Health care 2015: flight of the butterfly

Projecting out to the year 2015 sounds presumptuous. Who can predict that far ahead? Perhaps no one can. Social and organizational arrangements come slowly. It takes five years or so to implement simple concepts, sometimes decades for more radical changes. Once you have the ideas in tangible form, it can take another five years to get it working right. Early adopters bring others into the movement and, over 15-25 years, new directions dominate. It takes at least a generation of new practitioners to take on the new values and methods so what is likely to dominate in 2015 is beginning to be taken somewhat seriously as the successor movement to our current fad with externally imposed managed care. Put another way, entire generations of people will resist new ideas, making implementation unlikely until their control fades and a new generation takes the helm. The exciting challenge for the observer is to address the issue of where health is and should be going. Both are difficult challenges. Agreeing on what is important and what is not represents a competitive challenge. How do we perceive the world? Surely our value sets will color what we see. Who is not predisposed to select a future where they fit and their pet theories are likely to become reality. For these and other reasons, it is probably easier to agree on what we would like to see happen in the future than on what is happening. Unfortunately, unless we see the world as it is, we are less likely to be able to shift it in a direction we would like to see.     

An innovative approach to selecting an executive director

As a guide for how to select a new executive director, a family agency adopted the search committee process from higher education. The approach included clarifying agency goals and the director's qualifications, a board-staff screening, and interviews held jointly with public representatives before final board selection.     

A Bayesian Model and Stochastic Exposure (Dose) Estimation for Relative Exposure Risk Comparison Involving Asbestos‐Containing Dropped Ceiling Panel Installation and Maintenance Tasks

Assessing exposures to hazards in order to characterize risk is at the core of occupational hygiene. Our study examined dropped ceiling systems commonly used in schools and commercial buildings and lay‐in ceiling panels that may have contained asbestos prior to the mid to late 1970s. However, most ceiling panels and tiles do not contain asbestos. Since asbestos risk relates to dose, we estimated the distribution of eight‐hour TWA concentrations and one‐year exposures (a one‐year dose equivalent) to asbestos fibers (asbestos f/cc‐years) for five groups of workers who may encounter dropped ceilings: specialists, generalists, maintenance workers, nonprofessional do‐it‐yourself (DIY) persons, and other tradespersons who are bystanders to ceiling work. Concentration data (asbestos f/cc) were obtained through two exposure assessment studies in the field and one chamber study. Bayesian and stochastic models were applied to estimate distributions of eight‐hour TWAs and annual exposures (dose). The eight‐hour TWAs for all work categories were below current and historic occupational exposure limits (OELs). Exposures to asbestos fibers from dropped ceiling work would be categorized as “highly controlled” for maintenance workers and “well controlled” for remaining work categories, according to the American Industrial Hygiene Association exposure control rating system. Annual exposures (dose) were found to be greatest for specialists, followed by maintenance workers, generalists, bystanders, and DIY. On a comparative basis, modeled dose and thus risk from dropped ceilings for all work categories were orders of magnitude lower than published exposures for other sources of banned friable asbestos‐containing building material commonly encountered in construction trades.     

Policy instrument affordances: a framework for analysis

The present study uses the concept of technological efficacy derived from ecological psychology and design studies to offer an alternative way of analyzing how policy instruments affect change. Reasoning from this, the paper outlines a framework for analyzing policy instruments in terms of their affordances. We define affordances as the means through which an instrument exerts influence on its intended target audience. Using this approach, we contend that policy instruments may be analyzed as interfaces that organize social relations and create structures of opportunity and/or restrict possibilities for action. We argue that explicating the pathways through which instruments afford or constrain action is a central task for policy analysis. Our proposed framework of analysis builds on the idea that instruments yield effects by facilitating action and learning. We further contend that the actions that an instrument can facilitate or inhibit are determined by specific affordance modalities of the instrument in conjunction with contingencies of the actor and the policy environment. Examples from research policy are used to illustrate some of these effects.     

Household time activities,food waste,and diet quality: the impact of non-marginal changes due to COVID-19

Review of Economics of the Household - In early 2020, a novel coronavirus quickly spread across the globe. In response to the rapidly increasing number of confirmed U.S. cases, state and local...     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.     

The Incidence of Crime on Industry‐Level Foreign Direct Investment: An Assessment of OECD Member Countries*

In this article, we assess whether the incidence of crime helps to explain the variation in sectoral FDI flows. Using a panel of 29 Organization of Economic Co‐operation and Development (OECD) countries for the period 2003–2012, we employ a generalized method of moments (GMM) estimation strategy due to the potential for endogeneity between our variables of interest. Our results indicate that crime deters investment to the service sector. In particular, this effect is observed in the following service industry subsector: financial services. Policymakers interested in boosting FDI in the affected sectors should be concerned with policies that focus on the reduction of criminal activities.     

Utilizing Bayesian predictive power in clinical trial design

The Bayesian paradigm provides an ideal platform to update uncertainties and carry them over into the future in the presence of data. Bayesian predictive power (BPP) reflects our belief in the eventual success of a clinical trial to meet its goals. In this paper we derive mathematical expressions for the most common types of outcomes, to make the BPP accessible to practitioners, facilitate fast computations in adaptive trial design simulations that use interim futility monitoring, and propose an organized BPP-based phase II-to-phase III design framework.