Falls and the Social Isolation of Older Adults in the National Health and Aging Trends Study

Thesis (Ph.D.)--University of Washington, 2016-08

Women's Rights National Historical Park, Seneca Falls, New York /

Panel title.

Falls and other geriatric syndromes in Blantyre, Malawi: a community survey of older adults

Background The prevalence of geriatric syndromes (falls, immobility, intellectual or memory impairment, and incontinence) is unknown in many resource-poor countries. With an aging population such knowledge is essential to develop national policies on the health and social needs of older people. The aim of this study was to provide a preliminary survey to explore the prevalence of falls and other geriatric syndromes and their association with known risk factors in people aged > 60 years in urban Blantyre, Malawi. Methods This was a cross-sectional, community survey of adults aged > 60 years. Subjects were recruited at home or in the waiting areas of chronic care clinics. They were interviewed to complete a questionnaire on ageassociated syndromes and comorbid problems. The Abbreviated Mental Test (AMT) and Timed Up and Go (TUG) tests were carried out. Results Ninety-eight subjects were studied; 41% reported falling in the past 12 months, 33% of whom (13% of all subjects) were recurrent fallers. Twenty-five percent reported urine incontinence, 66% self-reported memory difficulties, and 11% had an AMT score < 7. A history of falling was significantly associated with urine incontinence (p=0.01), selfreported memory problems (p=0.004) and AMT score < 7 (p=0.02). Conclusions Geriatric syndromes, including falls, appear to be prevalent in older people in Blantyre, Malawi. Falling is associated with cognitive impairment and urinary incontinence. There is an urgent need for more understanding of geriatric problems in this setting to develop national policies on health and social needs of older people. It is likely that many of the contributory factors to falls would be amenable to multifactorial interventions similar to those found to be effective in developed countries.

The Impact of Community Social Capital on the occurrence of Injuries in adolescents and falls in older adults: Population-based Studies Conducted in Canadian samples

The objectives of this thesis were to study specific Canadian populations in order to examine; (1) relationships between the neighbourhood-level social capital and injuries in youth, as well as (2) falls in older adults, and; (3) to address methodological issues relevant to the study of such relationships. The thesis is comprised of four manuscripts. The first addresses methodological issues surrounding the validation of neighbourhood-level variables for the study of adolescent health, and demonstrates the existence of structural confounding in the study of related etiological relationships. Informed by the latter, the second manuscript examines the association between neighbourhood-level social capital and injuries in youth, and demonstrates that lower levels of social capital are protective factors for girls but not for boys. Manuscript 3 uses an international database focused on older adults, and shows that our existing measure of social capital is valid at neighbourhood levels, but also that there is a high possibility for the existence of structural confounding among Canadian older adults. The fourth manuscript then examines the association between neighbourhood-level social capital and the occurrence of falls in older adults and determines that differences between neighbourhoods are important factors in the occurrence of falls, and that higher levels of social capital are a risk factor for falls. Taken together, results from this thesis provide a better understanding of the role of neighbourhood-level social capital on the occurrence of injuries in Canadian youth and on the occurrence of falls in older adults. Our contributions were important both methodologically and etiologically.

Effectiveness of non-pharmacological interventions to prevent falls in older people: a systematic overview. The SENATOR Project ONTOP Series

Background: Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. Objectives: To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. Methods: We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. Results: Fifty-nine systematic reviews were identified which consisted of single, multiple and multi-factorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. Conclusions: The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.

Best after rain : waterfall discharges and the tourist experience

Waterfalls attract tourists because they are aesthetically appealing landscape features that are not part of everyday experience. It is generally understood that falls are usually seen at their best when there is a copious flow of water, especially after heavy rain. Guidebooks often contain this observation when referring to waterfalls, sometimes warning readers that the flow may be severely reduced during dry periods. Indeed, many visitors are disappointed when they see falls at such times. Some are saddened when the discharge of a waterfall has been depleted by the abstraction of water upstream for power generation or other purposes. While, for those in search of the Sublime or merely the superlative, size is often important, small waterfalls can give great pleasure to lovers of landscape beauty. According to guidebooks, however, even these falls are usually best seen after rain. Drawing on tourist and travel literature and personal journals from the eighteenth century to the present, and with reference to examples from different parts of the world, this paper discusses the importance of discharge in the tourist experience of waterfalls.

