late 1950s and early 1960s to analyze the reliability of nuclear weapon delivery systems were adopted in the early 1970s for probabilistic risk assessment of nuclear power reactors, a technology for which behavior was unknown. In turn, these analyses became an important foundation for performance assessment of nuclear waste disposal in the late 1970s. The evaluation of risk to human health and the environment from chemical hazards is built on methods for assessing the dose response of radionuclides in the 1950s. Despite a shared background, however, societal events, often in the form of legislation, have affected the development path for risk assessment for human health, producing dissimilarities between these risk assessments and those for nuclear facilities. An important difference is the regulator's interest in accounting for uncertainty.     

The coming alliance revolution in health care

Like it or not, the health care profession is being "shifted" into a revolutionary new world. The question is not will it change but rather how will it change? Who will determine its fate? What form will these changes take? What are the best alternatives for physicians, institutions, health care workers, insurers, employers, and, most importantly, patients? Some of the changes will come from government mandate, others from market forces. To understand what the future might bring, we should look at both the driving forces behind the changes and how other industries have responded to similar forces. An important consideration for health care professionals will be how, if at all, the concepts of collaboration and cooperation that are inherent in networking and alliances will guide their planning.     

Continuity of care: some experiences and thoughts

Continuity of health care is a goal to be achieved. Most are for it. Many claim to provide it. But how do we know we have it? What are the key features of continuity? While dictionaries do not define the phrase "continuity of health care," we do find definitions of "continuity." The Oxford English Dictionary, Second Edition, includes in its definitions: "the state or quality of being uninterrupted in sequence or succession, or in essence or idea; connectedness, coherence, unbroken..." Stedman's Medical Dictionary includes: "absence of interruption, a succession of parts intimately united..." These definitions stress an uninterrupted succession and include the concept that there needs to be a connection to the parts. Without that connection, continuity, in health care delivery or elsewhere, does not exist.     

Elicitation of Quantitative Data from a Heterogeneous Expert Panel: Formal Process and Application in Animal Health

This paper presents a protocol for a formal expert judgment process using a heterogeneous expert panel aimed at the quantification of continuous variables. The emphasis is on the process's requirements related to the nature of expertise within the panel, in particular the heterogeneity of both substantive and normative expertise. The process provides the opportunity for interaction among the experts so that they fully understand and agree upon the problem at hand, including qualitative aspects relevant to the variables of interest, prior to the actual quantification task. Individual experts' assessments on the variables of interest, cast in the form of subjective probability density functions, are elicited with a minimal demand for normative expertise. The individual experts' assessments are aggregated into a single probability density function per variable, thereby weighting the experts according to their expertise. Elicitation techniques proposed include the Delphi technique for the qualitative assessment task and the ELI method for the actual quantitative assessment task. Appropriately, the Classical model was used to weight the experts' assessments in order to construct a single distribution per variable. Applying this model, the experts' quality typically was based on their performance on seed variables. An application of the proposed protocol in the broad and multidisciplinary field of animal health is presented. Results of this expert judgment process showed that the proposed protocol in combination with the proposed elicitation and analysis techniques resulted in valid data on the (continuous) variables of interest. In conclusion, the proposed protocol for a formal expert judgment process aimed at the elicitation of quantitative data from a heterogeneous expert panel provided satisfactory results. Hence, this protocol might be useful for expert judgment studies in other broad and/or multidisciplinary fields of interest.     

A Social Network Contagion Theory of Risk Perception

Risk perceptions have, to a great extent, been studied exclusively as individual cognitive mechanisms in which individuals collect, process, and form perceptions as atomized units unconnected to a social system. These individual-level theories do not, however, help explain how perception of risk may vary between communities or within a single community. One alternative approach is based on a network theory of contagion. This approach, emerging largely from organizational and community social network studies, suggests that it is the relational aspects of individuals and the resulting networks and self-organizing systems that influence individual perceptions and build "groups or communities of like-minded" individuals. These social units, it is argued, behave as attitude, knowledge, or behavioral structures. The study reported in this article tests one aspect of this theoretical perspective. The central hypothesis proposes the existence of risk perception networks--relational groupings of individuals who share, and perhaps create, similar risk perceptions. To test this idea, data were collected from individuals involved in a community environmental conflict over a hazardous waste site cleanup. The statistical analysis used a matrix of relational social linkages to compare with a matrix of individual risk perceptions The analysis confirmed the hypothesis suggesting that social linkages in communities may play an important role in focusing risk perceptions.