Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

The design of organizations and the right to act

Recent innovations in the structure of formal organizations suggest possible directions for the design of schools to bring about high achievement. The structure of output-driven in contrast to administratively-driven schools is described, and designs are described which address both the goal of high achievement and the goal of reduced inequality.An earlier version of this paper was presented as the author's Sorokin Lecture at the annual meeting of the Eastern Sociological Society, Boston, March 1993.     

美国早期融合教育师资在线培养经验及启示

“办好公平而有质量的教育”是我国当前教育发展的主题,融合教育作为沟通普通教育和特殊教育的桥梁,是新时期 基础教育扩优提质计划的重要组成部分,亦是确保学前教育普及普惠的应有之义,其发展的关键在于培养高质量的融合 教育师资。通过对美国西南地区某研究型公立大学开发的一套早期融合教育师资在线培养课程进行解读,进而探究我国 学前融合教育教师培养路径。首先,从教学形式、教育对象和课程目标三方面分析该在线培养课程与同类型的线下课程 之间的差异：其次,总结该早期融合教育师资在线培养课程的特点;最后,结合该早期融合教育师资在线培养课程建设案 例,从教育对象、教育过程、课程评价和社会影响四方面,就创新我国学前融合教育人才培养方式的问题形成相应启示与 建议。     

园本教研创新促进园本课程建设的实践探索——以泉州台商投资区湖东实验幼儿园为例

加强园本教研是创新驱动园本课程建设的有效路径和关键动力。以泉州台商投资区湖东实验幼儿园依托园本教研创新驱动慧美课程建设探索为例,阐释初步形成的教育行动策略：坚持立足园本教研,夯实园本课程根基;持续创新教研策略,提升园本课程品质。     

Identifying and implementing pathways for organizational change – using the Framework for the Assessment of Children in Need and their Families as a case example

Change within social work organizations is incessant. This has implications for senior managers and elected members who have to manage these changes. The Department of Health has introduced new guidance entitled the Framework for the Assessment of Children in Need and their Families ( Department of Health 1999a ). The guidance is based on a number of principles that require an attitudinal shift in terms of assessing ways of safeguarding children and promoting their welfare. This paper describes strategic approaches to the effective introduction of the framework within social services departments and other child welfare organizations. Two models have been adapted from practice: the actual framework for assessing children and their families and the Protchaska and DiClementi model of change. These models complement each other. The adapted Assessment Framework provides a structure to assess the readiness of the organization for the implementation of the new framework. The model of change provides a schema for planning, implementing and reviewing the introduction and operation of the Framework for the Assessment of Children in Need and their Families. Although the focus of the paper is the introduction of the new guidance , the models can be utilized by senior managers in any social care organization who are facilitating major changes in the organization.     

M-quantile models with application to poverty mapping

Over the last decade there has been growing demand for estimates of population characteristics at small area level. Unfortunately, cost constraints in the design of sample surveys lead to small sample sizes within these areas and as a result direct estimation, using only the survey data, is inappropriate since it yields estimates with unacceptable levels of precision. Small area models are designed to tackle the small sample size problem. The most popular class of models for small area estimation is random effects models that include random area effects to account for between area variations. However, such models also depend on strong distributional assumptions, require a formal specification of the random part of the model and do not easily allow for outlier robust inference. An alternative approach to small area estimation that is based on the use of M-quantile models was recently proposed by Chambers and Tzavidis (Biometrika 93(2):255–268, 2006) and Tzavidis and Chambers (Robust prediction of small area means and distributions. Working paper, 2007). Unlike traditional random effects models, M-quantile models do not depend on strong distributional assumption and automatically provide outlier robust inference. In this paper we illustrate for the first time how M-quantile models can be practically employed for deriving small area estimates of poverty and inequality. The methodology we propose improves the traditional poverty mapping methods in the following ways: (a) it enables the estimation of the distribution function of the study variable within the small area of interest both under an M-quantile and a random effects model, (b) it provides analytical, instead of empirical, estimation of the mean squared error of the M-quantile small area mean estimates and (c) it employs a robust to outliers estimation method. The methodology is applied to data from the 2002 Living Standards Measurement Survey (LSMS) in Albania for estimating (a) district level estimates of the incidence of poverty in Albania, (b) district level inequality measures and (c) the distribution function of household per-capita consumption expenditure in each district. Small area estimates of poverty and inequality show that the poorest Albanian districts are in the mountainous regions (north and north east) with the wealthiest districts, which are also linked with high levels of inequality, in the coastal (south west) and southern part of country. We discuss the practical advantages of our methodology and note the consistency of our results with results from previous studies. We further demonstrate the usefulness of the M-quantile estimation framework through design-based simulations based on two realistic survey data sets containing small area information and show that the M-quantile approach may be preferable when the aim is to estimate the small area distribution function.     

On the Need for Restricting the Probabilistic Analysis in Risk Assessments to Variability

It is common perspective in risk analysis that there are two kinds of uncertainties: i) variability as resulting from heterogeneity and stochasticity (aleatory uncertainty) and ii) partial ignorance or epistemic uncertainties resulting from systematic measurement error and lack of knowledge. Probability theory is recognized as the proper tool for treating the aleatory uncertainties, but there are different views on what is the best approach for describing partial ignorance and epistemic uncertainties. Subjective probabilities are often used for representing this type of ignorance and uncertainties, but several alternative approaches have been suggested, including interval analysis, probability bound analysis, and bounds based on evidence theory. It is argued that probability theory generates too precise results when the background knowledge of the probabilities is poor. In this article, we look more closely into this issue. We argue that this critique of probability theory is based on a conception of risk assessment being a tool to objectively report on the true risk and variabilities. If risk assessment is seen instead as a method for describing the analysts’ (and possibly other stakeholders’) uncertainties about unknown quantities, the alternative approaches (such as the interval analysis) often fail in providing the necessary decision support.     

新课程标准下的音乐教师从教能力结构探析

本文以新的课程标准为基础,并以全新的理念、全新的思维、全新的方式对音乐教师的从教能力进行全新的解读。     

Quantifying the Distribution of Inhalation Exposure in Human Populations: 2. Distributions of Time Spent by Adults, Adolescents, and Children at Home, at Work, and at School

Using distributions of time spent at various ventilation levels, ranges of inhalation exposure in the population can be established. Distributions of exposure time were determined using results of a study by the California Air Resources Board (CARB) which focused on time spent by humans participating in various activities and the locations where the activities occurred. The daily at-home activities from the CARB study were assigned to one of three ventilation levels, generating aggregate time periods. Distinct age and gender populations were identified, and distributions for aggregate time were established for these populations at each of the ventilation levels. In addition to aggregate time spent at home, distributions for various ages and genders were established for aggregate time spent at school and work. By combining distributions of aggregate time with corresponding ventilation rates, the distribution of inhalation rates can be established for at home, at work, and at school exposures.     

Health Risks of Energy Systems

Health risks from fossil, renewable and nuclear reference energy systems are estimated following a detailed impact pathway approach. Using a set of appropriate air quality models and exposure-effect functions derived from the recent epidemiological literature, a methodological framework for risk assessment has been established and consistently applied across the different energy systems, including the analysis of consequences from a major nuclear accident. A wide range of health impacts resulting from increased air pollution and ionizing radiation is quantified, and the transferability of results derived from specific power plants to a more general context is discussed.