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Background: As delays or disorders in early language and communication are the most prevalent symptom in children with disabilities, early screening is crucial to promote prevention, early diagnosis, and intervention. However, to the best of our knowledge, no screening tool is available for the joint assessment of early language and social communication skills in European Portuguese (EP)‐learning children, which is critical for screening, monitoring and enrolment in appropriate early intervention services. Aims: (1) To adapt and validate the EP version of the Communication and Symbolic Behaviour Scales Developmental Profile™ (CSBS DP™) Infant–Toddler Checklist, a parental report for the screening of early language and social communication skills. (2) To conduct a cross‐cultural comparison between the EP adaptation and the original US version. Methods & Procedures: A total of 611 EP‐learning children (ages 6–24 months) were assessed on the CSBS DP Infant–Toddler Checklist. Normative data, psychometric characteristics (i.e., internal consistency and test–retest reliability), and cross‐cultural comparison between the EP and the original version were explored. Outcomes & Results: Internal consistency ranged from good to excellent and the test–retest reliability was excellent. The performance of the EP and US samples matched on almost all scores. However, EP children performed significantly better than their American peers in the Social compositive at 22 months and in the Symbolic composite at 20 months. No further differences were found. Conclusions & Implications: These findings showed that the EP CSBS DP Infant–Toddler Checklist seems to be a reliable screening tool of communicative and symbolic behaviours for EP‐learning children, which can be particularly relevant for decision‐making in clinical practice. WHAT THIS PAPER ADDS: What is already known on the subject: Early communication skills are known to be related to later language outcomes. Thus, screening tools for the early identification of children at risk for language and communication impairments, which may lead to monitoring and early intervention, have the potential to promote better outcomes. However, to the best of our knowledge, no screening tool is available for the assessment of early communication abilities in EP‐learning children. What this paper adds to existing knowledge: This study adapted and validated the EP CSBS DP Infant–Toddler Checklist, the first published parental report checklist for the assessment of early communication skills in EP. It described the psychometric characteristics of the adapted checklist, summarized the newly available normative data for EP‐learning infants and toddlers, and compared the performance of EP‐learning children with the original standardization sample reported for American English. The results demonstrated that this tool is a reliable instrument for the early screening of language, communicative and symbolic behaviours for EP‐learning children between 6 and 24 months of age. What are the potential or actual clinical implications of this work?: Given that early screening is crucial to promote prevention, early diagnosis and intervention, the availability of this tool is particularly relevant for children monitoring and their enrolment in appropriate early intervention services, helping decision‐making in clinical practice, in line with current guidelines regarding early monitoring and intervention to promote and support better outcomes. Thus, the tool and related normative data will be useful for paediatricians, family doctors, primary healthcare providers, developmental psychologists and speech–language therapists, among other professionals in the healthcare and educational fields, concerned with speech, language, and communication development and impairments. [ABSTRACT FROM AUTHOR]

The Family Group Conference (FGC) is grounded in a rights‐based framework, whereby children and their families have the right and responsibility to be primary decision‐makers when child protection issues arise, and the statutory agency has the responsibility to convene the entitled members of the family network to lead the decision‐making. A distinct core component of FGC—private family time (PFT)—allows families to discuss the information and formulate their responses and plans privately during conferencing. This paper describes how a large child welfare agency in the United States adapted PFT in two ways: (1) including a parent advocate (PA) and (2) abbreviating the amount of time allowed for this discussion. Given the lack of empirical research on the PFT component, this qualitative exploratory study sought to understand the functions and perceived impacts of PA‐supported PFT during initial child protective services (CPS) conferences at which decisions of child removal or placement were being contemplated. PFT served multiple beneficial functions and impacted families in several positive ways: families gained greater awareness of safety concerns, felt empowered and confident in the preferred safety and service plan, became increasingly engaged and involved in the case decision‐making process and ultimately felt less apprehensive. [ABSTRACT FROM AUTHOR]