Knowmore (House of Commons)

Knowmore (House of Commons) is a large scale generative interactive installation that incorporates embodied interaction, dynamic image creation, new furniture forms, touch sensitivity, innovative collaborative processes and multichannel generative sound creation. A large circular table spun by hand and a computer-controlled video projection falls on its top, creating an uncanny blend of physical object and virtual media. Participants’ presence around the table and how they touch it is registered, allowing up to five people to collaboratively ‘play’ this deeply immersive audiovisual work. Set within an ecological context, the work subtly asks what kind of resources and knowledges might be necessary to move us past simply knowing what needs to be changed to instead actually embodying that change, whilst hinting at other deeply relational ways of understanding and knowing the world. The work has successfully operated in two high traffic public environments, generating a subtle form of interactivity that allows different people to interact at different paces and speeds and with differing intentions, each contributing towards dramatic public outcomes. The research field involved developing new interaction and engagement strategies for eco-political media arts practice. The context was the creation of improved embodied, performative and improvisational experiences for participants; further informed by ‘Sustainment’ theory. The central question was, what ontological shifts may be necessary to better envision and align our everyday life choices in ways that respect that which is shared by all - 'The Commons'. The methodology was primarily practice-led and in concert with underlying theories. The work’s knowledge contribution was to question how new media interactive experience and embodied interaction might prompt participants to reflect upon the kind of resources and knowledges required to move past simply knowing what needs to be changed to instead actually embodying that change. This was achieved through focusing on the power of embodied learning implied by the works' strongly physical interface (i.e. the spinning of a full size table) in concert with the complex field of layered imagery and sound. The work was commissioned by the State Library of Queensland and Queensland Artworkers Alliance and significantly funded by The Australia Council for the Arts, Arts Queensland, QUT, RMIT Centre for Animation and Interactive Media and industry partners E2E Visuals. After premiering for 3 months at the State Library of Queensland it was curated into the significant ‘Mediations Biennial of Modern Art’ in Poznan, Poland. The work formed the basis of two papers, was reviewed in Realtime (90), was overviewed at Subtle Technologies (2010) in Toronto and shortlisted for ISEA 2011 Istanbul and included in the edited book/catalogue ‘Art in Spite of Economics’, a collaboration between Leonardo/ISAST (MIT Press); Goldsmiths, University of London; ISEA International; and Sabanci University, Istanbul.

Injury prevention in Queensland : report to Queensland Injury Prevention Council

Injury is the fourth leading cause of death in Australia. Injury rates in Queensland are amongst the highest in Australia and 21.5% of people surveyed for this research reported that their lifestyle or that of an immediate family member had been permanently affected by injury. Injury results in over 40,000 hospital admissions and 200,000 attendances at hospital Emergency Departments in Queensland each year. Queensland's death rate from injuries is higher than the national average, with consistently higher rates of deaths related to transport injuries. Queensland statistics also show higher than national average rates of injuries due to falls, homicide and accidental drowning. (Pike, Muller, Baade & Ward, 2000) In 2000-01 injuries represented over $4 billion (or 8%) of total health system expenditure, and 185,000 disability-adjusted life years (DALYs), or 7% of the total morbidity burden of disease and injury in Australia in 2003. (Begg, Vos, Barker, Stevenson, Stanley & Lopez, 2007). Injury is one of seven key health areas identified by the Commonwealth, state and territory governments for priority attention as National Health Priority Areas

Governance and effectiveness in regional planning: an analysis of North American, European, and Australasian practice

