How physician-employees experience their work lives in a changing HMO

The present study advances our understanding of both physician adaptation and the physician-organization relationship in a managed care environment defined by structural diversity and constant change. It does so through a longitudinal examination of a single group of physician-employees experiencing their work lives within a nonprofit health maintenance organization (HMO) in the midst of major strategic developments. Using interview, observation, and archival data collected over a five-year period, the analysis reveals that the form and substance of individual physician adaptation to organizational life is dependent upon social exchanges over time with the HMO, making it an emergent, evolutionary process rather than a pre-determined, static phenomenon. However, the results also demonstrate that physician adaptive response to rapid, unpredictable organizational change is slow and delayed, in particular when this change makes physicians more dependent on their employing organization. This confers an advantage onto the organization vis-à-vis professionals in interpreting and responding to environmental change. These insights should encourage sociologists to employ research designs and contingency models of physician attitudes and behavior that capture the dynamic and particularistic nature of everyday physician work life in contemporary health care.     

The Gambling Self-Efficacy Questionnaire: An Initial Psychometric Evaluation

Instruments to assess individuals' self-efficacy for the control of addictive behaviors have been useful for monitoring behavior change, predicting maintenance of treatment gains, and identifying potential relapse situations. The Gambling Self-Efficacy Questionnaire (GSEQ) was developed to assess perceived self-efficacy to control gambling behavior. A demographically diverse sample of 309 adult gamblers completed an initial set of 42 items, of which 16 were selected to form the final version of the GSEQ. The GSEQ showed high internal consistency ( = .96) and good test-retest reliability (r = .86). A factor analysis provided some support for a unitary factor structure. As expected, GSEQ scores were negatively correlated with reports of problematic gambling behavior. Participants experiencing problems related to their gambling behavior scored significantly lower on the GSEQ than those who were not experiencing gambling problems. This psychometric examination of the GSEQ supported its potential utility for treatment planning and outcome evaluation with problem gamblers.     

Explaining trends in UK immigration

Since the 1970s Britain has gone from being a country of net emigration to one of net immigration, with a trend increase in immigration of more than 100,000 per year. This paper represents the first attempt to model the variations in net migration for British and for foreign citizens, across countries and over time. A simple economic model, which includes the selection effects of differing income distributions at home and abroad, largely accounts for the variations in the data. The results suggest that although improved economic performance in the UK relative to overseas has tended to increase immigration, rising UK inequality has had an even larger effect. Immigration policies at home and abroad have also increased net immigration, particularly in the 1990s.

Decisions,Science, and Values: Crafting Regulatory Alternatives Analysis

Emerging “prevention‐based” approaches to chemical regulation seek to minimize the use of toxic chemicals by mandating or directly incentivizing the adoption of viable safer alternative chemicals or processes. California and Maine are beginning to implement such programs, requiring manufacturers of consumer products containing certain chemicals of concern to identify and evaluate potential safer alternatives. In the European Union, the REACH program imposes similar obligations on manufacturers of certain substances of very high concern. Effective prevention‐based regulation requires regulatory alternatives analysis (RAA), a methodology for comparing and evaluating the regulated chemical or process and its alternatives across a range of relevant criteria. RAA has both public and private dimensions. To a significant degree, alternatives analysis is an aspect of product design; that is, the process by which private industry designs the goods it sells. Accordingly, an RAA method should reflect the attributes of well‐crafted product design tools used by businesses. But RAA adds health and environmental objectives to the mix of concerns taken into account by the product designer. Moreover, as part of a prevention‐based regulatory regime, it implicates important public values such as legitimacy, equity, public engagement, and accountability. Thus, an RAA should reflect both private standards and public values, and be evaluated against them. This article adopts that perspective, identifying an integrated set of design principles for RAA, and illustrating the application of those principles.     

Urban tree cover: an ecological perspective

Analysis of urban tree cover is generally limited to inventories of tree structure and composition on public lands. This approach provided valuable information for resource management. However, it does not account for all tree cover within an urban landscape, thus providing insufficient information on ecological patterns and processes. We propose evaluating tree cover for an entire urban area that is based on patch dynamics. Treed patches are classified by their origin, structure, and management intensity. A patch approach enables ecologists to evaluate ecological patterns and processes for the entire urban landscape and to examine how social patterns influence these ecological patterns and processes.     

Conservatism of the Accident Sequence Evaluation Program HRA Procedure

This paper presents a limited assessment of the conservatism of the Accident Sequence Evaluation Program (ASEP) human reliability analysis (HRA) procedure described in NUREG/CR-4772. The data for this study are derived from simulator examination reports from the NRC requalification examination cycle for nuclear power plant operators. The ASEP procedure was used to estimate human error probability (HEP) values for critical tasks, and the HEP results were compared with the failure rates observed in the examinations. The ASEP procedure was applied by PNNL operator license examiners who supplemented the limited information in the examination reports with expert judgment based upon their extensive simulator examination experience. Comparison of the average of the ASEP HEP values with the fraction of the population actually failed and demonstrated that the ASEP HEP values are larger (conservative) by a statistically significant average factor of two. Partitioning of tasks into subgroups based on the ASEP HEP values and comparison of the subgroup average ASEP HEP values with observed subgroup failure rates showed little or no conservatism for small ASEP HEP values, but considerable conservatism for larger ASEP HEP values.     

Gender Differences in Pay of Young Management Professionals in the United States: A Comprehensive View

We conduct a comprehensive examination of the gender differences in pay focusing on multiple perspectives emanating from economics, social psychology, and gender studies. Data are drawn from surveys of MBA students conducted by the Graduate Management Admissions Council. Although women in both samples earn significantly less on average than men, when the effects of the study's variables are considered via multiple regression analysis, no significant difference in annual salary is observed. Our results show the importance of simultaneously considering the impact of human capital, job and firm characteristics, demographics, and cognitive skills. Structural differences are noted in the models estimated separately for men and women. However, the results from decomposing salary differentials are quite consistent with estimates from the single-equation models.     

THE TREATMENT OF BORDERLINE PERSONALITY DISORDER WITHIN A DISTRESSED RELATIONSHIP*

An integrated systemic-psychodynamic approach to the treatment of characterological disorders within conjoint marital therapy is suggested. Spouses' personality disorders may serve a homeostatic function within the marital relationship. Thus, any effort to effect change on either the marital or individual system level must address both the individual and relationship distress. Borderline personality disorder, an extreme characterological impairment, has been considered intractible, although object relations therapists have experienced success in treating such clients. The present paper draws from object relations and systemic therapies in developing a treatment approach to marriages which include at least one borderline spouse. A case example illustrates the conceptualizations and interventions which are proposed.     

Book reviews

Theory and Society -