Beyond enmeshment: evidence for the independence of intrusiveness and closeness-caregiving in married couples

In a 1996 article on family theory, we (Green & Werner) proposed that family enmeshment should not be equated with high cohesion and that the construct of enmeshment fails to discriminate between two distinct relationship processes: Closeness-caregiving and intrusiveness. In this study, our model of these two independent dimensions of family connectedness was tested by assessing spouses from 264 couples, using the California Inventory for Family Assessment (CIFA). The CIFA scales showed acceptable reliability. Significant interspouse validity correlations also were obtained. As predicted by our theory, factor analyses distinguished dimensions of intrusiveness (blurring of boundaries) from dimensions of closeness-caregiving (such as warmth and nurturance). On all but two factors, behaviors of only one spouse (but not of both) had interpretable loadings. That is, in most areas, the two spouses' behaviors did not load together to form meaningful factors. The latter finding suggests that family systems theory--with its central notion of reciprocally contingent behaviors between family members--may be useful in understanding only a few dimensions of spouses' behavior (such as reciprocal aggression) whereas personality-in-context theories may be better for understanding most other dimensions (such as warmth and nurturance).     

Passenger Rail Security,Planning, and Resilience: Application of Network,Plume, and Economic Simulation Models as Decision Support Tools

We built three simulation models that can assist rail transit planners and operators to evaluate high and low probability rail‐centered hazard events that could lead to serious consequences for rail‐centered networks and their surrounding regions. Our key objective is to provide these models to users who, through planning with these models, can prevent events or more effectively react to them. The first of the three models is an industrial systems simulation tool that closely replicates rail passenger traffic flows between New York Penn Station and Trenton, New Jersey. Second, we built and used a line source plume model to trace chemical plumes released by a slow‐moving freight train that could impact rail passengers, as well as people in surrounding areas. Third, we crafted an economic simulation model that estimates the regional economic consequences of a variety of rail‐related hazard events through the year 2020. Each model can work independently of the others. However, used together they help provide a coherent story about what could happen and set the stage for planning that should make rail‐centered transport systems more resistant and resilient to hazard events. We highlight the limitations and opportunities presented by using these models individually or in sequence.     

Whither Risk Assessment: New Challenges and Opportunities a Third of a Century After the Red Book

Six multi‐decade‐long members of SRA reflect on the 1983 Red Book in order to examine the evolving relationship between risk assessment and risk management; the diffusion of risk assessment practice to risk areas such as homeland security and transportation; the quality of chemical risk databases; challenges from other groups to elements at the core of risk assessment practice; and our collective efforts to communicate risk assessment to a diverse set of critical groups that do not understand risk, risk assessment, or many other risk‐related issues. The authors reflect on the 10 recommendations in the Red Book and present several pressing challenges for risk assessment practitioners.     

Neighborhood Quality, Environmental Hazards, Personality Traits, and Resident Actions

A survey of 798 New Jersey residents examined relationships among residents' neighborhood activities, perceptions of neighborhood quality, trust of experts, support for rebuilding cities and equal rights, and degree of optimism. Neighborhood activities increased with lack of trust and optimism. These personality characteristic measures were folded into multidimensional constructs that included local environmental hazards, respondents' ratings of their previous neighborhoods, and some demographic variables. Pessimism and values that support equal rights and rebuilding cities were weakly associated with poor quality neighborhood ratings.     

The supportive approach to therapy

This paper attempts to correct the misunderstanding of supportive therapy as non-specific, reassuring response to a patient's overwhelming stress. Supportive treatment methods require perceptive assessment of the particular coping skills used by the patient, and an understanding of the ways in which empathic contact revives the sense of capacity to endure. What is usefully supportive for one person may be anxiety provoking and undermining to another. Case examples are used to illustrate the clear definition, focus, and selectivity necessary in supportive treatment.Presented at a conference of the Department of Psychiatry, Mt. Auburn Hospital, Cambridge, MA Jan. 1977. At the time this work was done, the author was employed by McLean Hospital Outpatient Clinic and Harvard University Student Health Service, and on the Visiting Staff, Social Service Department, Mt. Auburn Hospital, Cambridge, MA     

Next-generation informatics. A new picture of quality medicine

It's up to the physician executive to make an informed choice when selecting a "next-generation" information system. Look for systems that truly integrate (not merely interface) managed care components, clinical capabilities, and other features in a model that mimics the workflow of an actual practice. Take the time to learn about the technology. Consider how a vendor's product will work at every point within your organization. Seven critical features that physician executives should consider in their decision-making are described.