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PubMed2002

Adolescent accounts of the UK National Lottery and scratchcards: an analysis using Q-sorts.

The study examined adolescents' accounts of the UK National Lottery and scratchcards. Q-sorts were used to examine the views of 62 participants aged between 11 and 15 years of age. Findings identified four distinct accounts in relation to the National Lottery (Moral Opposition, Luck Seeking, Rationalist, & Uncertainty), and four distinct accounts in relation to scratchcards (Scepticism, Thrill-Seeking, Rationalist, & Libertarian). Some of the accounts identified described the UK National Lottery and scratchcards as bona fide forms of gambling. Reports indicated that adolescents were pessimistic about the chances of winning large sums of money, while other accounts demonstrated gambling misperceptions particularly in relation to their belief in luck and the laws of probability. It is argued that to fully understand why adolescents take part in these activities it is important to consider the diverse ways that adolescents represent these activities. These differing representations will have consequences for measures aimed at reducing, preventing, or treating adolescent problem gambling. The utility of Q-sorts as a technique for examining the views of problem and non-problem gamblers is also discussed.

Adolescent↗
PubMed1997

Three accounts of the grammatical morpheme difficulties of English-speaking children with specific language impairment.

Several hypotheses have been offered to explain the grammatical morpheme difficulties observed in the speech of children with specific language impairment. Three of the accounts that could be evaluated in English were the focus of this study: the extended optional infinitive account, the implicit rule deficit account, and the surface account. Preschoolers with specific language impairment, a group of age controls, and a group of younger children matched for mean length of utterance were evaluated in their use of several theory-relevant grammatical morphemes. The findings revealed advantages for both the surface and extended optional infinitive hypotheses. In contrast, a test of the predictions based on the implicit rule deficit account suggested that the children studied here were not experiencing a deficit of this type.

Child, Preschool↗
PubMed1999

Altschul's legacy in mediating British and American psychiatric nursing discourses: common sense and the 'absence' of the accountable practitioner.

This paper contributes to an archaeology of knowledge in the field of psychiatric and mental health nursing. It focuses on a principal concern of contributors to literature on British psychiatric nursing: the problem of defining psychiatric nursing. Early British writers describing psychiatric nursing accomplished the 'presence' of psychiatric nursing as a discursive object, by discursively constructing the 'absence' of the psychiatric nurse doing, and being accountable for, 'appropriate' work. Altschul's (1972) Patient-nurse Interaction was the key text in this tradition, mediating British and American discourses, setting the methodological and substantive agenda for an important body of subsequent British psychiatric nursing research. The paper examines a number of topics in the American and British discourses mediated by Altschul: the privileging of nurses' presence and language in communication with patients; lay versus professional knowledge, and interaction as gossip; 'common sense' as a topic; common sense as different from 'identifiable perspective'; the problem of accountability and the hierarchy of credibility; accountability, the 'absent' nurse, and issues of method. Altschul's later work keeps in tension two potentially conflicting claims--on the one hand, that the practice of psychiatric nursing depends on the 'kind of person' the nurse is, and on the other, that specialist discourses have priority in determining the basis for practice. Altschul played a crucial role in establishing the role of research in British psychiatric nursing discipline: locating the accountable individual practitioner, and devising remedies for 'absence'. In doing so, she anticipated current discourses on nurses' accountability, particularly their inability to demonstrate 'evidence' of their 'effectiveness'.

History, 20th Century↗
PubMed2003

Directional harmonic theory: a computational Gestalt model to account for illusory contour and vertex formation.

Visual illusions and perceptual grouping phenomena offer an invaluable tool for probing the computational mechanism of low-level visual processing. Some illusions, like the Kanizsa figure, reveal illusory contours that form edges collinear with the inducing stimulus. This kind of illusory contour has been modeled by neural network models by way of cells equipped with elongated spatial receptive fields designed to detect and complete the collinear alignment. There are, however, other illusory groupings which are not so easy to account for in neural network terms. The Ehrenstein illusion exhibits an illusory contour that forms a contour orthogonal to the stimulus instead of collinear with it. Other perceptual grouping effects reveal illusory contours that exhibit a sharp corner or vertex, and still others take the form of vertices defined by the intersection of three, four, or more illusory contours that meet at a point. A direct extension of the collinear completion models to account for these phenomena tends towards a combinatorial explosion, because it would suggest cells with specialized receptive fields configured to perform each of those completion types, each of which would have to be replicated at every location and every orientation across the visual field. These phenomena therefore challenge the adequacy of the neural network approach to account for these diverse perceptual phenomena. I have proposed elsewhere an alternative paradigm of neurocomputation in the harmonic resonance theory (Lehar 1999, see website), whereby pattern recognition and completion are performed by spatial standing waves across the neural substrate. The standing waves perform a computational function analogous to that of the spatial receptive fields of the neural network approach, except that, unlike that paradigm, a single resonance mechanism performs a function equivalent to a whole array of spatial receptive fields of different spatial configurations and of different orientations, and thereby avoids the combinatorial explosion inherent in the older paradigm. The present paper presents the directional harmonic model, a more specific development of the harmonic resonance theory, designed to account for specific perceptual grouping phenomena. Computer simulations of the directional harmonic model show that it can account for collinear contours as observed in the Kanizsa figure, orthogonal contours as seen in the Ehrenstein illusion, and a number of illusory vertex percepts composed of two, three, or more illusory contours that meet in a variety of configurations.

