The Civilizing Process of Trust: Developing Quality Mechanisms which are Local,Professional‐led and thus Legitimate

‘Quality’ and ‘performance’ have become defining concepts for policymakers and health‐care systems alike. Yet whilst these principles are of fundamental importance, their practical implementation and assurance are far from straightforward. This commentary analyses the difficulties faced in enhancing quality and performance in the English NHS. Many recent initiatives have been driven through incentives and external auditing of the professionals providing health care on the frontline. Drawing on recent literature and research findings, we argue that this checking‐based ‘audit culture’ is fundamentally flawed in driving quality and performance. Many targets and measures are too crude to reflect important aspects affecting patient outcomes and therefore these frameworks lack legitimacy amongst professionals. An alternative, trust‐based model is proposed – one more capable of acknowledging the meaning, complexity and specificities inherent to professional work. Quality mechanisms developed locally by professionals are able to produce the legitimacy crucial for their effectiveness. It is argued that the normative obligation of approaches based on conditional trust is a more compelling incentive towards good practice than targets and sanctions. This governance by ‘the social’ is able to motivate a more holistically enlightened and consistent reflexivity towards practice, though it is only able to flourish in the absence of purposive‐rational systems.     

Three's a crowd? The Nader vote in the 2000 presidential, election in U.S. metropolitan areas

The 2000 U.S. presidential election resulted in one of the closest and most controversial outcomes in U.S. history. Green Party candidate Ralph Nader had little chance of winning, but nevertheless impacted the race in several close states and arguably swung the race from Al Gore to George W. Bush. This research examines Ralph Nader's “urban strategy” to win 5% of the vote for president and the bases of his electoral support. This study uses the METRO_2000 data set which contains a variety of publicly available variables for 276 U.S. metropolitan statistical areas (MSAs) in the year 2000. The analysis uses OLS regression to examine the determinants of the percentage of the vote for Nader in each MSA. The results indicate that the Nader vote was positively influenced by key electoral variables such as the level of electoral participation, whether Nader was on the ballot or could be written in, and the closeness of the race in state polls leading up to the election. The Nader vote was also higher in MSAs with high percentages of voters who supported Nader programs including environmentalists, those favoring universal health care and gay rights, union members, and MSAs that were college towns or with high percentages of college-educated voters. Ralph Nader's urban strategy effectively mobilized enough of his electoral base to impact the 2000 election, but electoral constraints and the closeness of the race prevented him from achieving his goal of attaining 5% of the vote. This case holds lessons about the limits and possibilities of third party campaigns in U.S. presidential elections.     

Imagined past,present and futures in Murray–Darling Basin communities

Over the past three decades, irrigation-dependent rural communities in Australia's Murray–Darling Basin have experienced profound economic, social and environmental changes, which they are attempting to accommodate through local government policy. As a contribution to participatory policy design research, in consultation with local governments we carried out focus groups to explore diversity of individuals’ imagined past and present in two rural communities. This was followed by group development of a diverse range of future scenarios and agreement to three likely scenarios. The research identified presence or absence of three underlying themes – irrigation, innovation and inflow of people – that plausibly drive change in these rural communities. These themes are likely to be common to many rural communities that have depended on irrigated agriculture. They provide an example of participatory policy-making, as distinct from the historically employed top-down policy development that has occurred in the Murray–Darling Basin. Because of the diversity of perceptions of past, present and futures, and the ultimate adoption of business-as-usual within the final local government plans, the research emphasises the need to put effort into community deliberations to build cohesion and share ownership of the process for delivering locally nuanced community policy.     

The negative binomial–beta Weibull regression model to predict the cure of prostate cancer

In this article, for the first time, we propose the negative binomial–beta Weibull (BW) regression model for studying the recurrence of prostate cancer and to predict the cure fraction for patients with clinically localized prostate cancer treated by open radical prostatectomy. The cure model considers that a fraction of the survivors are cured of the disease. The survival function for the population of patients can be modeled by a cure parametric model using the BW distribution. We derive an explicit expansion for the moments of the recurrence time distribution for the uncured individuals. The proposed distribution can be used to model survival data when the hazard rate function is increasing, decreasing, unimodal and bathtub shaped. Another advantage is that the proposed model includes as special sub-models some of the well-known cure rate models discussed in the literature. We derive the appropriate matrices for assessing local influence on the parameter estimates under different perturbation schemes. We analyze a real data set for localized prostate cancer patients after open radical prostatectomy.     

