Risk Estimation and Value-of-Information Analysis for Three Proposed Genetic Screening Programs for Chronic Beryllium Disease Prevention

Genetic differences (polymorphisms) among members of a population are thought to influence susceptibility to various environmental exposures. In practice, however, this information is rarely incorporated into quantitative risk assessment and risk management. We describe an analytic framework for predicting the risk reduction and value-of-information (VOI) resulting from specific risk management applications of genetic biomarkers, and we apply the framework to the example of occupational chronic beryllium disease (CBD), an immune-mediated pulmonary granulomatous disease. One described Human Leukocyte Antigen gene variant, HLA-DP beta 1*0201, contains a substitution of glutamate for lysine at position 69 that appears to have high sensitivity (approximately 94%) but low specificity (approximately 70%) with respect to CBD among individuals occupationally exposed to respirable beryllium. The expected postintervention CBD prevalence rates for using the genetic variant (1) as a required job placement screen, (2) as a medical screen for semiannual in place of annual lymphocyte proliferation testing, or (3) as a voluntary job placement screen are 0.08%, 0.8%, and 0.6%, respectively, in a hypothetical cohort with 1% baseline CBD prevalence. VOI analysis is used to examine the reduction in total social cost, calculated as the net value of disease reduction and financial expenditures, expected for proposed CBD intervention programs based on the genetic susceptibility test. For the example cohort, the expected net VOI per beryllium worker for genetically based testing and intervention is $13,000, $1,800, and $5,100, respectively, based on a health valuation of $1.45 million per CBD case avoided. VOI results for alternative CBD evaluations are also presented. Despite large parameter uncertainty, probabilistic analysis predicts generally positive utility for each of the three evaluated programs when avoidance of a CBD case is valued at $1 million or higher. Although the utility of a proposed risk management program may be evaluated solely in terms of risk reduction and financial costs, decisions about genetic testing and program implementation must also consider serious social, legal, and ethical factors.     

Older family-carers' views on the future accommodation needs of relatives who have an intellectual disability

Over the past 20 years, research across the developed world has identified trends towards ageing of the population with learning/intellectual disability. Alongside is the recognition that family-carers are also ageing. Recently, the UK government has sought to identify the future housing needs of dependents with intellectual disability residing with older carers. Consequentially, a city council commissioned this qualitative study involving 28 older carers. The findings indicate a need for information about housing options, a lack of practical support and feelings of marginalisation. The conclusions suggest key roles for social services in providing proactive support and advice to family-carers, and a greater degree of joint working between social services departments and housing agencies. These resonate with similar international studies and provide the opportunity to focus on the perspectives of family-carers. Their experiences are real, and if welfare professionals are to work with people with intellectual disability and their family-carers, acknowledging their views is essential.     

THE EFFECTS OF INTERDISCIPLINARY EDUCATIONAL FORMATS ON CONCEPT RETENTION AND PROBLEM–SOLVING ABILITY*

The purpose of this study was to examine the effects of different interdisciplinary problem-oriented formats on a student's knowledge of and retention of disciplinary concepts and principles, his application of these concepts and principles to disciplinary problems, and his use of a discipline in his analysis of a complex problem. Performances of students enrolled in the experimental sections were compared to those of students enrolled in standard lecture-discussion sections. Regression analysis was used to analyze students' performance in order to control the effects of differences in student backgrounds. It was found that altering the pedagogical format and reward system within the experimental sections had no significant effect upon student performances in the experimental, problem-oriented program. In general, this study indicates that students taught in the standard lecture-discussion format in which grades are determined by examination over course material retain concepts and principles, apply these concepts and principles to disciplinary problems, and integrate disciplinary concepts into their analysis of complex problems as well as, if not better than, students taught in an interdisciplinary, problem-solving format.     

Perceived Risk and Uncertainty of Nuclear Waste: Differences Among Science,Business, and Environmental Group Members1

This paper presents survey results on perceived risk regarding the management of nuclear waste. Using data taken from random mail surveys of members of scientific, business, and environmental groups in Colorado and New Mexico in the summer of 1990, we examine differences between the groups in their expressed perceptions of risk and also their assessments of the certainty of their beliefs. We consider whether (a) greater uncertainty is associated with greater perceived risks and (b) whether there is greater responsiveness to new information for those whose beliefs are least certain. We find that there are connections between perceived risk and uncertainty, and there is a greater tendency to update risk assessements from a position of greater initial uncertainty. There are, however, differences between the groups as well as asymmetries in their responses to new information. The latter suggests that perceived risks will ratchet upward over time even when information is not biased toward more or less risk.     

Text,competence and logic: An exercise

Professional medical practice, like other organizational conduct, relies upon records which document transactions between members and their clientele. Medical practitioners employ a set of conventions providing for the systematic recording and interpretation of medical record cards that forms a social organization underlying the records cards' ordinary usage. In this paper we examine these conventions and develop a computer program which captures elements of their structure and use. By doing so we illustrate one way in which sociological analysis can contribute to the design of intelligent systems. We also suggest that the emerging discipline of Artificial Intelligence might find recent developments in sociology pertinent to its concerns.