Unjust Freedom: The Ethics of Client Self-Determination in Runaway Youth Shelters

Client self-determination has been called the most confounding and professionally debilitating concept of all the intellectual principles under-girding social work (Rothman, 1989). Identifying the appropriate parameters of client self-determination is a particularly acute problem for social workers employed by runaway and homeless youth shelters where minors are making adult decisions free from parental guidance. We examine the ethical dimensions of practice with minor clients in runaway shelters by arguing that a conflict exists between the liberty-based principle of self-determination and the justice-based notion of client competency. We analyze the conflict by using minimal distributive justice as the organizing principle of social work practice. We conclude that client self-determination in runaway shelters should be restricted and that presuming client competence violates the basic value tenets of the profession.     

Older women's fears of violence: the need for interventions that enable active ageing

Women's fear of violence can impact negatively on their active participation in life. An ageing survey conducted with 2,620 Australian respondents aged 50 to 90 years examined aspects of work, learning, social, spiritual and emotional status, health, vision, home, life events, demographics, and asked an open-ended question about what being actively engaged in life meant. Ordinal regression was carried out on two dependent variables: wanting and needing to learn to discourage violence. Analyses found that as women's age increased, those on lower incomes were more likely than others to say they needed to learn how to discourage violence against them. This paper investigates the variables associated with the findings-transport, finances, news media, home safety, and reduced social interactions. Results highlight the importance of understanding women's fear in the context of personal and social issues, and the need to provide learning opportunities to improve safety and social engagement.     

Explaining the Flight of Cupid’s Arrow: A Spatial Random Utility Model of Partner Choice

Spatial homogamy may be defined as follows: anyone may be attracted to anyone else, but near candidates are more attractive than distant candidates. In this article, we propose a model of partner choice, where homogamy is defined in terms of spatial, demographic, socioeconomic and cultural similarity. A spatial choice model using random utility theory is formulated, taking into account a relaxation of the independence from the irrelevant alternatives property, as spatial alternatives are not independent of one another. We model partner choice given the characteristics of the chosen partner and a choice set of alternatives, using unique micro data on all new cohabiters in the Netherlands, linked to other relevant data sets. The model takes the spatial locations of potential candidates within a choice set into account, including an indicator for the spatial similarity between alternatives. We find that spatial homogamy is a vital component of partner matching, aside from and adding to the spatial effects in demographic, socioeconomic and cultural homogamy. Given a choice set of partners, the highest likelihood of a match occurs with a person who is born and lives near by, who is close in age, is in the same life stage and has the same marital status, who has the same educational and income level and the same labour market status, who speaks the same dialect and lives in a culturally similar residential area. The distance effect is most pronounced for those individuals with lower levels of education and those living in rural areas.     

Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)

Several colorectal cancer (CRC) screening models have been developed describing the progression of adenomas to CRC. Currently, there is increasing evidence that serrated lesions can also develop into CRC. It is not clear whether screening tests have the same test characteristics for serrated lesions as for adenomas, but lower sensitivities have been suggested. Models that ignore this type of colorectal lesions may provide overly optimistic predictions of the screen‐induced reduction in CRC incidence. To address this issue, we have developed the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model that includes the adenoma‐carcinoma pathway and the serrated pathway to CRC as well as characteristics of colorectal lesions. The model structure and the calibration procedure are described in detail. Calibration resulted in 19 parameter sets for the adenoma‐carcinoma pathway and 13 for the serrated pathway that match the age‐ and sex‐specific adenoma and serrated lesion prevalence in the COlonoscopy versus COlonography Screening (COCOS) trial, Dutch CRC incidence and mortality rates, and a number of other intermediate outcomes concerning characteristics of colorectal lesions. As an example, we simulated outcomes for a biennial fecal immunochemical test screening program and a hypothetical one‐time colonoscopy screening program. Inclusion of the serrated pathway influenced the predicted effectiveness of screening when serrated lesions are associated with lower screening test sensitivity or when they are not removed. To our knowledge, this is the first model that explicitly includes the serrated pathway and characteristics of colorectal lesions. It is suitable for the evaluation of the (cost)effectiveness of potential screening strategies for CRC.     

Repurposing Materials and Waste through Online Exchanges: Overcoming the Last Hurdle

Online material and waste exchanges (OMWEs) provide online channels to repurpose by‐products, unused materials and waste from industrial and commercial facilities. Unfortunately, OMWE's also have challenges. First, sellers may have access to other disposal options and, as a result, may not fully commit to the exchange. Second, buyers can face high uncertainty about the product exchanged and the transaction being undertaken. Overcoming these challenges is the “last hurdle” to making OMWEs successful. This study investigates the factors that reduce the buyers' uncertainty and increase the sellers' commitment to the OMWE. We analyze novel transaction‐level data from an online exchange (MNExchange.org) combined with other archival public records on county‐level repurposing and disposal statistics. First, we find that regional repurposing policies and alternatives have a complementary effect on sellers' commitment toward OMWEs, resulting in increased OMWE exchanges. However, regional disposal policies and alternatives have a substitution effect on sellers' commitment, resulting in reduced exchange success. Further, greater product and transaction information reduce the buyer's uncertainty and increase exchange success. Finally, the analysis shows that users' (buyers and sellers) heavily rely on their prior experience with OMWEs. Specifically, higher familiarity between the buyer–seller pair and familiarity with the OMWE system leads to higher likelihood of exchange success. This study lays the foundation for understanding OMWEs and has important implications for developing policies and operations to increase online transactions of by‐products, materials and wastes.     

Modelling PK/QT relationships from Phase I dose‐escalation trials for drug combinations and developing quantitative risk assessments of clinically relevant QT prolongations

In current industry practice, it is difficult to assess QT effects at potential therapeutic doses based on Phase I dose‐escalation trials in oncology due to data scarcity, particularly in combinations trials. In this paper, we propose to use dose‐concentration and concentration‐QT models jointly to model the exposures and effects of multiple drugs in combination. The fitted models then can be used to make early predictions for QT prolongation to aid choosing recommended dose combinations for further investigation. The models consider potential correlation between concentrations of test drugs and potential drug–drug interactions at PK and QT levels. In addition, this approach allows for the assessment of the probability of QT prolongation exceeding given thresholds of clinical significance. The performance of this approach was examined via simulation under practical scenarios for dose‐escalation trials for a combination of two drugs. The simulation results show that invaluable information of QT effects at therapeutic dose combinations can be gained by the proposed approaches. Early detection of dose combinations with substantial QT prolongation is evaluated effectively through the CIs of the predicted peak QT prolongation at each dose combination. Furthermore, the probability of QT prolongation exceeding a certain threshold is also computed to support early detection of safety signals while accounting for uncertainty associated with data from Phase I studies. While the prediction of QT effects is sensitive to the dose escalation process, the sensitivity and limited sample size should be considered when providing support to the decision‐making process for further developing certain dose combinations. Copyright © 2016 John Wiley & Sons, Ltd.     

Applying the use of activity in the assessment of malingering: A case illustration

The assessment of malingering has predominantly been considered within the domains of neuropsychologists and psychiatrists, who use consistency of performance criteria similar to those used in functional capacity evaluations (FCE). The use of activity has traditionally been used in occupational therapy as an assessment and treatment modality with goals not always considered obvious and which could easily be used for diversional reasons. The appropriate use of activity adds an additional dimension to a layered approach of using multiple data sources and methods as recommended by FCE practitioners and neuropsychologists alike. The case illustration aims to explain the above using a layered model.