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This paper examines the use of influence diagrams to help understand political processes within organizations. This technique is illustrated through a case study of a new extended care facility connected to a hospital. Advantages of influence diagrams are highlighted by comparing the level of understanding before and after the technique was used. The improvement in performance that may be derived from the use of influence diagrams is discussed. Finally, the implications of the case for important issues in organization theory, particularly those dealing with internal politics and conflict, are discussed. [ABSTRACT FROM AUTHOR]

This paper examines the impact of Turkish social and economic change upon behavior of administrative elites across two decades. Data for two age cohorts and for 1956, 1965, and 1974 were obtained. The findings emphasize the effects of the creation of new organizations upon both career mobility and job satisfaction. The interactions of the opportunity structure generated by the formation of new organizations and individual marketability explained mobility and job satisfaction for the 20 years studied. Cross-sectional relationships differed markedly at the three times; therefore, generalizations based upon one set of time-bound circumstances do not hold at another time. This lack of generalizability is emerging as a major problem in behavioral science research, so these Turkish data have relevance to this broader problem. [ABSTRACT FROM AUTHOR]

The rotation of individuals among settings is considered from a causal-modeling and a quasi-experimental perspective. The assumptions underlying appropriate research designs and possible modes of data analysis are discussed. Similarities and differences between several designs based on short time series are outlined. Examples are drawn from studies of productivity in an American factory and job satisfaction among Turkish administrators. [ABSTRACT FROM AUTHOR]

A simple model of consumer behavior is used to structure data on environmental change, organizational mobility, and satisfaction taken from studies of Turkish and French élites.¹ Despite the widely different subject matter of the two data sets, a microeconomic formulation proved conceptually fruitful. The consumer-behavior paradigm is forwarded as a means of integrating findings from diverse areas of interest; some of the limitations of the approach are also discussed. The consumer-behavior model promises to be particularly useful in relating economic, political, and organizational change to individual behavior. [ABSTRACT FROM AUTHOR]

When a political system becomes competitive, the political influence of bureaucrats seems to undergo a sharp decline. How do bureaucrats react to these changes? Time-series data-data which would aid in tracing such changes-have not generally been available. This study uses information collected from Turkish bureaucrats at two points in time, 1956 and 1965, to consider changes in bureaucratic recruitment and job satisfaction over the period. In 1956 problems of social and political conflict seemed paramount; by 1965 problems of technical change had assumed major importances. Many members of the administrative elite appeared to be reacting favorably to new opportunities outside the central ministries in which they had previously been employed. [ABSTRACT FROM AUTHOR]

Abstract: We used the Health Services Commission data from Manitoba, Canada to identity complications resulting from hysterectomy, cholecystectomy, and prostatectomy which led to hospital readmissions. For each procedure, two specialists independently judged whether the readmissions were for surgery-related complications on the basis of liberally interpreted literature guidelines. Then, each pair of physicians met to resolve differences; only complications agreed upon by physicians were retained in our computer-based analysis. The analysis was done in Three steps: algorithms were developed using guidelines from the literature, physician input, and 1974 hospital claims; these were then modified using 1975 data: finally, the algorithms were tested with 1976 data. The computerized algorithms developed were compared with the clinical decisions of physician panels. The results showed high specificity, sensitivity, and predictive value. Given the increasing availability of routinely collected data bases, the possibilities for inexpensively monitoring the outcomes of different providers and institutions are appealing. More extensive validation and application of the methodology to a greater number of procedures are necessary to implement such a program. (Am J Public Health 1985: 75:1288-1295.) [ABSTRACT FROM AUTHOR]

Abstract: This paper' explores the relationships among physician supply, workload (output per physician), and utilization (physician services per capita) in rural Manitoba. Surgery taking place within a patient's home area and that taking place outside this area arc discussed. Longitudinal and cross-sectional analyses are compared, Although the average surgeon does more surgical procedures than docs the average general practitioner, the number of procedures performed varies greatly within each specialty. Individual physician workloads remained fairly stable over time when a surgically active physician moved into an area, while population utilization increased 17 per ¢. When such physicians left an area, the surgical workloads of the physicians increased significantly (18.7 per ¢) while population utilization stayed essentially the same. Both physician workload and surgical utilization in control areas increased gradually (between 6 and 7 per ¢) over' the period studied. Several models of physician behavior were investigated using data on individual procedures as well as overall figures. A model emphasizing the importance of physician discretion appeared to provide the best fit with the data. (Am J Public Health 1983: 73:414421.) [ABSTRACT FROM AUTHOR]