Brain↗
PubMed1989

The effect of applicant age, job level, and accountability on perceptions of female job applicants.

We used simulated videotaped employment interviews to assess the effect of accountability on impressions of female job applicants. One hundred and twenty American undergraduates majoring in business and personnel related areas were informed that they would be participating in the pilot testing of a new employee placement technique. The age of the job applicant (25, 40, or 55 years), the position for which they were being considered (assistant director or director), and the degree to which subjects were made to feel accountable for their impressions of the applicant (low or high accountability) were manipulated, resulting in a 3 x 2 x 2 between-subjects design. The predicted interaction between accountability and applicant age applicant age was found on age-related adjective checklist items. Increasing the subjects' accountability produced more stereotypical impressions of all applicants, along with a tendency to attribute the applicant's behavior to dispositional factors.

Adult↗
PubMed1996

Dimensions of accountability for not-for-profit hospitals and health systems.

This article examines four dimensions of accountability as they apply to not-for-profit hospitals and health systems: political accountability, particularly relating to the retention of tax-exempt status; commercial accountability associated with the nonprofit hospital's role of selling low cost and high value health services to a variety of commercial payers; community accountability in terms of addressing community health and other social needs, and clinical/patient accountability in terms of access and quality outcomes.

Community-Institutional Relations↗
PubMed2006

Do prevailing societal models influence reports of near-death experiences?: a comparison of accounts reported before and after 1975.

Transcendental near-death experiences show some cross-cultural variation that suggests they may be influenced by societal beliefs. The prevailing Western model of near-death experiences was defined by Moody's description of the phenomenon in 1975. To explore the influence of this cultural model, we compared near-death experience accounts collected before and after 1975. We compared the frequency of 15 phenomenological features Moody defined as characteristic of near-death experiences in 24 accounts collected before 1975 and in 24 more recent accounts matched on relevant demographic and situational variables. Near-death experience accounts collected after 1975 differed from those collected earlier only in increased frequency of tunnel phenomena, which other research has suggested may not be integral to the experience, and not in any of the remaining 14 features defined by Moody as characteristic of near-death experiences. These data challenge the hypothesis that near-death experience accounts are substantially influenced by prevailing cultural models.

Adult↗
PubMed1979

Accountability in health care: an essay on mechanisms, muddles, and mires.

This paper presents a critical evaluation of several theories of accountability and their applicability to health care concerns. The authors first provide a preliminary refinement of the imprecise concept of accountability itself and then examine four major types (political; bureaucratic; professional; and economic-consumer). Then, by using disciplinary perspectives provided by several schools of thought in political science (legislative supremacy; general manager theory; government by bureaucracy; objective responsibility; citizen participation), they discuss the degree of accountability presently found in various American health policies. After identifying the inherent dilemmmas within any credible accountability approach to health care programs as now utilized in the United States, the authors recommend that all types of accountability be integrated and strengthened by relying more explicitly on practices characteristic of development administration.

Delivery of Health Care↗
PubMed2006

The Alberta Bone and Joint Health Institute: creating sustainable accountability through collaboration, relevant measurement and timely feedback.

A robust accountability strategy is at the core of creating a safe, efficient, effective and sustainable system of healthcare. The commitment to be accountable must extend far beyond the providers of care to include every person involved in the funding, administration, delivery and support of patient care (both directly and indirectly). The Alberta Bone and Joint Health Institute has fostered a new system that will measure, analyze and give valuable feedback to all stakeholders in all three essential domains of system accountability: access, quality and cost. The Institute has employed four key strategies to create system accountability in a hip and knee pilot project: collaboration between stakeholders in defining goals and measures that matter to them; the use of "world's best evidence" to drive decisions and to establish goals and benchmarks to measure against; collection of useful data and its analysis to inform improvement decisions; and timely feedback of relevant data in domains of interest to stakeholders on system outputs in the key domains. While these strategies have not yet been proven to be effective in creating the desired "culture of accountability," they are having a significant clinical impact and do have potential to lead to that outcome.