Introduction: The United States has been unsuccessful in containing the rapid spread of COVID‐19. The complex epidemiology of the disease and the fragmented response to it has resulted in thousands of ways in which spread has occurred, creating a situation where each community needs to create its own local, context‐specific learning model while remaining compliant to county or state mandates. Methods: In this paper, we demonstrate how cross sector collaborations can use the Cynefin Framework, a tool for decision‐making in complex systems, to guide community response to the COVID‐19 pandemic. Results: We explore circumstances under which communities can inhabit each of the four domains of systems complexity represented in the Cynefin framework: simple, complicated, chaotic, and complex, and describe the decision‐making process in each domain that balances health, economic, and social well‐being. Conclusion: This paper serves as a call to action for the creation of community learning systems to improve community resilience and capacity to make better‐informed decisions to address complex public health problems during the pandemic and beyond. [ABSTRACT FROM AUTHOR]

Daubert required judges to base their decisions about the admissibility of expert witness testimony in large part on the reliability and validity of empirical observations. Because judges have a wide array of duties and may not be equipped to understand the complexities of statistical analysis, some jurists have recommended that court-appointed experts assist judges in their gatekeeping function. To assist such experts in scrutinizing empirical papers, we propose a Structured Statistical Judgement (SSJ) that takes advantage of advances in the various statistical methods - such as effect sizes that adjust for error - which have allowed researchers to report increasingly more reliable and valid observations. We also include supplementary materials that court-appointed experts can use both as a codebook to operationalize the SSJ and as a quick reference that will aid consultation with judges. An initial application of the SSJ examined all 93 empirical articles published in Psychology, Public Policy, and Law and Law and Human Behavior in 2015 and resulted in excellent interrater reliability (π = 0.83; π = 0.95; π = 0.97), at the same time it indicated that a majority of the articles fail to include the comprehensive and transparent statistical analysis that would be most useful to courts. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Among research‐focused nursing doctoral (PhD) programs in the United States, the traditional dissertation format has recently given way to a series of publication‐ready manuscripts, often bookended by introduction and conclusion chapters. To help programs make decisions about the use of these formats, this study undertook a national survey of programs offering PhDs in nursing. The purpose of this study was to explore the advantages and disadvantages of the traditional format versus manuscript option for dissertations among nursing PhD programs in the United States. Design: Cross‐sectional census survey of U.S. nursing PhD programs. Methods: A web‐based survey was administered to all U.S. nursing PhD programs. Respondents indicated formats offered, factors contributing to decisions of which formats to offer, and lessons learned. Descriptive statistics and inductive content analyses were used for analysis. Findings: Of 121 eligible institutions, 79 provided eligible responses (66.7%). The majority (59%) offered both formats; 11% offered the manuscript option only, and 24% offered the traditional format only. Faculty support (or lack thereof) contributed to adoption (or not) of the manuscript option. Respondents' approaches to the manuscript option (e.g., number of papers) and advice are summarized. Conclusions: Manuscript option dissertations are commonly offered and provide benefits to students and faculty; however, thoughtful implementation is critical. Programs need to agree upon clear expectations and have graduate school support (e.g., formatting). Faculty need mentorship in advising manuscript option students who choose to use this format, and the time and support. Finally, students need additional writing skills that could be provided through coursework or via individual work with mentors. Clinical Relevance: As nursing education continues to expand further into doctoral research, programs must examine dissertation formats in order to both prepare future nurse scholars and disseminate nursing research that is critical to improving nursing education, patient care, and clinical practice. [ABSTRACT FROM AUTHOR]

As organizational security breaches increase, so too does the need to fully understand the human factors that lead to these breaches and take the necessary steps to minimize threats. The present study evaluates how three sets of employee characteristics (demographic, company-specific, and skills-based) predict an employee's likelihood of becoming a security breach victim. In order to move beyond traditional evaluations of security threats, which generally consider security threats individually, analyses in this paper approach security vulnerability from a more holistic approach to analyze four risk categories concurrently: phishing, passwords, bring your own device (BYOD), and company-supplied laptops. Findings from a survey of 250 employees at a medium-sized American information technology (IT) consulting firm identify higher-risk employees across the four risk areas and provide new insights into the challenges organizations face when trying to ensure the protection of company data. [ABSTRACT FROM AUTHOR]

Objectives To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions ( MCCs). Design Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. Setting Survey conducted through the Health Care Systems Research Network ( HCSRN) and Claude D. Pepper Older Americans Independence Centers ( OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. Participants Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. Measurements A 'top box' methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. Results The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. Conclusion Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this 'high-need, high-cost' population and the healthcare delivery systems responsible for serving it. [ABSTRACT FROM AUTHOR]