Public automobile insurance programs in Saskatchewan, Manitoba, and British Columbia raise a number of questions of equity and efficiency. This paper examines the programs from several different viewpoints, comparing the actuarial categories, rate structures, and incentives in the public insurance provinces with those in Alberta. Suggestions are offered for improving the equity and efficiency of the programs. Questions of openness of information and organizational learning are discussed on the basis of Saskatchewan and Manitoba experiences. [ABSTRACT FROM AUTHOR]

Three types of hospitals that deliver short-term health care are discussed in terms of several different models of hospital behavior. The structure-specialization model emphasized hospital control structure as a determinant of goal emphasis, while the exchange model stressed the interdependencies between the organization and essential resource suppliers in its environment. In so far as the models differed, the exchange model was supported by aggregate data (obtained from the American Hospital Association). Additionally, a competence model emphasizing the possibility that certain hospital types may perform relatively well on several dimensions was partially confirmed. Suggestions are forwarded for future research along these lines. [ABSTRACT FROM AUTHOR]

The article reports that conflicts between evaluators and administrators are endemic to policy research. Although considerable attention has been paid to problems of administrator acceptance of research designs involving randomization, the more mundane problems arising from day-to-day interaction between evaluators and administrators have received less attention. These comments will treat a number of the problems which can generate friction in the researcher-practitioner relationship.

Compares the bureaucracies of Turkey, Egypt and Pakistan. Marginal importance of the religious similarity among the countries for the student of Middle Eastern bureaucracies; Attitudes of bureaucrats in the three countries; Indicators of job satisfaction in bureaucrats.

The article presents a study which analyzes the use of old surveys for designing longitudinal studies, building data banks and estimating bias. The study is based upon a 1956 research study of Ankara University Political Science Faculty graduates. That research focused on course preference, feelings toward the program offered at the Political Science Faculty, and job satisfaction. The questions included in the research were all included in the study conducted by the author. Moreover, the items designed to get at the socialization, values, and occupational mobility of the graduates were also incorporated.

The current emphasis on environmental problems has resulted in the passage of new legislation and increasing public pressure upon individual companies seen as polluters. However, factors which influence organizations to change their ways are rather hazy. In the absence of clear market controls, particular businesses may fight environment-oriented legislation, complying only when political and legal avenues have been exhausted. One way to try to generate such knowledge about pollution is to consider different kinds of systems, both alone and where they come in contact with each other. Such a focus emphasizes the interdisciplinary nature of the study of pollution. This paper uses both single variables and component variables based on factor analysis to study possible independent and dependent variables related to water quality. A recent analysis of water pollution control laws has suggested that deteriorating water quality has a number of consequences at the state level. Such change in water quality seems to spur legislative interest in pollution problems, enforcement efforts and expenditures on pollution.

The article reports that there are a number of approaches to the study of environmental politics. Environmental politics can be treated in terms of variables which may or may not-affect policy outputs and outcomes. Specific independent variables might include various political, economic, and organizational variables. These variables can be studied for their own intrinsic interest, although it is more theoretically relevant and policy relevant to attempt to link such variables to outputs and outcomes.

Two surveys of villagers performed a year apart suggest possible attitude changes in Turkey over the period from 1962 to 1963. The hypothesis that an increase in frustration between 1962 and 1963 resulted in higher levels of regression and aggression in 1963 was explored by using attitudinal items asked on both surveys; the data were found to be consistent with this hypothesis. Economic and political change in Turkey in the 1962-1963 period was offered as a possible explanation underlying the observed changes. [ABSTRACT FROM AUTHOR]

A substantial number of experiments with nonzero-sum games have been successfully fitted within the framework developed by Atkinson in his work on drive strength and achievement motivation. This analysis emphasizes three major variables-incentive, expectancy, and motive-as determinants of drive strength and the consequent probability of a cooperative response. The need for experiments specifically designed to vary these parameters should be clear. [ABSTRACT FROM AUTHOR]

Investigates the attitudes distribution-oriented and development-oriented governors in Turkey. Differences in the social background between the development-oriented and the distribution-oriented governors; Interest in agriculture; Comparison between time-budgeting practices and relationships with other officials.