Over the past several years, there has been resurgent interest in regional planning in North America, Europe and Australasia. Spurred by issues such as metropolitan growth, transportation infrastructure, environmental management and economic development, many states and metropolitan regions are undertaking new planning initiatives. These regional efforts have also raised significant question about governance structures, accountability and measures of effectiveness.n this paper, the authors conducted an international review of ten case studies from the United States, Canada, England, Belgium, New Zealand and Australia to explore several critical questions. Using qualitative data template, the research team reviewed plans, documents, web sites and published literature to address three questions. First, what are the governance arrangements for delivering regional planning? Second, what are the mechanisms linking regional plans with state plans (when relevant) and local plans? Third, what means and mechanisms do these regional plans use to evaluate and measure effectiveness? The case study analysis revealed several common themes. First, there is an increasing focus on goverance at the regional level, which is being driven by a range of trends, including regional spatial development initiatives in Europe, regional transportation issues in the US, and the growth of metropolitan regions generally. However, there is considerable variation in how regional governance arrangements are being played out. Similarly, there is a range of processes being used at the regional level to guide planning that range from broad ranging (thick) processes to narrow and limited (thin) approaches. Finally, evaluation and monitoring of regional planning efforts are compiling data on inputs, processes, outputs and outcomes. Although there is increased attention being paid to indicators and monitoring, most of it falls into outcome evaluations such as Agenda 21 or sustainability reporting. Based on our review we suggest there is a need for increased attention on input, process and output indicators and clearer linkages of these indicators in monitoring and evaluation frameworks. The focus on outcome indicators, such as sustainability indicators, creates feedback systems that are too long-term and remote for effective monitoring and feedback. Although we found some examples of where these kinds of monitoring frameworks are linked into a system of governance, there is a need for clearer conceptual development for both theory and practice.

The STRATIFY tool and clinical judgment were poor predictors of falling in an acute hospital setting

Objective: To compare the effectiveness of the STRATIFY falls tool with nurses’ clinical judgments in predicting patient falls. Study Design and Setting: A prospective cohort study was conducted among the inpatients of an acute tertiary hospital. Participants were patients over 65 years of age admitted to any hospital unit. Sensitivity, specificity, and positive predictive value (PPV) and negative predictive values (NPV) of the instrument and nurses’ clinical judgments in predicting falls were calculated. Results: Seven hundred and eighty-eight patients were screened and followed up during the study period. The fall prevalence was 9.2%. Of the 335 patients classified as being ‘‘at risk’’ for falling using the STRATIFY tool, 59 (17.6%) did sustain a fall (sensitivity50.82, specificity50.61, PPV50.18, NPV50.97). Nurses judged that 501 patients were at risk of falling and, of these, 60 (12.0%) fell (sensitivity50.84, specificity50.38, PPV50.12, NPV50.96). The STRATIFY tool correctly identified significantly more patients as either fallers or nonfallers than the nurses (P50.027). Conclusion: Considering the poor specificity and high rates of false-positive results for both the STRATIFY tool and nurses’ clinical judgments, we conclude that neither of these approaches are useful for screening of falls in acute hospital settings.

Intimate Drowning

intimate drowning 50 minute performance + installation work ice | salt | tears | This work is about death. Grief The relationships before The aftermath - of confusion, violence, isolation The never ending questions The devastating loss and paranoia "Since my wife died, I have spent the last six years treading water - trying to stop myself from drowning. Sometimes I catch myself not breathing. I have to remind myself that I can't live underwater no matter how much I want to." Grief. Loss. Tears. Fear. Sadness Water. Milk. Salt. Ice Falling. Waiting Submerged. Suffocated. Broken ties Intention. Lack of focus. Intensity of focus Fighting. Screaming. Wailing Blue. White. Black. Blackness The doors open: we walk through a gauze curtain and discover a dark space with a square of light in the middle of the room. As we walk closer to the light, we see a girl writing in charcoal on the floor around a square box filled with milk. She is writing the same thing over and over. The more she writes the more desperate she becomes: I am listening… We have to keep walking past. She isn’t writing for us. We find our seats Two people: one slowly breaking the hundreds of fragile strings that tie her to the other. The other is pleading with her to stop: Please. Please don’t. Please Avril. …Please don’t One girl facing away from us. She is slowly swimming on the spot without water. Projected next to her are images of her drowning under water. Salt falls in front of her. Behind her. A wall of salt. She is bound to the spot. Underwater and still breathing. Swimming in her own tears. She won’t escape. She wants to stay, but desires nothing Two people standing in a large square box filled with milk. They start in intimacy. The relationship begins to dissolve before us. One fights to be with/on/behind the other. The other fights her off. The milk is splashed. Why aren't they being careful? In the darkness there is scrubbing. Someone is scrubbing the floor. The other girl is on her knees trying to erase the original writing. The traces left behind that we have no control over. We only see her for a second, but hear her in the darkness. Scrubbing. It is pointless. You can't erase the past.

