The science of choosing the right decision threshold in high-stakes diagnostics.

Many diagnostic tasks require that a threshold be set to convert evidence that is a matter of degree into a positive or negative decision. Although techniques of decision analysis used in psychology help one select the particular threshold that is appropriate to a given situation and purpose, just the concept of adjusting the threshold to the situation is not appreciated in many important practical arenas. Testing for the human immunodeficiency virus (HIV) and for dangerous flaws in aircraft structures are used here as illustrations. This article briefly reviews the relevant techniques and develops those two examples with data. It suggests that use of the decision techniques could substantially benefit individuals and society and asks how that use might be facilitated.     

Situational judgment tests in high-stakes settings: issues and strategies with generating alternate forms

This study used principles underlying item generation theory to posit competing perspectives about which features of situational judgment tests might enhance or impede consistent measurement across repeat test administrations. This led to 3 alternate-form development approaches (random assignment, incident isomorphism, and item isomorphism). The effects of these approaches on alternate-form consistency, mean score changes, and criterion-related validity were examined in a high-stakes context (N = 3,361). Generally, results revealed that even small changes in the context of the situations presented resulted in significantly lower alternate-form consistency. Conversely, placing more constraints on the alternate-form development process proved beneficial. The contributions, implications, and limitations of these results for the development of situational judgment tests and high-stakes testing are discussed.     

Rethinking professional ethics in the cost-sharing era

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions--an "aspirational ethic" that exhorts physicians to treat all patients the same regardless of their ability to pay, and an "agency ethic" that calls on physicians to be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay.     

Beyond the exclusively propositional era

Contemporary epistemology has assumed that knowledge is represented in sentences or propositions. However, a variety of extensions and alternatives to this view have been proposed in other areas of investigation. We review some of these proposals, focusing on (1) Ryle's notion of knowing how and Hanson's and Kuhn's accounts of theory-laden perception in science; (2) extensions of simple propositional representations in cognitive models and artificial intelligence; (3) the debate concerning imagistic versus propositional representations in cognitive psychology; (4) recent treatments of concepts and categorization which reject the notion of necessary and sufficient conditions; and (5) parallel distributed processing (connectionist) models of cognition. This last development is especially promising in providing a flexible, powerful means of representing information nonpropositionally, and carrying out at least simple forms of inference without rules. Central to several of the proposals is the notion that much of human cognition might consist in pattern recognition rather than manipulation of rules and propositions.The preparation of this article was supported in part by National Institutes of Health Grants No. NICHD-19265 and NICHD-06016. We would like to thank Rita Anderson, David Blumenfeld, Robert McCauley, and Patricia Siple for helpful discussions on points in this paper.     

The doctor-patient relationship in the post-managed care era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a "post-managed care era," where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

Parallel path: Poliovirus research in the vaccine era

One goal of the scientific research enterprise is to improve the lives of individuals and the overall health of societies. This goal is achieved through a combination of factors, including the composition of research portfolios. In turn, this composition is determined by a variety of scientific and societal needs. The recent history of polio research highlights the complex relations between research policy, scientific progress and societal benefits. Here, we briefly review the circumstances leading to the possibility of eradication of poliovirus, evaluate the research environment that emerged following the introduction of a vaccine, and compare and contrast the current research framework with that for other infectious diseases. From this analysis, policy lessons with general applicability to scientific research are identified. The Center for Science, Policy, & Outcomes is a project of Columbia University in the City of New York, 1 Thomas Circle NW, Suite 1075, Washington, DC 20005, USA.     

Surviving in an era of insecurity

Abstract

Downsizing in its many guises, can have a profound impact on the employees who remain–the so-called survivors. The survivors of such change face many new demands and often find themselves in an environment comprising new organizational forms, different progression opportunities, and new rules for the employment relationship. Such changes may be geared to ensure the survival of the company, yet few organizations appear to provide the support and help required to facilitate personal survival for employees. At the interface between the organization and the individuals who remain lie many issues, including commitment, job security, career aspirations, and progression opportunities, which embody a different concept of career and its realization. This article explores career issues for survivors of the insecure organizational environment.     