Alberta↗
PubMed2004

Effects of objective and subjective account components on forgiving.

The authors explored the effects of the components of a harm-doer's account of her transgression on the victims' emotional reactions to the transgression and to the character traits that she attributes to the harm-doer. Participants were 480 people whom the authors asked to imagine an incident in which they were harmed by the careless behavior of a friend. Subsequently, the authors offered participants an account of the harm-doer. In a 2 x 2 x 2 x 2 x 2 between-subjects design, the authors manipulated 5 account components: Admitting Fault, Admitting Damage, Expressing Remorse, Asking for Pardon, and Offering Compensation. The authors measured the participants' perceptions of these components. Results indicated that (a) the subjective perception of account components occurs schematically so that components are implicitly perceived without being objectively present, (b) objective components affect victims' reactions via subjective perceptions of these components, (c) personality factors (Irreconcilability, Interpersonal Trust, and Trait Anger) affect victims' reactions directly. Finally, certain configurations of account components are more effective than others. Specifically, asking for pardon had an effect on forgiving only when it was combined with an acknowledgment of the damage and a compensation offer. This result suggests that in this situation, the victim perceives a harm-doer's asking for pardon without the other components as an insincere apology.

Adolescent↗
PubMed1998

Accountability and competence: occupational therapy practitioner perceptions.

OBJECTIVE: Occupational therapy practitioners must meet ever-increasing accountability demands in all service delivery environments. Accountability is made possible through the ongoing development of continued competence throughout a practitioner's career. Behaviors that demonstrate accountability and reflect competence include commitment, leadership, and professional knowledge. This article discusses issues related to accountability and competence, presents findings from focus group discussions with occupational therapy practitioners regarding professional competence, and identifies actions that will bring about greater understanding of this topic. METHOD: Thirty-nine randomly selected occupational therapy practitioners attended one of two focus groups. Participants responded to a structured discussion guide, including questions addressing the definition, process for sustaining, and outcomes of continued competence. RESULTS: Several themes emerged from these discussions. Views about what constitutes and contributes to continued competence in occupational therapy were diverse, and perceptions of occupational therapy "practice" were broad. Participants believed that the "outcomes" of a practitioner's continued competence were best defined as autonomy in executing the occupational therapy process. CONCLUSIONS: Findings offer potential language to articulate competence in occupational therapy and facilitate a discipline-wide conversation. The findings likewise challenge practitioners to assume new professional behaviors that require both personal and interpersonal skills. Such behaviors are critical to demonstrating accountability and competence.

Attitude of Health Personnel↗
PubMedDate not supplied

Accountability, trust and informed consent in medical practice and research.

During the last 25 years public policy in the UK has aimed to replace 'club' cultures and their supposedly suspect reliance on trust between professionals and public with a new public culture based on accountability and 'transparency'. These transformations have changed both clinical practice and public health policy in deep ways. Are the new conceptions of accountability adequate? Are obligations to be 'transparent' any more than requirements to disclose information which overlook the need for genuine communication? Can demands for ever fuller informed consent improve accountability to individual patients and research subjects? Could we devise more intelligent conceptions of accountability that support more intelligent placing and refusal of trust? What might intelligent conceptions of accountability suggest about proper clinical practice, public health medicine and professional responsibilities?

Biomedical Research↗
PubMed1991

Patient account managers' role comes into focus.

As hospitals begin to see their accounts receivable as a sleeping giant, the role of patient accounts managers may increase in importance. A 1991 survey of patient accounts managers reveals a 25 percent average salary increase over the 1988 figure. The responsibilities of patient accounts managers have remained much the same, with increased emphasis on the basics: receivables management, billing, and collection. A majority of patient accounts managers aspire to higher positions within healthcare finance and management. Most aspirants are well qualified in terms of education but may require professional certification before advancing.

Certification↗
PubMedDate not supplied

Making the health care delivery system accountable.

Accountability has become the fact of life for the health care provider and the delivery system. Until recently, accountability has been viewed primarily through the judicial process as issues of fraud and liability, or by managed care entities through evaluation of the financial bottom line. It is this second consideration and its ramifications that will be explored in this article. Appropriate measurement tools are needed to evaluate services, delivery, performance, customer satisfaction, and outcomes assessment. Measurement tools will be considered in light of the industry's unique considerations and realities. All participants, including insurers, employers, management, and health care providers and recipients, bear responsibilities which necessitate assessment and analysis. However, until the basic question, "Who is the customer?" is resolved, accountability issues remain complex and obscured. Accountability costs and impacts must be evaluated over time. They go way beyond bottom line cost containment and reduction. Accountability will be accomplished when the health care industry implements quality and measurement concepts that yield the highest levels of validity and appropriateness for health care delivery.