Rural and remote road safety study : final report

• Introduction: Concern and action for rural road safety is relatively new in Australia in comparison to the field of traffic safety as a whole. In 2003, a program of research was begun by the Centre for Accident Research and Road Safety - Queensland (CARRS-Q) and the Rural Health Research Unit (RHRU) at James Cook University to investigate factors contributing to serious rural road crashes in the North Queensland region. This project was funded by the Premier’s Department, Main Roads Department, Queensland Transport, QFleet, Queensland Rail, Queensland Ambulance Service, Department of Natural Resources and Queensland Police Service. Additional funding was provided by NRMA Insurance for a PhD scholarship. In-kind support was provided through the four hospitals used for data collection, namely Cairns Base Hospital, The Townsville Hospital, Mount Isa Hospital and Atherton Hospital.----- The primary aim of the project was to: Identify human factors related to the occurrence of serious traffic incidents in rural and remote areas of Australia, and to the trauma suffered by persons as a result of these incidents, using a sample drawn from a rural and remote area in North Queensland.----- The data and analyses presented in this report are the core findings from two broad studies: a general examination of fatalities and casualties from rural and remote crashes for the period 1 March 2004 until 30 June 2007, and a further linked case-comparison study of hospitalised patients compared with a sample of non-crash-involved drivers.----- • Method: The study was undertaken in rural North Queensland, as defined by the Australian Bureau of Statistics (ABS) statistical divisions of North Queensland, Far North Queensland and North-West Queensland. Urban areas surrounding Townsville, Thuringowa and Cairns were not included. The study methodology was centred on serious crashes, as defined by a resulting hospitalisation for 24 hours or more and/or a fatality. Crashes meeting this criteria within the North Queensland region between 1 March 2004 and 30 June 2007 were identified through hospital records and interviewed where possible. Additional data was sourced from coroner’s reports, the Queensland Transport road crash database, the Queensland Ambulance Service and the study hospitals in the region.----- This report is divided into chapters corresponding to analyses conducted on the collected crash and casualty data.----- Chapter 3 presents an overview of all crashes and casualties identified during the study period. Details are presented in regard to the demographics and road user types of casualties; the locations, times, types, and circumstances of crashes; along with the contributing circumstances of crashes.----- Chapter 4 presents the results of summary statistics for all casualties for which an interview was able to be conducted. Statistics are presented separately for drivers and riders, passengers, pedestrians and cyclists. Details are also presented separately for drivers and riders crashing in off-road and on-road settings. Results from questionnaire data are presented in relation to demographics; the experience of the crash in narrative form; vehicle characteristics and maintenance; trip characteristics (e.g. purpose and length of journey; periods of fatigue and monotony; distractions from driving task); driving history; alcohol and drug use; medical history; driving attitudes, intentions and behaviour; attitudes to enforcement; and experience of road safety advertising.----- Chapter 5 compares the above-listed questionnaire results between on-road crash-involved casualties and interviews conducted in the region with non-crash-involved persons. Direct comparisons as well as age and sex adjusted comparisons are presented.----- Chapter 6 presents information on those casualties who were admitted to one of the study hospitals during the study period. Brief information is given regarding the demographic characteristics of these casualties. Emergency services’ data is used to highlight the characteristics of patient retrieval and transport to and between hospitals. The major injuries resulting from the crashes are presented for each region of the body and analysed by vehicle type, occupant type, seatbelt status, helmet status, alcohol involvement and nature of crash. Estimates are provided of the costs associated with in-hospital treatment and retrieval.----- Chapter 7 describes the characteristics of the fatal casualties and the nature and circumstances of the crashes. Demographics, road user types, licence status, crash type and contributing factors for crashes are presented. Coronial data is provided in regard to contributing circumstances (including alcohol, drugs and medical conditions), cause of death, resulting injuries, and restraint and helmet use.----- Chapter 8 presents the results of a comparison between casualties’ crash descriptions and police-attributed crash circumstances. The relative frequency of contributing circumstances are compared both broadly within the categories of behavioural, environmental, vehicle related, medical and other groupings and specifically for circumstances within these groups.----- Chapter 9 reports on the associated research projects which have been undertaken on specific topics related to rural road safety.----- Finally, Chapter 10 reports on the conclusions and recommendations made from the program of research.---- • Major Recommendations : From the findings of these analyses, a number of major recommendations were made: + Male drivers and riders - Male drivers and riders should continue to be the focus of interventions, given their very high representation among rural and remote road crash fatalities and serious injuries.----- - The group of males aged between 30 and 50 years comprised the largest number of casualties and must also be targeted for change if there is to be a meaningful improvement in rural and remote road safety.