The Use of Lay Assessors

This paper reports on some findings from a research study conductedby the authors for the Commission for Social Care Inspection.It examines the reasons for the involvement of lay assessorsand perceptions of the effectiveness of lay assessors in specificregulatory functions.     

Medicare and Medicaid Reimbursement Rates for Nursing Homes Motivate Select Culture Change Practices But Not Comprehensive Culture Change

Components of nursing home (NH) culture change include resident-centeredness, empowerment, and home likeness, but practices reflective of these components may be found in both traditional and “culture change” NHs. We use mixed methods to examine the presence of culture change practices in the context of an NH’s payer sources. Qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation. Findings indicate that heightened coordination of Medicare and Medicaid could influence NH implementation of reform practices.     

Diesel Engine Exhaust and Lung Cancer Mortality: Time‐Related Factors in Exposure and Risk

To develop a quantitative exposure‐response relationship between concentrations and durations of inhaled diesel engine exhaust (DEE) and increases in lung cancer risks, we examined the role of temporal factors in modifying the estimated effects of exposure to DEE on lung cancer mortality and characterized risk by mine type in the Diesel Exhaust in Miners Study (DEMS) cohort, which followed 12,315 workers through December 1997. We analyzed the data using parametric functions based on concepts of multistage carcinogenesis to directly estimate the hazard functions associated with estimated exposure to a surrogate marker of DEE, respirable elemental carbon (REC). The REC‐associated risk of lung cancer mortality in DEMS is driven by increased risk in only one of four mine types (limestone), with statistically significant heterogeneity by mine type and no significant exposure‐response relationship after removal of the limestone mine workers. Temporal factors, such as duration of exposure, play an important role in determining the risk of lung cancer mortality following exposure to REC, and the relative risk declines after exposure to REC stops. There is evidence of effect modification of risk by attained age. The modifying impact of temporal factors and effect modification by age should be addressed in any quantitative risk assessment (QRA) of DEE. Until there is a better understanding of why the risk appears to be confined to a single mine type, data from DEMS cannot reliably be used for QRA.     

Reanalysis of the DEMS Nested Case‐Control Study of Lung Cancer and Diesel Exhaust: Suitability for Quantitative Risk Assessment

The International Agency for Research on Cancer (IARC) in 2012 upgraded its hazard characterization of diesel engine exhaust (DEE) to “carcinogenic to humans.” The Diesel Exhaust in Miners Study (DEMS) cohort and nested case‐control studies of lung cancer mortality in eight U.S. nonmetal mines were influential in IARC's determination. We conducted a reanalysis of the DEMS case‐control data to evaluate its suitability for quantitative risk assessment (QRA). Our reanalysis used conditional logistic regression and adjusted for cigarette smoking in a manner similar to the original DEMS analysis. However, we included additional estimates of DEE exposure and adjustment for radon exposure. In addition to applying three DEE exposure estimates developed by DEMS, we applied six alternative estimates. Without adjusting for radon, our results were similar to those in the original DEMS analysis: all but one of the nine DEE exposure estimates showed evidence of an association between DEE exposure and lung cancer mortality, with trend slopes differing only by about a factor of two. When exposure to radon was adjusted, the evidence for a DEE effect was greatly diminished, but was still present in some analyses that utilized the three original DEMS DEE exposure estimates. A DEE effect was not observed when the six alternative DEE exposure estimates were utilized and radon was adjusted. No consistent evidence of a DEE effect was found among miners who worked only underground. This article highlights some issues that should be addressed in any use of the DEMS data in developing a QRA for DEE.     

Urbanicity Moderates Associations between Family Income and Adolescent Academic Achievement

Research has shown that family income's relations to early childhood achievement is stronger in large inner cities and weaker in less urbanized areas. Research has not yet considered whether links between family income and achievement in adolescence differ across the urban to rural landscape. Using nationally representative data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (N ≈ 9,350), this study examines differences in family income's links with eighth‐grade achievement across large urban, small urban, suburban, and rural communities. The point at which income‐achievement links plateau occurs later in the income distribution in less urbanized areas. The magnitude of the association between family income and reading and science skills also differs across the urban‐rural continuum, such that family income has stronger relations to reading and science achievement in urban cities and weaker links in suburban and rural communities.     

Exploring youths' perceptions of the hidden practice of youth work in increasing social capital with young people considered NEET in Scotland

This small-scale research explores the generation of social capital in young people growing up in one urban area and one rural area in Scotland via community-led youth work projects that aim to re-engage young people categorised as NEET (Not in Employment Education or Training). By looking at their varied and complex biographies, it considers young people's experiences and perceptions of their communities and their transitions from education to the workplace. Using social capital as a theoretical lens, we examined the impact that youth work can have not just on these important transitions but also upon the young people themselves. By visiting two different sites of engagement we were able to explore whether the type of initiative (media or sports) or place (urban or rural) had an impact on the generation of capital for young people. The youth work practice in both areas acted as a glue between the young people and their communities, creating opportunities where the two could be bound together and relationships created. This occurred in both sites regardless of the area or type of initiative and confirmed in this study that youth work acts as a site of capital building.     

THE NEW EPISTEMOLOGY AND THE MILAN APPROACH: FEMINIST AND SOCIOPOLITICAL CONSDDERATIONS*

While the new epistemology and related models of therapy are claimed to have radical social implications, the Milan approach is in ill repute amongst feminists who see it as conservative in relation to women's issues. This paper explores the sociopolitical implications of the new epistemology and the Milan approach, concluding that, while second order cybernetics has greater potential to incorporate a radical social analysis, it has, nevertheless, failed to do so. The application of second order cybernetics in family therapy appears to be constrained by the sociopolitical conservatism of its proponents.