This paper proposes an inductive analysis of the decision as to whether to return or to relocate by persons in the State of Louisiana, United States, who evacuated after Hurricanes Katrina and Rita in August and September 2005, respectively. Drawing on interviews with evacuees in these events and extensive fieldwork in the impacted area, the paper seeks to identify the folk dimensions of the decision-making process, assess their arrangements, and situate the process in the larger context of risk and resilience in an advanced society. It suggests that, despite the material and emotional upheaval experienced by affected persons, the decision-making process is a rational endeavour combining a definite set of tightly interconnected factors, involving material dimensions and substantive values that can act in concert or in conflict. In addition, it indicates that there are significant variations by geographic areas, homeownership, and kind of decision. Some theoretical implications, practical measures, and suggestions for future research are examined. [ABSTRACT FROM AUTHOR]

This paper examines how child welfare workers in England, Norway and the USA (California) perceive children's participation building on 91 qualitative interviews. First, analysing the data using Hart's ladder of children's participation, we found that all Norwegian workers perceived children's participation as some form of decision‐making, whereas 40% of English and 35% of US workers embraced views of children's participation that can be considered token or non‐participation. Second, we coded the data for main themes and found that child welfare workers in all three countries perceived children's participation as hearing the child's opinion and information gathering. The themes of age, maturity and ability to form an opinion also emerged from the data. English workers' reflections about children's participation were more nuanced than their Norwegian and US counterparts; and US workers understood children's participation as children providing valuable information during the investigation of a case more frequently than workers in England and Norway. We discuss the implications of these findings on future research. [ABSTRACT FROM AUTHOR]

Health security has become a popular way of justifying efforts to control catastrophic threats to public health. Unfortunately, there has been little analysis of the concept of health security, nor the relationship between health security and other potential aims of public health policy. In this paper I develop an account of health security as an aversion to risky policy options. I explore three reasons for thinking risk avoidance is a distinctly worthwhile aim of public health policy: (i) that security is intrinsically valuable, (ii) that it is necessary for social planning and (iii) that it is an appropriate response to decision-making in contexts of very limited information. Striking the right balance between securing and maximizing population health thus requires a substantive, and hitherto unrecognized, value judgment. Finally, I critically evaluate the current health security agenda in light of this new account of the concept and its relationship to the other aims of public health policy. [ABSTRACT FROM AUTHOR]

This article introduces the 16 articles appearing in the 2009 and 2010 volumes of Analyses of Social Issues and Public Policy that were submitted in response to a call for papers on 'The Social Psychology of the 2008 United States Presidential Election.' The papers touch a wide array of election topics, comparing the backgrounds and values of voters and nonvoters, those voting for different candidates, and those who choose which candidates they support early vs. late during the campaign. These papers, together with several others on media representations of candidates, highlight the continuing presence of race in shaping political attitudes and preferences, and also emphasize the evolution of American prejudices in the election process, from overt rejection of individuals who are racially different, to qualified political support under certain circumstances. Other papers in the collection focus on the role of gender as well as race, and also on some of the many ways in which presidential elections reflect and shape the self-concepts of American voters. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to increase international collaboration on end of life care (EoLC) in critical care. Objectives included highlighting key challenges for critical care nurses in EoLC through a transcribed interview between a clinician, an educationalist and a researcher who all hold an EoLC focus. Background: EoLC continues to hold high profile within international health care arenas, including critical care units. Whilst end of life care remains well debated, it still presents many challenges for everyday practitioners. Dialogue with international colleagues and disciplines may provide opportunity for further understanding of this complex and sensitive area. Conclusions: A key issues to arise from this venture of shared learning was that futility of treatment is problematic for all. This is further complicated in the USA where the concept of (family) autonomy strongly shapes EoLC decision making. Relevance to clinical practice: This paper demonstrates that there are opportunities for nurses within health care teams which could be addressed through education and professional development initiatives. Furthermore, knowledge from other disciplines can provide a useful lens through which to improve our understanding of EoLC. [ABSTRACT FROM AUTHOR]

