Industrial rationalization of a cottage industry: multi-institutional hospital systems

The environment facing hospitals, generally supportive until the 1970s, may now be characterized as complex, turbulent, and constrained. In response to such environmental conditions, hospitals have adopted new strategies and structures. The strategies, described as corporate rationalization, have led away from the traditional structure of freestanding, autonomous hospitals and toward the formation of multi-institutional systems. These systems are designed to provide sufficient strength to cope with the environment, to acquire scarce and valued resources, to allow organizational stability, to achieve organizational purpose, to enable growth and/or survival, and to enhance market position. The impact of multi-hospital systems is viewed in two major areas: acquisition, retention, and utilization of economic and human resources, and organizational, political, and social factors.     

Two Decades of Change: A Ranking of Key Issues Affecting Intergovernmental Relations

This article describes the results of a 1981 survey of 1,000randomly selected scholars of American government and politicswho were asked to rank the most significant intergovernmentalevents and trends of the past twenty years. Responses were receivedfrom almost 40 percent of these scholars; no significant returnbiases were detected. These scholars ranked civil rights andvoting rights acts as the most significant events of these decades.General Revenue Sharing and the reapportionment cases were rankedsecond and third in importance. The increased flow of federaldollars to states and local governments was ranked the mostimportant trend affecting intergovernmental relations, followedby the increased public disaffection with government and thegrowing dependence of local governments on state and federalaid. The Vietnam War and the inflationary spiral it initiatedwas ranked as the most significant social event affecting thecourse of intergovernmental relations, followed closely by theenergy crisis and the beginnings of the "Great Society." Thearticle also examines the effects of party identification, age,year of degree, government experience, region, and city sizeon scholarly attitudes toward these events and trends. Whilethe overall rankings were not dramatically altered, partisanship,region, and city size all were factors found to be noticeablyrelated to scholarly rankings of these important events andtrends.     

B. Reviews: general

A HISTORY OF THE ARAB PEOPLES. By ALBERT HOURANI. London, Faber and Faber, 1991. xviii, 551pp. £25 (hb).

STUDIES IN ARAB HISTORY. Edited by DEREK HOPWOOD. (St.Antony's/Macmillan series.) London, Macmillan, 1990. 189pp. 5 plates and 3 figures.

A HISTORY OF THE SELJUKS: ?BRAHIM KAFESOGLU'S INTERPRETATION AND THE RESULTING CONTROVERSY. Translated and edited By GARY LEISER. Carbondale and Edwardsville, Southern Illinois University Press, 1988. 208pp. Genealogical charts, maps in end covers. $29.95.

THE HISTORY OF THE JEWS IN THE LATIN KINGDOM OF JERUSALEM. By JOSHUA PRAWER. Oxford, Clarendon Press, 1988. xv, 310pp. 5 maps.

ARAB HISTORY AND THE NATION STATE: A STUDY IN MODERN ARAB HISTORIOGRAPHY 1820–1980. By YOUSSEF M. CHOUEIRI. (Exeter Arabic and Islamic Series.) London & New York, Routledge, 1989. xix, 238pp. £35.00

THE END OF EMPIRE IN THE MIDDLE EAST: BRITAIN'S RELINQUISHMENT OF POWER IN HER LAST THREE ARAB DEPENDENCIES. By GLEN BALFOUR‐PAUL. Cambridge, Cambridge University Press, 1991. xxiv, 278pp. £30.00.

THE LETTERS OF T.E. LAWRENCE. Edited by MALCOLM BROWN. Oxford, Oxford University Press, 1991. xi, 564pp. £8.95 (pb).

A PRINCE OF OUR DISORDER: THE LIFE OF T.E. LAWRENCE. By JOHN H. MACK. Oxford, Oxford University Press, 1990. xxvi, 561pp. £9.95 (pb).

UN GRAND RABBIN SEPHARADE EN POLITIQUE 1892–1923. Presented and edited by ESTHER BENBASSA. Mesnil‐sur‐l'Estrée, CNRS, 1990. 263pp.

THE SUPREME MUSLIM COUNCIL: ISLAM UNDER THE BRITISH MANDATE FOR PALESTINE. By URI M. KUPFERSCHMIDT. Leiden, Brill, 1987.

AFTER THE EAGLES LANDED: THE YEMENITES OF ISRAEL. By HERBERT S. LEWIS. Boulder, Westview Press, 1989. xix, 277pp., photographs, glossary.

LAND BEFORE HONOUR: PALESTINIAN WOMEN IN THE OCCUPIED TERRITORIES. By KITTY WARNOCK. (Women in Society: A Feminist List.) London, Macmillan Educational Press, 1990. 199pp.

PEASANT POLITICS IN MODERN EGYPT: THE STRUGGLE AGAINST THE STATE. By NATHAN BROWN. New Haven and London, Yale University Press, 1990. 280pp. 2 maps. £25.00.

SOCIETY AND STATE IN THE GULF AND ARAB PENINSULA. By KHALDOUN HASAN AL‐NAQEEB. London and New York, Routledge, 1990. xvii, 206 pp. £35

THE TURBULENT GULF. By LIESL GRAZ. London, I.B. Tauris, 1990. xi, 312pp. £17.95.

IRAN: THE KHOMEINI REVOLUTION (COUNTRIES IN CRISIS). Edited by MARTIN WRIGHT. Contributors: Nick Danziger, Martin Howe, Baqer Moin, Reza Navabpour, Sir Anthony Parsons, Vahe Petrossian, Amit Roy and Martin Wright. London, Longman, 1989. 128pp. Maps, ills. £6.95.

