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.     

Deterred by debt? Young people,schools and the escalating cost of UK higher education

Popular commentaries lament that reforms to the financing of Higher Education (HE) in the UK will operate as a significant deterrent to HE participation amongst students from less advantaged backgrounds. This view of debt as a deterrent is powerful and exists not only at a societal level, but also, as we show, is present in schools. Our data reveal, however, that these ‘debt commentaries’ play out very differently across schools according to the nature of their catchment and the sorts of views staff hold about pupils in relation to their fear of debt. Furthermore, students’ views on debt largely contradict these popular ‘debt-as-deterrent’ narratives and instead are often characterised by acceptance, ambivalence and at times positive orientations towards the prospect of debt. These findings vividly illuminate both the regional and institutional specificity of staff and student decision making in relation to ‘debt’, hence they have substantial implications for HE funding policy specifically and debates about widening participation in HE more generally, where ensuring greater equity in the scope of choices young people have when it comes to choosing a university is a pressing concern.     

Family of Origin Supervision in the Workplace: Impacts on Therapist and Team Functioning

The Adolescent and Family Unit at Redbank House carried out a trial of Bowen's Family of Origin Coaching that has prompted us to comment on the usefulness of this approach as a component of clinical supervision. This article will describe how this trial came about, the process adaptations required to make it possible and how some of the ethical dilemmas raised by this approach were addressed. Personal reflections from the team members will be shared, and our observations in terms of impact of this form of supervision on clinical functioning, team cohesion and service provision will then be discussed. In essence, we aim to provide an anecdotal account of our experience and ask the question, ‘Is supervision that focuses on the therapist's individual functioning as a product of their intergenerational patterns a valid use of resources in a clinical setting?’     

Grading Gems: Appraising the Quality of Research for Social Work and Social Care

The impetus towards basing practice and policy decisions moreexplicitly on sound research requires tools to facilitate thesystematic appraisal of the quality of research encompassinga diverse range of methods and designs. Five exemplar toolswere developed and assessed in terms of their usefulness inselecting studies for inclusion in a systematic review. Thewidely used ‘hierarchy of evidence’ was adaptedand used to appraise internal validity. Four tools were thendeveloped to appraise the external validity dimensions of generalizability(two scales) and methods of data collection (two scales). Methodsof combining the scores generated by each tool were explored.Qualitative and quantitative studies were appraised, not separatedinto two spheres but by using complementary tools developedto appraise different aspects of rigour. There was a high levelof agreement between researchers in applying the tools to twenty-twostudies on decision making by professionals about the long-termcare of older people. The scales for internal validity and generalizabilitydiscriminated between the qualities of studies appropriately.The two tools to appraise data collection gave diverse results.Excluding studies that scored in the lowest category on anyscale appeared to be the scoring system that was most justifiable.This approach is presented to stimulate debate about the practicalapplication of the evidence-based initiative to social workand social care. This study may assist in developing clearerdefinitions and common language about appraising rigour thatshould further the process of selecting robust research forsynthesis to inform practice and policy decisions.     

Analysis of the Bovine Spongiform Encephalopathy Maternal Cohort Study: Evidence for Direct Maternal Transmission

In an initial exploratory analysis of the bovine spongiform encephalopathy (BSE) maternal cohort study data we demonstrate several confounding effects in the study design. Given these effects, we assess a variety of statistical models to determine the relative contributions of direct maternal transmission of the aetiological agent of BSE and of genetic susceptibility to the observed maternally enhanced risk of BSE in the offspring of affected dams. To control for the substantial between-herd variation in the risk of exposure to the BSE agent, it is essential that analyses take into account the matched pair structure of the data. Maternal exposure is estimated to be most important in animals born within 150 days of disease onset in their dams. The analysis of a full survival likelihood model indicates that the hypothesis of maternal transmission with no genetic variation in susceptibility fits the data significantly better than the hypothesis of genetically variable susceptibility with no maternal transmission. However, models incorporating both maternal transmission and genetically variable susceptibility fit the data significantly better than pure maternal transmission models. Although genetic susceptibility cannot be excluded as the cause of the cohort study results in the absence of detailed genotyping, the analysis of these study data suggest that low level maternal transmission of BSE is, at least in part, responsible for the significantly enhanced risk of BSE in the offspring of affected dams. Similar results indicating significant maternal transmission in the later stages of the dam incubation period are obtained from the independent analysis of data on the dam–offspring relationships among confirmed BSE cases.     

Correlates of physical violence at school: A multilevel analysis of Australian high school students

Studies of school violence have been generally been informed either by social disorganisation or social control theory. However applications of social disorganisation theory to school violence sometimes make little attempt to control for individual differences in propensity to violent behaviour. This study of 2,616 Australian high school students uses multilevel modelling techniques to see whether various characteristics of the school (e.g. lack of clarity about school rules, school responsiveness to racism, school size, ethnic composition) are related to the risk of physical violence between students, once individual and family risk factors for violent behaviour have been taken into account. The results suggest that school characteristics and developmental factors both play an important role in shaping the risk of violence at school.     

Ancestral Inference in Population Genetics Models with Selection (with Discussion)

A new algorithm is presented for exact simulation from the conditional distribution of the genealogical history of a sample, given the composition of the sample, for population genetics models with general diploid selection. The method applies to the usual diffusion approximation of evolution at a single locus, in a randomly mating population of constant size, for mutation models in which the distribution of the type of a mutant does not depend on the type of the progenitor allele; this includes any model with only two alleles. The new method is applied to ancestral inference for the two‐allele case, both with genic selection and heterozygote advantage and disadvantage, where one of the alleles is assumed to have resulted from a unique mutation event. The paper describes how the method could be used for inference when data are also available at neutral markers linked to the locus under selection. It also informally describes and constructs the non‐neutral Fleming–Viot measure‐valued diffusion.     

A new rank test for the K-Sample problem

The treatment sum of squares in the one-way analysis of variance can be expressed in two different ways: as a sum of comparisons between each treatment and the remaining treatments combined, or as a sum of comparisons between the treatments two at a time. When comparisons between treatments are made with the Wilcoxon rank sum statistic, these two expressions lead to two different tests; namely, that of Kruskal and Wallis and one which is essentially the same as that proposed by Crouse (1961,1966). The latter statistic is known to be asymptotically distributed as a chi-squared variable when the numbers of replicates are large. Here it is shown to be asymptotically normal when the replicates are few but the number of treatments is large. For all combinations of numbers of replicates and treatments its empirical distribution is well approximated by a beta distribution     

Blackmail,boycott and genocide: The language of group conflict

This article examines the mis‐use of language that is often encountered in conflict situations involving ethnic and national groups. The various abuses of the words ‘Blackmail’, ‘Boycott’, and ‘Genocide’ are examined in the context of a number of recent conflicts. It is pointed out that the protagonists in such disputes frequently alter the meaning of words in an effort to make a special plea for their position. The author further warns of the serious consequences for the analysis of such conflicts should observers, journalists and commentators adopt the partisan terminology of the disputants.