A comparison of objective and subjective measures of clinical competence

The purpose of this study was to determine if objective performance measures from a simulated patient practical examination were related to faculty subjective assessments of surgery students' performance. Another purpose was to determine if those students performing well on a simulated patient practical examination were the same students awarded honor ratings by faculty. Faculty ratings of students (n = 72) on history taking ability, physical exam skills, problem identification, use of investigations, problem integration, patient management, and patient relations skills were correlated with objective measures on these same criteria achieved on a practical exam employing three simulated patient cases. Correlations were also calculated to study the relationship between practical exam scores and honor rating recipients. Results indicated significant relationships between faculty subjective ratings and practical exam outcomes on all practical examination skills except physical exam skills and patient management skills. Findings also indicated the performance of honor students on the practical examination was significantly better than non-honor students on two skills: history-taking and patient relations. The implications of these research findings are discussed.     

Youth, identity, and homosexuality: the changing shape of sexual life in contemporary Brazil

This essay examines the relationship between homosexuality and adolescence in contemporary Brazil, focusing on a distinction between two rather different systems of sexual meanings that have structured the experience of same-sex relations: a traditional model of the sexual universe that continues to dominate sexual life in rural areas, and a more modern set of notions that has become increasingly important in the cities. It examines the ways in which these rather different systems have affected the experience of same-sex desires and practices during youth or adolescence, and suggests some of the ways in which the emergence of a gay subculture in urban Brazil has transformed the range of sexual possibilities and choices currently available to young men and women.     

Informality and Employment Relationships in Small Firms: Humour,Ambiguity and Straight‐talking

This paper presents in‐depth qualitative research on three small professional service firms whose owner‐managers sought to introduce greater degrees of formality in their firms’ working practices and employment relationships. We focus on humour as an ambiguous medium of informality, yet viewed by owner‐managers as a tool at their disposal. However, while early studies of humour in small and medium‐sized enterprises support such a functionalist view, our findings indicate its significant limitations. We argue that humour obscures but does not resolve disjunctive interests and it remains stubbornly ambiguous and resistant to attempts to functionalize it. Our findings contribute to studies of humour in small and medium‐sized enterprises by challenging its utility as a means of managerial control or employee resistance. They also contribute to studies of employment relationships by exploring humour's potentially disruptive influence within the formality–informality span, especially as small and medium‐sized enterprises seek greater degrees of formalization, with implications for how those relationships are conducted and (re)negotiated on an ongoing basis.     

Nonparametric regression estimation at design poles and zeros

ABSTRACT In most treatments of nonparametric regression, it is assumed that the marginal density of the explanatory variables is strictly bounded away from zero and infinity. This note investigates the pointwise asymptotics for nonparametric regression when this assumption fails, that is, the marginal density of the explanatory variable has either an isolated zero or a pole at the point of interest.     

Cognitive therapy and behavioural coping in the management of work-related stress: An intervention study

Transactional models of stress emphasize the importance of cognitive appraisal of potential stressors in the determination of the stress response. This appraisal can be modified by the use of techniques normally associated with cognitive therapy. The contribution of a specifically cognitive component when intervening in work-related stress has not been well evaluated to date. This research seeks to determine the effectiveness of stress management training in the treatment of the work-related effects of stress by comparing the role of modifying dysfunctional cognitions with the teaching of appropriate behavioural coping strategies. Participants were allocated to one of two intervention conditions or to a waiting list control group. Those in the intervention conditions received group stress management either with the focus on delivering cognitive therapy techniques or with the focus on behavioural coping skills. Measures of general health were taken at the beginning and end of intervention and at 3-month follow-up. Participants in the cognitive therapy groups who were reporting symptoms of general ill-health at the start of the intervention showed a significant improvement at follow-up. Cognitive therapy appears to have been an effective intervention in work-related stress. Those in the behavioural group showed a smaller but still clinically effective improvement. Results are discussed in terms of methodological issues and implications for future research. It is suggested that changes in cognitive appraisal may need to be developed.