On “Black Swans” and “Perfect Storms”: Risk Analysis and Management When Statistics Are Not Enough

Two images, “black swans” and “perfect storms,” have struck the public's imagination and are used—at times indiscriminately—to describe the unthinkable or the extremely unlikely. These metaphors have been used as excuses to wait for an accident to happen before taking risk management measures, both in industry and government. These two images represent two distinct types of uncertainties (epistemic and aleatory). Existing statistics are often insufficient to support risk management because the sample may be too small and the system may have changed. Rationality as defined by the von Neumann axioms leads to a combination of both types of uncertainties into a single probability measure—Bayesian probability—and accounts only for risk aversion. Yet, the decisionmaker may also want to be ambiguity averse. This article presents an engineering risk analysis perspective on the problem, using all available information in support of proactive risk management decisions and considering both types of uncertainty. These measures involve monitoring of signals, precursors, and near‐misses, as well as reinforcement of the system and a thoughtful response strategy. It also involves careful examination of organizational factors such as the incentive system, which shape human performance and affect the risk of errors. In all cases, including rare events, risk quantification does not allow “prediction” of accidents and catastrophes. Instead, it is meant to support effective risk management rather than simply reacting to the latest events and headlines.     

Intergenerational Support and Marital Satisfaction: Implications of Beliefs About Helping Aging Parents

Everyday support given to aging parents is a salient aspect of married life that may have implications for marital quality. Among 132 middle‐aged couples drawn from Wave 1 of the Family Exchanges Study, the authors examined the moderating effects of each spouse's normative and motivational beliefs about helping parents on associations between the frequency of everyday support that wives and husbands gave to their own parents and marital satisfaction. Husbands' more frequent provision of support was linked to wives' greater marital satisfaction when reports of personal rewards linked to helping parents were high for wives or low for husbands. Conversely, wives' more frequent provision of support was linked to husbands' lower marital satisfaction when reports of filial obligation were low for husbands or high for wives. Findings highlight the interdependence within couples and indicate that both spouses' perceptions are important in understanding linkages between intergenerational support and marital satisfaction.     

Informal Care Intensity and Caregiver Drug Utilization

Providing informal care has negative health consequences for informal caregivers. If these health consequences increase drug utilization among caregivers, estimates of health care savings from informal care—mainly realized through reductions in utilization among care recipients—should consider the increased drug costs incurred by informal caregivers. This paper evaluates whether more intensive informal caregivers have higher drug utilization than less intensive caregivers, controlling for initial health status and other factors. We find that informal care intensity is associated with higher drug consumption. An increase of 10% of total informal care per day is associated with a 0.7% increase in drugs. The small magnitudes indicate that, in this application, it is not important to consider caregiver drug utilization when quantifying the net savings to the health care system of informal care. For individual caregivers, such as those who take multiple drugs per month and/or have no drug coverage, the increase in drug utilization associated with intensive caregiving is likely to be costly.     

Decision‐making in early clinical drug development

This paper illustrates an approach to setting the decision framework for a study in early clinical drug development. It shows how the criteria for a go and a stop decision are calculated based on pre‐specified target and lower reference values. The framework can lead to a three‐outcome approach by including a consider zone; this could enable smaller studies to be performed in early development, with other information either external to or within the study used to reach a go or stop decision. In this way, Phase I/II trials can be geared towards providing actionable decision‐making rather than the traditional focus on statistical significance. The example provided illustrates how the decision criteria were calculated for a Phase II study, including an interim analysis, and how the operating characteristics were assessed to ensure the decision criteria were robust. Copyright © 2016 John Wiley & Sons, Ltd.     

Medicalizing the optimal: Anti-aging medicine and the quandary of intervention

The emergence of anti-aging medicine over the past two decades has posed tremendous challenges for traditional categories that define the relationship between aging and biomedicine. The frameworks of nature and disease have been critical in marking how biomedicine can and should intervene. Anti-aging advocates posit that because aging is a predictable, biological universal, it is natural and can therefore be understandable. Moreover, proponents accept and perpetuate the pervasive construction that aging is a painful decline. Here, its undesirability coupled with its knowability render the process of aging ameliorable. Thus, anti-aging advocates argue that aging is natural, not a disease, but should nonetheless serve as a site of intervention. Situating the optimization of the aging process as their primary goal, many anti-aging advocates assert that it is more emblematic of human nature to liberate the body from its perceived biological constraints than it is natural to age.     

