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.     

The knowledge of caring: revisiting the need for knowledge support of carers

Foster carers' knowledge of caring for abused and neglected children is a largely under-researched area. We know very little about the nature of carers' knowledge in relation to caring for children who have been abused or neglected. This paper reports on an exploratory study which examined the knowledge of caring. Qualitative data were analysed based on in-depth interviews with 10 foster carers in Queensland, Australia. A range of knowledge was identified showing an interaction of both personalized and formal understandings in the caring response. Given the breadth of knowledge recognized from the analysis, this paper presents one dimension of their knowing: theory and abuse-indicated understandings. Participants' responses in these areas were at times sound, but many struggled to provide convincing and well-formed explanations of topics, such as attachment, harm and child development which may suggest that their understandings are not what they could be. Although further research is needed on a larger scale, this study does highlight the necessity to re-examine processes and strategies for carer knowledge support, so as to strengthen their understanding of these issues.     

On the Breslow–Holubkov estimator

Breslow and Holubkov (J Roy Stat Soc B 59:447–461 1997a) developed semiparametric maximum likelihood estimation for two-phase studies with a case–control first phase under a logistic regression model and noted that, apart for the overall intercept term, it was the same as the semiparametric estimator for two-phase studies with a prospective first phase developed in Scott and Wild (Biometrica 84:57–71 1997). In this paper we extend the Breslow–Holubkov result to general binary regression models and show that it has a very simple relationship with its prospective first-phase counterpart. We also explore why the design of the first phase only affects the intercept of a logistic model, simplify the calculation of standard errors, establish the semiparametric efficiency of the Breslow–Holubkov estimator and derive its asymptotic distribution in the general case.     

Motivational Enhancement Counseling Strategies in Delivering a Telephone-Based Brief HIV Prevention Intervention

Motivational enhancement therapy (MET) interventions are being increasingly added to the menu of behavioral interventions for HIV prevention. They present few logistical and psychological barriers for at-risk persons who are ambivalent about transmission risk reduction and appear to offer promise of being transferable to community based organizations and public health programs. We describe the principles of motivational interviewing, a counseling style often used in conjunction with MET, and demonstrate and discuss its application with case examples drawn from a recent pilot trial of a telephone-delivered brief motivational enhancement for HIV risk reduction with men who have sex with men (MSM).     

The Influence of Acculturation on Breastfeeding Initiation and Duration for Mexican-Americans

This paper uses data from the Fragile Families and Child Wellbeing Study to test the hypotheses that (1) similar to other positive pre- and post-natal outcomes, Mexican immigrant mothers are more likely to breastfeed, and to breastfeed longer, than white or Mexican-American mothers; and (2) acculturation accounts for the ethnic/nativity differential in breastfeeding initiation and duration. The results support both hypotheses. Mexican immigrants to the U.S. are much more likely than whites to breastfeed, and to breastfeed longer. Mexican-American mothers, after controlling for background characteristics, have similar initiation and duration to whites. Using expanded acculturation measures developed for this paper, acculturation accounts for some of the difference between whites and Mexican immigrants in breastfeeding initiation, and much of the difference for breastfeeding duration. The results suggest that low levels of acculturation operate to protect Mexican immigrants from choosing to formula-feed, which gives their babies many health advantages, and may be associated with better health outcomes across the life course. The results also suggest that successive generations of Mexican immigrants may abandon breastfeeding, which is deleterious for their infants.     

用自家公寓开画廊是怎样一种感受?

夜色渐晚,几位年轻人在我的厨房里穿着内衣.其中一人趴在被改造成临时DJ台的炉灶上,用一台小唱片机放起了重组的黑胶唱片:与"科学怪人"异曲同工,几张不同的唱片被切成碎片,然后重新粘合在一起,音乐听起来十分疯狂.公寓那晚相当拥挤,而在场的绝大多数人都很困惑.     

郭店楚简《成之》等篇杂志

《郭店楚墓竹简》自从1998年问世后,一直引起中国内外学者的关注,成为研究先秦文字、历史、思想等领域的热门对象。然由于此批竹简的复杂性,再加上研究时间不长,因而尚有许多基本问题有待解决,而这些问题又是与竹简内容的正确理解息息相关的。如果郭店楚简几篇儒家逸书中的部分问题能够解决,便能够对其思想内涵及历史意义达到更进一步的认识。对《成之》篇作两处简序上的调整及对某些字提出新的读法后,便突显出了其中“恒”、“疾”、“终”的进阶概念,关于圣人对善道之“不拾”观念也可以有更深的理解。另外,对《唐虞之道》作简序调整,对《六德》中“多”字给新的解释,涉及问题虽小,但给先秦思想史研究带来的意义不可低估。     

Group therapy with sexually abused boys: Notes toward managing behavior

This article examines the gender-specific defense mechanisms of sexually abused boys as they emerge in group therapy, using Finkelhor's model of traumagenic dynamics. Concrete interventions address the acting out behavious that are typical for this population, connecting the acting out behaviors to the boys' common background of sexual abuse. Without these concrete interventions to address the unsafe, aggressive behaviours of sexually abused boys, their problems and experiences cannot be shared, nor can the group therapist address the issues outlined in a curriculum for group therapy for sexually abused children.