This paper examines the use of climate forecasting in water management in Brazil and the United States (U.S.). Specifically, it seeks to understand how different institutional arrangements shape the willingness and ability of water managers to incorporate technoscience, especially seasonal climate forecasting (SCF), in their decision-making process. It argues that among the many factors shaping the willingness of water managers to use SCF, institutional design and change is critical to explain different patterns in Brazil and the U.S. Moreover, factors related to individual flexibility, discretion, and accountability also affect the ability of managers to use climate information in water management. This paper finds that while water managers in the U.S operate in a mostly fragmented and risk-averse system – which constrains the adoption of innovation – decision makers in Brazil can afford more flexibility to introduce new decision tools as a result of widespread water management reforms initiated in the 1990s. [ABSTRACT FROM AUTHOR]

Abstract The cost of health care fraud and abuse is enormous. Not only is it costing us a lot of money but one wonders how many more people could afford and receive medical insurance if fraud and abuse were significantly lower. This paper will show that the problem is embedded in the way America does health business. The problem needs to be better addressed by both the criminal justice community and the health care industry. Most importantly, those making the health care industry policy decisions need to make a paradigm shift. The system is out of balance because of past policies and decisions that have given excessive power and liberty to the medical services community and insurance providers. Using O’Toole's Compass Card of the four major ideas that have influenced political decision-making as a guide, this paper recommends that current decision-making needs to strengthen the equality and community poles and restrict the liberty and efficiency poles so that more balance might exist within the American health care system. Talcott Parsons saw the dangers of commercializing health care over half a century ago. The health care scene of today shows that he was correct in his appraisal. [ABSTRACT FROM AUTHOR]

Much of the discourse in the bioethics literature on what is often called 'cesarean delivery on maternal request' has focused on balancing respect for patient autonomy with attention to the short- and long-term risks of this procedure to maternal and neonatal well-being. And while there has been some analysis of the social and economic costs inherent in performing cesareans, much of the clinical and ethical analysis has concluded that, given the degree of risk to the mother and neonate from a primary or single repeat cesarean delivery, there is sufficient justification for pregnant women to request and obtain this procedure from obstetricians willing to meet such requests. However, these same analyses often caution that physicians should not offer these elective cesareans to all women, but only to those who initiate the request. This paper analyzes recommendations that do not promote universal access to these procedures and concludes that such a policy is ethically unjustifiable, as it treats women who do not inquire about such procedures differently. Depriving appropriate candidates-for example, healthy women who are good surgical candidates and desire only or two children-of information about elective cesarean delivery is a form of undue influence on women's decision-making.. [ABSTRACT FROM AUTHOR]

ABSTRACT Child welfare has long been a concern for American Indians, so much so that Congress passed the Indian Child Welfare Act (ICWA) in 1978. The ICWA was intended to address was the large number of children placed out of home as a result of abuse and/or neglect, and the corresponding lack of tribal and community input regarding their removal and placement. This paper focuses on one group of American Indian people, the Lakota, whose children are overrepresented in the child welfare system. As a promising practice, shared decision-making will be offered as a culturally appropriate model to build dialogue and cooperation between social workers and their Lakota clients. Shared decision-making holds promise to help address the important social justice issues identified by Congress and by the Lakota people in the 1970s and which remain largely unresolved some 40 years later. [ABSTRACT FROM AUTHOR]

This paper examines the shift from vulnerability to political responsiveness in presidential and gubernatorial disaster decisions in the United States from 1953-2009 (President Dwight D. Eisenhower to President Barack Obama) using annual request, declaration, and approval data from multiple sources. It makes three key conclusions: first, the 1988 Stafford Act expanded federal coverage to all categories of disasters, added a significant range of individual types of assistance, and provided extensive funding for recovery planning. Second, the election effects on disaster decisions increased over time whereas the impact of social and economic vulnerability (measured by scope of disaster) declined. Third, the changes affected governors more than presidents, and the choices of governors drove those of presidents. The analysis underscores the increasingly political nature of the disaster decision-making process, as well as the difficulty in emphasising mitigation and preparedness as intensively as response and recovery. Proactive intervention yields fewer political rewards than responsiveness. [ABSTRACT FROM AUTHOR]