----- + Motorcyclists - Single vehicle motorcycle crashes constitute over 80% of serious, on-road rural motorcycle crashes and need particular attention in development of policy and infrastructure.----- - The motorcycle safety consultation process currently being undertaken by Queensland Transport (via the "Motorbike Safety in Queensland - Consultation Paper") is strongly endorsed. As part of this process, particular attention needs to be given to initiatives designed to reduce rural and single vehicle motorcycle crashes.----- - The safety of off-road riders is a serious problem that falls outside the direct responsibility of either Transport or Health departments. Responsibility for this issue needs to be attributed to develop appropriate policy, regulations and countermeasures.----- + Road safety for Indigenous people - Continued resourcing and expansion of The Queensland Aboriginal Peoples and Torres Strait Islander Peoples Driver Licensing Program to meet the needs of remote and Indigenous communities with significantly lower licence ownership levels.----- - Increased attention needs to focus on the contribution of geographic disadvantage (remoteness) factors to remote and Indigenous road trauma.----- + Road environment - Speed is the ‘final common pathway’ in determining the severity of rural and remote crashes and rural speed limits should be reduced to 90km/hr for sealed off-highway roads and 80km/hr for all unsealed roads as recommended in the Austroads review and in line with the current Tasmanian government trial.----- - The Department of Main Roads should monitor rural crash clusters and where appropriate work with local authorities to conduct relevant audits and take mitigating action. - The international experts at the workshop reviewed the data and identified the need to focus particular attention on road design management for dangerous curves. They also indicated the need to maximise the use of audio-tactile linemarking (audible lines) and rumble strips to alert drivers to dangerous conditions and behaviours.----- + Trauma costs - In accordance with Queensland Health priorities, recognition should be given to the substantial financial costs associated with acute management of trauma resulting from serious rural and remote crashes.----- - Efforts should be made to develop a comprehensive, regionally specific costing formula for road trauma that incorporates the pre-hospital, hospital and post-hospital phases of care. This would inform health resource allocation and facilitate the evaluation of interventions.----- - The commitment of funds to the development of preventive strategies to reduce rural and remote crashes should take into account the potential cost savings associated with trauma.----- - A dedicated study of the rehabilitation needs and associated personal and healthcare costs arising from rural and remote road crashes should be undertaken.----- + Emergency services - While the study has demonstrated considerable efficiency in the response and retrieval systems of rural and remote North Queensland, relevant Intelligent Transport Systems technologies (such as vehicle alarm systems) to improve crash notification should be both developed and evaluated.----- + Enforcement - Alcohol and speed enforcement programs should target the period between 2 and 6pm because of the high numbers of crashes in the afternoon period throughout the rural region.----- + Drink driving - Courtesy buses should be advocated and schemes such as the Skipper project promoted as local drink driving countermeasures in line with the very high levels of community support for these measures identified in the hospital study.------ - Programs should be developed to target the high levels of alcohol consumption identified in rural and remote areas and related involvement in crashes.----- - Referrals to drink driving rehabilitation programs should be mandated for recidivist offenders.----- + Data requirements - Rural and remote road crashes should receive the same quality of attention as urban crashes. As such, it is strongly recommended that increased resources be committed to enable dedicated Forensic Crash Units to investigate rural and remote fatal and serious injury crashes.----- - Transport department records of rural and remote crashes should record the crash location using the national ARIA area classifications used by health departments as a means to better identifying rural crashes.----- - Rural and remote crashes tend to be unnoticed except in relatively infrequent rural reviews. They should receive the same level of attention and this could be achieved if fatalities and fatal crashes were coded by the ARIA classification system and included in regular crash reporting.----- - Health, Transport and Police agencies should collect a common, minimal set of data relating to road crashes and injuries, including presentations to small rural and remote health facilities.----- + Media and community education programmes - Interventions seeking to highlight the human contribution to crashes should be prioritised. Driver distraction, alcohol and inappropriate speed for the road conditions are key examples of such behaviours.----- - Promotion of basic safety behaviours such as the use of seatbelts and helmets should be given a renewed focus.----- - Knowledge, attitude and behavioural factors that have been identified for the hospital Brief Intervention Trial should be considered in developing safety campaigns for rural and remote people. For example challenging the myth of the dangerous ‘other’ or ‘non-local’ driver.----- - Special educational initiatives on the issues involved in rural and remote driving should be undertaken. For example the material used by Main Roads, the Australian Defence Force and local initiatives.

