Alternative Methods for Computing the Sensitivity of Complex Surveillance Systems

Stochastic scenario trees are a new and popular method by which surveillance systems can be analyzed to demonstrate freedom from pests and disease. For multiple component systems—such as a combination of a serological survey and systematically collected observations—it can be difficult to represent the complete system in a tree because many branches are required to represent complex conditional relationships. Here we show that many of the branches of some scenario trees have identical outcomes and are therefore redundant. We demonstrate how to prune branches and derive compact representations of scenario trees using matrix algebra and Bayesian belief networks. The Bayesian network representation is particularly useful for calculation and exposition. It therefore provides a firm basis for arguing disease freedom in international forums.     

Validity of work-related assessments

Insufficient evidence of the validity of work-related assessments is frequently reported as a major concern in occupational rehabilitation. Despite this concern, and the continuing development of new and old assessments, no comprehensive evaluation of the evidence has been conducted. OBJECTIVES: The purpose of this study was to first determine the extent and quality of available evidence for the validity of work-related assessments, and then where sufficient evidence was available, determine the level of validity. STUDY DESIGN: This study examined available literature and sources in order to review the extent to which validity has been established for 28 work-related assessments. RESULTS: The levels of evidence and validity are presented for each assessment. Most work-related assessments have limited evidence of validity. Of those that had adequate evidence, validity ranged from poor to good. There was no instrument that demonstrated moderate to good validity in all areas. Very few work-related assessments were able to demonstrate adequate validity in more than one area, or with more than one study, even when contributory evidence was included. CONCLUSION: With this study clinicians will be able to examine their options with regard to the validity of the assessments they choose to use.     

The levers of influence

Physicians often determine the demand for health care services, as well as control the clinical processes aimed at improving health outcomes at the individual and population level. Given their important role in enhancing health status and improving the health care delivery system, it is critical that physician executives master the tools necessary to positively influence physician behavior. But changing behavior is far more complex than "doing it or not doing it." The Nike slogan "just do it" is motivating, but over-simplified. The roots of human change include: consciousness-raising, emotional arousal, commitment, helping relationships, self-reevaluation, reward, and environmental control. A model to effectively influence behavior is presented and includes setting clear expectations, measuring and monitoring performance, providing feedback, and rewarding and recognizing improvement. If all else fails, try discipline. This five-step approach is based on the science of human behavior and working with physicians in diverse settings, ranging from academic medical centers to small practices.     

Negative impact of sexual abuse on adult male gender: Issues and strategies of intervention

Although male sexual abuse has co-existed with female sexual abuse, the professional literature has paid minimal attention to the impact of sexual abuse of male children to their adult adaptation. This paper concentrates on the negative impact of sexual abuse on the adult male's gender identity. Examples of eight male clients' responses to sexual abuse in their adult life and the therapeutic framework utilized to work with them are discussed in the paper.This paper was originally presented at the ICAPP conference, 1993.He teaches advanced clinical practice, Human Behavior and AIDS ELECTIVE. He maintains a private practice specializing in Gay men, persons with HIV virus.     

Pollution disclosures,pollution performance and economic performance

This study examines the association between pollution disclosures and pollution performance and between pollution disclosures and economic performance for firms in highly polluting industries. An index of pollution disclosures is developed and correlated with indices of pollution performance and economic performance. The results confirm earlier findings that there is no association between pollution disclosures and pollution performance. As far as the association between economic performance and pollution disclosures is concerned, the results show that the subgroup of large firms with poor economic performance provides the most detailed pollution information. For smaller firms there is no association between economic performance and pollution disclosures.     

Book Review

Book reviewed in this article:
Daniel P. M oynihan , Maximum Feasible Misunderstanding: Community Action in the War on Poverty. N.Y.: Free Press, 1969. xxi, 218 pp. $5.95.     

Freedom of choice and diversity of options: Some difficulties

This paper explores the possibility for a (non-preference-based) freedom ranking of opportunity sets that is sensitive to the diversity of the options. It turns out that how distances between sets and alternatives are measured is crucial to the derivation of such a ranking. Several proposals are examined, each of which is shown to lead to impossibility results. Earlier versions of this paper were presented at conferences in Kortrijk, Osnabrück, Oisterwijk, Caen and Pavia. I thank the participants at these conferences for their comments. I would also like to thank Steven Hartkamp, Theo Kuipers, Clemens Puppe and especially Kotaro Suzumura for their helpful comments. Furthermore, I am very grateful to Somdeb Lahiri for pointing out a mistake in a previous version of this paper.