ISRAEL AND THE PALESTINIANS (COUNTRIES IN CRISIS). Edited by MARTIN WRIGHT. Contributors: Paul Cossali, Roger Hardy, Lawrence Joffe, Noah Lucas, David McDowall, Elfi Pallis, Martin Wright. London, Longman, 1989. 131pp. Maps, ills. £6.95.

MAJOR POLITICAL EVENTS IN IRAN, IRAQ AND THE ARABIAN PENINSULA 1945–1990. By TREVOR MOSTYN. New York & London, Facts on File, 1991. xii, 308pp. £14.95.

WOMEN AT WORK IN THE GULF: A CASE STUDY OF BAHRAIN. By MUNIRA A. FAKHRO. London, Kegan Paul International. 184pp. £45.00

THE POLITICAL ECONOMY OF TURKEY: DEBT, ADJUSTMENT AND SUSTAINABILITY. Edited by TOSUN ARICANLI and DANI RODRIK. Basingstoke, Macmillan, 1990. 275pp. £40 (hb).

AFGHANISTAN: A COUNTRY LAW STUDY. By GHOLAM H. VAFAI. Washington, Library of Congress, 1988. 63pp.

RESISTANCE AND CONTROL IN PAKISTAN. By AKBAR S. AHMED. London & New York, Routledge, 1991. xxiii, 207pp. £12.99 (pb).

MASTERING ARABIC: By JANE WIGHTWICK and MAHMOUD GAAFAR. (Macmillan Master Series.) London, Macmillan, 1990. 370pp.

FROM CODE‐SWITCHING TO BORROWING: A CASE STUDY OF MOROCCAN ARABIC. By JEFFREY HEATH. (Library of Arabic Linguistics, monograph 9.) London, Kegan Paul International, 1990. 328pp.

ARISTOTELIAN LOGIC AND THE ARABIC LANGUAGE IN ALFARABI. By SHUKRI B. ABED. Albany, State University of New York Press, 1991. xxv, 201pp.

OGHUSICA AUS IRAN. By GERHARD DOERFER, WOLFRAM HESCHE, JAMSHID RAVANYAR. Wiesbaden, Harrassowitz, 1990. ix, 146pp. DM 56.‐

ABBASID BELLES LETTRES. Edited by Julia Ashtiany, T.M. Johnstone, J.D. Latham, R.B. Serjeant and G. Rex Smith. (The Cambridge History of Arabic Literature, Vol.II, 1.) Cambridge, Cambridge University Press, 1990. xiii, 517pp.

PENSEE MYTHIQUE, IDEOLOGIE ET ASPIRATIONS SOCIALES DANS UN CONTE DES MILLE ET UNE NUITS. By PATRICE COUSSONNET. (Supplément aux Annales Islamologiques—Cahier no. 13). Cairo, Institut français d'archéologie orientale, 1989. 67 pp. 6 plates.

THE MEADOWS OF GOLD: THE ABBASIDS. By MAS'UDI. Tr. and ed. by PAUL LUNDE and CAROLINE STONE. London and New York, Kegan Paul International, 1989. x, 469pp. £30.00

POESlA ESTRÓFICA (CEJELES Y/O MUWA??AHAT) ATRIBUIDA AL MlSTICO GRANADINO A?‐?u?TARI (SIGLO XIII d.C.).(Preedición, traducción, estudio e índices.) By F. CORRIENTE. Madrid, CSIC, Instituto de Filología, Departamento de Estudios Árabes, 1988. [6], 379pp.

ISLAM, THE STRAIGHT PATH. By JOHN L. ESPOSITO. Oxford University Press, 1988. viii, 230pp. £6.95.

TRADITIONAL ISLAM IN THE MODERN WORLD. By SEYYED HOSSEIN NASR. London, KPI, 1987. x, 335pp.

IN A CALIPH'S KITCHEN: MEDIAEVAL ARABIC COOKING FOR THE MODERN GOURMET. By DAVID WAINES. London, Riad el‐Rayyes Books, 1989. 119pp. 44 colour plates. £14.00.     

Slim just left town: decisionmaking on an intensive care unit

The title of this paper comes from an incident that occurred while I was participating in morning rounds on the pediatric and surgical intensive care unit of a large, midwest tertiary care center. The patient under discussion was an eight-week-old girl who had been born without kidneys, and who had been cared for on the unit for seven weeks. In the previous week, the baby's condition had gone steadily downhill, as she experienced on medical catastrophe after another. One of the nurses asked the staff doctor who was leading rounds that morning, "What are the baby's chances?" The physician replied, "Her chances are slim." To which one of the young residents immediately answered, "Slim just left town."     

Social science and the Courts

Social scientists have increasingly become involved in the submission of amicus curiae or friend of the court briefs in legal cases being decided by state and federal courts. This increase has triggered considerable debate about the use of briefs to communicate relevant social science research. This article evaluates the strengths and weaknesses of various methods of summarizing social science research for the courts. It also reviews the procedures for submitting briefs developed by the American Psychology-Law Society which, in collaboration with the American Psychological Association, has submitted its first brief inMaryland v. Craig, a case recently decided by the U.S. Supreme Court.The authors wish to thank James Ogloff, Kathy Roesch, and Claudia Worrell for their comments on an earlier draft