Taking Uncertainty Seriously: From Permissive Regulation to Preventative Design in Environmental Decision Making

This paper contrasts two paradigms of environmental regulatory decision making, permissive regulation and preventative design, with respect to their treatment of scientific and legal uncertainty and the allocation of legal standards and burdens of proof. Permissive regulation, which is the predominant approach in Canada, suffers two types of statistical errors. A type I error occurs when, for example, a pollution control device is unjustly imposed on an industry. A type II error occurs when no action is taken to control an industry when, in fact, damage is taking place. Concern to prevent type I errors often leads to type II errors. Attempts to resolve these problems through incremental changes in legislation and policy have generally failed. This article illustrates the scientific and regulatory problems associated with \u27permissive regulation through an analysis of environmental common law, legislation, and regulation. Protection of environmental quality requires regulatory decision making rooted in the principles of precautionary, preventative action that tends to minimize costly type II errors. With the preventative design approach now being used in several jurisdictions, the regulatory burden of proving harm is shifted from regulators to the polluters who must demonstrate safety. European and American initiatives as well as international agreements illustrate the historical development and implementation of this preventative design perspective. This article suggests that Canadian legislation and regulations be written with this approach

An Analysis of the Reflection Component in the EPICS Model of Service Learning

Service learning is a pedagogy providing a structured environment for students to link service with course learning objectives. Key to the service learning experience is critical reflection. This gives students the opportunity to examine their coursework in the context of the service they provide to their community and, in a broader sense, the impact they can have on the world. Research has shown that students participating in service learning have a higher comprehension of the course material and also develop an awareness of their local community and the issues it faces. In engineering, there are many examples of service-learning programs ranging from freshman introductory courses to senior capstone courses. Despite their successes, an area that the engineering education community has yet to fully develop is the reflection component of service learning. This paper addresses the development of reflection activities and materials in the Engineering Projects in Community Service (EPICS) program at Purdue University. EPICS engages students in long-term design projects that provide technical solutions to problems faced by local community service organizations. It is a multidisciplinary (composed of students from 20 majors), vertically integrated (freshman-senior), engineering-based design course. Students design, build, test, and deploy projects meeting the specific needs of their community partners. Reflection has been integrated in the EPICS program through curricular activities and key milestones of the course. These activities guide students through the reflection process on a variety of topics. Critical reflection on the design process and teaming complement those on more traditional areas of ethics and social context to enhance a student\u27s service learning experience. This paper presents an overview of the reflection activities that have been developed, interpretations of student reflections from these activities, and plans to evolve the reflection component in EPICS

Global and mitosis-specific interobserver variation in mitotic count scoring and implications for malignant melanoma staging

AIMS Staging is the gold standard for predicting malignant melanoma outcome but changes in its criteria over time indicate ongoing evolution. One notable recent change from the 8 edition of the AJCC staging manual was removal of mitotic count. We explore the extent that this feature is limited by interobserver error in order to find ways to improve its fitness for use should it be revisited in future staging versions. METHODS AND RESULTS In a cohort of 476 patients with melanoma ≤ 1.0 mm, a mitotic count of 0 vs 1 was significant for metastasis-free survival, but not melanoma-specific or overall survival. In 10 melanomas that were 0.9 to 1.0 mm thick, the mitotic count intra-class correlation coefficient for histopathologists was 0.58 (moderate agreement). Uniquely, we also assessed agreement for specific putative mitotic figures, identifying precise reasons why specific mitotic figures qualified for scoring or elimination. A kappa score was 0.54 (moderate agreement). We also gathered data on other staging features. Breslow thickness had an intraclass correlation coefficient of 0.41 (moderate agreement) and there was a systematic difference between histopathologists across cases (p = 0.04). Every case had a range that crossed the AJCC8 0.8 mm pT1a/pT1b staging boundary. Ulceration was only identified in 2 out the 10 cases. For ulceration, kappa agreement score was 0.31 (fair). CONCLUSION This study supports the removal of mitotic count from staging but shows that its scoring is substantially affected by interobserver variation, suggesting that more prescriptive guidelines might have a beneficial impact on its prognostic value

