Multi-Stage Model Estimates of Lung Cancer Risk from Exposure to Diesel Exhaust, Based on a U.S. Railroad Worker Cohort

A California Environmental Protection Agency (Cal/EPA) report concluded that a reasonable and likely explanation for the increased lung cancer rates in numerous epidemiological studies is a causal association between diesel exhaust exposure and lung cancer. A version of the present analysis, based on a retrospective study of a U.S. railroad worker cohort, provided the Cal/EPA report with some of its estimates of lung cancer risk associated with diesel exhaust. The individual data for that cohort study furnish information on age, employment, and mortality for 56,000 workers over 22 years. Related studies provide information on exposure concentrations. Other analyses of the original cohort data reported finding no relation between measures of diesel exhaust and lung cancer mortality, while a Health Effects Institute report found the data unsuitable for quantitative risk assessment. None of those three works used multistage models, which this article uses in finding a likely quantitative, positive relations between lung cancer and diesel exhaust. A seven-stage model that has the last or next-to-last stage sensitive to diesel exhaust provides best estimates of increase in annual mortality rate due to each unit of concentration, for bracketing assumptions on exposure. Using relative increases of risk and multiplying by the background lung cancer mortality rates for California, the 95% upper confidence limit of the 70-year unit risks for lung cancer is estimated to be in the range 2.1 x 10(-4) (microg/m3)(-1) to 5.5 x 10(-4) (microg/m3)(-1). These risks constitute the low end of those in the Cal/EPA report and are below those reported by previous investigators whose estimates were positive using human data.     

The Effects of Gender and Relationship Context Cues on Responsive Sexual Desire in Exclusively and Predominantly Androphilic Women and Gynephilic Men

Sexual desire may be “responsive,” emerging from sexual arousal to sexually competent cues. Cues that elicit sexual arousal and desire differ, however, by gender and direction of sexual attractions. Further, relationship context cues are thought to be important for responsive desire, but this has not been tested directly. The current study examined gynephilic men’s (n = 27) and exclusively (n = 23) and predominantly (n = 17) androphilic women’s dyadic and solitary responsive sexual desire, as well as genital and self-reported arousal, to audio narratives varying by gender (male, female) of the sexual partner and relationship context (stranger, friend, long-term relationship). Consistent with previous literature, gynephilic men’s solitary and dyadic desire were gender-specific (greater to female than to male sexual partners). Exclusively androphilic women’s dyadic desire differentiated less to cues of gender than gynephilic men’s, and their solitary desire did not differentiate by gender cues at all, replicating previous research. Androphilic women with some gynephilia reported a gender-nonspecific pattern of dyadic and solitary desire (i.e., responsive desire to both male and female narratives). No effect of relationship context was found for any groups. Results suggest that responsive sexual desire may be more closely associated with self-reported than genital arousal patterns.     

Negotiating the boundaries of intimacy: the personal lives of asexual people

This paper uses findings from research diaries to explore the use of practices of intimacy among asexual people. While much of the literature to date has focused on the supposedly transformative and political nature of uniquely asexual practices of intimacy, our findings suggest something different. Rather than seeking to transform the nature of intimate relationships, asexual people make pragmatic adjustments and engage in negotiations to achieve the forms of physical and emotional intimacy they seek. We discuss this in relation to three areas: friendships, sex as a practice of intimacy, and exclusion from intimacy. Our findings suggest the importance of not only considering the social context in which asexual people practise intimacy, but also how the practices in which they engage may be shared with non‐asexual people.     

Do People Believe Combined Hazards Can Present Synergistic Risks?

