Cox regression of clustered event times with covariates missing not at random

Motivated by a recent tuberculosis (TB) study, this paper is concerned with covariates missing not at random (MNAR) and models the potential intracluster correlation by a frailty. We consider the regression analysis of right‐censored event times from clustered subjects under a Cox proportional hazards frailty model and present the semiparametric maximum likelihood estimator (SPMLE) of the model parameters. An easy‐to‐implement pseudo‐SPMLE is then proposed to accommodate more realistic situations using readily available supplementary information on the missing covariates. Algorithms are provided to compute the estimators and their consistent variance estimators. We demonstrate that both the SPMLE and the pseudo‐SPMLE are consistent and asymptotically normal by the arguments based on the theory of modern empirical processes. The proposed approach is examined numerically via simulation and illustrated with an analysis of the motivating TB study data.     

Phenomenology in End-of-Life Care: Implications for Philosophy and Clinical Practice

Care of the terminally ill and dying in the hospice setting is a growing practice field for social workers. Support to family, as well as the patient, is implicit in hospice care, adding to the reach and impact of the hospice social worker’s role. As people age and approach the end of life, they may encounter changes in their experience of time, space and of the material world. They often have to redefine the role of hope in their day to day lives. Based on these changing experiences and perceptions, phenomenology, with its focus on a patient’s subjective, lived experience, has implications for end-of-life care. The role of empathy and compassion are also explored in relation to existential experiences of the terminally ill through the lens of phenomenology and Eastern philosophy. To complement the Western biomedical model of care for the dying, insight from Eastern philosophical traditions, which view living and dying on the same continuum, and provide an expanded view of suffering bring comfort and understanding to how living and dying are processed within the phenomenology of patient experience and the hospice model of care. Case vignettes demonstrate social work theory and practice at the intersection of various interrelated phenomena when caring for those facing the end of life.     

Beards and Bloomers: Flight Attendants,Grievances and Embodied Labour in the Canadian Airline Industry, 1960s–1980s

This paper examines union grievances dealing with the body, appearance and demeanour fought by the Canadian Air Line Flight Attendants Association, on behalf of its female and male members over a 30‐year period. Taking a historical, materialist‐feminist approach, we examine how workers used the grievance system to resist regulations they believed contradicted their right to dignified labour. We ask how and why bodily regulation differed for men and women, and how this changed over time, as the union merged its male and female job occupations. Using arbitrated grievances, union records and discussion of these issues in the mass media, we show how both feminism and service union activism encouraged flight attendant resistance to airlines’ efforts to regulate the appropriate body and attire for male and female workers. The use of labour law offered workers some respite from regulation, but did not facilitate fundamental questions about the power of management to ‘dress’ its workers.     

Infant–Mother and Infant–Caregiver Emotional Relationships: Process Analyses of Interactions in Three Contemporary Childcare Arrangements

Emotional relationships in infant–mother dyads in families where mothers provided full‐time childcare were compared with those of families where mothers used in‐home childcare providers and family childcare providers (N = 245). Infant relationships with childcare providers were also studied. Emotional relationships were adequate in all three childcare arrangements, but infant–mother dyads in in‐home childcare arrangements displayed healthier emotional relationships than infant–mother dyads in mother care arrangements; no differences in the health of emotional relationships with infants emerged among the three types of childcare providers (mother care, in‐home childcare, family childcare). Infant–mother dyads in in‐home childcare arrangements also displayed healthier emotional relationships than infant–in‐home childcare caregiver dyads, but infant–mother and infant–caregiver dyads were comparable in family childcare families. Emotional relationships in infant–mother and infant–caregiver dyads were not correlated, regardless of the type of childcare.     

