Two cultures: one life

Recognition of the communal nature of the culture and traditionsof many refugees who have resettled in Australia in recent years,particularly those from African countries, has urged a strongerconsideration of community-based approaches to their recoveryand resettlement. In 2004, a framework of recovery, developedto enhance the mental health and well-being of refugees duringresettlement in Australia, was applied to a community capacity-buildingprogramme among South Sudanese refugees living in an outer westernsuburb of Melbourne. This paper explores the integration ofrecovery goals into the structures and processes initiated throughoutthe programme. It assesses the contribution of this model tostrengthening the community's ability to adjust to resettlementand enable greater control in determining their lives in Australia.     

Estimating the expense of a mandatory home-and community-based personal assistance services benefit under Medicaid

Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability. DESIGN AND METHODS: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS. RESULTS: New expenditures for PAS are estimated to be $1.4-$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA). IMPLICATIONS: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.     

Potential Uncertainty Reduction in Model‐Averaged Benchmark Dose Estimates Informed by an Additional Dose Study

A methodology is presented for assessing the information value of an additional dosage experiment in existing bioassay studies. The analysis demonstrates the potential reduction in the uncertainty of toxicity metrics derived from expanded studies, providing insights for future studies. Bayesian methods are used to fit alternative dose‐response models using Markov chain Monte Carlo (MCMC) simulation for parameter estimation and Bayesian model averaging (BMA) is used to compare and combine the alternative models. BMA predictions for benchmark dose (BMD) are developed, with uncertainty in these predictions used to derive the lower bound BMDL. The MCMC and BMA results provide a basis for a subsequent Monte Carlo analysis that backcasts the dosage where an additional test group would have been most beneficial in reducing the uncertainty in the BMD prediction, along with the magnitude of the expected uncertainty reduction. Uncertainty reductions are measured in terms of reduced interval widths of predicted BMD values and increases in BMDL values that occur as a result of this reduced uncertainty. The methodology is illustrated using two existing data sets for TCDD carcinogenicity, fitted with two alternative dose‐response models (logistic and quantal‐linear). The example shows that an additional dose at a relatively high value would have been most effective for reducing the uncertainty in BMA BMD estimates, with predicted reductions in the widths of uncertainty intervals of approximately 30%, and expected increases in BMDL values of 5–10%. The results demonstrate that dose selection for studies that subsequently inform dose‐response models can benefit from consideration of how these models will be fit, combined, and interpreted.     

“All of My Lovers Fit Into This Scale”: Sexual Minority Individuals’ Responses to Two Novel Measures of Sexual Orientation

Previous qualitative research on traditional measures of sexual orientation raise concerns regarding how well these scales capture sexual minority individuals’ experience of sexuality. The present research focused on the critique of two novel scales developed to better capture the way sexual and gender minority individuals conceptualize sexuality. Participants were 179 sexual minority (i.e., gay, lesbian, bisexual, pansexual, queer, asexual) individuals who identified as cisgender (n = 122) and transgender (n = 57). Participants first completed the new scales, then provided qualitative responses regarding how well each scale captured their sexuality. The Sexual-Romantic Scale enabled the measurement of sexual and romantic attraction to each sex independently (same-sex and other-sex). Participants resonated with the way the Sexual-Romantic scale disaggregated sexual and romantic attraction. Although cisgender monosexual (lesbian/gay) individuals positively responded to the separation of same- and other-sex attraction, individuals with either plurisexual (bisexual, pansexual, or fluid) or transgender identities found the binary conceptualization of sex/gender problematic. The Gender-Inclusive Scale incorporated same- and other-sex attraction as well as dimensions of attraction beyond those based on sex (attraction to masculine, feminine, androgynous, and gender non-conforming individuals). The incorporation of dimensions of sexual attraction outside of sex in the Gender-Inclusive Scale was positively regarded by participants of all identities. Findings indicate that the Sexual-Romantic and Gender-Inclusive scales appear to address some of the concerns raised in previous research regarding the measurement of sexual orientation among sexual minority individuals.     

Applications of the Capability Approach in the Health Field: A Literature Review

The scientific understanding of the causes of global warming is based on a vast body of rigorous, peer-reviewed research, but there is little systematic empirical evidence on consequences for humans. Using direct questions about satisfaction with winter and with summer weather, I show that warming’s effects on subjective well-being can be reliably estimated from cross-sectional survey data across a broad temperature spectrum and, moreover, that these effects are large. Combining a US national survey (N = 2295) and standard National Oceanic and Atmospheric Administration data on actual month-by-month temperatures at each location over many years, shows that changes to be expected from the widely discussed, allegedly “dangerous”, 2 °C of global warming are both familiar and small, equivalent to moving from Wisconsin to Michigan, or Virginia to North Carolina, or more generally 180 miles south. Such warming will greatly increase Americans’ satisfaction with winter weather, especially in the north, but somewhat decrease satisfaction with summer weather in both north and south. On balance, the nation benefits slightly. Regional differences are large, with northerners’ gains roughly equivalent to a 1–2 % increase in their GDP, while southerners losses are about the same size. These changes are important, about as large as the combined financial implications of all other aspects of global warming. They have important policy implications, suggesting that prompt action to reduce carbon emissions may not be optimal because that would restrict warming both in the summer and in the south (gains) but also in the winter and in the north (losses).