When push comes to shove: implementing VBAC practice guidelines

The dramatic increase in U.S. cesarean sections over the past two decades has been significantly driven by repeat C-sections. In response to this trend, clinical guidelines recommending vaginal birth after cesarean-section (VBAC) have been promulgated by national organizations. Adherence to these guidelines would reduce the number of repeat C-sections, lower the overall C-section rate, and improve both the quality and the cost of health care. While these guidelines have received professional endorsement, their implementation has been clouded by issues of patient acceptance and provider payment. To examine implementation of these guidelines by health care organizations, the authors surveyed 156 members of the American College of Physician Executives to determine their policies, practices, and attitudes toward VBAC guidelines. Those surveyed generally were medical directors in HMOs, hospitals, and other practice settings. The findings indicate that the health care organizations represented by these physician executives have not consistently implemented VBAC guideline and that they are reluctant to hold physicians, their patients, or hospitals accountable for the financial, utilization, and quality impact of the elective decision ot to pursue appropriate VBACs. We conclude that, even when widely accepted, clinical practice guidelines may be ineffective in reducing the costs or improving the quality of medical care.     

Listening Environment and the Bottom Line: How a Positive Environment Can Improve Financial Outcomes

Amidst the onslaught of communication at work, employees’ voices can be neglected in favor of the bottom line. This research initiates an exploration of the relationship between employee perceptions of the listening environment at work and organizational financial performance indicators. In this exploratory pilot study, we collected data from N = 65 employees of a single firm with multiple geographically and financially independent units. Using simple regression analysis, researchers compared data between units to determine if employee perceptions of positive qualities of the listening climate are related to improvement in sales and net income. Results suggest a potentially positive relationship between employees’ perceptions of a positive listening environment and these organizational performance indicators, suggesting that listening is an important step in building the communication climate of a productive company.     

Learning Life Skills Through Challenging and Negative Experiences

Child and Adolescent Social Work Journal - Youth who are socially vulnerable are disproportionately confronted with culminating risk factors that impact their everyday lives. Within positive youth...     

Benchmarking for small- to medium-sized enterprises

This paper identifies which benchmarking databases are available for small- to medium-sized enterprises and the best way to conduct a benchmarking project given the limiting factors which exist at the present time. First, the meaning of benchmarking and performance measures, and their importance to an enterprise are explained. Second, frameworks for the identification of critical performance measures are considered. Third, different types of industrial benchmarking are identified and defined. Fourth, publicly accessible databases are critically reviewed against the requirements of industrial benchmarking. Fifth, the results of the critical review are presented in tabular form. Sixth, conclusions are drawn as how best to proceed with a benchmarking project at the present time. Seventh, recommendations for how best to address the issues raised by the critical review are presented.     

Social interactions and the salience of social identity

We explore the effect of identity salience on behaviour in a simple social interaction. Specifically, we compare ultimatum bargaining across three treatments: priming subjects with a shared identity, priming subjects with an identity distinct from those with whom they will interact, and priming subjects with no particular identity. We find that subjects are most cooperative in the identity-priming treatment and least cooperative in the distinctiveness-priming treatment. Similarly, subjects reveal the highest demands in the identity-priming treatment and the lowest demands in the distinctiveness-priming treatment. We discuss the implications of these results with respect to the literature on organizational identity.     

Love and Hooking Up in the New Millennium: Communication Technology and Relationships among Urban African American and Puerto Rican Young Adults

Communication technology is a central feature of young people's lives, but its role in romantic and sexual relationships has not been thoroughly examined. This article describes how young adults use communication technology for partnering across relationship stages (formation, maintenance, and dissolution) and types (serious/casual), and proposes implications of usage in relationships. This study analyzed qualitative data from a five-week, prospective, coital diary method with related debriefing interviews (N = 70) of African American and Puerto Rican men and women aged 18 to 25 years in Hartford and Philadelphia. Cell phones, including calls, text messaging, and mobile Internet, were the most common forms of communication technology used for partnering goals. Participants reported using cell phones to pursue partnering goals across all relationship stages, including formation (meeting, screening, and getting to know new partners), maintaining existing relationships, and breaking up. Cell phone uses depended on the type of relationship (serious/casual) and the participants' intentions and desires. Results indicated that cell phones are an important element of communication among young adults in romantic and sexual relationships. Specific features of cell phone communication shape the process and context of partnering. Future research should explore emerging communication technologies and implications for psychosocial development, dating violence, and sexual behavior.     

