Evaluating the implementation of health policy: pre-hospital care in Pennsylvania.

A statewide study of ambulance services was conducted to inform executive and legislative decision making regarding Emergency Medical Services in Pennsylvania. The study focused on the training status of ambulance personnel, turnover, and coordination between state and local levels. The study found indications that adequate numbers of trained personnel were often not making ambulance trips. A variety of issues that might cause and solve this problem are discussed, as are the dissemination and utilization of the study's results.     

Warten auf Amtsfluren

This article analyzes waiting and the situation of waiting in bureaucratic organizations. First, five central features of waiting are characterized: centrality of time, goal orientation, enforced passivity, serial isolation and event contingency. The different modalities of waiting resulting from social figurations and cultural and societal contexts are distinguished. In a second step hallways and waiting rooms in government offices are investigated in terms of the territorial allotments and demarcations imposed by bureaucratic power. These rooms and public spaces are considered as both sources of and repositories for the waiting clients’ emotional responses. This then leads to a phenomenological analysis of empirical situations of waiting as investigated through participatory observation in various administrative government offices in Berlin. Here interest centers on the situational negotiations and impression management of the actors as well as on the emotional coloring of waiting by the uncertain nature of its outcome.     

Recreation Demand Choices and Revealed Values of Leisure Time

An approach to jointly estimating an endogenous marginal value of time function and a recreation budget share equation is developed. The specification requirements for the marginal value of time function, to ensure consistency with the maintained hypothesis of two binding constraints on choice, are articulated. The estimating model consistent with these requirements that nests several conventional treatments of the marginal value of time is highly significant. The general endogenous marginal value of time model outperforms other approaches and shows a more complex relationship between the marginal value of time and the individual's wage than has been used in previous work. (JEL J22 , Q26 )     

EMOTIONALLY FOCUSED COUPLES THERAPY: AN OUTCOME STUDY*

In a within-subjects design in which couples acted as their own controls, assessment was completed at four times: at the time of intial contact, after an eight-week waiting period, after eight sessions of Emotionally Focused Marital Therapy, and at an eight-week follow-up. Couples reported no significant changes on measures of dyadic adjustment, intimacy, target complaint reduction and goal attainment after the waiting period, but significant changes were found after treatment.     

Driving to Work: The Front Seat Work of Paramedics to and from the Scene

The work paramedics do in the front of the ambulance on their way to and from the scene is central to the safety and well‐being of both paramedics and patients. However, most research on paramedics and emergency medical services assumes rather than empirically explores the actual happenings of what paramedics do in the front of their ambulance. In this article, I move beyond this taken‐for‐granted understanding of front‐seat work by taking readers in the front of the ambulance and exploring the hidden work paramedics do on their way to and from the scene. I draw on data from an institutional ethnography into the socially organized work and work settings of paramedics, which included over 200 hours of observations and over 100 interviews with paramedics. This article adds to research on the sociology of work and health and illness by focusing explicitly on how paramedics give meaning to their work setting, the social conditions and relations central to their work practices, and how their work knowledge is actually put into practice. In doing so, I shed light on an ever‐important occupational group in health care that has garnered little sociological attention to date.     

Waiting on Others: Gender in the Medical Waiting Room

In this article, I describe how gendered interactions and power dynamics play out in medical waiting rooms. While people are spending time idle, waiting for the next thing to happen (i.e., to check in, to see the doctor, to pay), social processes continue to occur and reinforce these gendered interactions and dynamics. Using data collected from ethnographic observations of medical waiting rooms in the Midwestern United States, this article illustrates that waiting offers another opportunity to understand the subtle ways that gendered expectations and hierarchies are perpetuated. Patients, their friends, and families do gender in medical waiting rooms through the amount of auditory and physical space they take up and the ways in which they behave and respond to the actors and expectations in this space.     

Improving patient satisfaction with waiting time

Waiting times are a significant component of patient satisfaction. A patient satisfaction survey performed in the author's health center showed that students rated waiting time lowest of the listed categories--A ratings of 58% overall, 63% for scheduled appointments, and 41% for the walk-in clinic. The center used a quality improvement process and instituted schedule and reception area changes. A follow-up survey 3 months later showed A ratings of 73% overall, 81% for scheduled appointments, and 56% for the walk-in clinic. A repeat survey 4 months later showed A satisfaction ratings of 79% overall, 85% for scheduled appointments, and 68% for the walk-in clinic. The author discusses strategies the center used to improve patient satisfaction with waiting time.     