A critical commentary on follow-up studies and “desistance” theories about transgender and gender non-conforming children

Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e. desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary “phase.” This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender non-conforming children. Methods: A critical review methodology is employed to systematically interpret four frequentlycited studies that sought to document identity outcomes for gender non-conforming children (often referred to as “desistance” research). Results: Methodological, theoretical, ethical, and interpretive concerns regarding four “desistance” studies are presented. The authors clarify the historical and clinical contexts within which these studies were conducted to deconstruct assumptions in interpretations of the results. The discussion makes distinctions between the specific evidence provided by these studies versus the assumptions that have shaped recommendations for care. The affirmative model is presented as a way to move away from the question of, “How should children’s gender identities develop over time?” toward a more useful question: “How should children best be supported as their gender identity develops?” Conclusion: The tethering of childhood gender diversity to the framework of “desistance” or “persistence” has stifled advancements in our understanding of children’s gender in all its complexity. These follow-up studies fall short in helping us understand what children need. As work begins on the 8th version of the Standards of Care by the World Professional Association for Transgender Health, we call for a more inclusive conceptual framework that takes children’s voices seriously. Listening to children’s experiences will enable a more comprehensive understanding of the needs of gender non-conforming children and provide guidance to scientific and lay communities

Triple-Antiretroviral Prophylaxis to Prevent Mother-To-Child HIV Transmission through Breastfeeding—The Kisumu Breastfeeding Study, Kenya: A Clinical Trial

Timothy Thomas and colleagues report the results of the Kisumu breastfeeding study (Kenya), a single-arm trial that assessed the feasibility and safety of a triple-antiretroviral regimen to suppress maternal HIV load in late pregnancy

Pooled Individual Data Analysis of 5 Randomized Trials of Infant Nevirapine Prophylaxis to Prevent Breast-Milk HIV-1 Transmission

Background. In resource-limited settings, mothers infected with human immunodeficiency virus type 1 (HIV-1) face a difficult choice: breastfeed their infants but risk transmitting HIV-1 or not breastfeed their infants and risk the infants dying of other infectious diseases or malnutrition. Recent results from observational studies and randomized clinical trials indicate daily administration of nevirapine to the infant can prevent breast-milk HIV-1 transmission

Human preferences for sexually dimorphic faces may be evolutionarily novel

A large literature proposes that preferences for exaggerated sex typicality in human faces (masculinity/femininity) reflect a long evolutionary history of sexual and social selection. This proposal implies that dimorphism was important to judgments of attractiveness and personality in ancestral environments. It is difficult to evaluate, however, because most available data come from large-scale, industrialized, urban populations. Here, we report the results for 12 populations with very diverse levels of economic development. Surprisingly, preferences for exaggerated sex-specific traits are only found in the novel, highly developed environments. Similarly, perceptions that masculine males look aggressive increase strongly with development and, specifically, urbanization. These data challenge the hypothesis that facial dimorphism was an important ancestral signal of heritable mate value. One possibility is that highly developed environments provide novel opportunities to discern relationships between facial traits and behavior by exposing individuals to large numbers of unfamiliar faces, revealing patterns too subtle to detect with smaller samples

TeenEARS: development of a pilot assessment battery for cochlear implanted adolescents

Changes in selection criteria have led to the inclusion of pre-lingually deafened adolescents as potential cochlear implant candidates, depending on their degree of residual hearing, access to and use of acoustic amplification, use of oral communication, and other factors such as motivation and support. Outcomes results in adolescents vary widely, and it has become evident that there is a need for a test battery that can assess a wide range of skills over time. This article presents the development and validation of one such test battery: TeenEARS. Eleven tests were assessed for inclusion in the test battery. Consideration was given to the ability of the test to measure improvement over time; the fact that there needed to be easier and more difficult tests in terms of language, communication and listening; the need for closed and open-set assessments; and a range of listening tasks: from sounds to conversational language. Data on 23 adolescents assessed and judgment based on clinical experience resulted in eight tests being included in the TeenEARS test battery