The assessment of values in medical decision making

Individuals, families, and health care providers consider medical treatment decisions in light of their respective values about life iin varying states of health. The clarification of health care values is important not only in the context of everyday clinical decision making, but also for advance care planning and the resolution of ethical dilemmas. This article argues that objective assessment tools may facilitate the process of clarifying and communicating health care values in these contexts. The article reviews arguments for the importance of values assessment in health care planning, methods used to date for health care values assessment, conceptual and methodological challenges for the measurement of health care values, and lessons learned through the process of developing and piloting a Health Care Values Survey. Objective values assessment tools appear useful for eliciting health care values, although multiple challenges for reliable, valid, and clinically useful measurement of values are identified.     

Lower-Status Participation and Influence:Task Structure Matters

Status hierarchies readily form in groups and , once established , limit lower-status group members' opportunities for contributing to and influencing group decisions . Recent findings , however , suggest that the type of task on which a group works may allow lower-status individuals to break through power and prestige orders in a cooperative way while conflicting with ideas of their higher-status group members . In this article , we review a research program that investigates how task structure relates to status and influence in small groups . In one experiment, using groups of three female students as participants , we found that open-structured tasks allow lower-status group members to participate , receive positive evaluations , and improve their status more than closed-structured tasks . In a second experiment, using groups of two female students and a female experimenter as participants , we found that open-structured tasks and lower-status confederates foster more divergent thinking and indirect influence than closed-structured tasks and higher-status sources . Our findings contribute to the understanding of how immediate problem-solving environments contribute to status change and influence in small groups.     

Lessons Learned From the First-Year Evaluation of a Small-Scale Home Visitation Program

ABSTRACT

Home visitation programs to prevent child maltreatment are offered in many communities. Agencies in these communities want to help families in need while under increased pressure to provide effective services. Funding is limited and competitive; some agencies might choose to limit funds spent on supervision, training, and evaluation as a way to provide more direct service. In this article, we use an implementation science framework and the results of an evaluation of a small home visitation program to underscore the importance of ongoing training and supervision, attention to fidelity, and program evaluation. The evaluation included 17 families entering the program during 21 months. Evaluators visited families in their homes at the beginning of the program and again 10 months later. Like many other well-intended, small-scale programs, this one “borrowed” from evidence-based models and expanded enrollment criteria in an attempt to better serve families. Findings from the evaluation suggest that the program, as it was carried out, was not effective at reducing parenting behaviors known to be associated with child maltreatment. We offer advice to funding and community agencies based on these findings and implementation science. Future evaluation research must pay greater attention to fidelity and implementation.     

System of Systems Engineering and Risk Management of Extreme Events: Concepts and Case Study

The domain of risk analysis is expanded to consider strategic interactions among multiple participants in the management of extreme risk in a system of systems. These risks are fraught with complexity, ambiguity, and uncertainty, which pose challenges in how participants perceive, understand, and manage risk of extreme events. In the case of extreme events affecting a system of systems, cause‐and‐effect relationships among initiating events and losses may be difficult to ascertain due to interactions of multiple systems and participants (complexity). Moreover, selection of threats, hazards, and consequences on which to focus may be unclear or contentious to participants within multiple interacting systems (ambiguity). Finally, all types of risk, by definition, involve potential losses due to uncertain events (uncertainty). Therefore, risk analysis of extreme events affecting a system of systems should address complex, ambiguous, and uncertain aspects of extreme risk. To accomplish this, a system of systems engineering methodology for risk analysis is proposed as a general approach to address extreme risk in a system of systems. Our contribution is an integrative and adaptive systems methodology to analyze risk such that strategic interactions among multiple participants are considered. A practical application of the system of systems engineering methodology is demonstrated in part by a case study of a maritime infrastructure system of systems interface, namely, the Straits of Malacca and Singapore.     

“Living with electronic data interchange: Implementation and practical applications for EDI from the perspective of the ILS vendor,the librarian,and the book vendor,” a report from the ALCTS,automated acquisitions/in-process control systems discussion group session at the ALA midwinter conference,January 1996

Abstract

The libraries in the Western North Carolina Library Network (WNCLN) seek effective ways to provide patrons with a complete list of electronic journals provided through their various aggregator services, so patrons can determine e-journal access to article citations. The WNCLN libraries (Appalachian State University, the University of North Carolina at Asheville, and Western Carolina University) accomplished this through their shared catalog (Innovative Interfaces, Inc. [INNOPAC]), data provided by Serials Solutions, and local computer programming. Brief MARC records, with locally created key titles, provide an interim solution to the complexities of aggregator services. Serials Review 2002; 28:108–112.     

Do Benefits of U.S. Food Assistance Programs for Children Spillover to Older Children in the Same Household?

The Women, Infants and Children (WIC) program targets low-income individuals in nutritionally vulnerable groups in the U.S. The food benefits individuals receive could be shared with other family members or may free a portion of the family budget. National Health and Nutrition Examination Survey data are used to examine whether children who are age-ineligible for WIC (age 5–17), that live in WIC-participating families have healthier diets than similar children in nonparticipating families. Results show children in WIC-participating families score higher on the Healthy Eating Index than children in non participating families. This association is stronger for children in families with two or more WIC participants compared with children living with only one or no WIC participants.     

STRENGTHENING DOMESTIC VIOLENCE THEORIES: INTERSECTIONS OF RACE, CLASS, SEXUAL ORIENTATION, AND GENDER

Current family therapy theories and practices of domestic violence place an important emphasis on gender. Employing the notion of intersectionality, this article demonstrates how the relevance and applicability of contemporary theories and practices may be enhanced through the inclusion of primary dimensions of social life, including but not limited to race, class, and sexual orientation. Theoretical in nature, this article suggests future directions for theory construction and clinical practice, drawing on literature not easily accessible to most marital and family therapists.     

CLASS SIZE AND CLASS HETEROGENEITY

We study how class size and class composition affect the academic and labor market performance of college students, two crucial policy questions given the secular increase in college enrollment. Our identification strategy relies on the random assignment of students to teaching classes. We find that a one standard deviation increase in class‐size results in a 0.1 standard deviation deterioration of the average grade. Further, the effect is heterogeneous as it is stronger for males and lower income students. Also, the effects of class composition in terms of gender and ability appear to be inverse U‐shaped. Finally, a reduction of 20 students (one standard deviation) in one’s class size has a positive effect on monthly wages of about €80 ($115) or 6% over the average.