Density based exploration of bivariate data

The difficulties of assessing details of the shape of a bivariate distribution, and of contrasting subgroups, from a raw scatterplot are discussed. The use of contours of a density estimate in highlighting features of distributional shape is illustrated on data on the development of aircraft technology. The estimated density height at each observation imposes an ordering on the data which can be used to select contours which contain specified proportions of the sample. This leads to a display which is reminiscent of a boxplot and which allows simple but effective comparison of different groups. Some simple properties of this technique are explored.Interesting features of a distribution such as arms and multimodality are found along the directions where the largest probability mass is located. These directions can be quantified through the modes of a density estimate based on the direction of each observation.     

‘Reasonable and necessary’ care: the challenge of operationalising the NDIS policy principle in allocating disability care in Australia

Disability reform in Australia centres on a National Disability Insurance Scheme (NDIS), which aims to provide lifelong, individualised support based on the principle of ‘reasonable and necessary’ care. As a universal rights‐based scheme it represents a historical shift in allocation principles in Australia's disability policy. Nonetheless, attention will be on determining who receives what care given the diversity of personal and family contexts. The aim of this paper is to discuss the operational complexities of a principle of reasonable and necessary care with reference to the findings of a three‐year study on the experiences and perspectives of disability care of 25 adults with acquired disability, their 22 nominated family members and 18 service providers. Evidence from this study suggests enacting the principle of reasonable and necessary care and support will be problematic, in particular as it relates to personalising the level and scope of services, balancing formal and informal care, and principles of equity. The paper contributes to the literature about allocation principles in social policy and the challenges of implementation. Further, it provides an empirically informed discussion of some of the specific policy implementation challenges concerning the NDIS.     

The Challenge of Leadership in Front Line Clinical Teams Struggling to Meet Current Policy Demands

Teams, and their managers, working at the interface between government policy and service to clients are subject to high levels of anxiety arising out of the persecutory manner in which well-intended policy demands are delivered and cost efficiencies imposed. Informed by Bion's ideas about group behaviours, these responses can be understood as a form of defensive behaviour and identified as Basic Assumption Me-ness. Basic Assumption Me-ness in team managers takes the form of managerialism at the expense of leadership, developing a shell that acts as a protection for the lonely, overburdened, vulnerable and soft inside. This hardness, evident through increased unavailability and a rather sadistic use of boundaries, is communicated to staff, who in turn pass it onto clients. In this manner, it infects all relationships thus stifling emotional engagement, creative thinking and practice. This paper then explores ways in which team leaders, courageous enough to take up their authority in an emotionally engaged manner, can reverse these dynamics to the relief and benefit of all concerned. Leaders need to insist on attendance at meetings and supervision where cases can be properly considered; demonstrate an ability to think about risk as ever present in the work because, as all are well aware, no amount of form filling can eliminate this; and acknowledge that the work requires constant assessment and judgement as well as an ability to stay with the unknown. The aim is to be responsive to the daily struggles of team members working face-to-face with clients and to remain aware of ‘the reality on the ground’ when engaging in an equally lively way with senior management.     

Hepatitis B virus seroconversion rates among health sciences students in the southeastern United States

ABSTRACT

Objective: To investigate the hepatitis B virus (HBV) seroconversion rate among health sciences students. Participants: The study included pharmacy, doctor of nursing, and medical students over 18 years of age enrolled at the University of South Carolina between 2007 and 2011. Methods: The primary end point was HBV seroconversion rates among students at the initial reporting period. Seroconversion was defined as hepatitis B surface antibody (anti-HBs) level greater than or equal to 10 mIU/mL. Multivariate regression analysis was used to determine predictive factors of seroconversion. Results: Of 777 records, data were available for 709 students. An 83.9% seroconversion rate was observed after a mean of 10 years between vaccine receipt and anti-HBs evaluation. Students with incomplete HBV vaccine series and longer time between initial series and evaluation were less likely to exhibit antibody response. Conclusions: These data highlight the importance of assessment and documentation of HBV vaccination series among health sciences students prior to direct patient care activities.     

Addressing Elder Abuse: The Waterloo Restorative Justice Approach to Elder Abuse Project

The Community Care Access Centre (CCAC) of Waterloo Region, in partnership with a number of other social service agencies, designed and implemented a restorative justice model applicable to older adults who have been abused by an individual in a position of trust. The project was very successful in building partnerships, as many community agencies came together to deal with the problem of elder abuse. The program also raised the profile of elder abuse in the community. However, despite intensive efforts, referrals to the restorative justice program were quite low. Because of this, the program moved to a new organizational model, the Elder Abuse Response Team (EART), which has retained the guiding philosophy of restorative justice but has broadened the mandate. The team has evolved into a conflict management system that has multiple points of entry for cases and multiple options for dealing with elder abuse. The team has developed a broad range of community partners who can facilitate referrals to the EART and also can help to provide an individualized response to each case. The transition to the EART has been successful, and the number of referrals has increased significantly.