Exposure Reconstruction for the TCDD-Exposed NIOSH Cohort Using a Concentration- and Age-Dependent Model of Elimination

Recent studies demonstrating a concentration dependence of elimination of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) suggest that previous estimates of exposure for occupationally exposed cohorts may have underestimated actual exposure, resulting in a potential overestimate of the carcinogenic potency of TCDD in humans based on the mortality data for these cohorts. Using a database on U.S. chemical manufacturing workers potentially exposed to TCDD compiled by the National Institute for Occupational Safety and Health (NIOSH), we evaluated the impact of using a concentration- and age-dependent elimination model (CADM) (Aylward et al., 2005) on estimates of serum lipid area under the curve (AUC) for the NIOSH cohort. These data were used previously by Steenland et al. (2001) in combination with a first-order elimination model with an 8.7-year half-life to estimate cumulative serum lipid concentration (equivalent to AUC) for these workers for use in cancer dose-response assessment. Serum lipid TCDD measurements taken in 1988 for a subset of the cohort were combined with the NIOSH job exposure matrix and work histories to estimate dose rates per unit of exposure score. We evaluated the effect of choices in regression model (regression on untransformed vs. ln-transformed data and inclusion of a nonzero regression intercept) as well as the impact of choices of elimination models and parameters on estimated AUCs for the cohort. Central estimates for dose rate parameters derived from the serum-sampled subcohort were applied with the elimination models to time-specific exposure scores for the entire cohort to generate AUC estimates for all cohort members. Use of the CADM resulted in improved model fits to the serum sampling data compared to the first-order models. Dose rates varied by a factor of 50 among different combinations of elimination model, parameter sets, and regression models. Use of a CADM results in increases of up to five-fold in AUC estimates for the more highly exposed members of the cohort compared to estimates obtained using the first-order model with 8.7-year half-life. This degree of variation in the AUC estimates for this cohort would affect substantially the cancer potency estimates derived from the mortality data from this cohort. Such variability and uncertainty in the reconstructed serum lipid AUC estimates for this cohort, depending on elimination model, parameter set, and regression model, have not been described previously and are critical components in evaluating the dose-response data from the occupationally exposed populations.     

When You Can't Afford to Leave Home: Clinical Implications of Economic Realities

Young adults entering the job market are finding that, despite strong corporate profits, economic growth is not trickling down to worker earnings, and federal policies are moving from the notion of entitlement to one of blame (Uchitelle, 1996, Sec. 4, p. 1). Adolescence is becoming increasingly confusing, since for many Americans economic opportunity is more fantasy than reality. This article highlights the declining opportunity for young adults and points out the limitations of existing adult developmental theory, both of which call for altered treatment conceptualizations that include the clinician operating as an anthropologist and utilizing the concepts of relationship-differentiation and response/ability from Stone Center writings.     

Corporate planning at Rolls-Royce Motors Limited

In this article the authors describe the introduction to date of a formal planning process at a British manufacturing company which, according to its recent performance, had no pressing need to implement radical change. Is Rolls-Royce Motors' decision the symptom of a new trend in industry to overhaul planning techniques while the going is good? How was company morale used to justify a new planning style? Why did an evidently capable organization choose to engage consultancy assistance? While the company's intentions are not yet fully achieved, its experience may be of benefit to others contemplating a similar decision.     

The changing structure of food retailing in europe: the implications for strategy

European food retailers have increased their scale and scope while concentrating sales into large stores. Strategic implications include the need for scale to compete and organisational relationships to move from supply push to demand pull retailing. Consequences are different for private label and for branded manufacturers, who must respond to the demands of retail supply chains whilst retaining control of product development. Further concentration in both sectors is likely. Consumers are more mobile, but more captive to the retailer in store. Public policy makers are challenged to find new measures of retail power and both allow for innovation and ensure equitable shopping opportunities.     

Strength of attachment: Survey coverage of people with tenuous ties to residences

This article draws on evidence from an exploratory survey of living situations to assess the validity of assumptions about residence and to offer methodological innovations to improve coverage of people with tenuous attachment to households. These innovations include more inclusive probes and questions used to compile the roster of household residents; a review of the places a person stayed the previous few months; and a Residential Attachment scale that measures strength of attachment to households. This scale shows that it takes more probing to list tenuously attached people than most surveys do, suggesting that tenuously attached people are likely to be omitted from the typical survey roster. The Residential Attachment scale is correlated with social and economic participation in households, suggesting that participation is fairly high even among those with tenuous or no residential attachment.     

Importance of interpolation when constructing double-bootstrap confidence intervals

We show that, in the context of double-bootstrap confidence intervals, linear interpolation at the second level of the double bootstrap can reduce the simulation error component of coverage error by an order of magnitude. Intervals that are indistinguishable in terms of coverage error with theoretical, infinite simulation, double-bootstrap confidence intervals may be obtained at substantially less computational expense than by using the standard Monte Carlo approximation method. The intervals retain the simplicity of uniform bootstrap sampling and require no special analysis or computational techniques. Interpolation at the first level of the double bootstrap is shown to have a relatively minor effect on the simulation error.