Aged↗
PubMed2000

Participation in voluntary individual savings accounts: an analysis of IRAs, 401(k)s, and the TSP.

New voluntary individual savings accounts have been proposed by some as a part of, or in addition to, Social Security. The success of these proposals would depend greatly on how many workers participate. This paper compares participation rates in three existing voluntary individual account-type plans--Individual Retirement Accounts (IRAs), 401(k)s, and the federal Thrift Savings Plan (TSP)--to clarify expectations about who might participate in a voluntary individual account system. It finds that participants in IRAs, 401(k)s, and the TSP tend to be disproportionately male, higher earners, older, full-time workers, and either white or nonblack minorities compared with the population at large. Differences in earnings explain much of the difference between participation rates of men and women, however, but less of the difference between participation rates of workers of different races. Whether participation in a new system of voluntary individual accounts would resemble participation in IRAs, 401(k)s, or the TSP would depend on a number of factors. For instance, the population covered by 401(k)s and the TSP is much smaller than that covered by Social Security. Average earnings are also higher among 401(k) and TSP participants than for workers covered by Social Security, which, based on these findings, suggests that participation rates could be lower in a universal system. Participation would also depend on many other factors, however, such as the extent of matching contributions or other financial incentives, the investment options available, and the amount of education provided to potential participants.

Black or African American↗
PubMed2002

Viability of the health protection account in Hong Kong.

OBJECTIVE: To evaluate the viability of the Health Protection Account proposed by the Hong Kong Special Administrative Region Government. DESIGN: Retrospective study. SETTING: The Hospital Authority of Hong Kong. MATERIALS AND METHODS: Data were obtained from hospital and specialist out-patient clinic admissions. The expected health cost for each patient from the age of 65 years to the average age of life expectancy (83 years) was estimated, as was the contribution to these health costs from the Health Protection Account. RESULTS: If individuals contribute 1% of their salary to the Health Protection Account from age 40 to 65 years, the Account can only cover 4% of the actual health costs. CONCLUSION: The Health Protection Account, as proposed, does not ease the financial burden of increasing health care costs in the elderly. Increasing the contribution rate or reducing the age at which contributions to the scheme are started are possible viable options for making the scheme sustainable. However, the current economic situation is such that the public would not favour either of these alternatives. It is envisaged that the Government will need to continue to finance the health care of its citizens by taxation. A gradual increase in user charges might be the only future option for controlling government health expenditure.

Adult↗
PubMed1996

Can medical savings accounts for the nonelderly reduce health care costs?

OBJECTIVE: To understand how medical savings account (MSA) legislation for the nonelderly would affect health care costs. DESIGN: Economic policy evaluation based on the RAND Health Expenditures Simulation Model. SETTING: National probability sample of nonelderly noninstitutionalized households. PARTICIPANTS: Persons in 23 157 sampled households from the 1993 Current Population Survey. INTERVENTIONS: Medical savings account legislation would allow all Americans who are covered only by a catastrophic health care plan to set up a tax-exempt account that they can use to pay medical bills not covered by their health insurance. The interventions we evaluate differ in the deductibles of the catastrophic plan and in whether the employee or employer funds the MSA. MAIN OUTCOME MEASURES: Changes in national health expenditures and net societal benefits of health care. RESULTS: If all insured nonelderly Americans switched to MSAs, their health care expenditures would decline by between 0% and 13%, depending on how the MSAs are designed. However, not all nonelderly Americans would choose MSAs; taking into account selection patterns, health spending would change by + 1% to -2%. CONCLUSIONS: Medical savings account legislation would have little impact on health care costs of Americans with employer-provided insurance. However, depending on the size of the catastrophic limit, waste from the excessive use of generously insured care could be reduced, and MSAs would be attractive to both sick and healthy people.

Cost Sharing↗
PubMed1976

Perspectives on accountability in mental health and retardation services.

Public mental health and mental retardation agencies are under increasing pressure to demonstrate their accountability in fiscal, legal, program, and other areas. The author discusses some of the problems and issures in pinpointing accountability and identifies eight areas of accountability--to patients, to program and management staff, to a chief executive, to a legislative body, to the public, to one's profession, and to one's self. He describes ways in which accountability can be demonstrated and emphasizes that, for mental health professionals, the overriding issue in accountability must be the provision of high-quality care and treatment for the mentally ill and mentally retarded.

Behavior Therapy↗