Living with Dementia: Lay Definitions of Alzheimer's Disease among African American Caregivers and Sufferers

While the medical world aggressively pursues scientific knowledge about Alzheimer's disease, sufferers and caregivers live with this ailment, not as patients, but as people going about their lives, needing and providing care. This article reports explanations of Alzheimer's from the perspectives of African American family caregivers and sufferers. Data were collected from thirty‐six families using participant observation and focus group interviews. Although caregivers sought and used medical expertise, their explanations of Alzheimer's were not only nonmedical, but not necessarily explanations of illness per se. Alzheimer's was presented instead as a way of being, predominantly characterized by views of the sufferer as childlike and by issues of continuity/discontinuity, though some saw Alzheimer's as part of a larger picture.     

Ambiguity and the abstract tact: A signal detection analysis

The Analysis of Verbal Behavior - Four observers who had completed a formal course in projective test techniques were asked to discriminate House-Tree-Person (H-T-P) drawings made by psychiatric...     

Outcome-related Performance Indicators and Organizational Control in the Public Sector1

There is increased interest in the widespread dissemination of outcome performance data to secure enhanced strategic control of public sector organizations. This paper adumbrates the rationale for such schemes, and outlines the potential distortions induced by excessive reliance on outcome-related performance indicators, inferred from experience in the management control and Soviet literature. The paper gives an outline of the performance review process in the United Kingdom National Health Service, and presents the results of a case study of the impact of the publication of outcome performance data in the maternity services. The research detected many of the expected distortions arising from reliance on performance indicator schemes, and concludes that they may have significant dysfunctional consequences. The paper does not however advocate the abandonment of performance audit in the public sector. Instead, it warns that great attention should be given to the managerial incentives implicit in any strategic control scheme, and that the style with which the scheme is applied will have important bearings on its effectiveness.     

The Effect of Neglecting Correlations When Propagating Uncertainty and Estimating the Population Distribution of Risk

Interest in examining both the uncertainty and variability in environmental health risk assessments has led to increased use of methods for propagating uncertainty. While a variety of approaches have been described, the advent of both powerful personal computers and commercially available simulation software have led to increased use of Monte Carlo simulation. Although most analysts and regulators are encouraged by these developments, some are concerned that Monte Carlo analysis is being applied uncritically. The validity of any analysis is contingent on the validity of the inputs to the analysis. In the propagation of uncertainty or variability, it is essential that the statistical distribution of input variables are properly specified. Furthermore, any dependencies among the input variables must be considered in the analysis. In light of the potential difficulty in specifying dependencies among input variables, it is useful to consider whether there exist rules of thumb as to when correlations can be safely ignored (i.e., when little overall precision is gained by an additional effort to improve upon an estimation of correlation). We make use of well-known error propagation formulas to develop expressions intended to aid the analyst in situations wherein normally and lognormally distributed variables are linearly correlated.     

Using panel methods to model waiting times for National Health Service surgery

Summary. Long waiting times for non-emergency (elective) procedures are a central feature of the UK's National Health Service, with about 1 million people waiting for surgery at any one time. This paper develops empirical models of the demand for and supply of elective surgery which simultaneously determine waiting times. The models are tested by using a panel of annual data for 5499 small areas from 1991 to 1998. Supply and demand functions are estimated for all specialties combined and for seven individual specialties, using panel data methods that incorporate simultaneously determined variables. The elasticity of demand with respect to waiting time varies between specialties but is always quite small. The results are discussed in the light of UK Government policy initiatives designed to reduce waiting times substantially. The analysis suggests that these initiatives will not stimulate demand markedly and therefore stand a good chance of succeeding provided that adequate additional resources are made available.     

Live Consultation Without A One-Way Screen†

This article is about a method of teamwork in which both the therapist and the consultant are present in the same room as the family. It distinguishes between the therapeutic team of consultant and therapist and the therapeutic system of consultant, therapist and family. It outlines some particular advantages and disadvantages which are present when working in the same room as the family and emphasises the importance of the careful preparation and maintenance of the therapeutic team if its creative potential for the family is to be fulfilled.