A Comparison of Partially Adaptive and Reweighted Least Squares Estimation

The small sample performance of least median of squares, reweighted least squares, least squares, least absolute deviations, and three partially adaptive estimators are compared using Monte Carlo simulations. Two data problems are addressed in the paper: (1) data generated from non-normal error distributions and (2) contaminated data. Breakdown plots are used to investigate the sensitivity of partially adaptive estimators to data contamination relative to RLS. One partially adaptive estimator performs especially well when the errors are skewed, while another partially adaptive estimator and RLS perform particularly well when the errors are extremely leptokur-totic. In comparison with RLS, partially adaptive estimators are only moderately effective in resisting data contamination; however, they outperform least squares and least absolute deviation estimators.     

Accounting for the transition from inpatient to outpatient surgery

This article reports on some of the factors that have advanced and impeded hospital progress in moving from inpatient to outpatient surgery. Early on, patients, physicians, and hospital administrators all agreed that outpatient surgery had an intuitive appeal. Patients liked it because they didn't have to go in the hospital. Physicians liked it because they could get in and out of the outpatient surgery center more easily than the main hospital operating room. Administrators recognized the inherent appeal of outpatient procedures but were unable or unwilling to switch services from inpatient to outpatient for a variety of reasons. First, empty hospital beds and diminished scope of inpatient operations are a threat to the power of administrators. Moving surgery from inpatient to outpatient settings reduces inhouse operations. Second, reimbursement incentives were definitely in favor of continued inpatient care long after technology was in place for outpatient care. The third and most critical reason was that cost data on outpatient operations were just not available for making decisions on when to move into the outpatient setting. This review of the literature was intended to document the lack of relevant cost-based accounting. Instead, many other factors that more directly slowed progress were encountered. More than anything, this illustrates the erratic course of progress in health care reform.     

Through community eyes: the transition of international organizations from community aid to development in postconflict Sierra Leone

Sierra Leone experienced an 11-year civil war, brutalizing its people and destroying its communities. With the cessation of violence, international organizations helped to secure peace, deliver aid and supplies, and, after, assist with development projects. This grounded theory study, which aims to understand the role these organizations played from the viewpoint of community members in 2 communities, posits that community members’ regard of international organizations lessened as their efforts transitioned from securing the peace and relief efforts to aid for development. Highlighted are the successes and challenges of this work and a broad discussion of implications and recommendations.     

The performance of model averaged tail area confidence intervals

We investigate the exact coverage and expected length properties of the model averaged tail area (MATA) confidence interval proposed by Turek and Fletcher, CSDA, 2012, in the context of two nested, normal linear regression models. The simpler model is obtained by applying a single linear constraint on the regression parameter vector of the full model. For given length of response vector and nominal coverage of the MATA confidence interval, we consider all possible models of this type and all possible true parameter values, together with a wide class of design matrices and parameters of interest. Our results show that, while not ideal, MATA confidence intervals perform surprisingly well in our regression scenario, provided that we use the minimum weight within the class of weights that we consider on the simpler model.     

Indian Country Poverty: Place‐Based Poverty on American Indian Territories, 2006–10

This article examines place‐based poverty in Indian Country, emphasizing that reservation characteristics are influenced by the system of federal Indian policy that affects American Indian self‐determination and antipoverty strategies within reservation boundaries. Using data from the American Community Survey five‐year file, 2006–10, I model poverty rates using multivariate, nested regression along key dimensions associated with American Indian antipoverty strategies and place‐based poverty. The results indicate that rates of female‐headed households and opportunity structures, such as lack of work, contribute to higher rates of reservation poverty while gaming acts as a slight buffer against poverty. Surprisingly, natural‐resource‐related occupations, thought to be associated with expropriation of tribal resources, was not associated with higher poverty, while self‐governance compacts, acting as a proxy for tribal autonomy, had no significant impact on poverty rates. As tribal governments seek to address poverty through strategies enabled by self‐determination policies, there is a critical need for more comprehensive and reliable data to understand how and whether tribal governments can effectively adapt federal policies to specific reservation conditions.     

A Grounded Theory of Sexual Minority Women and Transgender Individuals’ Social Justice Activism

Psychosocial benefits of activism include increased empowerment, social connectedness, and resilience. Yet sexual minority women (SMW) and transgender individuals with multiple oppressed statuses and identities are especially prone to oppression-based experiences, even within minority activist communities. This study sought to develop an empirical model to explain the diverse meanings of social justice activism situated in SMW and transgender individuals’ social identities, values, and experiences of oppression and privilege. Using a grounded theory design, 20 SMW and transgender individuals participated in initial, follow-up, and feedback interviews. The most frequent demographic identities were queer or bisexual, White, middle-class women with advanced degrees. The results indicated that social justice activism was intensely relational, replete with multiple benefits, yet rife with experiences of oppression from within and outside of activist communities. The empirically derived model shows the complexity of SMW and transgender individuals’ experiences, meanings, and benefits of social justice activism.     

A Cost–Benefit Analysis of a Family Systems Intervention for Managing Pediatric Chronic Illness

Despite recent increases of psychosocial programs for pediatric chronic illness, few studies have explored their economic benefits. This study investigated the costs–benefits of a family systems‐based, psychosocial intervention for pediatric chronic illness (MEND: Mastering Each New Direction). A quasi‐prospective study compared the 12‐month pre–post direct and indirect costs of 20 families. The total cost for program was estimated to $5,320. Families incurred $15,249 less in direct and $15,627 less in indirect costs after MEND. On average, medical expenses reduced by 86% in direct and indirect costs, for a cost–benefit ratio of 0.17. Therefore, for every dollar spent on the program, families and their third payers saved approximately $5.74. Implications for healthcare policy and reimbursements are discussed.     

‘We’re Civil Servants’: The Status of Trauma-Informed Care in the Community

ABSTRACT

Trauma-informed care (TIC) in social service organizations means that the organizations operate with the understanding that everyone involved has possibly experienced trauma in their lifetime. This qualitative study examined local service organizations’ usage of the 5 main principles of TIC: safety, trustworthiness, collaboration, empowerment, and choice (as developed by Fallot & Harris, 2006). Ten focus groups (n = 69) and 6 individual interviews (n = 6) with employees from administration through management were interviewed such that almost all facets of each agency were represented. The participants were asked about their agencies’ policies and practices for utilizing the 5 principles of TIC. The results suggest that the vast majority of organizations in this study implemented many of the principles of TIC with clients, though they had not labeled their practices as “trauma-informed.” However, although clients were receiving TIC, some of the principles were neglected as they pertain to staff, such as choice and empowerment. The findings of this study suggest that agencies are unaware of the relevance of TIC as it relates to staff. It is recommended that future research examine whether the use of TIC in agencies prevents “burnout,” high turnover rates, and vicarious traumatization of staff.