NEW DIRECTIONS IN MEDICAL OUTCOMES RESEARCH: THE VIEW FROM HARVARD

This study evaluates the emerging field of medical outcomes research based on interviews at Harvard Medical School. Medical outcomes research at Harvard is multifaceted, but may be summarized as involving certain key components. The emphasis at Harvard is on “quality of care,” viewed as a combination of outcomes evaluation and process evaluation, delivery of the service and its result. In a time of shrinking budgets, outcomes and process research can be justified economically because of the relatively low cost of patient self‐reports and because of their usefulness. Physicians may be motivated to measure quality of care by emphasizing the positive effects of research on the process of care and outcomes. Medical outcomes research is a field that is undergoing change and is becoming increasingly oriented toward the practical needs of patients and physicians.     

Staying in the Game or Changing It: An Analysis of Moves and Turns in Negotiation

As parties bargain over the terms of an agreement, they are concurrently negotiating their relationship. In this parallel negotiation, parties seek to position themselves to advantage by using a variety of strategic moves. In so doing the other party can be put into a defensive position making it difficult to advocate effectively. Turns, such as interrupting, correcting, questioning, naming, and diverting, challenge these moves. Turns can be used restoratively to move out of a defensive position or participatively, to engage the other in collaboration. Anticipating strategic moves and having turns in mind is part of preparing to negotiate.     

Institutionalizing Legal Consciousness: Regulation and the Embedding of Market Participants in the Securities Industry in Ghana and Fiji

How do differences in the implementation of regulation impact market behavior? I propose a theoretical framework to understand this impact as part of the process of embedding market participants through the institutionalization of legal consciousness within a field of action. I use this framework to understand the impact of the difference in the implementation of securities regulation in Ghana and Fiji. In Fiji, where the regulatory agency is more present and process‐oriented, brokers operate with a greater orientation toward formal rules. In Ghana, where the regulatory agency is distant and auditing, brokers rely on explicit enforcement of floor‐based norms. Conceiving of legal consciousness as an emergent feature of a field of social action advances the understanding of how legality is institutionalized, since the emergent structure shapes the orientations, behavior, and relations of actors within the field.     

Descriptive Study of Precursors to Sex Offending among 813 Boys and Girls: Antecedent Life Experiences

In order to understand the precursors to sexual offending among youth and the associated gender differences, the records of 813 sexually abusive children (659 boys and 154 girls) referred for an evaluation of their sexually inappropriate and coercive behavior were reviewed and coded. These children ranged in age from 3 to 18 when they committed their first hands-on offenses. All were under the care of the Massachusetts Department of Social Services either prior to or as a result of their behavior. Principle findings included: (1) a high proportion of girls (19 percent) in a sample of children flagged as sexually abusive to other children, (2) an exceptionally high base rate of severe maltreatment and associated clinical and psychiatric sequelae, and (3) girls were significantly more likely to be sexually abused, and when sexually abused the abuse lasted longer, was more severe, and involved more perpetrators. In addition, the girls were significantly more likely to witness domestic violence and to witness sexual deviance within the home. For all other types of abuse, there were no group differences, and (4) all of the children were subjected to a very high level of caregiver instability.     

On evaluating evaluations

The act of evaluation requires an expenditure of resources. In Part I of this paper, we present a simple decision tree model borrowed from operations research to provide a conceptual framework for considering whether or not to commit such resources. In Part II, once the evaluation is carried out, we address the problem of evaluating the evaluation as a vehicle for producing useful information to decisionmakers. Evaluation inputs, processes, and outcomes are defined and discussed within the context of comprehensive evaluation of evaluations.     

Assessing mothers' and fathers' violence toward children as a function of their involuntary participation in family work

This study examines the association between parents' violence toward children and their involuntary participation in family work. Involuntary participation in family work is conceptualized as a form of role strain measured by the disparity between the amount of responsibility husbands and wives would prefer to assume in the home and the amount of family work they actually perform. The prediction guiding this research is that differences of this kind are more associated with mothers' violence than fathers'. Regression analysis with a national sample of parents supports this hypothesis. Nonetheless, the association between such role strain and violence is quite weak, suggesting that additional research is required in formulating and measuring this relationship.