Governmentality by Network in English Primary Healthcare

In England, the quality of clinical work is being regulated in new ways following recent developments in “clinical governance” policy and apparent failures in the previous system of medical self‐regulation. Using multiple case studies, this paper examines how these changes are affecting professional governmentality and discipline in general practice. Formal organizational structures play little role in clinical governance there. Clinical quality is managed largely through semi‐formal networks, relying on medical self‐surveillance. Compliance is achieved largely by discursive appeals to the legitimacy of clinical governance, but local GPs’ leaders also argue that governments might otherwise regulate medical practice more actively. As yet the effects of clinical governance activity on service delivery are slight. Professional self‐regulation is replacing permissive exception management with more collegial, directive methods.     

Explaining individual level support for organ procurement policy

The demand for human organs for transplantation – both from live and deceased donors – has become a public health issue in the United States, as thousands of Americans die each year due to the lack of a needed transplant. The current policy basis for organ procurement is voluntarism as federal organ procurement policy, based on the 1984 National Organ Transplant Act (NOTA), prohibits the exchange of human organs for “valuable consideration.” While an increasing number of policy analysts, including some ethicists, have advocated for financial incentives to induce more donations, a variety of factors – such as the legislative status quo, ongoing ethical concerns, and uncertain public support – have resulted in little use of financial incentives. We argue that a better understanding of public opinion is an important prerequisite for any move toward the use of financial incentives. Consequently, we develop and test a model to explain individual level attitudes toward legalizing and regulating the sale of human organs for transplant. We find that political ideology, gender, age and geographic region are important predictors of support.     

How does consumer age affect the desire for new products and brands? A multi-group causal analysis

Marketing lacks comprehension on the increasingly important segment of mature consumers in regard to their behavior and respective reasons for certain behavior. This study on the desire for alternative products or brands within the domain of fast moving consumer goods was capable of verifying differences among age-groups. While the keenness for cross-buying increases with age, the desire for switching to other familiar brands than the one usually purchased, and the desire for switching to new brand alternatives decrease with age; Thus indicating age-patterns in product category-specific innovativeness and variety seeking. The study also considers a wide range of behavioral determinants such as product satisfaction, product involvement, category experience, perceived purchase risk etc. mediating the effect of age on these desires, giving a fairly good picture of the unveiled causes for the age group differences. Furthermore, the issue of age potentially operating as a moderating variable on the effects of the behavioral determinants on the desires for product and brand alternatives found consideration in this study, but was proven to be of marginal relevance.     

Return to work among employees with mental health problems: Development and validation of a self-efficacy questionnaire

Abstract

Because of the costs to both the organization and the individual, it is important that employees who are sick-listed with mental health problems are facilitated in their return to work (RTW). In order to provide adequate interventions, it is necessary to obtain a better understanding of the RTW process of people with mental health problems. Work-related self-efficacy (SE) might play a key role within this process. This paper describes the development and validation of the return-to-work self-efficacy’ scale (RTW-SE) for employees with mental health problems. Three Dutch samples of sick-listed employees were used to validate the 11-item instrument (N=2214). Based on the factor structure and reliability results, RTW-SE was conceptualized as a unitary construct. The associations with general SE, locus of control, coping, physical workload and mental health problems support the construct validity of this scale. Most importantly, RTW-SE proved to be a robust predictor of actual return to work within three months. The encouraging preliminary psychometric properties of the scale make it a potentially valuable tool in research and in clinical practice and occupational health care settings, both before and after employees have returned to work.     

Online signal extraction by robust regression in moving windows with data-adaptive width selection

Online (also ‘real-time’ or ‘sequential’) signal extraction from noisy and outlier-interfered data streams is a basic but challenging goal. Fitting a robust Repeated Median (Siegel in Biometrika 69:242–244, 1982) regression line in a moving time window has turned out to be a promising approach (Davies et al. in J. Stat. Plan. Inference 122:65–78, 2004; Gather et al. in Comput. Stat. 21:33–51, 2006; Schettlinger et al. in Biomed. Eng. 51:49–56, 2006). The level of the regression line at the rightmost window position, which equates to the current time point in an online application, is then used for signal extraction. However, the choice of the window width has a large impact on the signal extraction, and it is impossible to predetermine an optimal fixed window width for data streams which exhibit signal changes like level shifts and sudden trend changes. We therefore propose a robust test procedure for the online detection of such signal changes. An algorithm including the test allows for online window width adaption, meaning that the window width is chosen w.r.t. the current data situation at each time point. Comparison studies show that our new procedure outperforms an existing Repeated Median filter with automatic window width selection (Schettlinger et al. in Int. J. Adapt. Control Signal Process. 24:346–362, 2010).