NASA's Constellation Program, formulated in 2005 to achieve the objectives of maintaining American presence in low Earth orbit, returning to the Moon for purpose of establishing an outpost, and exploring Mars and beyond in the first half of the 21st century, was cancelled in 2010 [US Congress, NASA Authorization Act, Public Law 11-267, 2010]. This paper describes the lessons learned developed by the staff of the Constellation Program to advise future programs, as well as program and system engineering managers of similar national efforts. These lessons learned are offered by those who experienced the day-to-day challenges of managing an effort planned as a multidecade undertaking. This effort spanned all 10 NASA Centers, multiple large-scale acquisitions, and required modernizing an infrastructure designed and sized largely for the Apollo program in the 1960s. Moreover, it required leading a workforce generationally removed from the previous human spacecraft launch and entry development challenges. Key lessons learned from the Constellation Program are addressed and cover program elements in which systems engineers provide leadership and/or assistance to program management, including program planning, requirements development, system design methodology, management structure, decision-making, and communications in a national program. ©2012 Wiley Periodicals, Inc. Syst Eng 16: [ABSTRACT FROM AUTHOR]

This paper seeks to understand the process by which immigrants decide whether or not to return to their home countries. It aims to analyse the potential for return migration rather than the actual migration process. Empirically, it is based on the narratives of 30 Turkish immigrants living in the United States. The findings indicate that: (1) multiple controllable and uncontrollable, micro- and macro-level factors in both the home and the host countries interact over time to tip the scales towards - or away from - return migration; and (2) most immigrants live in a perpetual state of ambivalence about whether or not to engage in return migration. These findings are discussed, and implications are presented for both practice and policy. [ABSTRACT FROM AUTHOR]

International relations theory took shape in the 1950s in reaction to the behavioral social science movement, emphasizing the limits of rationality in a context of high uncertainty, weak rules, and the possibility of lethal conflict. Yet the same discipline rapidly developed “rational choice” models applied to foreign policy decision making or nuclear strategy. This paper argues that this transformation took place almost seamlessly around the concept of “decision.” Initially associated with an antirationalist or “decisionist” approach to politics, the sovereign decision became the epitome of political rationality when it was redescribed as “rational choice,” thus easing the cultural acceptance of political realism in the postwar years. [ABSTRACT FROM AUTHOR]

The decision to take a young person away from his or her family into out-of-home care and treatment is the most drastic intervention within the statutory powers bestowed upon social services. The results of reports on the quality of residential treatment reveal that state supervision has not proven to be a good substitute for parental care. In this paper we analyse the decision-making process when young persons are placed in residential care. Focus groups and individual interviews with different stakeholders were conducted. The results show that the placements are a collective process involving negotiations between the different parties with a coordinating social worker in the middle, with the aim to bring something to build hope on in often desperate situations, regardless of the specific treatment method used. To inform the process, the social workers draw on a 'collective memory' shared among colleagues in the department. Important signs of quality of a residential unit were the relational and collaborative competence from the staff. The inclination to use soft, diffuse information in decision-making shows a striking lack of evidence upon which social workers can build well-informed and knowledge-based decisions. [ABSTRACT FROM AUTHOR]

The Disaster Deficit Index (DDI) measures macroeconomic and financial risk in a country according to possible catastrophic scenario events. Extreme disasters can generate financial deficit due to sudden and elevated need of resources to restore affected inventories. The DDI captures the relationship between the economic loss that a country could experience when a catastrophic event occurs and the availability of funds to address the situation. The proposed model utilises the procedures of the insurance industry in establishing probable losses, based on critical impacts during a given period of exposure; for economic resilience, the model allows one to calculate the country's financial ability to cope with a critical impact. There are limitations and costs associated with access to resources that one must consider as feasible values according to the country's macroeconomic and financial conditions. This paper presents the DDI model and the results of its application to 19 countries of the Americas and aims to guide governmental decision-making in disaster risk reduction. [ABSTRACT FROM AUTHOR]

This paper examines the operation of the presidential advisory system during the 9/11 and Hurricane Katrina crises in order to explain the marked differences in presidential crisis leadership performance during the acute phase of both crises. It first presents a conceptual framework for the systematic study of “crisis advisory configurations” around presidents, based on an integrated review of the advisory systems and crisis management literatures. Second, the framework is applied to George W. Bush's performance in three crucial crisis leadership task domains—sense making, decision making, and meaning making. The article concludes by identifying key challenges of building crisis management capacity around heads of government such as the U.S. president. [ABSTRACT FROM AUTHOR]

