Improvement of Highway Safety I: Identification of Causal Factors Through Fault-Tree Modeling1

As the first article of a two-part series, the purpose of this paper is to examine the functional factors that contribute to automobile accident occurrence and to model the causation structure in the form of a fault-tree. The fault-tree model provides an intuitive framework for qualitatively decomposing possible pathways to accident occurrence. Fault-tree analysis also provides a statistical representation of how interacting driver, vehicle, and environmental factors contribute to the likelihood of automobile accident occurrence. The application of this model facilitates pinpointing those factors that most contribute to accident causation and subsequently enables the identification and comparison of potential crash avoidance technologies.     

For the Love of Fluffy: Respecting,Protecting, and Empowering Transitional Objects in the Context of High-Conflict Divorce

ABSTRACT

Transitional objects are those idiosyncratically determined, beloved blankies and stuffed animals that communicate an absent parent’s affection. As such, transitional objects serve the short-term need to cope with separation, and the long-term need to move toward autonomy. This article discusses the value, use, and misuse of transitional objects in the context of coparental conflict. The concept of alienation-by-proxy is introduced. Specific recommendations are provided, including the therapeutic creation and empowerment of transitional objects to assist children experiencing separation anxiety, consideration of the role of transitional objects in child custody evaluations, and the court’s responsibility to encourage litigating parents to respect the child’s needs for transitional objects.     

The potential impact of comparative effectiveness research on U.S. Health Care expenditures

Comparative effectiveness research (CER) has the potential to slow health care spending growth by focusing resources on health interventions that provide the most value. In this article, we discuss issues surrounding CER and its implementation and apply these methods to a salient clinical example: treatment of prostate cancer. Physicians have several options for treating patients recently diagnosed with localized disease, including removal of the prostate (radical prostatectomy), treatment with radioactive seeds (brachytherapy), radiation therapy (IMRT), or—if none of these are pursued—active surveillance. Using a commercial health insurance claims database and after adjustment for comorbid conditions, we estimate that the additional cost of treatment with radical prostatectomy is $7,300, while other alternatives are more expensive—$19,000 for brachytherapy and $46,900 for IMRT. However, a review of the clinical literature uncovers no evidence that justifies the use of these more expensive approaches. These results imply that if patient management strategies were shifted to those supported by CER-based criteria, an estimated $1.7 to $3.0 billion (2009 present value) could be saved each year.     

Mother–Child Conflict and Sibling Relatedness: A Test of Hypotheses From Parent–Offspring Conflict Theory

Parent–offspring conflict theory (POCT) has been underutilized in studies of human family dynamics. An implication of POCT is that the presence of siblings will increase conflict in biological parent–child dyads, and that half siblings will increase that conflict more than full siblings. Evidence consistent with this prediction was found in a longitudinal study of 236 early adolescent children and their mothers. Following parental disruption, the entry of younger maternal half siblings into the home was uniquely associated with elevated conflict between mothers and their biological children, independent of the effects of family size, socioeconomic status, and maternal depression. As predicted by the model, the effect of parental disruption on mother–child conflict was partially mediated by the entry of half siblings (but not stepfathers) into the home.     

Claiming Lesbian History: The Romance Between Fact and Fiction

The contested field of lesbian history exists along a continuum, with undisputed evidence on one end and informed speculation on the other. Lesbian historical fiction extends the spectrum, envisioning the lives of lesbian pirates, war heroes, pioneers, bandits, and stock romantic characters, as well as the handful of protagonists examined here whose quests specifically highlight the difficulty and importance of researching the lesbian past. The genre blossomed in the 1980s, just as the Foucauldian insistence that homosexual identity did not exist before the late nineteenth century gained sway in the academy. The proliferation of lesbian historical fictions signals the growing desire for more thorough (if not completely factual) historical underpinnings of the burgeoning lesbian identities, communities, and politics set in motion in the 1970s.     

Caring Adults: A Brief Report Assessing Adults’ Needs in Feeling More Comfortable Having Sexual Health Conversations with Youth in South Texas

Abstract

Objectives: As part of a larger Substance Abuse and Mental Health Services Administration-funded project in South Texas, this study sought to understand adults’ needs with regard to engaging in sexual health conversations with youth and young adults.

Methods: A total of 223 participants were surveyed to assess comfort engaging in sexual health conversations. Data were analyzed using thematic coding. Stigma surrounding sexual health conversations underlined all themes.

Results: Differences by gender and sexual orientation in the data were noted. Stigma around sexual health topics reduced participants’ comfort.

Conclusions: To this end, interventions must go beyond psychosocial and educational programs and address societal factors that contribute to the stigma.     

Shortcuts in complex engineering systems: a principal-agent approach to risk management

In this article, we examine the effects of shortcuts in the development of engineered systems through a principal-agent model. We find that occurrences of illicit shortcuts are closely related to the incentive structure and to the level of effort that the agent is willing to expend from the beginning of the project to remain on schedule. Using a probabilistic risk analysis to determine the risks of system failure from these shortcuts, we show how a principal can choose optimal settings (payments, penalties, and inspections) that can deter an agent from cutting corners and maximize the principal's value through increased agent effort. We analyze the problem for an agent with limited liability. We consider first the case where he is risk neutral; we then include the case where he is risk averse.     

Associations between measures of health-related physical fitness and cardiometabolic risk factors in college students

abstract

Objective: To determine the influence of health-related fitness on cardiometabolic risk factors in college students. Participants: 75 traditional students (33 men and 42 women, 21.8±1.8 years old) at a university in southeastern U.S. Methods: Height, weight, waist circumference, body composition, blood pressure, lipids, glucose, insulin, c-reactive protein, and glucose tolerance were measured. Indices of insulin sensitivity were calculated. Aerobic and muscular fitness were measured. Regression and correlation analyses, and comparisons of cardiometabolic markers in low- vs high-fit participants were performed. Results: Men and women with low muscular fitness exhibited higher fasting insulin, and poorer insulin sensitivity index scores than those with high muscular fitness. In addition, women with high body fat percentage exhibited higher fasting and 2-hour insulin levels and lower insulin sensitivity index scores than those with low body fat percentages. Conclusions: College students possessing low levels of health-related physical fitness exhibited less favorable cardiometabolic risk profiles.     

Medicine and Social Work: An Exploration in Interprofessionalism,Edited by Helen Rehr. Neal Watson Academic Publications,New York, 1974. $3.95 Paper

This article presents the results of focus groups conducted with participants following the completion of a Child Welfare Practice Certificate Program. Concept mapping was used as the guiding research method for the data collection and analysis. Social work students and child welfare workers generated statements during the focus group session that were then sorted into conceptual piles. Participants then rated the statements as to their importance and practicality and their interest in learning about them. Results revealed that the concept Reporting, Assessment, and Case Planning in the Real World was rated highest in all three categories. Recommendations are provided regarding infusing a child welfare curriculum into social work programs, and the authors discuss how concept mapping can be used in evaluation research.