Shared planning: a new foundation for quality criteria.

The Chinese word for crisis has two characters. One for danger and one for opportunity. A crisis is a time for awakening to new perspectives and for asking different questions. The widely touted "liability crisis" in the health care field provides just such a time for new approaches. Perhaps there is a way to establish market mechanisms for decision making that gives expression to the desires and values of consumers while respecting the abilities and preferences of physicians. Quality might then be the result of natural selection or, more accurately, of market demand. Such a system would acknowledge that quality in medicine is not for defining. It's for having. Quality should be obtained in bargaining for services, not in mandates of professional regulation.     

THREE APPROACHES TO FAMILY THERAPY: A STUDY OF CONVERGENCE AND DIVERGENCE*

The literature on professional development suggests that the process of segmentation or specialization within a profession logically accompanies the aggregation, dissemination and application of new and expanding bodies of knowledge. The present study empirically examines the extent and dimensions of this process of segmentation within the family therapy movement by comparing the belief and action systems of 1000 experienced family therapists oriented to one of three major models of family therapy. Two theses are suggested which may explain the findings depicting a unique patterning of similarities and differences among the three models; each implying different directives and implications for the continued growth of the interdisciplinary practice of family therapy.     

Assessing Cross-Media Impacts: A Comparative Risk Approach

The Oregon Department of Environmental Quality has developed a Cross-Media Comparative Risk Assessment model to address certain regulatory concerns. The model generates a Human and Ecological Risk Index for a facility releasing toxins into the environment. The risk indices are based on chemical fate and transport predictions, toxicity, population density, and ecological sensitive areas. The model can be used to rank facilities for inspection or as a tool to assess the progress of pollution prevention programs. Regulatory permitting departments can use the model to address the cross-media transfer of pollutants from one environmental compartment to another. The versatility of the model allows adaptation to each specific users needs.     

A Bayesian growth and yield model for slash pine plantations

We formulate a traditional growth and yield model as a Bayes model. We attempt to introduce as few new assumptions as possible. Zellner's Bayesian method of moments procedure is used, because the published model did not include any distributional assumptions. We generate predictive posterior samples for a number of stand variables using the Gibbs sampler. The means of the samples compare favorably with the predictions from the published model. In addition, our model delivers distributions of outcomes, from which it is easy to establish measures of uncertainty, such as highest posterior density regions.     

The benefits of a nap during prolonged work and wakefulness

Prolonged work scenarios with demands for sustained performance are increasingly common. Because sleep loss inevitably compromises functioning in such situations, napping has been proposed as a countermeasure. The optimal timing of the nap relative to its benefits for performance and mood is not known, however. To address this issue, 41 healthy adults were permitted a two-hour nap at one of five times during a 56-hour period of intermittent work, with no other sleep. Naps were placed 12 hours apart, near the circadian peak (P) or trough (T), and were preceded by 6(P), 18(T), 30(P), 42(T), or 54(P) hours of wakefulness. Work test bouts occurred every few hours and consisted of a variety of psychomotor and cognitive tasks as well as mood scales completed at the beginning, middle and end of each bout. A total of eight performance and 24 mood parameters were derived from the bouts and compared between groups at all test points prior to and following the naps. An estimate of the extent to which each nap condition differed from the control (P54) condition was derived by totalling the proportion of test points that yielded statistically significant results relative to the total number of tests conducted both before and after naps.

Although all performance and most mood parameters displayed a circadian-modulated deterioration as the protocol progressed, a nap appeared to attentuate the extent of this change in all performance parameters but not in mood parameters. Overall, the timing of the nap across days and within the circadian cycle was irrelevant to its effect on performance, suggesting that it diminished the intrusion of sleepiness into behavioural functioning, even though subjects were phenomenally unaware of this benefit.     

Management Information Systems and Corporate Planning

If we accept the correlation between MIS and computer based systems then the corporate planner has to consider the impact on his own company of a major new function. In so far as computers and the associated highly paid staff are concerned, the planner is certainly threatened with a major cost growth area that develops a momentum of its own. He may need all his energy to contain this growth in highly expensive resources to a scale that matches the company's overall operations. On the other hand an emphasis on management information and redesigned systems may lead to radical redesign and improvement in profitability of a company's operations. These two aspects are different sides of the same coin and in the future the corporate planner will play a dominant part in determining whether a company enjoys the benefits as well as incurs the costs of a sophisticated MIS.     

Remembering the lizard: reconstructing sexuality in the rooms of narcotics anonymous

The crack epidemic was devastating to poor American communities in part because of the destruction wrought by the system of exchanging sex for drugs, which was a key feature of the crack-use culture. Sex-for-drugs exchanges were often conducted under unsafe circumstances and were linked to the spread of AIDS and other STDs, as well as unplanned pregnancies. The existence of this alternative system of sexual relationships threatened the economic viability of established commercial sex work and undermined the status and power of women. Narcotics Anonymous (NA) meetings helped men and women recover from crack addiction through a well-described 12-step process. Described as the rooms, these time- and space-specific encounters helped people become sober in the context of neighborhoods that were centers of the drug trade. Because of the key role of sex in the crack culture, transformation of sexual relationships was essential to establishing and maintaining sobriety. The manner in which the rooms of NA influence the sexuality and lifeworld of addicted people is explored using Barker's theory of ecological psychology.     

Major factors influencing HIV/AIDS project evaluation

This article aimed at finding out if participatory processes (group discussions, enactments, and others) do make a valuable contribution in communication-based project implementation/evaluation and the fight against HIV/AIDS. A case study backed by documentary analysis of evaluation reports and occasional insights from interviews stood as the main methods. To identify values, the state of beneficiaries prior to and after project implementation/evaluation was compared. Participatory processes were noted to have created an enabling environment for project beneficiaries to become activists for social change, leading to the limiting of the spread of HIV/AIDS through sexual behavior and a change of attitude--the essence required for successful intervention. Group participatory processes were also noted to have contributed in overriding, to a great extent, limitations arising from sociodemographic differences in the attainment of project objectives and limitations arising from differences in forms of evaluation (internal versus external evaluators).     

What a Weberian approach to interests can contribute to economic sociology

This review essay addresses Richard Swedbergs recent attempt to redefine the field of economic sociology. Grounding his position in Max Webers work, Swedberg advocates a type of economic sociology that not only focuses on social relations but also considers culture and interests, arguing that it is interests that drive action but that they are shaped by culture and enacted through social relations. We conclude our analysis with a consideration of the practical and empirical implications of this new approach for the study of economic life.