The Impact of Learning and Labor Attrition on Worker Flexibility in Dual Resource Constrained Job Shops

This study investigates the impact of worker learning, worker flexibility, and labor attrition on the system performance of a dual resource constrained (DRC) job-shop. The effects of learning and labor attrition have not been previously addressed in DRC literature. Results from the study, consistent with previous literature, show that the greatest benefits are achieved when inter-departmental worker flexibility is incrementally introduced into the system. In addition, the learning environment, which depends on the initial processing time of jobs and the learning rates of workers, is shown to impact the acquisition of flexibility. The study also shows that the impact of labor attrition on system performance under certain shop conditions may be significant.     

Sex/love skirmishes: “swinging,” “polyamory,” and the politics of naming

The contested definitions of “swinging” and “polyamory” reveal profound inconsistencies in the logics of sex, love, commitment, and coupledom. In this article, I use a number of non-monogamy blogs and online glossaries as examples of the way these two words are often deployed against each other in an effort to position the speaker in relation to mononormative practices of sex and love. Leaving aside questions of the accuracy of particular definitions, I map a range of definitions against two existing scholarly/activist tools for describing relationship styles, specifically Gayle Rubin’s “Charmed Circle” and Meg-John Barker’s sex/love continuums. This exercise is doubly fruitful: first, the tools reveal the political stakes of the definitional debates; second, the definitions demonstrate that the distinctions we commonly use to distinguish between types of relationships—including types of non-monogamous relationships—in fact rely on mononormative assumptions about sex, love, and friendship. If “mononormativity” is defined as the system of ideas, institutions, and practical orientations that provide the backdrop against which the idea of monogamy as coherent, common, natural, and right congeals, the sex/love skirmishes of “swinging” and “polyamory” remind us that its logics are both pervasive and deeply fractured.     

State-authorizing citizenship: the narrow field of civic engagement in the liberal age

Liberal citizens are held ethically accountable not only for their own acts and behaviors, but also those of their state. Reciprocally, a proper liberal subject is one that metonymizes with the state, merging their fates and moral worth, and taking personal responsibility for the state’s actions. I claim that as a result, the liberal subject is not only self-authorizing according to liberal theories of moral autonomy, but also state-authorizing. I demonstrate the above claims through a consideration of changing activist practices among the Israeli political left. I show that the hegemonic model of civic engagement is oriented towards the state and state policy as the privileged and naturalized site of ethical intervention. I then describe the ways this model hampers political endeavors by restricting the sites of intervention as well as structural access to political participation. I also consider contemporary efforts at political engagement that bypass the state.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

Alternative and complementary therapies for the menopause

Despite a re-evaluation of risks in recent years, hormone replacement therapy is still surrounded by controversy. Almost 30% of women in a recent survey sought a natural approach to combat climacteric symptoms. Nevertheless, a large proportion of patients felt that they wanted a good safety profile and strong evidence base for treatment. This article seeks to review the evidence supporting non-hormonal approaches to treatment. There is only conflicting evidence at best to support alpha-2 agonists, e.g. clonidine and limited evidence for dihydroepiandrosterone and natural progesterones. There is limited randomized controlled trial data for gabapentin, selective norepinephrine re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs), many of these studies being related to breast cancer patients. Of the herbal medicinal products, the largest evidence base rests with phytoestrogens. A Cochrane Database review looking at all types of phytoestrogens, e.g. red clover extracts, dietary soya and soya extracts concluded that there was no evidence to support improvement in climacteric symptoms and the meta-analysis of a 178 studies on soy products was inconsistent. Nevertheless, other studies disagree. Mammographic density is not affected by soy or phytoestrogen products and recent in vitro work shows only a weakly proliferative effect of soy isoflavone on breast cancer cells and evidence that soy isoflavone blocks the proliferative effect of estradiol on these cells. There are no studies looking at clinical outcome measures for cardiovascular disease but a number of studies looking at biochemical markers including arterial wall stiffness and apolipo protein B. Recent studies have also looked at the effects of red clover isoflavone on mood and depression, using specific depression rating scales. Finally, it is important to note that herbal medicinal products should not be used without caution. Some may produce quite marked side-effects in high doses and others can interact with pre-existing medication. A strategy for which patients are suitable for herbal medicinal products is reviewed.