Flying through the hospital: efficiency and safety of an ergonomic solution

In hospitals many horizontal transfers (from stretcher to bed etc.) are performed from the moment a patient is admitted (f.e. with an ambulance) through examination departments all the way to the wards. These transfers can be very strenuous and solutions may be to use a special lifting device that accompanies the patient on this route: a stretcher sling This is a specially designed disposable lifting sling for horizontal transfers and repositioning, the sling can easily be connected to a ceiling or mobile lift. The ambulance service, two hospitals and a manufacturer decided to study the effects. The stretcher sling travels with the patient. Does this provide an ergonomically sound solution and is this an effective and efficient solution? The results were positive, but a behavioral change was also necessary.     

Waiting in the Lower Ninth Ward in New Orleans: A Case Study of the Tempography of Hyper‐Marginalization

In the aftermath of Hurricane Katrina residents were forced to wait. Here the state played a familiar role where waiting is used to dominate or subordinate or further marginalize the poor. Residents of the Lower Ninth Ward, however, used waiting as a basis for interacting with other community members and as a way to structure social life. In doing so, they created a timescape of hyper‐marginalization where waiting became normative. In examining this timescape, I conduct a tempography of the neighborhood and distinguish between three forms of waiting as interaction.     

Singlehood,Waiting, and the Sociology of Time1

This article explores how a temporal analysis of singlehood can contribute both to new conceptualizations of singlehood as well as to the study of social time. Prevalent interpretations of waiting single women offer a useful case study as they highlight the temporal organization of social life. Waiting is examined as an interactive setting representing and producing societal symbols, timetables, and collective schedules. Furthermore, this particular form of waiting is mostly featured as an unexpected delay and, accordingly, strengthens the widespread understanding of singlehood as a temporary and transitory life phase. Based on a content analysis, this article seeks to theorize some of the temporal aspects of singlehood, analyze its discursive implications, and study how it reflects and structures dominant discourses of family and social life.     

The influence of the modality of telecooperation on performance and workload

Current industrial processes often involve the collaboration of people at distant and remote locations. The technological media for such a tele-cooperation reach from simple email or text-based chatting systems to highly-sophisticated systems for an interactive video-conferencing. But with limited bandwidth the communication between persons at distant locations is often restricted to single modalities. Although this may still be suitable for some tasks, it may result into serious shortcomings and decreased performance with complex tasks like cooperative assembly or maintenance. This is because restricted communication reduces the availability of a common ground, i.e. sharing a common understanding of knowledge, opinions, and goals. The study presented in this paper examines the effect of different communication media on performance of a collaborative assembly task. The results show that tele-cooperation leads to additional verbal communication (AM(direct)=71.1s; AM(video)=145.6s; AM(audio)=204.7s) and, thus, longer times to complete the task (AM (direct)=45.95 min; AM (video)= 50.2 min; am AM(audio)=56.16 min). The percentage of relative speech duration also increases significantly. Workload measurement with NASA-TLX did not show any significant differences between cooperation modes. The results allow estimating the effect of reduced communication modalities on time to complete an assembly task. This facilitates a quantification of temporal requirements in time-critical maintenance and repair tasks.     

Statistical power for nonequivalent pretest-posttest designs. The impact of change-score versus ANCOVA models

Nonequivalent controlled pretest-posttest designs are central to evaluation science, yet no practical and unified approach for estimating power in the two most widely used analytic approaches to these designs exists. This article fills the gap by presenting and comparing useful, unified power formulas for ANCOVA and change-score analyses, indicating the implications of each on sample-size requirements. The authors close with practical recommendations for evaluators. Mathematical details and a simple spreadsheet approach are included in appendices.     

Cost sharing in a job scheduling problem

A set of jobs need to be served by a server which can serve only one job at a time. Every job has a processing time and incurs cost due to waiting (linear in its waiting time). The jobs share their costs using monetary transfers. We provide an axiomatic characterization of the Shapley value solution for this problem.     

How Many Highly Skilled Foreign-Born are Waiting in Line for U.S. Legal Permanent Residence?1

While the United States welcomes foreign-born students and trainees and, less warmly, temporary workers such as H-1B visa holders, it places an array of requirements, obstacles, and delays upon persons who would like to make the U.S. their permanent home. The number of people in the queue for legal permanent residence (LPR) is, however, difficult to ascertain. This paper estimates the number of highly skilled foreign-born persons waiting for LPR via the three main employment-based categories, separately by whether they are living in the United States or abroad, as well as the number of family members. We find that as of the end of FY 2006 there were about half a million employment-based principals awaiting LPR in the United States, together with over half a million family members, plus over 125 thousand principals and family members waiting abroad. These numbers dwarf the visas available annually – 120,120 plus any not used in the family preferences – suggesting that the long delays in gaining legal permanent residence are a visa number problem, not an administrative processing problem, as many believe. The backlog thus cannot be eliminated without a large change in public policy. The delay in gaining legal permanent residence could contribute to the decision of many highly skilled foreign-born to leave the United States.     