Response Thresholds and Demand/Withdraw Communication in Domestic Labor Conflict

Guided by Alberts, Tracy, and Trethewey’s (2011) integrated theory of the division of domestic labor (ITDDL), this study examines the influence of domestic labor response threshold on demand/withdraw communication in domestic labor conflict. Response threshold represents the point at which a negative stimulus produced by an unperformed task is of sufficient intensity to compel an individual to attend to it. One hundred and fifty-five heterosexual marital dyads (mean length of marriage = 19.98 years) completed an online questionnaire about their household labor conflict and response thresholds. Response thresholds were assessed using a photograph-based measure, and data were analyzed via an actor-partner interdependence model. Consistent with theoretical predictions, a significant actor-threshold-by-partner-threshold-by-sex interaction predicted reported demand/withdraw in domestic labor conflict. Individuals with low or mean response thresholds reported more self-demand/partner-withdraw the higher their partner’s response threshold, and this effect was more pronounced among women than men.     

An Integrated Scenario Ensemble-Based Framework for Hurricane Evacuation Modeling: Part 1—Decision Support System

This article introduces a new integrated scenario-based evacuation (ISE) framework to support hurricane evacuation decision making. It explicitly captures the dynamics, uncertainty, and human–natural system interactions that are fundamental to the challenge of hurricane evacuation, but have not been fully captured in previous formal evacuation models. The hazard is represented with an ensemble of probabilistic scenarios, population behavior with a dynamic decision model, and traffic with a dynamic user equilibrium model. The components are integrated in a multistage stochastic programming model that minimizes risk and travel times to provide a tree of evacuation order recommendations and an evaluation of the risk and travel time performance for that solution. The ISE framework recommendations offer an advance in the state of the art because they: (1) are based on an integrated hazard assessment (designed to ultimately include inland flooding), (2) explicitly balance the sometimes competing objectives of minimizing risk and minimizing travel time, (3) offer a well-hedged solution that is robust under the range of ways the hurricane might evolve, and (4) leverage the substantial value of increasing information (or decreasing degree of uncertainty) over the course of a hurricane event. A case study for Hurricane Isabel (2003) in eastern North Carolina is presented to demonstrate how the framework is applied, the type of results it can provide, and how it compares to available methods of a single scenario deterministic analysis and a two-stage stochastic program.     

A Preliminary Investigation of Risks for Adverse Outcomes of Relationship Seeking on Social Network Sites (SNS): A Descriptive Study of Women Over 50 Seeking Relationships on MySpace in Hillsborough County,Florida

In contrast to younger populations, little attention has been paid to the increase in seniors using Internet-based venues to find relationships and the potential risk for adverse outcomes this poses. This study examined data collected via an online survey from 45 ethnically diverse women aged 50+ “seeking relationships” on MySpace. The majority of women reported a relationship with someone they met online (85%). They also reported experiencing adverse events including financial exploitation (40%), threats (55%), and physical harm (38%) by someone they met online at levels greater than traditional relationship seeking in the general population. Directions for future research are explored.     

The consumer choice model: a humane reconstruction of the U.S. health care system

"Consumer choice," "defined contribution health programs," "voucher systems," and "health marts" are variations on a theme: employees buying their own health care. This new approach to health care purchasing, which is designed to minimize the role of employers, is being proposed by an array of economists and by both Republican and Democratic legislators as the best way to address the nation's health care ills. Although enabling national legislation is unlikely to pass soon, the debate will nevertheless change the face of health care in America. The prospect is reminiscent of the debate over "Clinton Care" in 1993--although legislation was never passed, managed care rapidly came to dominate the U.S. health care system. As this reform takes hold, beneficiaries will make their own health plan selections but will have more responsibility and may bear more cost. Providers will have to adapt to new, customer-driven requirements for performance, accountability, and communications but will also find opportunities in a marketplace that they will have a major role in shaping. Physicians, health plans, and insurers should understand how these proposals will transform their role in health care.