Satisfaction with Health Care and Community Esteem Among Rural Women

The present study examines the ways in which satisfaction with health care may be associated with the lives of rural women. One hundred thirty one rural women between the ages of 45 and 70 years completed measures of community esteem, life satisfaction, satisfaction with health care, health status, and mood. The results showed that rural women's satisfaction with their health care was associated with the extent to which they hold their community in esteem and their degree of life satisfaction. Moreover, women who had poor health were less satisfied with the available health care than were healthier women. These findings are discussed in terms of their implications for the well-being of rural communities in general.     

Auswirkungen von Downsizing-Maßnahmen auf das organisationale Commitment der verbleibenden Mitarbeiter: Ein Vorher-Nachher-Vergleich

This study examines the consequences of downsizing efforts on organizational commitment, job satisfaction and work motivation of the remaining workforce (?survivors“) in a middle-sized telecommunication company. Employees were surveyed five months prior to the downsizing process (n=150) and eleven months thereafter (n=160). The assessment of organizational commitment was based on a questionnaire that was developed by Allen and Meyer (1990) within the scope of their three-components-model which includes affective, continuous and normative commitment. Although layoffs — as one part of the whole downsizing process — were not implemented in the investigated company, but only in a sister enterprise, which is part of the same holding, the affective commitment of employees towards their corporation dropped. On the other hand, the normative and the balanced commitment remained constant. Moreover, every second survivor showed reduced job satisfaction and work motivation. It should be noted that although the results of reorganisation and restructuring did not directly affect the employees of the investigated company, the emotional linkage between employees and employer was affected in a negative way. Additional findings from qualitative interviews suggest that restructuring was perceived to cause a crack in the prevailing corporate culture and the psychological contract. In addition, a deterioration of work conditions through work overload resulted.     

Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective "dialogue" that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

Communicating Actionable Risk for Terrorism and Other Hazards⋆

We propose a shift in emphasis when communicating to people when the objective is to motivate household disaster preparedness actions. This shift is to emphasize the communication of preparedness actions (what to do about risk) rather than risk itself. We have called this perspective “communicating actionable risk,” and it is grounded in diffusion of innovations and communication theories. A representative sample of households in the nation was analyzed using a path analytic framework. Preparedness information variables (including content, density, and observation), preparedness mediating variables (knowledge, perceived effectiveness, and milling), and preparedness actions taken were modeled. Clear results emerged that provide a strong basis for communicating actionable risk, and for the conclusion both that information observed (seeing preparedness actions that other have taken) and information received (receiving recommendations about what preparedness actions to take) play key, although different, roles in motivating preparedness actions among the people in our nation.     

Women's political leadership participation around the world: An institutional analysis

Understanding institutional systems is critical for the advancement of women's participation in leadership in varying contexts. A unique and global analysis of the contextual factors that affect women in political leadership, this paper extends prior research in the field. This is a cross-country study where we ask, “How are societal-level institutional forces related to women's participation in political leadership?” We collected data from 8 secondary sources on 181 countries and conducted linear regression analyses with six institutional influences: the business environment, societal development, the economic environment, physical and technological infrastructure, political freedom, and culture. Results indicate that to increase the political leadership participation of women, we need to evaluate the following: customs and trade regulations, graft, the gender gap in political empowerment, public spending on education, the economic viability of the country, access to power and the internet, political freedom, and cultural variables like performance orientation, collectivism, and power distance.     

You have the job you wanted--now what?

We've had calls from physicians who finally have the medical management job they always wanted and then a month later they wondered why they wanted it. I asked seven physician executives to come together as a group and talk to me about this issue. I also asked them what skills they needed most when they first got the job and, as time passed, which skills continued to be most useful. I have not used their names because they were open enough to talk about some very sensitive issues.     

POWER APPROXIMATIONS FOR A TWO-ECHELON INVENTORY SYSTEM USING SERVICE LEVELS

We consider a two-echelon inventory system with one warehouse and several stores. The warehouse as well as the stores are controlled by periodic review (s, S) inventory policies. We study the interrelationship between the safety stocks at the warehouse and the stores. Stockouts at the warehouse will result in supply delays to the stores and cause the lead time to be stochastic. The stores may react by increasing their safety stock. However, there is a trade-off between the safety stock at the warehouse and the safety stock at the stores. We use a service level at the warehouse to quantify the effect of warehouse stockouts on the lead time to the stores. The service level at the warehouse is considered a decision variable to find the best compromise between the various safety stocks by minimizing the overall costs. Using power approximations for the (s, S) policies, we provide an iterative procedure for adjusting the lead time distribution to the stores; this can result in substantial savings, but it doesn't guarantee the overall optimality. Numerical studies are provided to test the accuracy of approximations. The effects of the different system parameters on the inventory policy give general guidelines for use of the policies.     

Recognizing Structural Nonidentifiability: When Experiments Do Not Provide Information About Important Parameters and Misleading Models Can Still Have Great Fit

In the quest to model various phenomena, the foundational importance of parameter identifiability to sound statistical modeling may be less well appreciated than goodness of fit. Identifiability concerns the quality of objective information in data to facilitate estimation of a parameter, while nonidentifiability means there are parameters in a model about which the data provide little or no information. In purely empirical models where parsimonious good fit is the chief concern, nonidentifiability (or parameter redundancy) implies overparameterization of the model. In contrast, nonidentifiability implies underinformativeness of available data in mechanistically derived models where parameters are interpreted as having strong practical meaning. This study explores illustrative examples of structural nonidentifiability and its implications using mechanistically derived models (for repeated presence/absence analyses and dose–response of Escherichia coli O157:H7 and norovirus) drawn from quantitative microbial risk assessment. Following algebraic proof of nonidentifiability in these examples, profile likelihood analysis and Bayesian Markov Chain Monte Carlo with uniform priors are illustrated as tools to help detect model parameters that are not strongly identifiable. It is shown that identifiability should be considered during experimental design and ethics approval to ensure generated data can yield strong objective information about all mechanistic parameters of interest. When Bayesian methods are applied to a nonidentifiable model, the subjective prior effectively fabricates information about any parameters about which the data carry no objective information. Finally, structural nonidentifiability can lead to spurious models that fit data well but can yield severely flawed inferences and predictions when they are interpreted or used inappropriately.