Dropouts and continuers in Gamblers Anonymous: Part four. Evaluation and summary

In this fourth part of a study of dropouts from Gamblers Anonymous, the design, aims and rationale of which are outlined in part 1 (Brown, 1985b) experiences of GA by a sample of dropouts who had attended more than one meeting are analyzed and compared with similarly obtained responses from a group of continuing attenders who had not gambled for at least one year. The overall pattern of findings from the three prior parts of the study is interpreted as suggesting that

1. Gamblers anonymous may be better at coping with those whose gambling has been severely excessive and had led to many problems. However GA's approach is not so easily accepted and therefore not so effective with those who seek help at an earlier stage in the development of their problems.
2. Gamblers Anonymous may work better with those who have few relapses or best with those who have none at all. Although it may be very helpful in avoiding relapses, it may be less helpful in dealing with them when they do occur.

problems of the representativeness of the sample, of generalizing to Gamblers Anonymous as a whole, and of arguing from associations to causes are discussed. A general picture of the organization as a whole is presented.     

Batch process control using QFD matrices and simulation

An intuitive method for providing decision support of production control activities is proposed in which qualitative management information is represented by way of Quality Function Deployment matrices, while quantitative information is collected in the form of a simulation model of the plant. The quantitative-to-qualitative transform is provided by way ofgoal programming and fuzzy decision rules-where the latter naturally complements the symbolic method of representing information.     

Model Uncertainty and Model Averaging in the Estimation of Infectious Doses for Microbial Pathogens

Food‐borne infection is caused by intake of foods or beverages contaminated with microbial pathogens. Dose‐response modeling is used to estimate exposure levels of pathogens associated with specific risks of infection or illness. When a single dose‐response model is used and confidence limits on infectious doses are calculated, only data uncertainty is captured. We propose a method to estimate the lower confidence limit on an infectious dose by including model uncertainty and separating it from data uncertainty. The infectious dose is estimated by a weighted average of effective dose estimates from a set of dose‐response models via a Kullback information criterion. The confidence interval for the infectious dose is constructed by the delta method, where data uncertainty is addressed by a bootstrap method. To evaluate the actual coverage probabilities of the lower confidence limit, a Monte Carlo simulation study is conducted under sublinear, linear, and superlinear dose‐response shapes that can be commonly found in real data sets. Our model‐averaging method achieves coverage close to nominal in almost all cases, thus providing a useful and efficient tool for accurate calculation of lower confidence limits on infectious doses.     

Seasonal patterns of fertility measures: A Bayesian approach

Becker (1981) presents some theory about related measures of fertility. He SUMMARY compares his theoretical predictions with observed relationships found in a set of data collected in Bangladesh. In general, he finds good agreement. In this paper, we reanalyse the data using Bayesian methods. In particular, we use Gibbs sampling to fit trigonometric regression models with autocorrelated errors. The results are generally in agreement with Becker's. However, evidence from one of the autocorrelation parameters and a residual analysis casts some doubt on whether the basic cosine model which is assumed fits the data well.     

Hip protectors in the elderly: lack of effectiveness or just suboptimal implementation?

Hip protectors seemed to be the only non-pharmacological intervention to effectively prevent hip fractures in high-risk populations. In contrast, recently published trials did not find hip fracture reduction through hip protector interventions. An updated Cochrane review concluded that the device is ineffective for community-dwelling elderly and of uncertain effectiveness for institutionalised elderly. However, some primary studies used suboptimal implementation of hip protectors, which has led to low adherence and ineffectiveness of the intervention. Shortcomings in implementation techniques have not been assessed by the Cochrane review. Therefore, reviewers should explicitly assess whether the intervention was well planned and competently administered. As a checklist cannot adequately assess individual, study-specific implementation flaws, we suggest narrative expert review and feedback to the authors of the primary study.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.