Genome-wide scans have revealed a significant role for de novo copy number variants (CNVs) and Single Nucleotide variants (SNVs) in the genetic architecture of schizophrenia. The present study attempts to parse schizophrenia based on the presence of such de novo mutations and attempts genotype-phenotype correlation. We examined phenotypic variables across three broad categories: clinical presentation, premorbid function, disease course and functional outcome and compared them in individuals with schizophrenia carrying either a de novo CNV, a de novo SNV, or no de novo mutation. Work skills were worst affected in patients carrying de novo CNVs. More learning disabilities were found in subjects carrying de novo SNVs. Patients with either mutation had older parents at birth and worse functional outcome as measured by SLOF scores. We found no relation between treatment resistance and the presence of de novo mutations. The combined consideration of the functional outcome scores and early deviant behaviours was found to have higher predictive value for underlying genetic vulnerability. Due to the rare nature of the de novo mutations the sample sizes studied here were small. Despite this, valuable phenotypic characteristics were identified in schizophrenia patients carrying de novo mutations and studying larger samples will be of interest., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The chemical nature of the interface between dentin and adhesive resin materials was characterized by micro-Raman spectroscopy. The resulting chemical profiles were correlated with photomicrographs obtained by SEM after an argon-ion-beam etching treatment of the sample surface. Two commercially available dentin adhesive systems, of which one was also applied with a different conditioning agent, were investigated. Raman spectra, which were recorded along line scans across the interface with a step increment of 1 micron, revealed that resin effectively penetrated 4 to 6 microns deep into the superficially decalcified dentin zone. Across the interface, a gradual transition from resin to dentin over the interdiffusion zone with a mixed contribution of both substances was noticed. Finally, resin appeared to penetrate to the entire decalcification depth of dentin regardless of the aggressiveness of the conditioning procedure.

The hardness and Young's modulus of the successive layers across a resin-dentin bonding area were determined by nano-indentation for four commercially-available dentin adhesive systems, of which two were also applied with a different conditioning agent. With a computer-controlled nano-indentation technique, minute triangular indentations were made within a small area of a few micrometers' diameter at a load of a few milli-Newtons. The load and displacement of the indenter were continuously monitored during the loading-unloading sequence, so hardness and Young's modulus could be computed as a function of the indenter geometry and the applied load. The hardness of the resin-dentin interdiffusion zone was significantly lower than that of unaltered dentin. A gradient of moduli of elasticity was observed from the rather stiff dentin over a more elastic resin-dentin interdiffusion zone and adhesive resin layer to the restorative composite. That gradient was more substantial in those systems that produced relatively thick adhesive resin layers or supplementally provided a filled low-viscosity resin as an intermediate layer between the adhesive resin and the bulk restorative composite. Such an elastic bonding area might have a strain capacity sufficient to relieve stresses between the shrinking composite restoration and the rigid dentin substrate, thereby improving the conservation of the dentin bond and, as a consequence, the marginal integrity and retention of the restoration.

In vitro vibrational wear tests were performed on 17 composites and one amalgam with human enamel as a reference. The specimens were fixed on a computer-controlled X-Y translation table that generated an oscillatory movement under small displacements. The dental material specimens were in permanent contact with an annealed chromium-steel counterbody. The tests were performed in ambient air of normal humidity at room temperature under non-lubricated sliding conditions. The friction between the counterbody and each of the various materials was measured on-line. After completion of the tests, the wear volumes were determined by contactless profilometry, and the wear pattern was studied with SEM. The simple vibrational test used in this study allowed a fast classification of different dental materials in terms of the relative wear on either the specimen or the counterbody material. The ratio of the wear volume of the counterbody versus the wear volume of the dental material specimen was used to accurately classify the materials according to their in vitro wear behavior, especially when this ratio was related to the total wear volume of the dental material specimen and the counterbody. From an analysis of the wear behavior of the both contacting materials, it became obvious that neither the wear of the dental materials nor of the chromium-steel counterbody appears to correlate with either the inorganic filler hardness, the intrinsic surface roughness, the surface hardness or the Young's modulus of the dental materials.

