An empirical examination of cost-adjusting in outpatient clinics

This paper presents an empirical methodology for examining cost-adjusting in relation to multiple-output health care providers. The methodology is subsequently implemented using a sample of California outpatient clinics. The empirical evidence is that these clinics do cost-adjust; that is, the clinics respond to low Medicare reimbursement by using lower quality to control the marginal costs of those patient groups not insured under a government-sponsored plan. In addition, clinics do not cost-adjust with respect to Medi-Cal patients, implying that various government reimbursement systems have different effects on a provider’s cost-adjusting behavior.     

A non-profit approach to addressing the effects of urbanization in the Lake Pontchartrain Basin, Louisiana

The Lake Pontchartrain Basin in southeast Louisiana is an estuarine watershed encompassing New Orleans, Baton Rouge, and wetlands that are an integral part of Louisiana's unique culture. In recent decades rapid growth and poorly planned development have resulted in a decrease in water quality and habitat loss, especially in St. Tammany Parish on the north shore of Lake Pontchartrain. In 1989, the Lake Pontchartrain Basin Foundation (LPBF), an environmental, non-profit organization, was formed to address and rectify environmental issues in the Basin. LPBF accomplishes its mission through programs addressing water quality, habitat protection, geographic information science, public access, and education.LPBF used the recent, rapid development occurring in St. Tammany Parish as a case study to examine the relationship between land use, water quality, and development in the Basin by investigating habitat change/urbanization, development in flood plains, and water quality. Through the integration of LPBF programs, it was found that urbanization is having a devastating impact on the parish's natural habitats and severely degrading water quality. Using these results, LPBF is educating Basin citizens on the protection of their habitats and water quality to insure that these resources may be available for future generations.     

Spaces of Participation in Pre‐School: Arenas for Establishing Power Orders?

This article reports an ethnographic study of pre‐school children's social knowledge domains. Results show how the children's shared knowledge concerning social status and social differentiation in the group was strengthened and confirmed during a traditional teacher‐led ring game, where they were supposed to choose a friend. We suggest that from the perspective of the children, the game situation may be understood as, at the same time, a space of participation and an arena for establishing the power order. From the perspective of the teacher, pedagogical intentions may be challenged as they encounter and are mediated and interpreted by children's peer‐cultures.     

Trait Expressiveness and Marital Satisfaction: The Role of Idealization Processes

This study examined the processes that underlie the association between trait expressiveness and marital satisfaction. A total of 168 newlywed couples participated in a four‐wave, 13‐year longitudinal study of marriage. Cross‐sectional and longitudinal path analyses suggested that expressiveness promotes satisfaction by leading spouses to engage in affectionate behavior and by leading them to idealize their partner. Expressive people formed idealized images of their partner because they brought out the best in their partner's behavior and because they interpreted their partner's behavior in a favorable light. The study extends previous research by showing that the benefits of trait expressiveness extend into the second decade of marriage and by providing a plausible explanation of the connections between trait expressiveness and marital satisfaction.     

A Bayesian Hierarchical Model for the Evaluation of a Website

Consider a website and the surfers visiting its pages. A typical issue of interest, for example while monitoring an advertising campaign, concerns whether a specific page has been designed successfully, i.e. is able to attract surfers or address them to other pages within the site. We assume that the surfing behaviour is fully described by the transition probabilities from one page to another, so that a clickstream (sequence of consecutively visited pages) can be viewed as a finite-state-space Markov chain. We then implement a variety of hierarchical prior distributions on the multivariate logits of the transition probabilities and define, for each page, a content effect and a link effect. The former measures the attractiveness of the page due to its contents, while the latter signals its ability to suggest further interesting links within the site. Moreover, we define an additional effect, representing overall page success, which incorporates both effects previously described. Using WinBUGS, we provide estimates and credible intervals for each of the above effects and rank pages accordingly.     

Applicability of a Neuroprobabilistic Integral Risk Index for the Environmental Management of Polluted Areas: A Case Study

Recently, we developed a GIS-Integrated Integral Risk Index (IRI) to assess human health risks in areas with presence of environmental pollutants. Contaminants were previously ranked by applying a self-organizing map (SOM) to their characteristics of persistence, bioaccumulation, and toxicity in order to obtain the Hazard Index (HI). In the present study, the original IRI was substantially improved by allowing the entrance of probabilistic data. A neuroprobabilistic HI was developed by combining SOM and Monte Carlo analysis. In general terms, the deterministic and probabilistic HIs followed a similar pattern: polychlorinated biphenyls (PCBs) and light polycyclic aromatic hydrocarbons (PAHs) were the pollutants showing the highest and lowest values of HI, respectively. However, the bioaccumulation value of heavy metals notably increased after considering a probability density function to explain the bioaccumulation factor. To check its applicability, a case study was investigated. The probabilistic integral risk was calculated in the chemical/petrochemical industrial area of Tarragona (Catalonia, Spain), where an environmental program has been carried out since 2002. The risk change between 2002 and 2005 was evaluated on the basis of probabilistic data of the levels of various pollutants in soils. The results indicated that the risk of the chemicals under study did not follow a homogeneous tendency. However, the current levels of pollution do not mean a relevant source of health risks for the local population. Moreover, the neuroprobabilistic HI seems to be an adequate tool to be taken into account in risk assessment processes.     

Adult Drug Treatment Courts: A Review

Drug treatment courts (DTCs), an alternative to traditional criminal courts, provide an innovative way to legally process some drug offenders. The origin and recent growth of the drug court system in the USA can be explained as an unintended consequence of a failing 'war on drugs'. In this article, we discuss the spread of adult DTCs throughout the USA, the main components of drug courts, controversies surrounding DTCs, and some criticisms of drug courts. We summarize the recent evaluations of adult DTCs, and highlight various DTC factors that have been found to reduce individual drug use and criminal activity. We also offer suggestions for future research on DTCs and conclude with policy recommendations.     

Effects of Category Order on Answers in Mail and Telephone Surveys1

Abstract Past research suggests that mail surveys encourage a primacy effect, which is a tendency to choose the first answers from a list, whereas telephone surveys encourage a recency effect, a tendency to choose the last answers from a list. This paper summarizes results from 82 new experiments conducted in 12 separate surveys in seven states. Only four of 33 mail survey comparisons exhibited significant primacy effects, while five of 26 experiments in telephone surveys exhibited recency effects. In addition, only three of 23 cross-method comparisons produced a significant primacy/recency effect in the expected manner. The conclusion is that the prevalence of primacy and recency effects has been over-estimated by past research and a new theoretical approach that takes into account multiple causation is needed for examining these effects.