The risk attributable to some hazard combinations can be greater than the sum of the risk attributable to each constituent hazard. Such "synergistic risks" occur in several domains, can vary in magnitude, and often have harmful, even life-threatening, outcomes. Yet, the extent to which people believe that combined hazards can present synergistic risks is unclear. We present the results of two experimental studies aimed at addressing this issue. In both studies, participants examined synergistic and additive risk scenarios, and judged whether these were possible. The results indicate that the proportion of people who believe that synergistic risks can occur declines linearly as the magnitude of the synergistic risk increases. We also find that people believe, despite scientific evidence to the contrary, that certain hazard combinations are more likely to present additive or weakly synergistic risks than synergistic risks of higher magnitudes. Furthermore, our findings did not vary as a simple function of hazard domain (health vs. social), but varied according to the characteristics of the specific hazards considered (specified vs. unspecified drug combinations). These results suggest that many people's beliefs concerning the risk attributable to combined hazards could lead them to underestimate the threat posed by combinations that present synergistic risks, particularly for hazard combinations that present higher synergistic risk magnitudes. These findings highlight a need to develop risk communications that can effectively increase awareness of synergistic risks.     

Community Treatment Orders for People with Serious Mental Illness: A New Zealand Study

New Zealand legislation allows for the involuntary outpatienttreatment of people with serious mental illness. This studyexamines the views of service users, family members and mentalhealth professionals (MHPs) about the impact of this regime.Semi-structured interviews were completed with forty-two serviceusers, twenty-seven family members and ninety MHPs, with recentexperience of the regime. Participants were asked to commenton the functions of community treatment (or non-resident) orders,their benefits and restrictions, decisions about their terminationand any impact on relationships. Most service users believedthe main purpose of the order was to ensure they took medication.They also believed the order provided better access to othertreatments, supported accommodation and care from MHPs. Familiesconsidered the orders provided relief for them and a supportivestructure for their relative’s care. MHPs found the ordersuseful for engaging service users in a continuing therapeuticrelationship, and for promoting treatment adherence. In eachgroup, a majority of those interviewed viewed involuntary communitytreatment in a generally positive light, while acknowledgingthe restrictions imposed on service users’ freedom.     

A design for testing clinical strategies: biased adaptive within-subject randomization

We propose a method for assigning treatment in clinical trials, called the 'biased coin adaptive within-subject' (BCAWS) design: during the course of follow-up, the subject's response to a treatment is used to influence the future treatment, through a 'biased coin' algorithm. This design results in treatment patterns that are closer to actual clinical practice and may be more acceptable to patients with chronic disease than the usual fixed trial regimens, which often suffer from drop-out and non-adherence. In this work, we show how to use the BCAWS design to compare treatment strategies, and we provide a simple example to illustrate the method.     

Toolkits for Equity: An Antiracist Framework for Scholarly Publishing

Abstract

Fueled by a recent groundswell of support, scholarly publishing organizations are formalizing their focus on equity and inclusion, yet there is still a lack of effective programs and solutions actually in place. A cross-organizational working group is developing antiracism toolkits (for organizations, for allies, and for Black, Indigenous, and People of Color) to transform scholarly publishing workplaces and organizational cultures. The resources, which will be hosted at c4disc.org, provide a common framework for analysis, a shared vocabulary, best practices, and training materials to guide individuals and organizations as they address systemic inequities specific to the scholarly publishing community. Originally planned as a presentation at the NC Serials Conference in March 2020, this article introduces the toolkits and explains why an antiracist framework is essential to transforming scholarly publishing.     

From safety contract to safety agreement

1. Confusion and controversy continue to surround the definition and use of safety contracts. 2. A safety agreement based on Orlando's Nursing Theory may be a more practical, concise, and nurse-patient friendly means to promote patient safety. 3. The key ingredients in a safety agreement are identifying patients' immediate safety needs and decreasing patients' immediate distress related to safety through the nurse-patient relationship. 4. The value of a safety agreement lies not in the tool itself but in its promotion of a nurse-patient relationship that involves communication and collaboration.     

Operationalising caseload midwifery in the Australian public maternity system: Findings from a national cross-sectional survey of maternity managers

Background

Despite high-level evidence of the benefits of caseload midwifery for women and babies, little is known about specific practice arrangements, organisational barriers and facilitators, nor about workforce requirements of caseload. This paper explores how caseload models across Australia operate.