Practitioners preferences of care coordination for older people: A discrete choice experiment

These findings demonstrate the importance of organisations providing care coordination for older people receiving long-term funding. Further research is required to investigate the influence of service setting on practitioner preferences.

This study explored practitioner preferences about the relative value of attributes of care coordination services for older people. A Discrete Choice Experiment (DCE) survey was used to identify the views of 120 practitioners from 17 services in England in 2015. The survey design was informed by an analysis of standards of care coordination, a postal survey and a consultation with carers of older people. Results of the DCE survey were supplemented by a content analysis of qualitative comments and fieldwork notes. Most respondents were over 30 years of age, female and almost half worked part-time. Continuity of care (care provided by the same care coordinator) and the ability to access the range of services outlined in the care plan were the most important service attributes. Service setting influenced practitioner preferences. Those in specialist services for people with dementia identified the length of time a service was provided as another important attribute. The DCE methodology has provided the opportunity to systematically canvas practitioner preferences.     

SPINNING AGAINST THE TIDE: THE 1987 INQUIRY INTO NURSING IN VICTORIA

This article draws on research into the 1987 inquiry into nursing in Victoria, which was commissioned to appease nursing unrest over unresolved issues in the settlement of the historic 1986 nurses' strike. It explores questions surrounding the perceived dichotomy between professional and industrial issues in nursing. The report from the inquiry became an instrumental policy document that was operationalised by a formal implementation process. The process attempted to use strategies of professionalism rather than unionism, to appease nursing unrest and to advance nursing reforms. The involvement of the Victorian Branch of the Australian Nurses Federation (ANF) was central to the process. During this period, the distinction between the industrial and professional parameters of many nursing issues were shown to be blurred, despite attempts to separate them in the report. Future strategies for the development of nursing should acknowledge the limitations of professionalisation, found by this study to be divisive among nurses, reinforcing the power differential between administrative and clinical nurses.     

Mechanistic Insights Aid the Search for CFC Substitutes: Risk Assessment of HCFC-123 as an Example

An international consensus on the need to reduce the use of chlorofluorocarbons (CFCs) and other ozone-depleting gases such as the halons led to the adoptions of the 1987 Montreal Protocol and Title VI of the 1990 Clean Air Act Amendments, "Protecting Stratospheric Ozone." These agreements included major provisions for reducing and eventually phasing out production and use of CFCs and halons as well as advancing the development of replacement chemicals. Because of the ubiquitous use and benefits of CFCs and halons, an expeditious search for safe replacements to meet the legislative deadlines is of critical importance. Toxicity testing and health risk assessment programs were established to evaluate the health and environmental impact of these replacement chemicals. Development and implementation of these programs as well as the structural-activity relationships significant for the development of the replacement chemicals are described below. A dose-response evaluation for the health risk assessment of the replacement chemical HCFC-123 (2,2-dichloro-1,1,1-trifluoroethane) is also presented to show an innovative use of physiologically based pharmacokinetic (PBPK) modeling. This is based on a parallelogram approach using data on the anesthetic gas halothane, a structural analog to HCFC-123. Halothane and HCFC-123 both form the same metabolite, trifluoroacetic acid (TFA), indicative of the same metabolic oxidative pathway attributed to hepatotoxicity. The parallelogram approach demonstrates the application of template model structures and shows how PBPK modeling, together with judicious experimental design, can be used to improve the accuracy of health risk assessment and to decrease the need for extensive laboratory animal testing.     

UPPER BOUNDS FOR EFFICIENCY FACTORS IN BLOCK DESIGNS

Upper bounds are derived for efficiency factors in block designs with particular types of variety or block concurrence matrices. These bounds compare favorably with existing upper bounds.     

Testing a new model of mentoring

Mentoring programs are effective only when mentors become significant adults in the lives of youth. Mentors who achieve this status provide support that helps youth develop important psychological and behavioral assets, such as self-esteem and the ability to cope, thus promoting healthy adjustment. These processes are evident in findings of an evaluation of outcomes in a Big Brothers Big Sisters of America program.     

Implications of Developmental Toxicity Study Design for Quantitative Risk Assessment

Standard experimental designs for conducting developmental toxicity studies typically include three- or four-dose levels in addition to a control group. Some researchers have suggested that designs with more exposure groups would improve dose-response characterization and risk estimation. Such proposals have not, however, been supported by the results of simulation studies, which instead back the use of fewer dose levels. This discrepancy is partly due to using a known dose–response pattern to generate data, making model choice obvious. While the carcinogenicity literature has explored implications of different study designs, little attention has been given to the role of design in developmental toxicity risk assessment (or noncancer toxicology in general). In this research, we explore the implications of various experimental designs for developmental toxicity by resampling data from a large study of 2,4,5-trichlorophenoxyacetic acid in mice. We compare the properties of benchmark dose (BMD) estimation for different design strategies by randomly selecting animals within particular dose groups from the entire 2,4,5-T database of over 77,000 birth outcomes to create smaller "pseudo-studies" that are representative of standard bioassay sample sizes. Our results show that experimental designs which include more dose levels have advantages in terms of risk characterization and estimation.     

Data Available for Evaluating the Risks and Benefits of MTBE and Ethanol as Alternative Fuel Oxygenates

The wide-scale use of methyl tertiary butyl ether (MTBE) in gasoline has resulted in substantial public controversy and action to ban or control its use due to perceived impacts on water quality. Because oxygenates are still required under federal law, considerable research has focused on ethanol as a substitute for MTBE. In this article, we summarize the currently available literature on the air and water quality risks and benefits of MTBE versus ethanol as alternative fuel oxygenates. We find that MTBE-fuel blends are likely to have substantial air quality benefits; ethanol-fuel blends appear to offer similar benefits, but these may be at least partially negated because of ethanol's propensity to increase emissions and ambient concentrations of some air contaminants. Releases of gasoline containing either MTBE or ethanol could have an impact on some drinking water sources, although the impacts associated with MTBE tend to relate to aesthetics (i.e., taste and odor), whereas the impacts associated with ethanol generally relate to health risk (i.e., greater exposure to gasoline constituents such as benzene). It is likely that these water quality impacts will be outweighed by the air quality benefits associated with MTBE and perhaps ethanol use, which affect a much larger population. A lack of data on environmental exposures and associated health impacts hinders the completion of a comprehensive quantitative risk-benefit analysis, and the available air and water quality data should be evaluated in a broader risk-management context, which considers the potential life-cycle impacts, costs, and feasibility associated with alternative fuel oxygenates.