Priority setting in health care: on the relation between reasonable choices on the micro-level and the macro-level

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework.     

A case history: from traumatic repetition towards psychic representability

This paper is devoted principally to a case history concerning an analytic process extending over a period of almost ten years. The patient is B, who consulted the author after a traumatic episode. Although that was her reason for commencing treatment, a history of previous traumatogenic situations, including a rape during her adolescence, subsequently came to light. The author describes three stages of the treatment, reflected in three different settings in accordance with the work done by both patient and analyst in enabling B to own and work through her infantile and adult traumatic experiences. The process of transformation of traumatic traces lacking psychic representation, which was undertaken by both members of the analytic couple from the beginning of the treatment, was eventually approached in a particular way on the basis of their respective creative capacities, which facilitated the patient's psychic progress towards representability and the possibility of working through the experiences of the past. Much of the challenge of this case involved the analyst's capacity to maintain and at the same time consolidate her analytic posture within her internal setting, while doing her best to overcome any possible misfit (Balint, 1968) between her own technique and the specific complexities of the individual patient. The account illustrates the alternation of phases, at the beginning of the analysis, of remembering and interpretation on the one hand and of the representational void and construction on the other. In the case history proper and in her detailed summing up, the author refers to the place of the analyst during the analytic process, the involvement of her psychic functioning, and the importance of her capacity to work on and make use of her countertransference and self-analytic introspection, with a view to neutralizing any influence that aspects of her 'real person' might have had on the analytic field and on the complex processes taking place within it.     

Be It Ever So Humble...: The Controversial Issue of Psychotherapy Groups in the Home Office Setting

Group leaders who have home offices may be disclosing more about their personal lives than they consciously intend. While the home office may be convenient and financially advantageous for the leader, this disclosure can be problematic for both the group therapist and group members. It may provide more information about the leader than some members want to know or are able to metabolize. And although poor boundary maintenance can occur in a professional office setting as well, the leakage in the home office is inevitable. The potential pitfalls seem to be at least threefold: over-stimulation, gaslighting, and the emperor's new clothes effect. These hazards exist independently of the leader's training, competence, or ethics. This paper examines the impact of the home office setting on group treatment. Leaders who practice from the home need to be ever-vigilant of untoward treatment reactions that are related to the setting itself. The article provides vignettes that illustrate the benefits and liabilities of the home office.     

文本表述结构对空间维度非线索更新的影响

采用实时窗口阅读技术,探讨阅读中文本表述结构在情境模型空间维度非线索更新中的作用。实验一结果表明,阅读中,如果文本叙述中采用以人为参照的描述方式,那么可以促进相应空间设置内物体的实时更新。实验二考察了空间设置不同程度的描述对空间信息加工中的影响,结果发现,相对于对空间设置的简单描述,在文本中对空间设置进行精细阐述更有利于情境模型空间维度非线索更新的达成。     

交往情景下个体对说谎的理解及其道德评价

研究探讨了个体理解交往情景下说谎／说真话概念及其道德评价上的年龄差异,以及事实成份、交往动机与交往情景因素在其中的作用。结果表明：(1)3岁到4岁是说谎概念理解的转折点;(2)除3岁儿童外,大部分被试依据事实成份来理解谎前真话;(3)从小学开始,随着年龄的增长,个体对“白谎”与直率真话的道德评价中越来越多地考虑到交往动机或情景因素。     

Blindsided? September 11 and the Origins of Strategic Surprise

The devastating terror attacks of 11 September 2001 have often been characterized as a "bolt from the blue." Drawing inspiration from the political psychological literature on strategic surprise, this article poses the deceptively simple question of why so many U.S. policymakers were caught so woefully off guard last year. Through a preliminary empirical exploration of three broad explanatory "cuts" derived from the relevant interdisciplinary literature—psychological, bureau–organizational, and agenda–political—the authors seek to shed light on the sources of failure that may have contributed to 9/11 and point to promising avenues of investigation for future research as the available empirical record becomes more complete.     

PREVENTING SCHOOL VANDALISM AND IMPROVING DISCIPLINE: A THREE-YEAR STUDY

Vandalism is a major problem facing educators and taxpayers alike. The present investigation analyzed how vandalism costs and student disruption were related to the implementation of a training and consultation package designed to increase the reinforcing ambience of the school. A positive environment, it was posited, would displace previous events that may have set the occasion for vandalism, with cues to promote productive school performance. Eighteen elementary and junior high schools were involved over a 3-year period. Using a delayed treatment control design, treatment was delivered following either 4 or 13 months of baseline. During treatment, teams of school personnel attended training workshops in behavioral strategies for reducing vandalism and disruption by students in school. Each team also met regularly on its campus to plan and implement programs on a schoolwide basis. To demonstrate that reinforcing procedures were actually implemented and accompanied by change in student performance, these variables were periodically probed throughout the study. Project staff also provided consultation. Vandalism costs decreased significantly (p < .05) more in treatment than control schools, with an average reduction of 78.5% for all project schools. Rates of praise delivered by project teachers and other randomly selected teachers in the school increased significantly (p < .05), and rates of off-task behavior by students decreased significantly (p < .05) following treatment. The staff development model used in this study appeared to be both feasible and economical.     

Comparing examinees to a control

When comparing examinees to a control, the examiner usually does not know the probability of correctly classifying the examinees based on the number of items used and the number of examinees tested. Using ranking and selection techniques, a general framework is described for deriving a lower bound on this probability. We illustrate how these techniques can be applied to the binomial error model. New exact results are given for normal populations having unknown and unequal variances.The work upon which this publication is based was performed pursuant to a grant [Grant No. NIE-G-76-0083] with the National Institute of Education, Department of Health, Education and Welfare. Points of view or opinions stated do not necessarily represent official NIE position or policy.     

The reliability and predictive ability of the Test of Infant Motor Performance (TIMP) in a community-based study in Bhaktapur,Nepal

AimIn a Nepalese setting, to measure the reliability of the Test of Infant Motor Performance (TIMP) and its ability to predict development scores at 6 months.MethodsNepalese infants (n = 705) were assessed by the TIMP when they were 8–12 weeks old and the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 6 months. Inter-rater agreement was expressed by intraclass correlation coefficients (ICCs), the internal consistency by Cronbach’s alphas and Pearson correlation coefficients. Predictive ability was estimated in linear regression models.ResultsInter-rater agreement was excellent (ICCs > 0.93). Alphas for the TIMP total scores were 0.76 for infants born to term and 0.72 in those born preterm. Correlation coefficients between TIMP total and Bayley-III subscale-scores ranged from 0.05 to 0.28 for term infants and from 0.15 to 0.43 for preterm infants. Using American norms, 56.3 % had TIMP scores within average and 43.7 % below average range. Bayley-III subscale scores were lower in children with TIMP scores below the average range, with the strongest estimates for Gross motor and Socio-emotional development.InterpretationThe reliability of the TIMP was acceptable, and the TIMP could be a feasible tool to monitor infant motor development in low-resource settings. Properties of the TIMP differed according to gestational age.     

FEED THE HUNGRY BEE: USING POSITIVE PEER REPORTS TO IMPROVE THE SOCIAL INTERACTIONS AND ACCEPTANCE OF A SOCIALLY REJECTED GIRL IN RESIDENTIAL CARE

We studied how rewarding peers for publicly reporting positive aspects of a socially rejected girl's behavior affected her social interactions and acceptance. The results indicated that positive peer reports reduced negative social interactions (to near zero) and increased positive interactions (to above 70%). In addition, social acceptance ratings of the girl increased from pre- to postintervention.