Modeling survival in childhood cancer studies using two-stage non-mixture cure models

Non-mixture cure models (NMCMs) are derived from a simplified representation of the biological process that takes place after treatment for cancer. These models are intended to represent the time from the end of treatment to the time of first recurrence of cancer in studies when a proportion of those treated are completely cured. However, for many studies overall survival is also of interest. A two-stage NMCM that estimates the overall survival from a combination of two cure models, one from end of treatment to first recurrence and one from first recurrence to death, is proposed. The model is applied to two studies of Ewing's tumor in young patients. Caution needs to be exercised when extrapolating from cure models fitted to short follow-up times, but these data and associated simulations show how, when follow-up is limited, a two-stage model can give more stable estimates of the cure fraction than a one-stage model applied directly to overall survival.     

Decentralizing Risk Analysis in Large Engineered Systems: An Approach to Articulating Technical and Socioorganizational Dimensions of System Performance1

Nuclear power production in France, as the domain of one national utility and one reactor builder, has a standardized profile of technical installations, safety procedures, and personnel qualifications. Despite this relative homogeneity, discrepancies are observed from one production unit to another, notably in the area of worker-safety performance. There is a strong implication for risk analysis: varying performance cannot be attributed solely to the technical dimensions of equipment, procedures, and human skills. The authors retain as a working hypothesis that safety performance is an outcome of interactions between technical and organizational factors. Traditional risk analysis appears to be underequipped to represent such interactions. The notion of decentralized risk analysis (DRA) is introduced as a means of achieving this goal. A program of applied research carried out in a NPP facility is presented. It aims at increasing, across plant work structure, knowledge and control of these interactions specific to the given context. Systematic measurements and feedback of social representations are performed, using a three-dimensional factor space of individual and organizational values. Direct involvement of the total plant population, transfer of analytic tools, methodological continuity, interactive elaboration of data, coordination of different levels of findings with operations, follow-up and feedback of measured change, are the main features of this DRA process. In the case cited, improvement observed in safety performance parallels changes in measured social representations. The value of DRA for articulating technical and organizational dimensions of risk, and for integrating information into decision-making, is argued.     

Reflecting emotions: The movement-mirroring test

This study tests the ability to mirror emotions by having second-year social work students and first-and second-year dance therapy students duplicate a videotape of a person expressing sadness, anger, and happiness. The ability to mirror is then compared to imaginative, expressive, and observational skills. Movement mirroring was found to correlate positively with, and was predictive of, observational skills. Mirroring was found not to be related to expressivity and the relationship between mirroring and imagination was unclear. Dance therapy students performed significantly better than social work students on the Movement-Mirroring Test, however, training did not improve their scores.     

Men's recognition of violence against women and spousal abuse: comparison of three groups of men

Our goal was to assess whether men in the following three groups differ in their ability to recognize and judge the severity of diverse forms of aggressive behavior: (a) men who reported being physically aggressive toward their spouses and who were entering treatment for domestic violence; (b) men who, after participating in a treatment program, were no longer physically violent; and (c) men who reported never having been physically violent towards their spouses (NPV group-non-physically violent). All 81 men in the study reported being verbally aggressive toward their spouses. Men who had been in treatment for spousal abuse and who had not been physically violent toward their spouses since finishing the program were better able than the other two groups to recognize emotionally abusive behaviors.     

Assessing the Barriers to Achieving Genuine Housing Choice for Adults with a Learning Disability: The Views of Family Carers and Professionals

It has been reported that the capability of adults with a learningdisability to choose their housing is too often impeded by theviews and actions of their family carers and involved professionals(McGlaughlin and Gorfin, with Saul, in press). This study furtherexplores these apparent barriers to providing genuine housingchoice for adults with learning disabilities. It discusses findingsfrom a series of focus groups which explored family and professionalviews about housing and choice. The views expressed indicatethat risk is a fundamental concern for both professionals andfamilies when considering more independent housing for thisgroup. Although opportunities for choice were generally supported,many argued for the need to assess the ability to make informeddecisions. There were also examples of problematic relationshipsbetween professionals and carers, creating a barrier to choice.Carers need involvement, information and support during thedevelopment of housing plans if the needs of the primary serviceusersare to be met. The barriers identified have to be removed ifservice-users are to truly become the focus of decisions andbe enabled to make genuine informed choices.     

