An Empirical Study of the Relations Between Hospital Volume,Teaching Status,and Service Quality

This paper contributes to research on quality drivers in healthcare settings by examining the relationships between patient volume, teaching mission, and process quality in US hospitals. To develop a model that accurately assesses the impact of patient volume and teaching status on quality, we draw on three related research streams pertaining to the volume–quality relationship, the comparative quality of care in teaching and non‐teaching hospitals, and quality drivers in service institutions. We propose the impact of patient volume on process quality varies across hospitals with different teaching intensities. The test of this proposition uses a large data set that measures process quality for treatments for heart attacks and heart failures in all major US hospitals. Our results suggest that, as hospital teaching intensity increases, greater patient volume is associated with decreased process quality. Never before was such a relationship uncovered. This initial finding has important practical implications. First, the regionalization policy of hospitals should be re‐evaluated in light of their teaching function. Second, the root causes for the lower quality scores of large, high resident‐to‐bed ratio teaching hospitals, compared with smaller versions, must be found.     

In and Out of Enactments: A Relational Perspective on the Short- and Long-term Treatment of Substance Abuse

This paper examines the contribution of a psychodynamic relational perspective to the treatment of substance abuse. Two cases of different lengths are presented to illustrate the therapeutic factors that contributed to successful recovery and long-term abstinence. Follow-up information on the successful outcome of both cases was available 7 years after the initiation of treatment. We discuss the critical role that the experience and processing of enactments played in both cases. Carol Ganzer, PhD, MSW, LCSW is on the faculty of the Institute for Clinical Social Work. She is a past president of the Chicago Association for Psychoanalytic Psychology and serves on the editorial boards of Clinical Social Work Journal and Beyond the Couch. She maintains an independent practice of psychotherapy and consultation in Chicago. Eric D. Ornstein, MA, LCSW, is a Clinical Associate Professor at Jane Addams College of Social Work, University of Illinois at Chicago. He is a field liaison in the College’s Field Division and currently teaches crisis intervention and field instruction workshops. He is on the Board of the Illinois Society for Clinical Social Work and Chair of their Education Committee.     

Writing the Other,Inscribing the Self

This research is concerned with fieldnotes as they form the building blocks of ethnography, at the representational intersection of self and other. Using fieldnotes generated by graduate students, we explore their dialectics of revelation and concealment, publicity and privacy, and awareness and unawareness, in the context of disciplinary politics.     

People, Land and Sustainability: Community Gardens and the Social Dimension of Sustainable Development

Community gardens vary enormously in what they offer, according to local needs and circumstance. This article reports on research and experience from the USA. The context in which these findings are discussed is the implementation of Local Agenda 21 and sustainable development policies. In particular, emphasis is given to exploring the social dimension of sustainable development policies by linking issues of health, education, community development and food security with the use of green space in towns and cities. The article concludes that the use of urban open spaces for parks and gardens is closely associated with environmental justice and equity.     

THE IMPACT OF LABOR CONTRACTS: EVIDENCE FROM BRAZIL

The conventional Keynesian model suggests that frictions created by nominal wage contracts generate a positive relationship between inflation and output. On the other hand, the New Classical/Real Business Cycle theory claims that firms and workers base their employment behavior, and hence output, on the marginal product of labor ignoring the efficiencies of fixed nominal wage contracts. Using Brazilian data, where nominal wages were indexed by law, tests show that fixed nominal wage contracts insignificantly affected output. Thus, the data support the view that fixed nominal wages play an insignificant role in determining the evolution of output. ( JEL E31)     

Integrating Software into PRA: A Test-Based Approach

Probabilistic risk assessment (PRA) is a methodology to assess the probability of failure or success of a system's operation. PRA has been proved to be a systematic, logical, and comprehensive technique for risk assessment. Software plays an increasing role in modern safety critical systems. A significant number of failures can be attributed to software failures. Unfortunately, current probabilistic risk assessment concentrates on representing the behavior of hardware systems, humans, and their contributions (to a limited extent) to risk but neglects the contributions of software due to a lack of understanding of software failure phenomena. It is thus imperative to consider and model the impact of software to reflect the risk in current and future systems. The objective of our research is to develop a methodology to account for the impact of software on system failure that can be used in the classical PRA analysis process. A test-based approach for integrating software into PRA is discussed in this article. This approach includes identification of software functions to be modeled in the PRA, modeling of the software contributions in the ESD, and fault tree. The approach also introduces the concepts of input tree and output tree and proposes a quantification strategy that uses a software safety testing technique. The method is applied to an example system, PACS.     

Infants' ERP Responses to Novel and Familiar Stimuli Change Over Time: Implications for Novelty Detection and Memory

Detection of novelty is an important cognitive ability early in development, when infants must learn a great deal about their world. Work with adults has identified networks of brain areas involved in novelty detection; this study investigated electrophysiological correlates of detection of novelty and recognition of familiarity in 9‐month‐old infants, using event‐related potentials (ERPs). Infants were familiarized with an event in the laboratory, then ERPs were recorded as they viewed repeated presentations of pictures of this familiar event and a novel event, along with single presentations of 30 trial‐unique events. A middle‐latency negative component was sensitive to degree of novelty, differing in amplitude and latency by stimulus condition and across repeated presentations. Long‐latency slow‐wave activity also related to stimulus condition. Findings have implications for our understanding of infants' detection of novel information and the processes that render the novel familiar.     

Children's Voices: The Views of Vulnerable Children on Their Service Providers and the Relevance of Services They Receive

This paper describes and analyses the views of vulnerable childrenof eleven years and under on the relevance of services theyreceived. The two research questions posed were, first, whatare effective practices for engaging with vulnerable children;and, second, how can the voices of vulnerable children be usedto influence the development of policy? The first question wasaddressed through a systematic review of existing literatureon effective strategies for interviewing vulnerable childrenand revealed that few studies that focus on interviewing youngchildren are designed to address effectiveness. As yet, notall young children are asked for their views by those makingdecisions about their lives, though their involvement increaseswith age. The second question was addressed through focus groupsand interviews which revealed that children hold many validviews related to their roles and relationships with serviceproviders and decisions being made concerning their lives. Itwas concluded that whilst children’s lived experienceof services they receive could contribute to the creation ofmore democratic communities in which children and their familiesparticipate, it remains to be seen whether the new Green Paper,Every Child Matters (DfES, 2003), increases their sense of autonomyor merely extends the degree to which they are controlled.     

The Durham Miners' Gala and the spirit of community

Can industrial communities survive the loss of their industrialheritage? Can communities once thought to be in terminal declinereinvigorate themselves? Evidence from the Durham coalminingcommunities suggests that the answer to both questions is yes.This paper presents evidence from a study of the annual DurhamMiners' Gala – the ‘Big Meeting’ – thatreflects a revival of community vitality around the event. Togetherwith an analysis of the Gala itself, the complex backgroundto the resilience of the mining communities is explored.     

Training Counselors to Use Computer‐Assisted Career Guidance Systems More Effectively: A Model Curriculum

A model graduate training curriculum that emphasizes the counselor's role in assisting clients in the effective use of computer‐assisted career guidance (CACG) systems is described. This 4‐module graduate training program emphasizes client readiness and exploration using CACG systems, skill building and simulation exercises, and service learning with career clients. The study is evaluated from the perspectives of counselor educators, counselor trainees, and career clients. Findings from 4 institutions support the efficacy of a model curriculum for graduate training and the beneficial outcomes of using CACG systems under appropriate conditions.