The role of decision-maker preferences in tenancy selection of CBD office accommodation – preliminary literature review

The literature and anecdotal evidence suggests that that there is more to tenancy selection (firm location) than the profit maximisation drive that traditional neo-classical economic location theory suggests. In the first instance these models assume property markets are rational and perfectly competitive; the CBD office market is clearly neither rational nor perfectly competitive. This fact alone relegates such models to the margins of usefulness for an industry that seeks to satisfy tenant demand in order to optimise returns on capital invested. Acknowledgment of property market imperfections are universally accepted to the extent that all contemporary texts discuss the lack of a coherent centralised market place and incomplete and poorly disseminated information processes as fundamental inadequacies which characterise the property market inefficiencies. Less well researched are the facets of the market which allow the observer to determine market activity to be significantly irrational. One such facet is that of ‘decision maker preferences’. The decision to locate a business operation at one location as opposed to another seems ostensibly a routine choice based on short, medium and long term business objectives. These objectives are derived from a process of strategic planning by one or more individuals whose goal is held to be to optimise outcomes which benefit the business (and presumably those employed within it). However the decision making processes appear bounded by how firms function, the institutional context in which they operate, as well as by opportunistic behaviour by individual decision makers who allow personal preferences to infiltrate and ‘corrupt’ the process. In this way, history, culture, geography, as well as institutions all become significant to the extent that these influence and shape individual behaviour which in turn determine the morphology of individual preferences, as well as providing a conduit for them to take effect. This paper exams historical and current literature on the impact of individual behaviour in the decision making process within organisations as a precursor to an investigation of the tenancy decision making process within the CBD office market. Literature on the topic falls within a number of research disciplines, philosophy, psychology and economics to name a few.

Comparing the ethical predisposition of university students in five English-speaking countries : an examination of 14 questionable business practices

Recent years have seen intense scrutiny focused on the reported ethical breaches of enterprises across the globe. At the forefront of the accompanying criticism are the actions of giant American firms such as WorldCom, Arthur Anderson, and Enron. However, such deviations from acceptable standards of conduct have not been confined to the American market. Australia endured its era of “corporate excess” in the 1980s [Milton-Smith, 1997]. As a result, a spate of ethics-based research was undertaken in the early 1990s. More recently, China has been identified as a major venue for behavior deemed to be unacceptable, even unsafe. Issues such as counterfeit fashion items, software, and automobile parts have been a concern for several years [Gonzalez, 2007]. Perhaps more disconcerting are the recent recalls of children’s products, many of which were produced for leading toy companies such as Mattel and Fisher-Price, because of the use of dangerous lead-based paint. As one might anticipate, news reports and consumer protection agencies have been quick to condemn any action that falls within the “controversial” category. Indeed, many segments of society characterize such actions as unethical behavior. One result of this increased level of concern is the higher level of attention given to ethics in higher education programs. Even accreditation bodies such as AACSB have virtually mandated the integration of ethics into the curriculum. As a consequence, academicians have ramped up their ethics-based research agendas.