Advances in the assessment and prediction of interpersonal violence

This article underscores the weakness of clinical judgment as a mechanism for prediction with examples from other areas in the psychological literature. Clinical judgment has as its Achilles'heel the reliance on a person to incorporate multiple pieces of information while overcoming human judgment errors--a feat insurmountable thus far. The actuarial approach to risk assessment has overcome many of the weaknesses of clinical judgment and has been shown to be a much superior method. Nonetheless, the static/historical nature of the risk factors associated with most actuarial approaches is limiting. Advances in risk prediction will be found in part in the development of dynamic actuarial instruments that will measure both static/historical and changeable risk factors. The dynamic risk factors can be reevaluated on an ongoing basis, and it is proposed that the level of change in dynamic factors necessary to represent a significant change in overall risk will be an interactive function with static risk factors.     

Autonomy and audit--striking the balance

The Data Protection Act 1998 purports to implement European legislation which aims to protect the privacy of individuals. There were such concerns about the implications of the Act for certain research and audit that it became necessary to enact further legislation to enable such essential activities to continue. Although this empowers the Secretary of State for Health to approve proposals for these purposes, there should still be a requirement that the use of identifiable personal information without consent must be justified on compelling public interest grounds. It is this that can confound those seeking to rely on such justification. There can either be too cavalier an approach to the issue, and/or there is little sense of what considerations should come into play. This paper attempts to highlight some of the difficulties that are theoretically raised by some audit activities and set out the legal framework within which they must operate. However, the key focus is on how ethical considerations might inform the public interest argument.     

Managerial Responsibility

The concept of managerial responsibility is a shining thread in the literature of public administration, but its definition within our constitutional scheme remains elusive. How will we know responsible public management when we see it? We propose one answer: Public administration should be conducted according to what we term a “precept of managerial responsibility,” which involves four interrelated elements derived from the classical literature of public administration: judgment, accountability, balance, and rationality. We apply this precept to one of the most vexing problems of public administration theory and practice, institutional reform litigation. This application illustrates how the precept solves a major theoretical problem of American public administration by defining a role for administrative officers that fully comports with the Madisonian scheme of separated institutions—legislative, executive, and judicial—sharing power.     

Electro-acupuncture to prevent prolonged postoperative ileus:A randomized clinical trial

AIM:To examine whether acupuncture can prevent prolonged postoperative ileus(PPOI)after intraperitoneal surgery for colon cancer. METHODS:Ninety patients were recruited from the Fudan University Cancer Hospital,Shanghai,China. After surgery,patients were randomized to receive acupuncture(once daily,starting on postoperative day 1, for up to six consecutive days)or usual care.PPOI was defined as an inability to pass flatus or have a bowel movement by 96 h after surgery.The main outcomes were time to first fl...     

Government capacity to contract: health sector experience and lessons

Using case-study material of contracting for clinical and ancillary services in the health care sector of developing countries, this article examines the capacities required for successful contracting and the main constraints which developing country governments face in developing and implementing contractual arrangements. Required capacities differ according to the type of service being contracted and the nature of the contractor. Contracting for clinical as opposed to ancillary services poses considerably greater challenges in terms of the information required for monitoring and contract design. Yet, in some of the case-studies examined, problems arose owing to government's limited capacity to perform even very basic functions such as paying contractors in a timely manner and keeping records of contracts negotiated. The external environment within which contracting takes place is also critical; in particular, the case-studies indicate that contracts embedded in slow-moving, rule-ridden bureaucracies will face substantial constraints to successful implementation. The article suggests that governments need to assess required capacities on a service-by-service basis. For any successful contracting, basic administrative systems must be functioning. In addition, there should be development of guidelines for contracting, clear lines of communication between all agents involved in the contracting process, and regular evaluations of contractual arrangements. Finally, in cases where government has weak capacity, direct service provision may be a lower-risk delivery strategy. © 1998 John Wiley & Sons, Ltd.     

Children’s and Adolescents’ Expectations about Challenging Unfair Group Norms

Youth often hold group norms that perpetuate inequality. One way these norms can be changed is by challenging these norms by choosing to include new members into these groups who hold morally just norms. In the current study, children’s and adolescents’ inclusion decisions and social reasoning about challenging group norms through inclusion were investigated. The sample included 9–10 (children) and 13–14 year-olds (adolescents) (N?=?673, 54.4% female). Participants supported including challengers into groups holding norms supporting relational aggression and unequal allocation of resources, but they were less likely to support including a challenger into a physically aggressive group. Age-related differences and gender differences were found: children and female participants were more likely to include challengers than were adolescents and male participants. The findings indicate that youth support including new members who would challenge morally questionable group norms, but that their support depends on the specific norm the group holds.