We used claims data from the Canadian province of Manitoba to test alternative explanations for regional differences in tonsillectomy and adenoidectomy rates. Respiratory morbidity, standards of selection for operation, and surgical resources were compared with elective surgical rates across geographic areas. Statistically significant correlations were not found. Individual practice patterns were then examined. In some regions, a few physicians accounted for the great majority of tonsil/adenoid operations. In other regions, the work was much more widely distributed. Despite great variation among individual physicians in the frequency of performing tonsil/adenoid operations and the standards of selection for operation, use of these procedures and standards applied were only weakly related to such variables as physician age, place of training and specialty.

Mortality rates for acute myocardial infarction (AMI) in the province of Manitoba were studied by a retrospective, randomized survey of urban and rural hospital records. Urban hospitals had formal coronary care unit (CCU). Selected rural hospitals lacked CCUs but usually possessed portable monitoring and defibrillation equipment. Twenty-seven percent of 852 cases in the study population died. The mortality rate for unequivocal AMI was 14% to 15% to both urban and rural hospitals. Patients with possible AMI had high mortality rates in both facilities (41% to 45%). Subgroup analysis of the definite AMI population failed to reveal statistically significant differences in urban vs rural mortality, although a consistent trend toward superior performance in urban centers was found. The magnitude of the potential of a rural hospital intervention program to reduce the AMI mortality nevertheless appeared to be small.

Increasing use of administrative records for research purposes has led to the need to develop methods for linking records. Linkage of the data from the Manitoba Health Services Commission (MHSC) with Canadian Vital Statistics records was done to verify Manitoba deaths, to measure degree of agreement between the two data sets, and to link "cause of death" information from Vital Statistics back to medical histories. A multi-stage approach to matching was adopted. Individual records matching perfectly across a number of relevant variables in the two files were selected first, reducing the number of records going through the probability matching to manageable proportions. Overall, almost 96% of the MHSC records were well matched with Vital Statistics records. Both uses of the matched data and various ways to confirm data quality are discussed.

To assess whether the objectives of a new Extended Care Unit were reflected in the care of the patients and in the outcome of that care, an audit of the patients' records was performed. The audit sample involved 101 geriatric patients who had been admitted to the Unit for rehabilitation therapy, and then discharged. The study included assessment of the records for compliance with individual audit criteria, examination of the records in terms of a composite audit score, and analysis of the relationship between these scores and three outcome indices. Although the audit did not show a significant correlation between recorded care processes and treatment outcomes, it did reveal the extent to which the Unit's goals were reflected in the care process.

In the absence of good clinical evidence from a randomized trial, the authors performed a decision analysis to determine the potential value of early elective surgery (OPNOW) for patients with left-sided Staphylococcus aureus infective endocarditis. Initial impressions (before performance of decision analysis) and initial runs at the formal models using probability estimates derived from clinicians suggested that OPNOW (i.e., within a few days of starting antibiotics) offered no advantage over attempted medical cure (WAIT) (life expectancy: WAIT = 325 weeks; OPNOW = 255 weeks). Extensive sensitivity analyses identified critical variables that needed further empirical estimation. The Manitoba Health Services Commission database identified 127 incident cases of endocarditis between April 1, 1979, and March 31, 1985, enabling estimation of values for these critical variables. With these estimates, the early surgery strategy appeared much better than the previous analyses had suggested (life expectancy: WAIT = 208 weeks, OPNOW = 256 weeks). The authors believe that this approach of combining decision analysis with medical claims databases is useful as an alternative or precursor to randomized trials, especially where the resource requirements and logistic difficulties of performing randomized trials are great.

Cholecystectomy is one of the most frequently performed elective surgical procedures, and a major contributor to surgery-associated mortality. The well-documented variation in surgical rates across geographic areas has been attributed not simply to differences in disease prevalence but to factors such as varying rates of clinical and radiologic investigation and use of different indications for surgical treatment. The research uses a large claims-based data bank--the hospital and medical files maintained by the Manitoba Health Services Commission. The study focused first on the incidence of gallbladder operations in Manitoba's six rural and three urban areas. Age-adjusted surgical rates varied across regions from more than 50 operations per 10,000 persons aged 25 and over to less than 42. Such variation was considerably less than that noted earlier for the tonsillectomy/adenoidectomy (T&A) operation. Cholecystectomy and T&A rates were not significantly correlated across regions. Moreover, a region's cholecystectomy rate and its 'supply' of operating physicians (measured by a physician-to-population ratio) were not significantly associated. Because a large number of referrals to surgeons in urban centers take place, an analytical distinction between surgery done within the region and that done outside the region has been made. Some movement of rural patients with more serious conditions to urban hospitals is found. Questions of regionalization of surgery are discussed using 9 years of data on mortality following cholecystectomy and biliary tract surgery.

