Quality circles—Are they working in British factories?

A survey of Quality Circle programmes in British manufacturing companies reveals that Circles introduced and used properly with full management and trade union support can and do work and have many benefits. The findings suggest that current management attitudes and actions are more detrimental to the establishment and success of a circle programme than that of the trade unions. Based on the findings, indications are made of the factors which will assist companies who are considering the introduction of a Quality Circle programme and also help those companies currently using Circles to make and keep them effective.     

The inter-rater reliability and validity of self-report of risk factors for cumulative trauma disorders within the hand therapist population - a pilot study

OBJECTIVES: This study examined the validity of hand therapists' self-report of cumulative trauma disorder (CTD) risk factors by comparing the self-report to observations performed by the raters. Inter-rater reliability was also analyzed between the raters who observed the hand therapists. STUDY DESIGN: Two raters simultaneously observed each hand therapist during a splinting task at a therapy facility. Following this task, the raters and the hand therapist independently completed an identical assessment tool. Thirteen therapists were observed and a total of six raters observed the therapists. Responses from two categories of the self-assessment, "posture" and "mechanical stress", were compared. Percentage of agreement was calculated by dividing the number of like responses by the total number of possible responses for each category. RESULTS: Overall inter-rater reliability was 72%, significantly above the accepted minimum standard of 60-70%, and validity was 39%, significantly below the accepted minimum. CONCLUSION: The high percentage of inter-rater reliability established consistency and accuracy among the raters in their observations. However, the low percentage of validity should prompt hand therapists to investigate the accuracy of a patient's self-report before relying on it for treatment.     

Hiding behind the cloth:child sexual abuse and the Catholic Church

The existence of child sexual abuse within the Catholic Church has shocked many. In this article, the authors review the history of child sexual abuse in the church, the recent events that brought this tragedy into societal consciousness, and the efforts by the church to conceal the abuse. Two sources of empirical literature, the general psychological writing on priest sex abuse and the psychoanalytic literature, on child sexual abuse are compared. Both sources of literature seek explanation for priests' child sexual abuse within the structure and culture of the church rather than viewing the priest as a "typical" sex predator. The authors argue that, in fact, the guilty priests are child predators who differ little from other child predators.     

Prevalence of overweight and obesity in collegiate American football players, by position

OBJECTIVE: The authors' purpose in this study was to determine overweight and obesity prevalence in a collegiate football team. PARTICIPANTS: Eighty-five National Collegiate Athletic Association (NCAA) Division I football players volunteered to participate. METHODS: The authors measured height, weight, and waist circumference (WC), and estimated body fat percentage (% BF) from bioelectrical impedance. RESULTS: Body mass index (BMI), WC, and % BF were all positively correlated (p < .01), but BMI overestimated the prevalence of overweight and obesity in 50.6% of the cases. Fourteen players (16%) qualified as obese under all 3 methods. Offensive linemen had significantly higher % BF (p < .01) than most other positions, and on average this group exceeded the at-risk criteria for BMI (> 30 kg/m2), WC (> 102 cm), and % BF (> 25%). CONCLUSIONS: BMI alone is not a valid indicator of overweight and obesity in a strength-trained athletic population. However, some collegiate football players, especially linemen, meet multiple criteria for obesity.     

“Healthy” Human Development Indices

In the Human Development Index (HDI), life expectancy is the only indicator used in modeling the dimension ‘a long and healthy life’. Whereas life expectancy is a direct measure of quantity of life, it is only an indirect measure of healthy years lived. In this paper we attempt to remedy this omission by introducing into the HDI the morbidity indicator, “expected lost healthy years” (LHE), used in the World Health Report Though LHE is only weakly correlated with life expectancy and displays considerable variation across countries, the ranking of nations using the adjusted HDI is very similar to that from the HDI. Nevertheless, there are some outlier countries (including large countries like China and the United States) that experience notable changes in rank. Given the considerable variation in the morbidity data across gender, we also adjust the Gender-related Development Index (GDI) in a similar fashion. The ranking using the adjusted GDI is very similar to that from the GDI, but it has a lower rank correlation with the HDI.     

Household skills and low wages

Household skills provide job skills when tasks in jobs and household production are similar and jobs produce substitutes for home-made services. Opportunity costs of higher education are foregone earnings during schooling and foregone household production while studying and later in life. I show that individuals in jobs requiring household skills accept lower wage rates than traditional human capital theory predicts, and that individuals with low household skills tend to enter higher education. According to these results, declining household skills may have contributed to the observed increasing demand for higher education by women.

Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Background

Extremity injuries (EI) and dementia are important causes of long-term care (LTC), but they can also cause each other and are often present concurrently. Mobility-limiting EI can increase the risk of dementia, and dementia increases the risk for falls, which are often the cause of EI. When EI and dementia are present together, they can increase their negative effect on long-term care risk. This study aims to assess the strength of this interaction and the role of different body regions and severities of EI regarding LTC risk.

Methods

We use Cox proportional-hazard models on LTC as dependent variable. EI (primarily fractures) and dementia (all types) are the central independent variables. We control for age, sex, rehabilitation and 18 relevant comorbidities. Analyses are based on health claims records for 2004–2010 for a random sample of about 122.000 insurants of Germany's largest public health insurance "AOK" aged 65+, about 25.000 of whom entered LTC.

Results

Without concurrent dementia, non-severe EI (NSEI) of the lower and both extremities and all kinds of severe EI (SEI) increase LTC risk (HR: hazard ratio with 95% confidence interval. Lower NSEI: HR?=?1.09 [1.05–1.14]; both NSEI: HR?=?1.36 [1.29–1.44]. Lower SEI: HR?=?1.67 [1.57–1.79]; upper SEI: HR?=?1.27 [1.19–1.37]; both SEI: HR?=?1.94 [1.81–2.07]). Dementia alone increases LTC risk more than fourfold (HR?=?4.23 [4.11–4.35]).Taking the interaction of EI and dementia into account, the concurrent presence of EI and dementia tends to increase the LTC risk more than expected for lower as well as upper NSEI and SEI. Summarily, when lower or upper EI and dementia are both present, the LTC risk tends to be higher than expected, suggesting synergistic effects.

Conclusions

EI and dementia are important independent risk factors for long-term care. When lower or upper EI and dementia are present together, the resulting long-term care risk is increased disproportionately. Since the concurrent presence of both conditions increases the risk for care need, and a working treatment for dementia is not in sight, preventing EI, lessening the impact of EI and improving the outlook after an EI could help to reduce LTC need in the coming decades.

     

Robustness properties of minimally‐supported Bayesian D‐optimal designs for heteroscedastic models

Bayesian D‐optimal designs supported on a fixed number of points were found by Dette & Wong (1998) for estimating parameters in a polynomial model when the error variance depends exponentially on the explanatory variable. The present authors provide optimal designs under a broader class of error variance structures and investigate the robustness properties of these designs to model and prior distribution assumptions. A comparison of the performance of the optimal designs relative to the popular uniform designs is also given. The authors' results suggest that Bayesian D‐optimal designs suported on a fixed number of points are more likely to be globaly optimal among all designs if the prior distribution is symmetric and is concentrated around its mean.     

An Investigation of Holland Types and the Sixteen Personality Factor Questionnaire‐Fifth Edition

The authors investigated the stability of the published Sixteen Personality Factor Questionnaire‐Fifth Edition (16PF; S. Conn & M. Rieke, 1994) predictors in predicting Holland types as measured by the Self‐Directed Search (SDS; J. Holland, B. Fritzsche, & A. Powell, 1994). Because the majority of the published regression equations contained unstable predictors, the authors developed modified multiple regression equations using the more stable predictors. However, these equations, although statistically significant, shared less than 50% of the variance with the criterion variable, suggesting limited practical utility or support for the domain overlap of the 16PF and the SDS. The authors recommend that the SDS be used when a measure of SDS types is needed.     

Estimating the Causal Effect of Low Tidal Volume Ventilation on Survival in Patients with Acute Lung Injury

Acute lung injury (ALI) is a condition characterized by acute onset of severe hypoxemia and bilateral pulmonary infiltrates. ALI patients typically require mechanical ventilation in an intensive care unit. Low tidal volume ventilation (LTVV), a time-varying dynamic treatment regime, has been recommended as an effective ventilation strategy. This recommendation was based on the results of the ARMA study, a randomized clinical trial designed to compare low vs. high tidal volume strategies (The Acute Respiratory Distress Syndrome Network, 2000) . After publication of the trial, some critics focused on the high non-adherence rates in the LTVV arm suggesting that non-adherence occurred because treating physicians felt that deviating from the prescribed regime would improve patient outcomes. In this paper, we seek to address this controversy by estimating the survival distribution in the counterfactual setting where all patients assigned to LTVV followed the regime. Inference is based on a fully Bayesian implementation of Robins' (1986) G-computation formula. In addition to re-analyzing data from the ARMA trial, we also apply our methodology to data from a subsequent trial (ALVEOLI), which implemented the LTVV regime in both of its study arms and also suffered from non-adherence.