Impact of situational framing and complexity on charismatic,ideological and pragmatic leaders: Investigation using a computer simulation

Revisiting the work of Weber [Weber, M. (1921). The theory of social and economic organizations. New York: Free Press], Mumford and colleagues (e.g., [Strange, J. M., & Mumford, M. D. (2002). The origins of vision: Charismatic versus ideological leadership. Leadership Quarterly, 13, 343?377; Mumford, M.D. (2006). Pathways to outstanding leadership: A comparative analysis of charismatic, ideological and pragmatic leaders. Mahwah, NJ: Erlbaum.]) explored the thesis that in addition to charismatic leadership, there exist at least two additional pathways to outstanding leadership: ideological and pragmatic. Despite the compelling results of initial studies, however, questions remain as to when and under what situational conditions these three leaders operate most effectively. As such, an experiment was conducted to investigate two noteworthy contextual influences: 1) situational congruence with a leader's mental model and 2) environmental complexity. The experiment made use of a computerized leadership simulation where participants took on the role of a university chancellor. Results indicate that leader type, complexity, and situational framing were critical factors in determining leader performance on multiple game performance criteria as well as creative process criteria. Implications and avenues for future research are discussed.     

Domination and total domination in complementary prisms

Let G be a graph and be the complement of G. The complementary prism of G is the graph formed from the disjoint union of G and by adding the edges of a perfect matching between the corresponding vertices of G and . For example, if G is a 5-cycle, then is the Petersen graph. In this paper we consider domination and total domination numbers of complementary prisms. For any graph G, and , where γ(G) and γ _t (G) denote the domination and total domination numbers of G, respectively. Among other results, we characterize the graphs G attaining these lower bounds. Research supported in part by the South African National Research Foundation and the University of KwaZulu-Natal.     

Pathways to happiness: From personality to social networks and perceived support

The present study attempts to incorporate individual personality into a social network account of subjective wellbeing (SWB) by proposing and testing a path model in which social relationships (egocentric social networks and perceived social support, PSS) mediate the relationship between personality and SWB. We found that network characteristics (including network size, emotional closeness, and proportion of new contacts) are related to SWB largely via the mediation of PSS. Additionally, network size and proportion of new contacts function as important mediating mechanisms linking extraversion, agreeableness and openness to PSS and SWB.     

Examining the Relationships Between Resilience,Mental Health,and Academic Persistence in Undergraduate College Students

Abstract

Objective: In this study, the relationships between measures of interpersonal resilience, intrapersonal resilience, and mental health were examined with respect to academic and social integration, key determinants of academic persistence. Participants: A sample (n = 605) of undergraduate students was recruited from 2 midwestern universities during the 2007–2008 academic year. Methods: Hierarchal (or sequential) regression analysis examined whether the inter- and intrapersonal resilience and mental health measures contributed to explaining variance in the response variables of university cumulative grade point average (GPA) and university sense of belonging. Results: The intrapersonal resilience factors contributed to explaining variance in cumulative GPA in addition to aptitude and achievement. Furthermore, there was a strong statistical correlation between the inter- and intrapersonal resilience factors and mental health. Conclusions: The demands in college are significant and there is a need for more research on the concept of resilience as it relates to college health and academic persistence.     

Auditing Nonphysician Providers' Visits through a Computer-Assisted System

Abstract

The Medical Department is using a computer-assisted system for auditing care provided by mid-level practitioners. Standards of care and corresponding checklist forms have been developed for six common ambulatory problem areas. These include: Respiratory complaints, headache, gastrointestinal disorders, urinary tract infections, male genitourinary problems, and minor trauma. The standards for the diagnostic process and treatment of each complaint were developed by a working group of physicians and mid-level practitioners. Providers complete a checklist form for each patient presenting with problems covered by the protocol. The checklist serves as the medical record for the visit. Checklist data is entered into a computer which audits the visit record against protocol standards. The computer identifies records containing discrepancies in the appropriateness of diagnosis, treatment plan, and physician consultation. The computer output is not the end of the audit process. It identifies encounter records which need further review. Because a discrepancy from the programmed standards does not necessarily reflect faulty medical judgement or care, these records are referred weekly to a physician-nurse audit team. The computerized system allows the auditors to focus their efforts on problems which may make a significant difference in patient care.

As a result, the Medical Department's audit process is both more comprehensive and more thorough than it was prior to the inception of this program. Since April 1, 1977, more than 15,000 encounters have been audited through this system.