This paper examines several approaches to studying ancillary services usage. The likely generalizability of results provides one criterion for picking site, study population and conditions studied. Breaking up such an aggregate figure as mean annual ancillary services charges per patient into its component parts helps identify the different contributors to high cost practice patterns. Potential differences in case mix are noted as providing the most severe threat to interpreting variation in ancillary services use across practitioners and practice settings. Strategies for dealing with case mix problems include: focusing on specific diseases and specific specialities, stratifying within diagnostic categories, using multiple comparisons and multivariate analysis, pairing of visits and episodes and applying small area techniques.

Health insurance systems are generating large numbers of claims filed by physicians and hospitals for reimbursement and accounting purposes. This paper describes and evaluates a measure of health status derived from physician and hospital claims filed for a sample of older Canadians during 1970-1977. Information on the number, type, and seriousness of reported diagnoses and the number and duration of hospitalizations and surgeries during each year were combined to generate annual Illness Scales ranging from 0 to 24. Alpha coefficients, measures of internal consistency, were between 0.82 and 0.84. Consistent with high validity, Illness Scale scores increased with age, were significantly associated with other health measures, and were strongly predictive of death and hospitalization in the following year. The ability to develop valid and reliable health status measures from insurance claims substantially expands the potential use of these data for research and evaluation.

This study concentrates on utilizing registries and assessing their quality for population-based research. A method of successive comparisons is used to develop and update a summary record of coverage (length of time on the registry) and mortality for each individual in the Manitoba Health Services Commission data base. Various ways to ascertain the accuracy of the summary records are discussed. These techniques are validated by efforts to follow over an 8-year period 4,794 individuals interviewed in 1971 as part of ongoing research on the Manitoba elderly. Ninety-seven percent of the total elderly sample (and 99% of those successfully matched with interviewees) were traced over 8 years. Deaths recorded on hospital claims but not on the master registry and possible unrecorded out-of-hospital deaths are outstanding problems with the Manitoba data base. Further checks against 1970-1977 vital statistics information in the Canadian Mortality Data Base will be made.

Research on adverse outcomes following common surgical procedures has suggested the importance of hospital and surgeon variables. Policy directions depend on which factors are important in influencing patient outcomes and what sorts of policies are feasible. Focusing on where a given procedure is performed highlights a concern for centralization; emphasizing who should perform a particular operation implies physician certification. Finally, monitoring involves identifying particular hospitals that appear to have relatively poor (or relatively good) results. This paper analyzes patient, surgeon, and hospital characteristics associated with serious postdischarge complications of hysterectomy, cholecystectomy, and prostatectomy in patients age 25 and over in Manitoba, Canada, following surgery during 1974 through 1976. The three procedures differ markedly in the ease of prediction of the probability of complications and in the predictive importance of patient, hospital, and physician variables. The predictors worked fairly well for cholecystectomy, somewhat less well for hysterectomy, and not well at all for prostatectomy. Hospital variables were not generally important in the multiple logistic regressions. After controlling for case mix and type of surgery, physician surgical experience was found to account for relatively large differences (almost two to one) in the probability of patient complications following cholecystectomy. Cholecystectomy might be a candidate for certification because of the epidemiology of the operation. As of the mid-1970s, a substantial proportion of the cholecystectomies were being performed by physicians with comparatively little ongoing experience with this type of procedure. Moreover, a monitoring perspective identified one hospital with a significantly higher postcholecystectomy complication rate, even after physician experience was taken into account. Both identifying which procedures should be attended to and focusing on problems following surgery are important beyond Manitoba and highly relevant to such American requirements as Peer Review Organizations. Methods of increasing the efficiency of using claims data for quality assurance studies are outlined.