“She was a little bit unrealistic”: Choice in healthcare decision making for older people

This paper examines autonomy, choice, options, and power in healthcare decision making for older people. Using discourse analysis and a case study from data gathered as part of an ethnographic field study we critique a common conceptualization of healthcare decision making as patients choosing from an array of options offered by healthcare providers. A discourse of “giving options and being realistic” used by healthcare providers is contrasted with the experience of a single patient's transitional care from hospital to home after hip fracture. This illustrates how a wide variety of actors, institutions, values, and resources take precedence in determining a discharge destination. While the accounts given by healthcare providers cast patient choice in respectful terms, an ethnographic approach illustrates that the “choices” are structured by a discourse which simplifies the complexity of what is offered and who gets to choose. In the case study the patient's choice was subjugated by expertise and institutional concerns; her options were largely illusory; and her autonomy was “at risk” due to her age, poor health, and limited resources. We use Foucault's ideas about discourse and governmentality to question the scope of agency in healthcare decision making. We argue that the conceptualization of informed patients making autonomous choices acts as “misdirection” which deflects problem solving and discussion away from a productive examination of the differences between healthcare system offerings and client needs. We conclude by posing questions to reorient the debate surrounding healthcare decision making for older adults and recommend a more participatory approach to designing social services.     

Benzene Inhalation by Parts Washers: New Estimates Based on Measures of Occupational Exposure to Solvent Coaromatics

Questions persist regarding assessment of workers’ exposures to products containing low levels of benzene, such as mineral spirit solvent (MSS). This study summarizes previously unpublished data for parts‐washing activities, and evaluates potential daily and lifetime cumulative benzene exposures incurred by workers who used historical and current formulations of a recycled mineral spirits solvent in manual parts washers. Measured benzene concentrations in historical samples from parts‐washing operations were frequently below analytical detection limits. To better assess benzene exposure among these workers, air‐to‐solvent concentration ratios measured for toluene, ethylbenzene, and xylenes (TEX) were used to predict those for benzene based on a statistical model, conditional on physical‐chemical theory supported by new thermodynamic calculations of TEX and benzene activity coefficients in a modeled MSS‐type solvent. Using probabilistic methods, the distributions of benzene concentrations were then combined with distributions of other exposure parameters to estimate eight‐hour time‐weighted average (TWA) exposure concentration distributions and corresponding daily respiratory dose distributions for workers using these solvents in parts washers. The estimated 50th (95th) percentile of the daily respiratory dose and corresponding eight‐hour TWA air concentration for workers performing parts washing are 0.079 (0.77) mg and 0.0030 (0.028) parts per million by volume (ppm) for historical solvent, and 0.020 (0.20) mg and 0.00078 (0.0075) ppm for current solvent, respectively. Both 95th percentile eight‐hour TWA respiratory exposure estimates for solvent formulations are less than 10% of the current Occupational Safety and Health Administration permissible exposure limit of 1.0 ppm for benzene.     

Army opinions about women in the army

Survey data collected from U.S. Army personnel show that Army women, who are a substantial minority (about 12 percent) in the Army, work in an environment in which their usefulness and accomplishments are viewed differently by men and women and also by personnel holding different ranks. The data suggest that the acceptance of women remains limited. Indeed, to even ask the questions which were asked about them would seem to marginalize women, to set them apart—and this in an institution that places a high value on cohesiveness. Individuals in other institutions may harbor similar reservations, but the Army appeared to be open to (and received) rather negative responses; other institutions may be different, or they may be more self-censoring. where she served as Provost and Academic Vice President for four years. She earned a Ph.D. in Political Theory from Columbia University. Her books include Nonviolent Power: Active and Passive Resistance, Bring Me Men and Women: Mandated Change at the U.S. Air Force Academy, Arms and the Enlisted Woman, and It's Our Military Too! Dr. Stiehm has served on the Defense Advisory Committee on Women in the Military, the California Postsecondary Education Commission, the California Vocational Education Commission, and as a consultant to the United Nations Commission for the Advancement of Women. She is also a member of the Council on Foreign Relations.     

Parent‐Child Communication About Adolescent Tobacco and Alcohol Use: What Do Parents Say and Does It Affect Youth Behavior?

Parent‐child communication about tobacco and alcohol use is assumed to be critical to child use of these substances, but it rarely has been systematically described and related to adolescent use. This study included a national sample of 537 adolescent‐parent pairs interviewed by telephone at baseline and again 1 year later. Factor analysis of parent reports of communication identified 3 domains: rules and discipline, consequences and circumstances, and media influences. Communication in these domains varied by family characteristics, including parents' substance use and mother's education level. Contrary to assumptions, parent‐child communication was not related to initiation of smoking or drinking. Additional analyses suggested, however, that parent‐child communication about rules and discipline predicted escalation of use.     

Understanding and working with adolescent neglect: perspectives from research,young people and professionals

This paper provides an overview of research about adolescent neglect funded by the Department of Children, Schools and Families (now the Department for Education) and the Department of Health. The paper examines what is known from literature about the causes of adolescent neglect, together with its potential consequences for well‐being. Drawing on qualitative data, the concept of neglect is explored from the perspectives of young people themselves and the professionals who work with them. Consideration is given to examples of interventions and preventative models geared towards addressing adolescent neglect. Key findings indicate that there is a need for both a re‐examination of current definitions of neglect in the light of age‐related distinctions and perspectives, and a fuller understanding of the particular needs of adolescents who are experiencing neglect. Additionally, the research highlights that there is a lack of research knowledge about neglectful parenting and the behaviour of young people, as well as limited understanding of interventions with neglected adolescents. Key themes from the research are discussed in terms of their implications for future practice, policy and research in relation to working to improve the welfare of neglected young people.     

Inductive Risk,Science, and Values: A Reply to MacGillivray

The argument from inductive risk (AIR) is perhaps the most common argument against the value-free ideal of science. Brian MacGillivray rejects the AIR (at least as it would apply to risk assessment) and embraces the value-free ideal. We clarify the issues at stake and argue that MacGillivray's criticisms, although effective against some formulations of the AIR, fail to overcome the essential concerns that motivate the AIR. There are inevitable trade-offs in scientific enquiry that cannot be resolved with any formal methods or general rules. Choices must be made, and values will be involved. It is best to recognize this explicitly. Even so, there is more work to be done developing methods and institutional support for these choices.     

Combinatorial algorithms for the maximum k-plex problem

The maximum clique problem provides a classic framework for detecting cohesive subgraphs. However, this approach can fail to detect much of the cohesive structure in a graph. To address this issue, Seidman and Foster introduced k-plexes as a degree-based clique relaxation. More recently, Balasundaram et al. formulated the maximum k-plex problem as an integer program and designed a branch-and-cut algorithm. This paper derives a new upper bound on the cardinality of k-plexes and adapts combinatorial clique algorithms to find maximum k-plexes.