Survival models of community tenure and length of hospital stay for the seriously mentally ill : a 10-year perspective

Objective: To examine the effects of personal and community characteristics, specifically race and rurality, on lengths of state psychiatric hospital and community stays using maximum likelihood survival analysis with a special emphasis on change over a ten year period of time. Data Sources: We used the administrative data of the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) from 1982-1991 and the Area Resources File (ARF). Given these two sources, we constructed a history file for each individual who entered the state psychiatric system over the ten year period. Histories included demographic, treatment, and community characteristics. Study Design: We used a longitudinal, population-based design with maximum likelihood estimation of survival models. We presented a random effects model with unobserved heterogeneity that was independent of observed covariates. The key dependent variables were lengths of inpatient stay and subsequent length of community stay. Explanatory variables measured personal, diagnostic, and community characteristics, as well as controls for calendar time. Data Collection: This study used secondary, administrative, and health planning data. Principal Findings: African-American clients leave the community more quickly than whites. After controlling for other characteristics, however, race does not affect hospital length of stay. Rurality does not affect length of community stays once other personal and community characteristics are controlled for. However, people from rural areas have longer hospital stays even after controlling for personal and community characteristics. The effects of time are significantly smaller than expected. Diagnostic composition effects and a decrease in the rate of first inpatient admissions explain part of this reduced impact of time. We also find strong evidence for the existence of unobserved heterogeneity in both types of stays and adjust for this in our final models. Conclusions: Our results show that information on client characteristics available from inpatient stay records is useful in predicting not only the length of inpatient stay but also the length of the subsequent community stay. This information can be used to target increased discharge planning for those at risk of more rapid readmission to inpatient care. Correlation across observed and unobserved factors affecting length of stay has significant effects on the measurement of relationships between individual factors and lengths of stay. Thus, it is important to control for both observed and unobserved factors in estimation.

Managing clients’ expectations at the outset of online Cognitive Behavioural Therapy (CBT) for depression

Background Engaging clients in psychotherapy by managing their expectations is important for therapeutic success. Initial moments in first sessions of therapy are thought to afford an opportunity to establish a shared understanding of how therapy will proceed. However there is little evidence from analysis of actual sessions of therapy to support this. Objective This study utilised recordings to examine how therapists manage clients’ expectations during the first two sessions of online Cognitive Behavioural Therapy (CBT). Methods Expectation management was investigated through conversation analysis of sessions from 176 client-therapist dyads involved in online CBT. The primary focus of analysis was expectation management during the initial moments of first sessions, with a secondary focus on expectations at subsequent points. Analysis Clients’ expectations for therapy were most commonly managed during the initial moments of first sessions of therapy. At this point, most therapists either outlined the tasks of the first and subsequent sessions (n=36), or the first session only (n=108). On other occasions (n = 32), no attempt was made to manage clients’ expectations by outlining what would happen in therapy. Observations of the interactional consequences of such an absence suggest clients may struggle to engage with the therapeutic process in the absence of appropriate expectation management by therapists. Conclusion Clients may more readily engage from the outset of therapy when provided with an explanation that manages their expectation of what is involved. Therapists can accomplish this by projecting how therapy will proceed, particularly beyond the initial session.

A dynamic Web agent for verifying the security and integrity of a Web site's contents

To harness safe operation of Web-based systems in Web environments, we propose an SSPA (Server-based SHA-1 Page-digest Algorithm) to verify the integrity of Web contents before the server issues an HTTP response to a user request. In addition to standard security measures, our Java implementation of the SSPA, which is called the Dynamic Security Surveillance Agent (DSSA), provides further security in terms of content integrity to Web-based systems. Its function is to prevent the display of Web contents that have been altered through the malicious acts of attackers and intruders on client machines. This is to protect the reputation of organisations from cyber-attacks and to ensure the safe operation of Web systems by dynamically monitoring the integrity of a Web site's content on demand. We discuss our findings in terms of the applicability and practicality of the proposed system. We also discuss its time metrics, specifically in relation to its computational overhead at the Web server, as well as the overall latency from the clients' point of view, using different Internet access methods. The SSPA, our DSSA implementation, some experimental results and related work are all discussed

Effect of pupil dilation and constriction on the distribution of bit errors within the iris

Texture information in the iris image is not uniform in discriminatory information content for biometric identity verification. The bits in an iris code obtained from the image differ in their consistency from one sample to another for the same identity. In this work, errors in bit strings are systematically analysed in order to investigate the effect of light-induced and drug-induced pupil dilation and constriction on the consistency of iris texture information. The statistics of bit errors are computed for client and impostor distributions as functions of radius and angle. Under normal conditions, a V-shaped radial trend of decreasing bit errors towards the central region of the iris is obtained for client matching, and it is observed that the distribution of errors as a function of angle is uniform. When iris images are affected by pupil dilation or constriction the radial distribution of bit errors is altered. A decreasing trend from the pupil outwards is observed for constriction, whereas a more uniform trend is observed for dilation. The main increase in bit errors occurs closer to the pupil in both cases.