Pre-play discussion consistently increases cooperation in dilemma interactions. Most explanations of this “cheap-talk” effect are based on either commitment or group solidarity effects. Because discussion about the upcoming dilemma allows participants to make promises and creates group solidarity, the 2 explanations are often confounded. This paper aims to clarify past results by having participants engage in an unrelated discussion prior to a dilemma interaction. We find that solidarity effects can be induced by minimal group categorizations, but are relatively weak. Discussions involving consequential but unrelated coordination tasks are shown to prime cooperative norms and increase cooperation with both in-group and out-group members. Our findings suggest that cheap talk may work for even cheaper reasons than previously thought. [ABSTRACT FROM AUTHOR]

Public participation is becoming increasingly common in environmental decision making. While researchers have focused on understanding why individuals get involved and the impact of their engagement, less is known about the forces that shape agency and legislative decision making regarding participation. This paper uses multinomial logistic regression to explore the determinants of public participation provisions in state hazardous waste programs over time. The results suggest that states with more liberal citizenry, higher levels of manufacturing, and urban areas are more likely to formalize the participation provisions in their hazardous waste programs. Comparatively, states with fewer Democratic representatives are more likely to informally engage in public participation procedures in their states programs. [ABSTRACT FROM AUTHOR]

In a companion article (Beier et al. 2006), we identified 2 sets of unreliable inferences that may compromise efforts to conserve the Florida panther (Puma concolor coryi). In spite of serious flaws in methodology and interpretation, these unreliable conclusions have appeared in prominent, peer-refereed scientific journals and have been repeatedly cited and miscited in support of panther conservation. Future editors and referees may reduce these errors by insisting on adherence to an Introduction, Methods, Results, and Discussion (IMRAD) format; checking improbable assertions attributed to earlier papers; and refusing to allow scientific inference in publication formats not subject to scientific peer review (e.g., editorials). We urge conservation biologists to view science as an adaptive process and to use the method of multiple working hypotheses (Chamberlin 1890) that are now a central feature of adaptive resource management (Walters 1986, Williams et al. 2002). We advocate a workshop approach, similar to that used for analysis of data for the northern spotted owl (Strix occidentalis; Anderson et al. 1999), to deal with scientific disagreement where, as in the case with panthers, stakeholders have entrenched points of view. Finally, we recommend the creation of an independent Scientific Steering Committee to address long-term issues of future research and monitoring of Florida panthers. [ABSTRACT FROM AUTHOR]

Cohabitation is now the modal path to marriage in the United States. Drawing on data from 115 in-depth interviews with cohabitors from the working and lower middle classes, this paper explores how economics shape marital decision making. We find that cohabitors typically perceive financial issues as important for marriage, and we delineate several key themes. Whereas some social scientists speculate that cohabitors must think that marriage will change their lives in order to motivate marriage, our findings suggest that cohabitors believe marriage should occur once something has already changed—in this case, their financial status. Our results also imply that political and scientific discourse on financial problems as deterrents to marriage should be broadened beyond a focus on poor unmarried parents. [ABSTRACT FROM AUTHOR]

To explore the generalised application of a discourse of cost reduction in the practice of medicine in the USA. Changes in the health services industry over the last 20 years have left much concern in the hearts and minds of many, providers and patients alike. Even for the millions of Americans who are able to purchase health insurance, the standard of care has changed. In some ways, the current managed-care climate has created an atmosphere of distrust between patients and their providers, and, more significantly, a general sense of dissatisfaction with the state of health care in the USA. In the midst of this discontent, health providers have begun to question their own roles in what is increasingly a for-profit health care system. Not surprisingly, medical educators now question whether the current health system is creating a new generation of doctors who are concerned with reducing costs without adequate review of clinical data. This paper examines the rationale applied in the management of a patient with end-stage liver disease in a teaching hospital. The case is re-socialised by situating it in an ethical discourse linked to the function of the for-profit health system. The decision about whether to give human albumin to an insured patient serves as a lens through which to examine how uncritical appeals to the discourse of ‘cost-effectiveness’ can supersede a patient- and data-oriented approach to medical decision making. This case illustrates the permeation of economic considerations into the core values of medicine, highlighting a detrimental ethical shift occurring in the field. The training of new doctors represents a site from which to resist this unwelcome transformation. [ABSTRACT FROM AUTHOR]

