Patients Are More than their Illnesses: The Use of Story in Medical Education

[W]hen a poet's mind is perfectly equipped for its work, it is constantly amalgamating disparate experiences; the ordinary man's experience is chaotic, irregular, fragmentary. The latter falls in love, or reads Spinoza and these experiences have nothing to do with each other, or with the noise of the type-writer or the smell of cooking; in the mind of the poet these experiences are always forming new wholes. —T.S. Eliot     

Separated Powers in the United States: The Ideology of Agencies,Presidents, and Congress

Government agencies service interest groups, advocate policies, provide advice to elected officials, and create and implement public policy. Scholars have advanced theories to explain the role of agencies in American politics, but efforts to test these theories are hampered by the inability to systematically measure agency preferences. We present a method for measuring agency ideology that yields ideal point estimates of individual bureaucrats and agencies that are directly comparable with those of other political actors. These estimates produce insights into the nature of the bureaucratic state and provide traction on a host of questions about American politics. We discuss what these estimates reveal about the political environment of bureaucracy and their potential for testing theories of political institutions. We demonstrate their utility by testing key propositions from Gailmard and Patty's (2007) influential model of political control and endogenous expertise development.     

Appointment Delay for Vacancies on the Federal Communications Commission

Confirmation politics for judicial appointees is an exhaustively studied phenomenon, but the politics of appointment for independent agencies is less well understood, because nominees are very rarely rejected and the Senate fails even to hold a recorded vote for most appointees. However, alternative evidence of conflict between the president and the Senate is available: the length of time it takes to fill a vacancy on a board or commission. An empirical assessment of FCC vacancies, based on an exponential regression model of vacancy duration, demonstrates that statutory restrictions on the partisanship of the board significantly deteriorate the efficiency of the appointment process. In addition, the appointment of minorities (though not of women) occurs only after unusually drawn‐out appointments. A straightforward test of whether divided government leads to extended vacancies turns up negative.     

Women in the 1946 and 1993 Japanese house of Representatives elections: The role of the election system

Japan ranks near the bottom among the world’s democracies in electing women to public office. This is typically attributed to its male-dominated culture. While we do not dismiss this cultural argument, we focus on the House of Representatives to present evidence that the Japanese election system has been a significant barrier to women. Japan was a world leader in electing women under the 1946 election system but, when the system changed in 1947, a steady decline began in elected women. The new election system recently adopted will only marginally increase the election of women to the House of Representatives.     

Characteristics and Co-occurrence of Adolescent Non-Suicidal Self-Injury and Suicidal Behaviours in Pediatric Emergency Crisis Services

During the potentially tumultuous adolescent period, non-suicidal self-injury (NSSI) and suicide attempts are relatively common, particularly amongst youth who present to mental health services. These phenomena frequently co-occur but their relationship is unclear. This study evaluated clinical data from 468 youth between the ages of 12 and 17 years (63.5% female) to determine the incidence of NSSI 24 h prior to presentation at emergency crisis services, evaluated the overlap between NSSI and suicide attempt, and examined the characteristics of different types of self-harm. Half of the adolescents presenting to emergency crisis services had self-harmed within the previous 24 h, with most of these (91%) classified as NSSI only. The percentage of youth with a suicide attempt was 5% and the co-occurrence of these two behaviours was 4%. Group differences in depressive symptoms, suicidal ideation and impulsivity were identified, with the co-occurring NSSI and suicide attempt group presenting with the highest level of psychopathology. This study underscores the necessity of assessing suicidal ideation and NSSI in all youth presenting to mental health services.     

Bureaucracy and innovation

Abstract: As public bureaucracies have increasingly assumed responsibility for the satisfaction of human needs a logical adjunct is that they be innovative and creative in fulfilling these tasks. While the literature on conditions necessary for innovative behaviour in public organizations is slim, this paper suggests that such a list should recognize that innovation is most likely to occur when a government wants action for symbolic reasons but does not know or care about what sort. This might best be characterized as a policy of benign neglect, but for purposes of innovation it allows the policy implementators a free hand in developing programs to fit local conditions and circumstances. The dilemma or paradox here is that while this relationship is necessary for innovation to occur it contains within it the seeds of its undoing. Increasing political prominence of the activity in question, and the growing demand on public resources to fund it lead to greater public awareness of the policy area; interest among other bureaucratic actors in one's activities and often subsequent competition for policy primacy; bureaucratic expansion to accommodate this increased public and political interest; and given this, the necessity for greater external review of policy developments and expenditures - all of which ultimately kills innovation. One of the best examples of this type of policy development is the federal government's experiments in designing “better” housing for Canadian Eskimo/Inuit peoples between 1953 and 1959. By the use of this case, the paper explores the innovative process in some detail, demonstrating the kind of creativity possible in public bureaucracies and the limits to such innovative activity once politicization of a policy field and bureaucratic growth occurs. Sommaire: Puisque les bureaucraties publiques ont assumé de plus en plus de responsabilités pour satisfaire aux besoins de l'humanité, un complément logique veut qu'elles soient innovatrices et créatives dans l'accomplissement de ces tâches. Même si la documentation relative aux conditions nécessaires pour une conduite innovatrice dans les organismes publics n'est pas très considérable, cet article propose qu'une liste de ces conditions devrait reconnaître que l'innovation a plus de chance de se manifester lorsqu'un gouvernement veut agir pour des raisons symboliques, mais ne sait pas trop comment ou ne se soucie guère des modalités. C'est ce que Ton pourrait appeler une politique de négligence bénigne, mais pour les fins de l'innovation cela laisse à ceux qui mettent en oeuvre les politiques le champ libre pour déveloper des programmes adaptés aux conditions et circonstances locales. Le dilemme ou paradoxe ici est que, même si cette politique est nécessaire pour que se produise une innovation, elle contient en elle les germes de sa perte. La visibilityé politique accrue de l'activité en cause et la pression qu'elle crée pour avoir accés à des resources pubnliques de plus considérables conduisent à une prise de conscience plus grande du public à l'égard de ce secteur de politiques: à un intérêt de la prt d'autres acteurs bureaucratiques pour cette activité et souvent à une concurrence vive a l‘égard du rang qu'elle occupe dans des politiques; à une expansion bureaucratique pour s'adapter aux intérêtes publics et politiques qui se sont accrues; et, par conséquent, au besoin d'un examen éxterné plus elabore des nouvelles politiques et des dépenses qu'elles occasionnent - tout ce qui en fin de compte détruit l'innovation. Les expériences du gouvernement fédéral pour mettre au pour mettre au point un “meilleur” système de logement pour les Exquimaux/Inuit entre 1953 et 1959, représentent l'un des meilleurs exemples de ce genre de développement de politiques. À laide de cet exemple, l'article examine d'une manière assez détaillée le processus innovateur en démontrant le genre de créativité possible dans les bureaucraties politiques et les limites d'une telle activité innovatrice une fois que se produisent la politisation d'un secterur de politiques et la croissance bureaucratique.