Aligning off-balance sheet risk, on-balance sheet risk and audit fees: a PLS path modelling analysis

This study focuses on using the partial least squares (PLS) path modelling technique in archival auditing research by replicating the data and research questions from prior bank audit fee studies. PLS path modelling allows for inter-correlations among audit fee determinants by establishing latent constructs and multiple relationship paths in one simultaneous PLS path model. Endogeneity concerns about auditor choice can also be addressed with PLS path modelling. With a sample of US bank holding companies for the period 2003-2009, we examine the associations among on-balance sheet financial risks, off-balance sheet risks and audit fees, and also address the pervasive client size effect, and the effect of the self-selection of auditors. The results endorse the dominating effect of size on audit fees, both directly and indirectly via its impacts on other audit fee determinants. By simultaneously considering the self-selection of auditors, we still find audit fee premiums on Big N auditors, which is the second important factor on audit fee determination. On-balance-sheet financial risk measures in terms of capital adequacy, loan composition, earnings and asset quality performance have positive impacts on audit fees. After allowing for the positive influence of on-balance sheet financial risks and entity size on off-balance sheet risk, the off-balance sheet risk measure, SECRISK, is still positively associated with bank audit fees, both before and after the onset of the financial crisis. The consistent results from this study compared with prior literature provide supporting evidence and enhance confidence on the application of this new research technique in archival accounting studies.

Aligning off-balance sheet risk, on-balance sheet risk and audit fees: a PLS path modelling analysis

This study focuses on using the partial least squares (PLS) path modelling methodology in archival auditing research by replicating the data and research questions from prior bank audit fee studies. PLS path modelling allows for inter-correlations among audit fee determinants by establishing latent constructs and multiple relationship paths in one simultaneous PLS path model. Endogeneity concerns about auditor choice can also be addressed with PLS path modelling. With a sample of US bank holding companies for the period 2003-2009, we examine the associations among on-balance sheet financial risks, off-balance sheet risks and audit fees, and also address the pervasive client size effect, and the effect of the self-selection of auditors. The results endorse the dominating effect of size on audit fees, both directly and indirectly via its impacts on other audit fee determinants. By simultaneously considering the self-selection of auditors, we still find audit fee premiums on Big N auditors, which is the second important factor on audit fee determination. On-balance-sheet financial risk measures in terms of capital adequacy, loan composition, earnings and asset quality performance have positive impacts on audit fees. After allowing for the positive influence of on-balance sheet financial risks and entity size on off-balance sheet risk, the off-balance sheet risk measure, SECRISK, is still positively associated with bank audit fees, both before and after the onset of the financial crisis. The consistent results from this study compared with prior literature provide supporting evidence and enhance confidence on the application of this new research technique in archival accounting studies.

Enterprise systems lifecycle-wide innovation readiness

Enterprise Systems have been touted as a key driver of delivering benefits through innovation in corporate Information Systems. The advent of such systems expects to deliver best practices that improve organizational performance. Yet, most Enterprise System installations struggle to see lifecycle-wide value of it. Considering that Enterprise Systems deliver lifecycle-wide innovation; we observe organizational readiness for lifecycle-wide Enterprise Systems innovation. The A VICTORY apriori model compares contributions of eight constructs for organizational readiness for continuous Enterprise Systems innovation. The model is tested responses of both client and implementation partner. Results indicate that six of the eight constructs of readiness make significant contributions to organizational readiness for Enterprise Systems innovation.

Enterprise system lifecycle-wide innovation - research in progress

Enterprise Systems purport to bring innovation to organizations. Yet, no past studies, neither from innovation nor from ES disciplines have merged their knowledge to understand how ES could facilitate lifecycle-wide innovation. Therefore, this study forms conceptual bridge between the two disciplines. In this research, we seek to understand how ES could facilitate innovation across its lifecycle phases. We associate classifications of innovation such as radical vs. incremental, administrative vs. technical innovation with the three phases of ES lifecycle. We introduce Continuous Restrained Innovation (CRI) as a new type of innovation specific to ES, considering restraints of technology, business processes and organization. Our empirical data collection at the implementation phase, using data from both the client and implementation partner, shows preliminary evidence of CRI. In addition, we state that both parties consider the implementation of ES as a radical innovation yet, are less interest in seeking further innovations through the system.

Social work with marginalised people who have a mild or borderline intellectual disability : practicing gentleness and encouraging hope

People with mild or borderline intellectual disabilities are a group of people who usually do not meet the eligibility criteria for specialist disability services, yet are high users of many generalist services, such as mental health, child protection, and criminal justice systems. They may traverse many services, often entering, exiting, and returning to the same service providers with few positive results. This article explores the practice approach of the Meryton Association, a medium-sized nongovernment agency located in Brisbane, Australia. The Meryton Association provides social work support to people with mild to borderline intellectual disabilities, actively assisting this group to build relationships, resources, knowledge, and autonomy in their everyday lives. Using qualitative in-depth interviews with Meryton Association staff and secondary analysis of Meryton Association policy and practice documents, the challenges and opportunities of using this practice approach have been documented. The article proposes that specialist services are needed that use a developmental approach, stress the importance of relationship, and the need to practice gentleness and hope in social worker-client interaction.