Health Care of American Indian Elderly: Determinants of the Perceived Difficulty Obtaining Access to Health Care

This study examines the perceived areas of difficulty in obtaining access to health care and the factors influencing that difficulty among elderly American Indians in a rural environment. One hundred thirty-seven elderly Indians in the Ponca and Pawnee tribes of Oklahoma were interviewed. Four major difficulties are reported: a long waiting period at Indian health centers, difficulty in making appointments to see physicians, language and cultural barriers to communication with the health care providers, and lack of available transportation. The long waiting period is the most serious problem, and lack of transportation is the least serious. The results of probit analysis show that physical health, automobile ownership, education, employment, and the presence of an informal caregiver are related to difficulty obtaining access to health care. Ways to minimize this difficulty are discussed.     

A state of limbo: the politics of waiting in neo‐liberal Latvia

This article presents an ethnographic study of politics of waiting in a post‐Soviet context. While activation has been explored in sociological and anthropological literature as a neo‐liberal governmental technology and its application in post‐socialist context has also been compellingly documented, waiting as a political artefact has only recently been receiving increased scholarly attention. Drawing on ethnographic fieldwork at a state‐run unemployment office in Riga, this article shows how, alongside activation, state welfare policies also produce passivity and waiting. Engaging with the small but developing field of sociological literature on the politics of waiting, I argue that, rather than interpreting it as a clash between ‘neo‐liberal’ and ‘Soviet’ regimes, we should understand the double‐move of activation and imposition of waiting as a key mechanism of neo‐liberal biopolitics. This article thus extends the existing theorizations of the temporal politics of neo‐liberalism.     

“The clock has been ticking,the calendar pages turning,and we are still waiting”: Infertile couples' encounter with time in the adoption waiting period

In this paper, the authors draw from sociological explorations of time and narrative theory to interpret the problem that time posed for 37 infertile couples waiting for a child to adopt. We also address their emotional and behavioral responses to their problematic encounter with time. The adoption waiting period can be usefully conceived of as a: a) temporal irregularity in social life; b) temporally unmarked transitional stage in the passage to parenthood; and as a c) special kind of social construction and product of the imagination. Confronting empty time, waiting couples humanized time spent in waiting and maintained hope by creating a temporal framework for the waiting period. They established a timeline, plotted the end of the wait, and created a rhythm for the duration of the wait. Short-waiting couples were able to maintain a sense of making progress toward their goal of a child. Long-waiting couples increasingly felt as if they were standing still or moving away from their goal. The findings contribute to the understanding of temporality in infertile couples and affirm the uncertainty and discomfort that the lack of temporal order can engender.The study described here, The transition to parenthood of infertile couples, is supported by Grant #NRO1707 from the National Center for Nursing Research, National Institutes of Health, 1988–1993. The authors thank the QS reviewers for their helpful critique of an earlier draft of this paper.     

Does it Work for Them — Does it Work for Us? Evaluating a New Model of Team Practice

This article describes a change in team practice from a model targeted at individual families to a combined model that supplements family therapy with group programs for children. Unacceptably long waiting lists for family counselling services, high levels of stress in clinicians, and consumer dissatisfaction motivated this change. Robust quantitative data and a qualitative analysis of the project confirm that the change has made a positive impact and the new treatment model deserves to be continued. The article concludes that internal team changes are insufficient in a treatment context which requires more profound changes beyond the boundaries of the team.     

Research note: The consequences of different methods for handling missing network data in stochastic actor based models

Although stochastic actor-based models (e.g., as implemented in the SIENA software program) are growing in popularity as a technique for estimating longitudinal network data, a relatively understudied issue is the consequence of missing network data for longitudinal analysis. We explore this issue in our research note by utilizing data from four schools in an existing dataset (the AddHealth dataset) over three time points, assessing the substantive consequences of using four different strategies for addressing missing network data. The results indicate that whereas some measures in such models are estimated relatively robustly regardless of the strategy chosen for addressing missing network data, some of the substantive conclusions will differ based on the missing data strategy chosen. These results have important implications for this burgeoning applied research area, implying that researchers should more carefully consider how they address missing data when estimating such models.     

Chuck and Pierre at the Welfare Office1

After an ethnographic vignette that encapsulates the typical trajectory of an applicant to welfare benefits observed during a year of collaborative fieldwork, this brief essay will put to work Tilly’s notion of “invisible elbow” and Bourdieu’s understanding of waiting as a strategy of power in order to clarify the cultural dynamics of a welfare waiting room in the age of neoliberalism.