To Disclose or Not to Disclose Biracial Identity: The Effect of Biracial Disclosure on Perceiver Evaluations and Target Responses

Are biracial people perceived more negatively than their monoracial counterparts? Across two studies, we compared ratings of warmth, competence, and minority scholarship worthiness for biracial (Study 1: Black/White, Study 2: Asian/White), White, and minority (Study 1: Black, Study 2: Asian) college applicants. Findings suggest that both biracial applicants were perceived as colder and sometimes less competent than both White and corresponding minority applicants. Moreover, biracial people were also perceived as less qualified for minority scholarships than other racial minorities, which is partially explained by penalties to warmth and competence. Study 3 shows that disclosing one's biracial identity makes biracial people vulnerable to negative feedback. Taken together, these studies suggest that biracial people who disclose their biracial identity experience bias from perceivers and may be more vulnerable to that bias because of the personal nature of racial disclosure. Findings are discussed considering the stereotype content model ( Cuddy, Fiske, & Glick, 2007 ), cultural stereotypes about biracial people ( Jackman, Wagner, & Johnson, 2001 ), and the costs of disclosing devalued identities.     

Towards a conceptual model of youth leadership development

Youth leadership development is a growing area of research and practice in recent years. This paper will present a conceptual model highlighting the key components necessary in cultivating young leaders including skills development, environmental factors and commitment to action. In each of these categories, a number of aspects, supported by international literature known to be important in developing leaders, are presented. In the skills section, important factors include social and emotional intelligence, the ability to collaborate with others (including problem solving and conflict resolution), the ability to articulate a vision and finally the ability to gain insight or knowledge into the particular subject area. Environmental conditions include having authentic opportunities that enable young people to practise and hone their skills. In terms of action, both the ability to inspire and motivate followers through high expectations and role modelling pave the way to having a good team on which to build youth leadership. This, together with mastery as developed through the ability to persist and endeavour, is critical to any successful youth leader.     

Navigating the Life Cycle of Trust in Developing Economies: One‐size Solutions Do Not Fit All

Trust is critical to the development and maintenance of collaborative and cohesive relationships in societies, broadly, and in organizations, specifically. At the same time, trust is highly dependent on the social context in which it occurs. Unfortunately, existing research involving trust remains somewhat limited to a particular set of developed economies, providing a window to explore a culture's stage of economic development as a key contextual determinant of trust within organizations. In this article, we review the state of the scholarship on trust and identify those qualities of trust that are common in organizations at similar stages of economic development, referred to as its etic aspects. We then also distinguish those elements of trust that are, to the contrary, culturally specific or emic in nature. We structure our discussion around the “life cycle of trust” (i.e., the creation, maintenance, and postfracture repair of trust) and consider unique factors in its application to developing economies. In doing so, we ground our examination in expository examples through field experience in Haiti. We conclude with the proposal of a framework for future research oriented toward the resolution of remaining theoretical and empirical queries as they relate to trust in developing economies.     

Dialogue and Challenge: Involving Service Users and Carers in Small Group Learning with Social Work and Nursing Students

This paper examines the rationale for service user and carer involvement in professional education and reflects on an initiative in which social work and nursing students undertook a sequence of joint learning in relation to mental health theory and practice. Central to this initiative was the promotion of opportunities for dialogue, both between students from different professional disciplines and between students, service users and carers. To enable this, much of the learning took place in small groups facilitated by either a service user or a carer.

Evaluation of this initiative indicated that, for the majority of social work and nursing students, learning from this shared experience had a major impact on their professional development. However, a small but significant minority found it hard to enter into a dialogue with others on a basis of equality and a sharing of their human as well as their professional experience. Some students indicated that they would have preferred a focus on acquiring more specialist professional knowledge and skills. This raises important issues in relation to the changing expectations of professionalism and professional education—and what really makes someone ‘fit for practice’.