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.     

The Politics of Hope and Despair: The Effect of Presidential Election Outcomes on Suicide Rates*

Objectives. This article examines the effect of election outcomes on suicide rates by combining the theory of social integration developed by Durkheim with the models of rational choice used in economics. Methods. Theory predicts that states with a greater percentage of residents who supported the losing candidate would tend to exhibit a relative increase in suicide rates. However, being around others who also supported the losing candidate may indicate a greater degree of social integration at the local level, thereby lowering relative suicide rates. We therefore use fixed‐effects regression of state suicide rates from 1981 to 2005 on state election outcomes during presidential elections to determine which effect is stronger. Results. We find that the local effect of social integration is dominant. The suicide rate when a state supports the losing candidate will tend to be lower than if the state had supported the winning candidate—4.6 percent lower for males and 5.3 percent lower for females. Conclusion. Social integration works at many levels; it not only affects suicide risk directly, but can mediate other shocks that influence suicide risk.     

Conditional interval estimation of the mean following rejection of a two sided test

The effect of rejecting a two-sided preliminary test of significance for the mean of a normal distribution upon subsequent interval estimation of the mean is examined. For the case where the variance is known, conditional confidence intervals may be shorter than unconditional intervals, in contrast to the one-sided preliminary test case examined by Meeks and D’Agostino (1983, The American Statistician, 7, 134-136) . For the case where the variance is unknown and must be estimated by the sample variance, it is shown that customary intervals do not offer uniformly greater or lesser coverage than the nominal level.     

Attributions and Avowals of Motive in the Study of Deviance: Resource or Topic?

In explaining human actions, scholars and laypeople alike employ explanatory devices such as 'motives'. This paper critically reevaluates the relationship between 'professional' and 'lay' invocations of motive, proposing a general reorientation of theory and research. This reorientation emphasizes the mundane 'practical grammar' of motives, and argues that motive deployment is inextricably tied to deviance, and therefore irremediably moral. It is argued, therefore, that motives should serve as a topic for scholarship, not a resource for scholarly use. Several landmark theories of motives, deviance, and explanations are critically reviewed from the proposed vantage. Finally, a brief survey of similarly-minded work is offered, focussing on ethnomethodological arguments and findings, as illustrations of the heuristic power and promise of the outlined approach.     

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.