Knowledge Brokering: The missing link in the evidence to action chain?

Transferring health care research into policy and practice is a messy and complex process which both policymakers and researchers can struggle with. A potential solution is to use individuals or organisations as knowledge brokers. Using a range of literature, this paper explains the theory behind knowledge brokering, identifies three models of brokering and explores the challenges of brokering. We suggest that clarifying these factors is a significant step towards planning well designed and rigorously evaluated brokering interventions. We also suggest that a clearly defined theoretical framework could help us to find out more about how brokering works and its effectiveness.     

Final report of the Color Additive Scientific Review Panel

The Color Additives Scientific Review Panel considered whether there was information sufficient to perform a carcinogenic risk assessment on the colors D&C Red No. 19 (R-19), D&C Red No. 37 (R-37), D&C Orange No. 17 (O-17), D&C Red No. 9 (R-9), D&C Red No. 8 (R-8) and FD&C Red No. 3 (R-3) and to evaluate the assessments sent to FDA as part of the petitions for use of the colors for drug and external uses by the Cosmetic, Toiletry and Fragrance Association (CTFA). There is a lack of human data concerning the colors for making a human health assessment, so the assessments are based upon the extrapolation of animal data. The risk assessments are determined for exposure to single chemicals. Excluded from consideration are possible effects from exposure to multiple chemicals, such as co-carcinogenesis, promotion, synergism, antagonism, etc. In the light of recent efforts in establishing a consensus in risk assessment, the Panel has determined that the CTFA assessments for R-10, O-17, and R-9 are consistent with present acceptable usages, although it questions some of the assumptions used in the assessments. The Panel identified a number of general assumptions made, and discusses their validity, their impact on total uncertainty, and the potential options to address the gaps in understanding that necessitate the assumption. The Panel also derived revised risk estimates using more "reasonable" assumptions than "worst-case" situations, for 90th percentile and average exposure. For those assumptions that are easily quantifiable, the Panel's estimates are less than an order of magnitude lower than the CTFA risk estimates, indicating that the underestimates and overestimates of the CTFA risk estimates tend to balance each other. The impact of most of the assumptions is not quantifiable. The assessment for R-3 is complicated by the fact that there is no good skin penetrance study for this color. It was assumed that the penetrance is similar to that of another water-soluble xanthene color, R-19. It is expected that the absorption of the color is not likely to exceed that of the smaller molecule, R-19. Therefore, the risk estimates are similar to the CTFA estimates, but with different reasoning. The estimates for R-8 and R-37 are different from the others in that there is a lack of any exposure or toxicological information on these colors.(ABSTRACT TRUNCATED AT 400 WORDS)     

Residential Building Codes,Affordability, and Health Protection: A Risk-Tradeoff Approach

Residential building codes intended to promote health and safety may produce unintended countervailing risks by adding to the cost of construction. Higher construction costs increase the price of new homes and may increase health and safety risks through income and stock effects. The income effect arises because households that purchase a new home have less income remaining for spending on other goods that contribute to health and safety. The stock effect arises because suppression of new-home construction leads to slower replacement of less safe housing units. These countervailing risks are not presently considered in code debates. We demonstrate the feasibility of estimating the approximate magnitude of countervailing risks by combining the income effect with three relatively well understood and significant home-health risks. We estimate that a code change that increases the nationwide cost of constructing and maintaining homes by $150 (0.1% of the average cost to build a single-family home) would induce offsetting risks yielding between 2 and 60 premature fatalities or, including morbidity effects, between 20 and 800 lost quality-adjusted life years (both discounted at 3%) each year the code provision remains in effect. To provide a net health benefit, the code change would need to reduce risk by at least this amount. Future research should refine these estimates, incorporate quantitative uncertainty analysis, and apply a full risk-tradeoff approach to real-world case studies of proposed code changes.     

Planning for permanency planning in foster care

The perceived severity of the problem of “drift” in the foster care system has encouraged agencies nationwide to accept permanency planning, but perhaps with limited attention to the planning process. This article examines the phenomenon of permanency planning from a planning perspective by focusing on: (a) definition of the permanency planning problem, (b) understanding of issues relevant to permanency planning (caseworker, program and systemic), (c) appreciation of the operational context (political, economic and social factors), and (d) evaluation of available options and possible consequences in developing or improving a permanency planning program. Permanency planning is not a simple, ready-made program applicable to any situation; it involves coordinated efforts by workers, service systems, and society in general, and requires time, commitment and resources. Successful planning for permanency planning can permit more children to grow up in homes providing continuity and stability.     

Opportunity theory and adolescent school-based victimization

While school-based adolescent victimization has received a great deal of public attention, there exist relatively few theoretically driven studies aimed at explaining this phenomenon. We address this paucity by providing a test of a criminal-opportunity model of school-based victimization using data on over 3,000 students from 40 different Kentucky middle and high schools. The effects of opportunity-related concepts are estimated for both violent and property victimization, and comparisons are made for each victimization type across middle- and high-school student subsamples. Findings suggest that criminal opportunity theory is relevant to the understanding of school-based victimization. In particular, indicators of exposure to crime and target antagonism appear to be robust predictors. Further, there appears to be substantial generalizability in the effects of opportunity-related variables across violent versus property victimization as well as across middle-school versus high-school contexts.     

Community corrections officers' attributions for sexual offending against children

The present research examined gender differences in community corrections officers' (CCOs') attributions for child sexual offending. Eighty-five CCOs were asked to write down the reasons why they thought men sexually abused children, and then rate their reasons using Benson's Attributional Dimensions Scale. The results found that CCOs' reasons regarding why men sexually abuse children strongly paralleled current scientific theories on the etiology of child sexual abuse. Also, significant gender differences were found regarding the frequency with which participants cited certain types of reasons for child sexual abuse. Female CCOs were more likely to cite power and control as a reason, while male CCOs were more likely to cite psychopathology as a reason for child sexual abuse. No other gender differences were found. The research, clinical, and educational implications pertaining to these findings are discussed.     

Psychiatric inpatients' experience of nursing observation. A United Kingdom perspective

1. Nursing observation is a key component of psychiatric inpatient nursing care. 2. Patients' experiences of being observed are strongly influenced by the attitudes and behaviors of the observing nurses. 3. Patients prefer to be observed by nurses they know and who talk to them.