Protecting human participants in long-term care research: the role of state law and policy

There has been substantial recent activity addressed at the challenge of protecting the rights and welfare of vulnerable human participants in various kinds of research protocols, on one hand, without unduly impeding the conduct of research that promises findings that may substantially improve health and quality of life for many beneficiaries of research, on the other. Many of the emerging recommendations for improved participant protection are relevant to, and in some cases explicitly targeted at, vulnerable older persons, including long-term, chronically dependent nursing home and home health patients, who may be approached by investigators. Thus far, virtually all of the discussion and recommendations regarding research participant protection pertain to possible legal and policy changes at the federal level. Yet, both current federal law and emerging policy recommendations defer, either expressly or by default through their silence, on some very important matters about research participation, especially regarding informed consent, determinations of decisional capacity, and surrogate decision-making authority, to the laws of individual states. This article analyzes and interweaves recommendations regarding the role of state law and public policy in protecting older persons who are or may become participants in long-term care research projects.     

Employment and mental hospitalization: the case of Buffalo, New York, 1914-55

This paper explores the connection between employment trends and state mental hospital admissions first presented by Brenner in Mental Illness and the Economy. The analysis is based on employment data for the Buffalo SMSA and admissions to the SMSAs only major public psychiatric hospital for the years 1914 to 1955. We employ a series of specifications in time-series analyses. Our findings contrast with Brenner's; unlike his analysis, ours indicates that employment is positively related to admissions. Consistent with other previous research, hospital capacity is also found to be important in predicting admissions. We offer a number of interpretations for the results, in particular noting the need for the examination of the stressful effects of work itself, not merely its loss.     

Capacity in the NGO Sector: Results from a National Survey in Cambodia

Capacity has become a prominent theme in the literature on nongovernmental organizations (NGOs) in the last few decades, due in part to the increasingly global role these organizations play in development. We analyze data obtained from a national sample of local and international NGOs operating in Cambodia, documenting capacity differences between these two groups as well as highlighting overall levels of capacity in the sector. The analysis covers a number of different organizational dimensions that have been associated with capacity, including structural characteristics and concrete management practices. Results suggest that international NGOs generally have greater capacity, but overall levels of capacity are relatively low for a variety of measures. We conclude with an exploratory cluster analysis that identifies four distinctive groups of NGOs based on capacity, providing additional insights into diversity within the sector. These findings will be useful for comparative NGO research and for capacity-building programs, in addition to helping establish an agenda for future research to monitor progress.     

Fertility Preferences and Cognition: Religiosity and Experimental Effects of Decision Context on College Women

Better models of culture and cognition may help researchers understand fertility and family formation. The authors examine cognition about fertility using an experimental survey design to investigate how fertility preferences of college women are affected by two prompts that bring to mind fertility‐relevant factors: career aspirations and financial limitations. The authors test the effects of these prompts on fertility preferences and ask how effects vary with respondent religiosity, an aspect of social identity related to fertility preferences. The authors find significant effects of treatment on fertility preferences when accounting for religiosity: Less religious women who considered their career aspirations or financial limitations reported smaller desired family size, but this effect was attenuated for more religious women. This study demonstrates how fertility preferences are shaped by decision contexts for some sociodemographic groups. The authors discuss how the findings support a social–cognitive model of fertility.     

USE OF EXPERT RATINGS AS SAMPLING STRATA FOR A MORE COST-EFFECTIVE PROBABILITY SAMPLE OF A RARE POPULATION

We consider situations in which externally observable characteristics allow experts to quickly categorize individual households as likely or unlikely to contain a member of a rare target population. This classification can form the basis of disproportionate stratified sampling such that households classified as "unlikely" are sampled at a lower rate than those classified as "likely," thereby reducing screening costs. Design weights account for this approach and allow unbiased estimates for the target population.We demonstrate that with sensitivity and specificity of expert classification at least 70%, and ideally at least 80%, our approach can economically increase effective sample size for a rare population. We develop heuristics for implementing this approach and demonstrate that sensitivity drives design effects and screening costs whereas specificity only drives the latter. We demonstrate that the potential gains from this approach increase as the target population becomes rarer. We further show that for most applications, unlikely strata should be sampled at 1/6 to ? the rate of likely strata.This approach was applied to a survey of Cambodian immigrants in which the 82% of households rated "unlikely" were sampled at ? the rate as "likely" households, reducing screening from 9.4 to 4.0 approaches per complete. Sensitivity and specificity were 86% and 91% respectively. Weighted estimation had a design effect of 1.26 so screening costs per effective sample size were reduced 47%. We also note that in this instance, expert classification appeared to be uncorrelated with survey outcomes of interest among eligibles.     

Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives

While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre‐intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in ‘real‐world’ settings.     

Spatial Planning in Ghana: Exploring the Contradictions

The purpose of this research is twofold: to explore the complexity of spatial plan preparation and implementation in Ghana using Kumasi as a case study; and second, to examine the contradictions of spatial plans and ‘actual development’ occurring in Kumasi. Using social science research methods (semi-structured interviews) and physical survey (land use plans), findings indicate that spatial planning in Kumasi is a bureaucratic process hijacked by urban planning agencies with limited involvement of urban residents. As a result, urban development is considerably influenced by spontaneous informal development patterns (i.e. self-organization). This phenomenon of self-organization is expressed in a context of uncertainty created by weak spatial planning system which encourages haphazard development. Regrettably, in Kumasi, self-organization is often overlooked by spatial planning agencies as they focused on rigid and exclusionary spatial plans. This paper advocates consideration and integration of self-organization processes in spatial planning efforts to respond adequately to the urban development challenges confronting Kumasi.     

Reflections on the intersection of power and competition in reflecting teams as applied to academic settings

This article explores the author's experiences with the concepts of power and competition as they intersect with aspects of reflecting team practices in academic settings. It draws upon Bishop's (2002) work, the elements of which are based on Starhawk's (1987) ideas of power with and power over. The article describes how competition and other power over practices of domination might unfold and intersect with reflecting-team practices. It is proposed that a power over practice, such as competition, which is prevalent in our society and universities, can be incompatible with the collaborative nature of reflecting teams. Suggestions for addressing the dissonance between the environment and reflecting team practice are offered.