Pivotal partings: Forced termination with a sexually abused boy

The termination phase of therapy is an integral part of the treatment process engendering its own unique set of dynamics. However, the potential eruption of new material dislodged by the trauma of the impending loss may in some cases require a reassessment of discharge goals and consequent alteration of treatment modality. The likelihood of new material surfacing at this critical juncture is perhaps highest among the caseloads of therapist trainees, wherein the termination date is forced by the time-limited nature of the learning contract. In the following article, supervisor and trainee detail the process of therapeutic shift from a dynamic to a crisis-oriented modality in the case of a young boy whose central trauma emerged during termination.     

The Australian model of immigration and multiculturalism: is it applicable to Europe?

"The aim of this article is to examine the experience of Australia with regard to immigration and ethnic diversity since 1945, and to discuss the relevance of this experience for Western Europe." The author finds that "since 1945, over 5 million settlers have come from many different countries, leading to a situation of great cultural diversity.... Over the last twenty years, a policy of multiculturalism has emerged, giving rise to several special institutions. This has had profound effects both on social policy and on concepts of national identity. The relevance of the Australian model for Western Europe is discussed."     

Development and accuracy of projections of population and households in the united states

The history of the official U. S. projections of population and house-holds in recent decades is briefly reviewed, with particular attention to methodology and the relation of the methodology to the accuracy of the projections. The introduction of the cohort-component procedure in the 1930’s opened the way for separate analysis of the trend of the components of births, deaths, and net immigration in connection with making population projections. As a further development, the period-fertility method of projecting births gave way in the 1960’s to the cohort-fertility method. Consideration is now being given to various methods involving parity-progression procedures. Some alternative methods and problems of measuring the accuracy of population projections are then considered. The percent “error” in the projected population growth, by components and age, and the range from high to low expressed as a percent should also be examined in addition to the percent “error” in the total population. However accuracy is measured, the projections made in the 1930’s and 1940’s were often wide of the mark, and those made in the 1950’s and 1960’s failed to anticipate the sharp changes which occurred, even though the actual figures usually fell within the range projected. Elaboration of projection methodology has not resulted in any great increase in the precision of the projections, largely because birth rates have fluctuated widely, and the fluctuations have proven difficult, if not impossible, to predict. The projections of households have had a roughly similar history, and the methods and problems of evaluation are somewhat similar. Their development has been characterized by the introduction of alternative and changing “headship” rates and increasing disaggregation of the data and procedures. The paper concludes with some generalizations based on U. S. experience. Although refinement of methods may contribute little to accuracy, accuracy is only one aspect of the usefulness of projections. The need for conditional projections and their analytical usefulness are such that there is no question that we should confidently continue to make them.     

Communicating Actionable Risk for Terrorism and Other Hazards⋆

We propose a shift in emphasis when communicating to people when the objective is to motivate household disaster preparedness actions. This shift is to emphasize the communication of preparedness actions (what to do about risk) rather than risk itself. We have called this perspective “communicating actionable risk,” and it is grounded in diffusion of innovations and communication theories. A representative sample of households in the nation was analyzed using a path analytic framework. Preparedness information variables (including content, density, and observation), preparedness mediating variables (knowledge, perceived effectiveness, and milling), and preparedness actions taken were modeled. Clear results emerged that provide a strong basis for communicating actionable risk, and for the conclusion both that information observed (seeing preparedness actions that other have taken) and information received (receiving recommendations about what preparedness actions to take) play key, although different, roles in motivating preparedness actions among the people in our nation.     

A real option theoretic fuzzy evaluation model for enterprise resource planning investment

The high failure rate of ERP implementation is due to a common pitfall that ERP projects are often enacted as merely investment into installation of IT infrastructure, rather than systematic planning of operation changes, business process re-engineering and a paradigm shift for the operation and management. To manage ERP investment in a changing environment for high payoff, this paper adopts a real option theoretic method. Fuzzy payoff valuation is introduced to deal with uncertainties in order to minimize the risk of failure. The proposed ERP evaluation model is geared towards small and medium enterprises. A case study is presented to validate the proposed fuzzy real options. The results indicate the potential of modeling ERP investment as “Expand”, “Contain” and “Abandon” options in different scenarios. The fuzzy real option model bestows a novel ex-ante cost analysis for justifying ERP investment in the implementation cycle.     

An empirical study of the relationship between a self-service technology investment and firm financial performance

More and more enterprises are taking advantage of self-service technologies (SSTs) in their customer-related operating activities, especially service firms. Although research on SSTs is prevalent, few studies have examined the impact of SSTs on firm financial performance. Given the growing importance of SSTs in the service industries in general and in the banking industry in particular, we therefore empirically examined the impacts of ATMs, one of the most widely accepted SSTs, on bank financial performance. Contrary to the existing literature, our results show ATMs have a positive relationship with profitability. However, we find no association between ATMs and growth performance.     

Conceptual and design issues in instrument development for research with bereaved parents

Many childhood deaths in the United States occur in pediatric intensive care units (PICUs) and parents have special needs in this death context. As an interdisciplinary research team, we discuss conceptual and design issues encountered in creating a new instrument, the Bereaved Parent Needs Assessment-PICU, for assessing parents' needs in this setting. Using a qualitative approach, our team previously explored how the culture and related ways of providing care in one urban Midwestern children's hospital PICU affected parents' bereavement needs and experiences. We describe using this qualitative foundation in the development of a new quantitative instrument to more widely validate and measure bereaved parents' needs around the time of a child's death across multiple PICUs. We highlight a series of issues that warrant consideration in designing a research instrument for this vulnerable population including setting and context, format and content, temporality, recruitment, and content expertise.     

A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.     

Corporate compliance programs: risk management for the future

The Department of Justice has estimated that the government loses $100 billion annually in health care fraud. Consequently, the government's health care fraud enforcement activities with respect to all health care providers and suppliers continue to grow. Last year alone, the government collected more than $8 billion in settlements, fines, and penalties involving health care fraud. Recent settlements with the government have begun to include corporate compliance programs that require continued government oversight of the health care organization as an essential part of the settlement. The first section of this article describes the legal significance of health care companies' having corporate compliance programs. The second section provides a sample list of topics that should be included in any corporate compliance program. Finally, we describe various issues related to the creation and implementation of corporate compliance programs.     

A comparison of quality and utilization problems in large and small group practices

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.