This paper investigates the effects of September 11, 2001 terrorists' attack on decision making. It was hypothesized that after terrorists' attacks people would make more conservative and less risky decisions, as a way of compensating for the feelings of insecurity caused by the disaster. Prospect Theory is used as theoretical framework. This theory has successfully accounted for decision making under normal circumstances. To verify whether and how the terrorists' attack against the USA influenced individual decision making processes, two samples of Italian university students were tested, one month and six months after the disaster. The results show the emergence of two tendencies, which are absent during ‘normal’ historical periods: a strong, long-term lasting search for security when the outcome of a decision is perceived as a gain, and a medium-term risk avoiding behavior in the loss domain. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper compares the decision-making approaches of two presidents, John F. Kennedy and George W. Bush, in relation to unanticipated international crises. One, President Kennedy, employed a broad body of expert opinion and entertained a wide range of options in meeting the Cuban Missile Crisis of 1963. The actions taken avoided a potential worldwide nuclear war. The other, George W. Bush, consulted only a few, like-minded colleagues and appears to have decided early on that a war directed against Iraq and Saddam Hussein was a necessity. The administration's justifications for the war were difficult to prove and the administration chose an essentially bilateral (as against a multi-lateral) approach. The Iraq War was won fairly easily, although its long-range consequences remain unclear. The two styles of decision-making present polarized approaches to international crisis situation management. [ABSTRACT FROM AUTHOR]

Ethical consensus and appellate court decisions view artificial nutrition and hydration (ANH) as medical treatment that can be refused like other treatments. However, advance directive statutes may produce obstacles for refusal of ANH, as distinct from other life-sustaining treatments, in patients who lack capacity. This paper reviews state statutes and appellate case law regarding medical decision making for patients who lack decisional capacity. Twenty states (39%) have one or more explicit statutory provisions delineating a separate and more stringent standard for ANH refusal. These standards include higher evidentiary standard; requirement for specific preauthorization, qualifying medical conditions, second medical opinion, or judicial review; refusal not permitted; refusal not permitted if death would result from “starvation” or “dehydration”; and previous law with higher standard applies to old documents. In 11 of these states and in eight others, statutory law contains language that could be misinterpreted, implying, but not rising to, an explicitly higher standard. Four appellate decisions departed from the judicial consensus that ANH can be refused like other treatments, but subsequent court decisions or legislative enactments reduced or eliminated their impact. Legislators and the courts should ask whether higher standards for ANH refusal are appropriate in light of case law authority that ANH should not be treated differently and in light of statutory language that preserves those common law rights. These higher standards may make it more difficult in certain states to refuse ANH for patients who lack capacity or place a burden on good practice by making providers fearful of the law. [ABSTRACT FROM AUTHOR]

The need to better understand landlord involvement in decision-making related to pesticide use and water quality issues is evidenced by several trends. These trends include the increasing documentation of water pollution by farm pesticides. the changing characteristics of farm ownership and operator tenure, and evolutions in resource policy and protection planing. This paper utilizes a theoretical approach to thy sociology of land tenure to interpret results from an investigation of landlord involvement in environmental decision making regarding pesticide selection on rented land. Eight counties with high susceptibility of water contamination by pesticides were selected for study. Structured, in-person interviews were administered to in-county landlords, and a mail survey was used to poll out-of-county landlords. Results indicate that participation is generation low with very little difference between landlords groups. Renters make most of the organizational and operational decisions on rented farmland. Landlord participation is predominantly based on economic, rather than on social or environmental, factors. Furthermore while economic variables are important predictors of participation for both groups gender and social ties to the renter tend to increase local landlord involvement, but not absentee involvement. These results have important implications for both federal programs and further research on land tenure anti environmental stewardship. [ABSTRACT FROM AUTHOR]

This paper addresses the ownership and control of farmland, presents a conceptual model of landed property, and uses it to examine landlord-tenant relations in Wisconsin. A profile of farmland owners is constructed using survey data from two agricultural counties. Particular attention is paid to who controls farm management decisions on rented land. Results suggest that tenants enjoy much latitude in managing rented land and that relations between landlords and tenants seem satisfactory to both parties. [ABSTRACT FROM AUTHOR]

The article discusses the graduate education opportunities in fisheries science in Canada and the U.S. as well as some of the issues that may influence students when they are making decisions about graduate schools. Some options for seeking graduate opportunities include reviewing papers of interest, contacting current graduate students, and searching the Web for online graduate postings. The main requirements of admission to a graduate program are a minimum grade point average (GPA) and approval from a potential supervisor.