Overworked? Lighten your load

Physician executives are suffering from creeping task migration--putting in too many hours for few appreciable results. Controlling this increasing workload has become one of the most important issues in health care, brought on by too few people trying to do too much. The only way to lessen the workload is to take charge, analyze, and act. Bosses won't care about the details. Several suggestions are presented to help physician executives downsize their workload while not reducing their output: (1) Compare your priorities with your boss's; (2) lighten up on the perfectionism; (3) change expectations; (4) look for "orphans" to cut--those projects that nobody is invested in; (5) don't target symbolic events; and (6) use logic to drive change. If you spend the next few months getting rid of the ineffective, inefficient, and redundant, you'll be ahead of the game. This is an ongoing task, and much easier done every three or four months than once a year.     

“Behind every woman in prison is a man”: Incarcerated Women’s Perceptions of How We Can Better Help Them in the Context of Interpersonal Victimization

ABSTRACT

Although women’s rates of incarceration have increased dramatically, the criminal justice system does not meet women’s unique needs. This article used qualitative methods to describe the responses of 113 incarcerated women to the following question: How can we better help women like you? Analyses focused on women’s experiences of victimization and highlighted how to address trauma in prison reform and abolition efforts. Women suggested how victimization fueled their criminal offending behavior, detailed re-victimization in the prison milieu, and identified program gaps during custody and after release. Opportunities for immediate action include policy advocacy, mitigation, and shifting to a trauma-informed correctional approach.     

Life Review and Heroic Narrative: Embracing Pathology and Attention to Context

Holding the Man (Conigrave, 1995), chronicles a fifteen-year relationship between Timothy Conigrave and his partner, John, and the process of their coping with John's impending death from AIDS related illness. In this article I discuss the autobiography as a naturalistic example of the therapeutic method of life review. What result would have emerged if a narrative therapist had assisted in the writing of the book? Based on my friendship with the protagonists, I would have argued for a less negative picture of the author, but Tim's aim seems to have been to represent the relationship in a dramatic form, with the author embracing his own pathology, and the imbalances and unfairness in their relationship. I suggest that employing methods which externalise pathology to elicit ‘the heroic 2 narrative’ may have disregarded these goals. I highlight the need to recognise and understand individual pattern and context, and raise alternative, less interventionist positions as appropriate for clients involved in such reviews of their lives.     

Fatal tradeoff? Toward a better understanding of the costs of not evacuating from a hurricane in landfall counties

Given the significant population increases in United States hurricane-prone coastal areas since 1970, we empirically model U.S. coastal hurricane fatalities from 1970 to 2007. The findings suggest that an apparent decline in hurricane fatality risk since 1970 may be overstated, especially considering the impact of evacuation levels achieved, and that various factors believed to affect the rate of hurricane fatalities have divergent outcomes. The research also illustrates the necessity of understanding the impact of a seminal storm such as Hurricane Katrina. In the analyses, we account for the coastal versus inland county location in the raw fatality data, as well as for the role of evacuation using zero-inflated specifications to handle the excessive number of zero fatality county observations. Initial results, with and without the fatalities from Hurricane Katrina, show that the expected count of fatalities increases by a factor of 1.7–3.4 for a one category level increase in storm strength, and begin to provide an understanding of the bias in the fatality data by varying the level of county evacuation achieved. Finally, we find a higher expected count of fatalities for more frequently struck counties, especially those in the Gulf of Mexico; a lower expected count of fatalities for counties with higher percentages of the population over 65, less than 18, and in poverty. We have also found that forecasting technology improvements have had a relatively minor effect on the expected count of fatalities.     

Health Care Reform and the Behavioral Health Workforce

Health care reform will increase the number of individuals who have access to substance abuse services. This impending influx of consumers has the potential of overwhelming the service capacity of providers within the field. Provisions included in the reform legislation might fall short of their intended goal to expand the number of service providers needed to deliver services. This article discusses unmet treatment need in the United States, the current numbers of service providers, and provisions within the reform legislation to increase the labor force. Recommendations are set forth that could help expand the number of providers in the field.     

A Definition and Categorization System for Advanced Materials: The Foundation for Risk‐Informed Environmental Health and Safety Testing

Novel materials with unique or enhanced properties relative to conventional materials are being developed at an increasing rate. These materials are often referred to as advanced materials (AdMs) and they enable technological innovations that can benefit society. Despite their benefits, however, the unique characteristics of many AdMs, including many nanomaterials, are poorly understood and may pose environmental safety and occupational health (ESOH) risks that are not readily determined by traditional risk assessment methods. To assess these risks while keeping up with the pace of development, technology developers and risk assessors frequently employ risk‐screening methods that depend on a clear definition for the materials that are to be assessed (e.g., engineered nanomaterial) as well as a method for binning materials into categories for ESOH risk prioritization. The term advanced material lacks a consensus definition and associated categorization or grouping system for risk screening. In this study, we aim to establish a practitioner‐driven definition for AdMs and a practitioner‐validated framework for categorizing AdMs into conceptual groupings based on material characteristics. Results from multiple workshops and interviews with practitioners provide consistent differentiation between AdMs and conventional materials, offer functional nomenclature for application science, and provide utility for future ESOH risk assessment prioritization. The definition and categorization framework established here serve as a first step in determining if and when there is a need for specific ESOH and regulatory screening for an AdM as well as the type and extent of risk‐related information that should be collected or generated for AdMs and AdM‐enabled technologies.     

New Developments in Statistical Computing

Many users of regression methods are attracted to the notion that it would be valuable to determine the relative importance of independent variables. This article demonstrates a method based on hierarchies that builds on previous efforts to decompose R ² through incremental partitioning. The standard method of incremental partitioning has been to follow one order among the many possible orders available. By taking a hierarchical approach in which all orders of variables are used, the average independent contribution of a variable is obtained and an exact partitioning results. Much the same logic is used to divide the joint effect of a variable. The method is general and applicable to all regression methods, including ordinary least squares, logistic, probit, and log-linear regression. A validation test demonstrates that the algorithm is sensitive to the relationships in the data rather than the proportion of variability accounted for by the statistical model used.