Times Are Tough—Brother,Can You Paradigm?

Ten years ago, the National Academy of Science released its risk assessment/risk management (RA/RM) “paradigm” that served to crystallize much of the early thinking about these concepts. By defining RA as a four-step process, operationally independent from RM, the paradigm has presented society with a scheme, or a conceptually common framework, for addressing many risky situations (e.g., carcinogens, noncarcinogens, and chemical mixtures). The procedure has facilitated decision-making in a wide variety of situations and has identified the most important research needs. The past decade, however, has revealed that additional progress is needed. These areas include addressing the appropriate interaction (not isolation) between RA and RM, improving the methods for assessing risks from mixtures, dealing with “adversity of effect,” deciding whether “hazard” should imply an exposure to environmental conditions or to laboratory conditions, and evolving the concept to include both health and ecological risk. Interest in and expectations of risk assessment are increasing rapidly. The emerging concept of “comparative risk” (i.e., distinguishing between large risks and smaller risks that may be qualitatively different) is at a level comparable to that held by the concept of “risk” just 10 years ago. Comparative risk stands in need of a paradigm of its own, especially given the current economic limitations. “Times are tough; Brother, can you paradigm?”     

Agreement Between Scales in the Measurement of Breast Cancer Risk Perceptions

The objective of this article is to compare the accuracy and numeric responses of breast cancer risk perception as measured by a frequency scale and percentage scale. A cross-sectional survey was conducted. Perceptions of five-year and lifetime breast cancer risk were measured using a frequency and a percentage scale. Estimation error was calculated as the absolute difference between actual breast cancer risk as determined by the Gail model and perceived risk. Agreement between scales was determined by calculating the mean and standard deviation of the difference between numeric responses. The study was conducted among women enrolled in two primary care clinics associated with an academic medical center. Two-hundred-fifty-four participants were recruited from one of the two participating internal medicine clinics. Inclusion criteria included female gender and age 40-84 years. Exclusion criteria included a history of breast cancer, dementia, or a life expectancy of less than two years. The frequency scale was more accurate than the percentage scale in estimating lifetime risk (p= 0.05), but less accurate in estimating five-year risk (p < 0.02). Only 79 participants (31%) were considered consistent scale users, providing identical responses when using the frequency and percentage scale for a given risk estimate. Although the mean difference (percentage-frequency scale) for estimates of breast cancer lifetime risk was only 2.4, the empirically determined 90% limits of agreement between the frequency and percentage scale for lifetime risk were wide, from -30 to 40. Higher numeracy was associated with consistent use of scales (OR 1.61, 95% CI; 1.09-2.37). We report disagreement in breast cancer risk perceptions when measured by a frequency and a percentage scale. The accuracy and direction of bias associated with each scale varies according to the time frame of risk being assessed.     

What recruiters can't/won't tell you. 6 questions that good headhunters won't answer.

If you're frustrated because a headhunter won't give you certain information about a hiring organization, get over it. There are some very good reasons why a respectable recruiter won't answer particular questions from job candidates. Find out the questions and why they won't answer them.     

Physician fee-setting requires scrutiny.

To avoid antitrust liability from physician fee-setting in HMOs and PPOs, participating physicians should share the risk of profit and loss. "Health Law" is a regular feature of Physician Executive contributed by the law firm of Epstein Becker and Green, P.C. Douglas A. Hastings, Esq., a partner in the firm's Washington, D.C., offices serves as column editor.     

Osteoporosis: an invisible, undertreated, and neglected disease of elderly men

This article highlights a silent disease that threatens the health and vitality of older men. Among elderly men and women, osteoporosis is among one of the leading causes of morbidity and mortality in the United States. Once perceived as only a female dominated disease, osteoporosis is now known to be gender blind. The following discussion will review the epidemiology and pathology of osteoporosis, and identify the concerns raised for men, including neglect. Special management considerations for older men and recommendations for future research into this overlooked major health problem will be explored. Better understanding of how osteoporosis affects older men may help to encourage prevention strategies earlier in life, appropriate screening and monitoring, as well as more effective treatment later in life.     

Headquarter Services in the Global Integration of Production

This study examines knowledge management within multinational enterprises (MNEs) by analyzing whether greater interdependence of production between U.S. parent firms and their foreign subsidiaries increases the provision of headquarter (HQ) services from the home country. The findings suggest that U.S. parents provide more assistance to their foreign subsidiaries that are linked in a global value chain than to those that are not involved in production sharing. This study builds on the earlier studies of the relationship between intra-MNE product flows and knowledge flows in multiple ways. First, it separately examines the relationship for high-tech and low-tech manufacturing industries, and finds that knowledge services from HQ that could be combined with knowledge of the subsidiary, such as R&D services, are primarily associated with production sharing with subsidiaries in high-tech manufacturing industries, which are assumed to be more technologically capable. Likewise, it finds that knowledge services from HQ that might be considered to be more passively received from the parent, such as industrial-type maintenance and design, are primarily associated with subsidiaries in low-tech manufacturing industries, which are assumed to be less technologically capable. Second, this study is the first one, to our knowledge, that gauges intra-firm knowledge flows using dollar-denominated measures of HQ services provided by parents to their subsidiaries.     

Qualitative Research: Valuable or Irrelevant?

This paper evaluates qualitative research methods in relation to the emancipatory research model. It identifies the main reasons why researchers opt for qualitative research, describes the principal data collection techniques used by them, and discusses some of the problems associated with these procedures. Drawing on insights gained from doing qualitative research in day centres for disabled young adults, I argue that these methodologies are fundamental to the emancipatory research paradigm; but their relevance can only be determined by researchers' willingness to challenge the institutions which control disability research production.