Siblings in lockdown: International evidence for birth order effects on child adjustment in the Covid19 pandemic

Supportive family relationships may mitigate the impact of the Covid19 pandemic on young children's adjustment, but existing work is limited by its focus on within-country variation and parental influences. Addressing these gaps, and drawing on reported buffering effects of older siblings on child mental health (Lawson and Mace, 2010), the current international study examined whether child adjustment problems were, on average, elevated by the pandemic and whether this buffering effect of older siblings would be maintained. In the first wave of the Covid19 pandemic (April to July 2020), 2516 parents of 3- to 8-year-old children living in Australia, China, Italy, Sweden, United Kingdom, and United States of America—six countries with contrasting governmental responses to the pandemic—completed an online survey about family experiences and relationships and child adjustment, as indexed by ratings on the Strengths and Difficulties Questionnaire (SDQ: R. Goodman, 1997). As expected, child SDQ total difficulty scores were elevated in all sites except Sweden (which notably did not enforce mass school closures). Compared to children without siblings, children with one or more older siblings showed fewer adjustment problems. Children from lone-parent households displayed more adjustment problems, as did those whose parents reported increased sibling conflict. Finally, child adjustment problems were negatively associated with family socio-economic status, but positively related to the indices of Covid-19 family disruption and government stringency. We discuss these findings in relation to existing work on asymmetric effects of older versus younger siblings, and siblings as sources of support.     

Giving HOPE and minimising trauma: An intervention to support women who are separated from their babies at birth due to safeguarding concerns

Whatever the circumstances, the separation of infants from their mothers at birth is a traumatic experience for all concerned. The paper reports on a study designed to improve practice in this highly sensitive area. An analysis of data collected through semi-structured interviews with 38 mothers who had experienced removal at birth identified four common themes: isolation and unacknowledged support needs; shame, stigma and the failure of others to acknowledge their maternal identity; acute trauma, immediate downturn and disenfranchised grief following infant removal; and strategies to mitigate their pain and grief. These last themes included the use of artefacts both as transitional objects to help mothers come to terms with the permanent loss of a baby, and as a means of keeping maternal identity alive and connecting with an infant who might eventually return home. In response to these findings, and in collaboration with a group of women with lived experience, HOPE boxes were designed to ameliorate the trauma and psychological burden borne by women in this situation. The contents of the boxes have been chosen to reflect the changing experiences of the women's journeys but also the range of possible potential outcomes. The intervention has considerable potential to minimise the trauma of this painful experience.     

Bayesian modelling of effects of prenatal alcohol exposure on child cognition based on data from multiple cohorts

High levels of prenatal alcohol exposure (PAE) result in significant cognitive deficits in children, but the exact nature of the dose-response relationship is less well understood. To investigate this relationship, data were assembled from six longitudinal birth cohort studies examining the effects of PAE on cognitive outcomes from early school age through adolescence. Structural equation models (SEMs) are a natural approach to consider, because of the way they conceptualise multiple observed outcomes as relating to an underlying latent variable of interest, which can then be modelled as a function of exposure and other predictors of interest. However, conventional SEMs could not be fitted in this context because slightly different outcome measures were used in the six studies. In this paper we propose a multi-group Bayesian SEM that maps the unobserved cognition variable to a broad range of observed outcomes. The relation between these variables and PAE is then examined while controlling for potential confounders via propensity score adjustment. By examining different possible dose-response functions, the proposed framework is used to investigate whether there is a threshold PAE level that results in minimal cognitive deficit.