Reinventing a medical specialty. Using anesthesiology as a model for change

In only a decade, anesthesiology has reversed its fortunes from an underrepresented specialty in the 1980 Graduate Medical Education National Advisory Committee report to "a specialty in trouble" featured in The Wall Street Journal. This article focuses on anesthesiology and its work force dilemma as an evolving specialist model for change. What is happening to anesthesiology will not be unique--managed care competition will affect all physicians. Most specialties will have to reshape curricula and redesign education programs and academic delivery systems concentrating on fewer trainees. What are the options for coping with physicians grieving over lost dreams, such as autonomy and solo practice, while redesigning a medical specialty? The authors untangle fact from fear, mission from myth, and offer strategic thinking and solutions.     

Existence of unbiased covariance components estimators

The condition of PINCUS (1974) for the estimability of covariance components in normal models is extended to the case of singular covariance matrices     

The fabric of engagement: the engagement and personality of managers and professionals in human and developmental disability services

Employee engagement is a complex and dynamic process that reflects each individual's unique, personal relationship with work. Engaged employees have a clear and defining connection to the organization's mission and purpose, and employee engagement is reflected in behaviors that meet or exceed expectations of service in the workplace. The purpose of this study was to explore relationships between personality and engagement among professionals and managers providing services to people with developmental disabilities. In particular, the authors investigated relationships between the 5-factor model of personality (FFM) and William Kahn's model of employee engagement encompassing physical, emotional, and cognitive components.     

The Cognitive Impact of Sexual Abuse and PTSD in Children: A Neuropsychological Study

Sexual abuse is known to have an impact on both child and adult mental health, but the neuropsychological basis of this effect is still largely unknown. This study compared neuropsychological test results from a group of 76 children, 13 of them sexual abuse victims with symptoms of post-traumatic stress disorder, 26 victims of sexual abuse who showed no symptoms post-traumatic stress disorder, and 37 controls. The groups were matched by age, sex, socioeconomic status, and educational level. Child sexual abuse was associated with reduced ability to inhibit automatic responses measured by the Stroop test regardless of post-traumatic stress disorder status. These findings indicate possible attentional inhibition difficulties in child victims of sexual abuse, which may help explain psychopathology associated with the experience.     

Introduction

Empirical studies of occupational structure in South Africa have tended to be unsatisfactory, detailed work on small sectors of the economy coexisting with across‐the‐board studies too crudely aggregated to allow for a precise assessment of a changing situation. This study presents the results of an analysis by ‘race’ into 14 occupational groups of South African employment outside agriculture, domestic service and the informal sector over the period 1969 to 1977. It argues that over the period there has been a definite increase in the share of owner I manager and, more particularly, petty bourgeois occupations, with a corresponding decline in the proportion of unskilled workers. It also suggests that changes in the ‘racial’ division of labour are more complex than has sometimes been supposed.     

The Significance of Socioeconomic and Ethnic Diversity for the Risk Communication Process

Risk communication is being characterized as one way of facilitating more effective, democratic and participatory risk management strategies. An emphasis on formal communication approaches as a means to improve decisions and decrease conflict will highlight the challenge of managing hazards within a culturally heterogeneous society. Communication and participatory strategies will be considered successful only if diverse communities can be engaged as partners in the policy process. Because responses to risks are embedded and evolve within broader social environments, achieving the promise of risk communication across a diverse society may not be possible absent an understanding of how sociocultural variables and past experiences shape the exchange of ideas or information in any particular situation. This paper considers the implications of ethnic and socioeconomic variability for the risk communication process, summarizing theoretical perspectives and empirical evidence on the link between sociocultural features and risk responses. Specifically, the factors that define the context of communication may influence: the initial framing of a risk issue, particularly, the adoption of an environmental justice vs. scientific/economic perspective; the perceived importance of various aspects of the decision problem; and prior beliefs about environmental hazards and agencies involved in risk management. Two examples of situations requiring communications about risk are presented and illustrate how these principles could operate in minority or lower-income communities. A significant challenge for health and regulatory officials will be to engage in an interactive process of information and opinion exchanges that is reasonable and effective within vastly different socioeconomic and cultural contexts.     

A Quantitative Examination of Identity Integration in Gay,Lesbian, and Bisexual People of Faith

Much of the religious/spiritual development of gays, lesbians, and bisexuals (GLBs) has focused on experiences of conflict and distress, providing little insight into how these identities can be integrated. The present study explored the religious and spiritual lives of GLBs with a specific focus on the integration of these identities. We conducted a retrospective secondary data analysis of 750 GLB individuals from the Northern California Health Study to quantitatively assess sexual orientation and religion/spirituality integration using hierarchical cluster analysis. Resulting MANCOVA analyses of the five revealed groupings (integrated, gay identity struggle, anti-religious/spiritual, secular, and low gay salience) present numerous statistically significant differences between these integration clusters and a variety of dependent variables including measures of demographics, religiosity/spirituality, gay identity, and multiple mental health outcomes. We discuss the implications of these findings while also making suggestions for future research.