The Experience and Practice of Approved Social Workers in Northern Ireland

Correspondence to Dr Roger Manktelow, School of Social and Community Sciences, University of Ulster Magee College, Derry, BT48 7JL, Northern Ireland. Summary This article reports on the first extensive survey of ApprovedSocial Worker (ASW) activity under the Mental Health (NorthernIreland) Order 1986. The integrated health and social servicesorganizational structure, the adverse effects on individualmental health of the legacy of thirty years of civil conflictand the move from hospital to community care are significantfeatures which have influenced the delivery of mental healthsocial work services locally. The practice and experience ofASWs was surveyed by postal questionnaire and user and carerexperience of compulsory hospital admission was investigatedby a series of focus groups. The study revealed that two-thirdsof ASWs had experience of acting as an applicant in compulsoryhospital admission during the past two years. Nearly half (42per cent) of these ASWs had reported experience of between oneand five admissions and one-tenth had completed over twentyadmissions in the two-year period. In only a small minorityof cases did joint face-to-face assessment with the GeneralPractitioner (doctor) take place; nearly half of ASWs reporteddifficulties in obtaining transport; and only one-fifth of ASWshad experience of acting as a second approved social worker.Half of ASWs reported experience of guardianship, either asapplicant or in making the recommendation. Both service usersand carers reported a lack of understanding about the role ofthe ASW and complained about the lack of alternative resourcesthat ASWs could use to prevent hospital admissions. These findingsare discussed and a number of recommendations are proposed forimprovements to approved social worker practice.     

The Prevalence of Uncorrected Refractive Errors in Adolescents Incarcerated in a Youth Detention Center

The purpose of this study was to determine the number of residents requiring corrective lenses in a youth detention center for juveniles from 12 to 18 years old over a 2-year period. A greater number of adolescents incarcerated for criminal activity in a detention center had uncorrected refractive errors (34.87 %) as compared to a comparable population in the public school system (22 %). The prevalence of significant refractive errors among incarcerated adolescents in this study is significantly higher than has been reported previously. The current study found a refractive error rate of almost 35 %. This difference can be explained by a number of factors in their social environments and identifies an area for potential intervention to reduce antisocial behavior in this population.     

Measurement of non-randomness in spatial distributions

Summary The measurement of departure from randomness in spatial distributions has widespread application in ecological work. Several “indices of non-randomness” are compared with regard to their dependence on sample number, sample size and density. Criteria for the best choice of index for specific situations are discussed. A new coefficientC _x is proposed for use with positively contagious distributions and tests of significance are given. WhenC _x and another index (S ²/m−1) are used for positive and negative contagion respectively, values ranging from −1 through 0 (random) to +1 are obtained, regardless of sample number, sample size or density.     

The foundations of econometrics-are there any

The conclusions of alogically consistent economic theory which strictly adheres to Aristotle's axioms of logic are factually true if its sufficient conditions are all factually true. Alternatively, if a conclusion of such a theory is false, then at- least one of its assumptions is false. Unfortunately, the factual truth of sufficient conditions cannot be established because the problem of induction i s impossible t o solve. It is algo true that the falsity of a conclusion cannot be established in the presence of uncertainty. While the philosophy of instrumentalism applied to sufficient and logically consistent explanations may provide useful solutions to immediate practical problems, the principles of simplicity, parsimony and profligacy--all of them requiring conditional deductive arguments--are useless as criteria for model choice.     

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.     

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.     

Medical Negligence and Resource Allocation in the NHS

The recent growth in medical malpractice claims and in awards for damages has created concern both amongst doctors and health administrators. Steps which have been taken by the Review Body on Doctors’and Dentists’Remuneration and policy now advocated by the BMA suggest a movement away from the current system of negligence and towards a stricter no-fault system of liability. Under the current system, medical negligence occurs when doctors have not met the standards of treatment expected by reference to current professional standards. Under a no-fault system patients would be entitled to compensation for losses which arise from treatment, irrespective of whether negligence had occurred; although the implication is that the amounts of compensation would necessarily be limited. While there are reasons to believe that financial difficulties for doctors and pressures on NHS budgets may be ameliorated by a no-fault system, there are other criteria against which the current system of negligence should be judged. This article attempts to provide a framework within which a negligence system may be assessed. In particular, attention is drawn to the educative role of a negligence system and to the provision of information which may improve decisions on resource allocation. A critique of the current system of medical negligence in the UK suggests that a package of reforms to improve the system would be better than further movements towards non-market solutions.     

Five legitimate definitions of correlated equilibrium in games with incomplete information

Aumann's (1987) theorem shows that correlated equilibrium is an expression of Bayesian rationality. We extend this result to games with incomplete information.First, we rely on Harsanyi's (1967) model and represent the underlying multiperson decision problem as a fixed game with imperfect information. We survey four definitions of correlated equilibrium which have appeared in the literature. We show that these definitions are not equivalent to each other. We prove that one of them fits Aumann's framework; the agents normal form correlated equilibrium is an expression of Bayesian rationality in games with incomplete information.We also follow a universal Bayesian approach based on Mertens and Zamir's (1985) construction of the universal beliefs space. Hierarchies of beliefs over independent variables (states of nature) and dependent variables (actions) are then constructed simultaneously. We establish that the universal set of Bayesian solutions satisfies another extension of Aumann's theorem.We get the following corollary: once the types of the players are not fixed by the model, the various definitions of correlated equilibrium previously considered are equivalent.     

EFFECTS ON THE PRIMARY CAREGIVER WHEN A FAMILY MEMBER EXPERIENCES ACQUIRED BRAIN INJURY

This pilot study examines a random sample of 20 families with adults who have experienced acquired brain injury. Information about family structure pre and post accident is obtained by structured and open ended interview along with identification of the role of the primary caregiver. Analysis of the role of primary caregiver demonstrates the importance of the role of mothers and wives and the extent to which greatly increased responsibilities are acquired post accident. These increased responsibilities are a burden and alter the women's lifestyle such that their quality of life, like that of the person with brain injury, is severely impaired. This is a distinct but often unheralded outcome of acquired brain injury.