A framework for rationing by clinical judgment

Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference to published population based thresholds. Notions of procedural justice are applied along with an analytical framework of six minimal requisites in order to facilitate fair bedside rationing: (1) a closed system that offers reciprocity, (2) attention to general concerns of justice, (3) respect for individual variations, (4) application of a consistent process, (5) explicitness, and (6) review of decisions. The process could be monitored for its applicability and appropriateness.     

PHYSICAL ATTRACTIVENESS, BODY IMAGE, AND WOMEN'S SEXUAL SELF-SCHEMA

Recently, Andersen and Cyranowski (1994) presented a self-report measure of women's sexual self-schema, or cognitive view of the self regarding sexuality. In the current study, we investigated potential relationships between women's sexual self-schema and physical attractiveness, body size and shape, and body image. Young adult women ( N = 199) completed questionnaires and were weighed, measured, and rated for facial attractiveness. Results revealed that sexual self-schema was unrelated to body size or shape, general body dissatisfaction, history of teasing about weight, and degree of investment in personal appearance. Sexual self-schema scores significantly correlated with experimenter-rated facial attractiveness, self-rated facial and bodily attractiveness, and degree of social avoidance due to concerns over personal appearance, however. In a multiple regression analysis, only self-rated facial attractiveness and social avoidance were unique predictors. Results are discussed with regard to implications for the development of women's sexual self-schema and directions for future research.     

Autocoun: A Computer-Based Automated Counseling Simulation System

This paper describes the development and initial testing of a computer-based counseling system which attempted to simulate certain counseling behavior of one counselor. Forty junior high school students experienced counseling (educational planning) with the system, and with either the counselor after whom the system was modeled (N = 20) or another counselor (N = 20). Subjects interacted with a time-sharing computer using TWX input. The basic objective was to determine the similarity of outcomes between the system, model counselor, and second counselor. Criteria included similarity of pupil appraisal statements and course selections. The machine system agreed with both human counselors on approximately 75 per cent of the appraisal statements and about 65 per cent of the course selections. Some data regarding pupil attitudes toward the system are also reported.     

Saying the right thing at the right time: a view through the lens of the analytic process scales (APS)

Skillful psychoanalytic technique presumably involves knowing what to say, and when and how to say it. Does skillful technique have a positive impact upon the patient? The study described in this article relied on ratings by experienced psychoanalysts using the Analytic Process Scales (APS), a research instrument for assessing recorded psychoanalyses, in order to examine analytic interventions and patient productivity (greater understanding, affective engagement in the analytic process, and so on). In three analytic cases, the authors found significant correlations between core analytic activities (e.g., interpretation of defenses, transference, and conflicts) and patient productivity immediately following the intervention, but only if it had been skillfully carried out. Findings were independently replicated by psychology interns.     

Religious Requirement: The case for Roman Catholic schools in the 1940s and Muslim schools in the 1990s

This article sets out the four principles which underlay Catholic schooling in the 1940s. Similar principles were expressed by Muslim leaders in the 1990s. The origins of Catholic schools in the 19th century are described, as is the 1870 Act which led to a great increase in their number. Twentieth-century Catholic writers set out the rights and duties of parents and the obligation of the state to fund Catholic schools. The stance of the church in the 1940s is examined in detail. Some characteristics of Islam are then described. Religious observance brings conflict for children attending maintained schools. Parents may campaign for change in these schools, or opt for independent Islamic schools. The conclusions of the Swann Report (1985) regarding separate schooling are set out, followed by the change in government policy after 1997. In conclusion, the article asks whether we may expect an increase in Muslim voluntary aided schools parallel to the earlier increase of Catholic schools.