Expectancy of success,subjective task-value,and message frame in the appraisal of value-promoting messages made prior to a high-stakes examination

Previous research has examined how subjective task-value and expectancy of success influence the appraisal of value-promoting messages used by teachers prior to high-stakes examinations. The aim of this study was to examine whether message-frame (gain or loss-framed messages) also influences the appraisal of value-promoting messages. Two hundred and fifty-two participants in Years 12 and 13 read vignettes of fictional students who were high or low in subjective-task value, and expectancy of success, and asked to imagine how that student would appraise either a gain or loss-framed message. A challenge appraisal followed vignettes with high subjective task-value and high expectancy of success whereas a threat appraisal followed vignettes with high subjective task-value and low expectancy of success. A loss-framed message resulted in a stronger threat appraisal, and a gain-framed message in a greater disregarding appraisal for the vignette with high subjective task-value and high expectancy of success. Value-promoting messages can be appraised in different ways depending on combinations of intrapersonal (subjective task-value and expectancy of success) and interpersonal (message-frame) influences.     

Literary critics in a new era

In this article I look at changes in the role of literary criticism in Russian literature since perestroika. The article draws on the research of Sergej Čuprinin and Birgit Menzel. Based on my readings of the debate among literary critics about what literary criticism is and should be, and focusing on the interrelationship in the triangle writer-critic-reader, I establish a typology of contemporary literary criticism: 1. the critic as a master of the “literary process”, 2. the critic as co-writer, 3. the critic as a guide for the reader.

A manifesto for the new MCDA era

The following manifesto has been prepared by five prominent workers in the field of MCDA. We are currently preparing a special issue on the issues that they raise (see Call for Papers on p. 128). We invite you to contribute to the debate in that issue, either in the form of a paper or a letter to the Editor.     

当代道教音乐的回顾与展望（下）

二、当代道教音乐研究之检讨1.研究价值和意义上述道教音乐研究成果的出现,所产生的社会影响和文化意义是重大的,尤其是其独特、珍贵的学术价值更是引人注目。归纳起来,笔者认为当代道教音乐研究的学术价值主要体现在以下几个方面:     

The humanities in medical education: Entering the post-evangelical era

Theoretical Medicine and Bioethics -     

当代道教音乐的回顾与展望（上）

前言从道祖老子《道德经》以及汉代道教经典《太平经》开始,关于音乐的论述在道教经典中屡见不鲜。可以说,道家、道教及文人学者研究道教音乐由来已久,纵横深广。然,将道教音乐作为一项相对独立的学术专题进行研究,把道教音乐作为一种有特色的传统民族文化对外宣传推广,却是近     

The perceived value of maths and academic self-efficacy in the appraisal of fear appeals used prior to a high-stakes test as threatening or challenging

Previous work has examined how messages communicated to students prior to high-stakes exams, that emphasise the importance of avoiding failure for subsequent life trajectory, may be appraised as threatening. In two studies, we extended this work to examine how students may also appraise such messages as challenging or disregard them as being of little relevance. In study one we piloted a questionnaire with students studying for their school leaving qualification in maths. Threat appraisals were correlated with low academic self-efficacy, high attainment value and low intrinsic value. Challenge appraisals were correlated with high academic self-efficacy, and high intrinsic, extrinsic and attainment value. In study two, we manipulated attainment value and academic self-efficacy in a series of vignettes. High value and high academic self-efficacy lead to challenge appraisals, high value but low academic self-efficacy lead to threat appraisals and low value lead to a disregarding of messages. These findings show that the relevance of messages is judged on attainment value in a primary appraisal and as a challenge or threat in a subsequent appraisal, based on the expectation of success or failure. These findings also highlight how the effectiveness of such messages may differ depending on student characteristics.     

Female delinquency in the emancipation era: A review of the literature

By the mid-1970s studies began to indicate that the era of women's emancipation had been accompanied by changes in the volume and character of female lawbreaking. In this paper, I critically review the growing literature that has attempted to measure and explain the alleged changes in female delinquency. I examine whether females have remained traditional in their delinquency patterns, whether the observed changes (if they exist at all) are real or the result of changing societal reactions, and whether female delinquents have been masculinized or in other ways influenced by the women's liberation movement or changing gender roles. I also review explanations of female delinquency that are derived from social control, power-control, strain, and subcultural theories. Finally, I argue that more attention needs to be given to understanding the role strain inherent in females' attempts to negotiate ambiguous or contradictory gender roles, and that the concept of role strain offers a promising explanation of contemporary patterns of female delinquency.Portions of this paper were adapted from R. J. Berger (Ed.), The Sociology of Juvenile Delinquency, Chicago: Nelson-Hall, 1990 forthcoming.