Diesel Engine Exhaust and Lung Cancer Mortality: Time‐Related Factors in Exposure and Risk

To develop a quantitative exposure‐response relationship between concentrations and durations of inhaled diesel engine exhaust (DEE) and increases in lung cancer risks, we examined the role of temporal factors in modifying the estimated effects of exposure to DEE on lung cancer mortality and characterized risk by mine type in the Diesel Exhaust in Miners Study (DEMS) cohort, which followed 12,315 workers through December 1997. We analyzed the data using parametric functions based on concepts of multistage carcinogenesis to directly estimate the hazard functions associated with estimated exposure to a surrogate marker of DEE, respirable elemental carbon (REC). The REC‐associated risk of lung cancer mortality in DEMS is driven by increased risk in only one of four mine types (limestone), with statistically significant heterogeneity by mine type and no significant exposure‐response relationship after removal of the limestone mine workers. Temporal factors, such as duration of exposure, play an important role in determining the risk of lung cancer mortality following exposure to REC, and the relative risk declines after exposure to REC stops. There is evidence of effect modification of risk by attained age. The modifying impact of temporal factors and effect modification by age should be addressed in any quantitative risk assessment (QRA) of DEE. Until there is a better understanding of why the risk appears to be confined to a single mine type, data from DEMS cannot reliably be used for QRA.     

Reanalysis of the DEMS Nested Case‐Control Study of Lung Cancer and Diesel Exhaust: Suitability for Quantitative Risk Assessment

The International Agency for Research on Cancer (IARC) in 2012 upgraded its hazard characterization of diesel engine exhaust (DEE) to “carcinogenic to humans.” The Diesel Exhaust in Miners Study (DEMS) cohort and nested case‐control studies of lung cancer mortality in eight U.S. nonmetal mines were influential in IARC's determination. We conducted a reanalysis of the DEMS case‐control data to evaluate its suitability for quantitative risk assessment (QRA). Our reanalysis used conditional logistic regression and adjusted for cigarette smoking in a manner similar to the original DEMS analysis. However, we included additional estimates of DEE exposure and adjustment for radon exposure. In addition to applying three DEE exposure estimates developed by DEMS, we applied six alternative estimates. Without adjusting for radon, our results were similar to those in the original DEMS analysis: all but one of the nine DEE exposure estimates showed evidence of an association between DEE exposure and lung cancer mortality, with trend slopes differing only by about a factor of two. When exposure to radon was adjusted, the evidence for a DEE effect was greatly diminished, but was still present in some analyses that utilized the three original DEMS DEE exposure estimates. A DEE effect was not observed when the six alternative DEE exposure estimates were utilized and radon was adjusted. No consistent evidence of a DEE effect was found among miners who worked only underground. This article highlights some issues that should be addressed in any use of the DEMS data in developing a QRA for DEE.     

Medical Negligence and Resource Allocation in the NHS

The recent growth in medical malpractice claims and in awards for damages has created concern both amongst doctors and health administrators. Steps which have been taken by the Review Body on Doctors’and Dentists’Remuneration and policy now advocated by the BMA suggest a movement away from the current system of negligence and towards a stricter no-fault system of liability. Under the current system, medical negligence occurs when doctors have not met the standards of treatment expected by reference to current professional standards. Under a no-fault system patients would be entitled to compensation for losses which arise from treatment, irrespective of whether negligence had occurred; although the implication is that the amounts of compensation would necessarily be limited. While there are reasons to believe that financial difficulties for doctors and pressures on NHS budgets may be ameliorated by a no-fault system, there are other criteria against which the current system of negligence should be judged. This article attempts to provide a framework within which a negligence system may be assessed. In particular, attention is drawn to the educative role of a negligence system and to the provision of information which may improve decisions on resource allocation. A critique of the current system of medical negligence in the UK suggests that a package of reforms to improve the system would be better than further movements towards non-market solutions.     

EFFECTS ON THE PRIMARY CAREGIVER WHEN A FAMILY MEMBER EXPERIENCES ACQUIRED BRAIN INJURY

This pilot study examines a random sample of 20 families with adults who have experienced acquired brain injury. Information about family structure pre and post accident is obtained by structured and open ended interview along with identification of the role of the primary caregiver. Analysis of the role of primary caregiver demonstrates the importance of the role of mothers and wives and the extent to which greatly increased responsibilities are acquired post accident. These increased responsibilities are a burden and alter the women's lifestyle such that their quality of life, like that of the person with brain injury, is severely impaired. This is a distinct but often unheralded outcome of acquired brain injury.     

The old left revisited: Machine technology as “social myth”

Recent perspectives on social movements have focused on the importance of organization, who participates, and the process by which they develop their social base. This paper uses the Old Left as an example of how symbols can serve as a mobilizing force for a social movement. The paper attempts to analyze the use of symbols in the Old Left by grafting Leo Marx's apolitical formulation of cultural antimonies (the machine and the garden) on George Sorel's political conceptualization of “social myths.” The paper examines how the machine operated as a “social myth” for the Old Left. The paper traces how the Old Left used the machine and machine power to dramatize the irresistible dynamism of a new industrial order.     

Social Trust,Social Partner Time and Television Time

Social trust is an important phenomenon, but the influence of important time-based measures upon trust has not been examined. Such measures include social contact and anti-social activity, such as television watching, which allows for the co-presence of other people. This paper reports on associations between trust and weighted means of co-present ‘social’ time (defined as time spent in various ‘social’ activities) and co-present time spent watching television, using the Australian Time Use Survey, 2006. It finds that trust is associated with social time spent in the co-presence of ‘strangers’ predominately from outside the household, and that TV watching in the co-presence of ‘familiars’—friends and family—is negatively associated with trust.     

A general method of constructing E(s2)-optimal supersaturated designs

There has been much recent interest in supersaturated designs and their application in factor screening experiments. Supersaturated designs have mainly been constructed by using the E ( s ²)-optimality criterion originally proposed by Booth and Cox in 1962. However, until now E ( s ²)-optimal designs have only been established with certainty for n experimental runs when the number of factors m is a multiple of n-1 , and in adjacent cases where m = q ( n -1) + r (| r | 2, q an integer). A method of constructing E ( s ²)-optimal designs is presented which allows a reasonably complete solution to be found for various numbers of runs n including n ,=8 12, 16, 20, 24, 32, 40, 48, 64.     

Probabilistic Inversion in Priority Setting of Emerging Zoonoses

This article presents methodology of applying probabilistic inversion in combination with expert judgment in priority setting problem. Experts rank scenarios according to severity. A linear multi‐criteria analysis model underlying the expert preferences is posited. Using probabilistic inversion, a distribution over attribute weights is found that optimally reproduces the expert rankings. This model is validated in three ways. First, consistency of expert rankings is checked, second, a complete model fitted using all expert data is found to adequately reproduce observed expert rankings, and third, the model is fitted to subsets of the expert data and used to predict rankings in out‐of‐sample expert data.