My System of Career Influences MSCI (Adult) Workbook

NOTE: This client booklet is to be used in conjunction with the MSCI (Adult) Facilitators Guide. Career development in the 21st century presents many challenges and opportunities. Throughout your life you will make countless decisions and experience numerous transitions. Each decision may be subject to a range of influences, for example people we know may give us an opinion, we may be attracted to a particular place or a particular salary, or we may simply want a change. No two people will have the same pattern of influences. The My System of Career Influences MSCI (Adult) is a qualitative career assessment reflection process based on recent developments in theory and practice. It uses a constructivist view and encourages a narrative and story-based approach to your career development. It has been used successfully with employees by career development practitioners working in a range of businesses and organisations from large to small and in one-on-one career counselling sessions as well as in a group setting.

Changes to commercial service provision among sex workers from Queensland, Australia

Introduction: The role of commercial sex in facilitating infection transmission is a subject of ongoing empirical enquiry, with little attention to the variety and extent of ‘non-traditional’ commercial services that pose a lesser risk of infection. This study sought to examine the supply and demand of a wide range of traditional and non-traditional commercial sexual services among sex workers and their clients from Queensland, Australia. Methods: Cross-sectional convenience sampling was used to compare female sex workers in 1991 (n=200, aged 16-46 years) and 2003 (n=247, aged 18-57 years) and from male clients in 2003. The client sample comprised 160 male clients aged between 19 and 72 years. Results: Over the comparison period there was a significant increase in the provision of ‘exotic’ or non-traditional sexual services. In 2003, the availability of bondage and discipline, submission, fantasy, use of sex toys, golden showers, fisting and lesbian double acts had increased dramatically, while ‘traditional’ services had mostly remained at similar levels. Moreover, the proportion of sex workers in some industry sectors providing ‘exotic’ commercial services seem to have risen over time. Conclusion: Undoubtedly, the sex industry has professionalised and now includes more sophisticated and specialized suppliers. As with any commercial business, the diversification of services is largely driven with client demand, with the ‘menu’ being generally broader than the majority of client preferences. However, although clients demands for particular commercial sexual services seems to have been met, with regard to anal sex and anal play, supply has failed to meet client demand. Disclosure of Interest Statement: Funding for the 2003 study was provided by the Prostitution Licensing Authority. Acknowledgement and sincere thanks to the men and women who participated in this study.

Women and ADR

Alternative dispute resolution, or ‘ADR’, is defined by the National Alternative Dispute Resolution Advisory Council as: … an umbrella term for processes, other than judicial determination, in which an impartial person assists those in a dispute to resolve the issues between them. ADR is commonly used as an abbreviation for alternative dispute resolution, but can also be used to mean assisted or appropriate dispute resolution. Some also use the term ADR to include approaches that enable parties to prevent or manage their own disputes without outside assistance. A broad range of ADR processes are used in legal practice contexts, including, for example, arbitration, conciliation, mediation, negotiation, conferencing, case appraisal and neutral evaluation. Hybrid processes are also used, such as med-arb in which the practitioner starts by using mediation, and then shifts to using arbitration. ADR processes generally fall into one of three general categories: facilitative, advisory or determinative. In a facilitative process, the ADR practitioner has the role of assisting the parties to reach a mutually agreeable outcome to the dispute by helping them to identify the issues in dispute, and to develop a range of options for resolving the dispute. Mediation and facilitated negotiation are examples of facilitative processes. ADR processes that are advisory involve the practitioner appraising the dispute, providing advice as to the facts of the dispute, the law and then, in some cases, articulating possible or appropriate outcomes and how they might be achieved. Case appraisal and neutral evaluation are examples of advisory processes. In a determinative ADR process, the practitioner evaluates the dispute (which may include the hearing of formal evidence from the parties) and makes a determination. Arbitration is an example of a determinative ADR process. The use of ADR processes has increased significantly in recent years. Indeed, in a range of contemporary legal contexts the use of an ADR process is now required before a party is able to file a matter in court. For example, Juliet Behrens discusses in Chapter 11 of this book how the Family Law Act 1975 (Cth) now effectively mandates attendance at pre-filing family dispute resolution in parenting disputes. At the state level, in Queensland, for example, attendance at a conciliation conference can be required in anti-discrimination matters, and is encouraged in residential tenancy matters, and in personal injuries matters the parties must attend a preliminary compulsory conference. Certain ADR processes are used more commonly in the resolution of particular disputes. For example, in family law contexts, mediation and conciliation are generally used because they provide the parties with flexibility in terms of process and outcome while still ensuring that the negotiations occur in a positive, structured and facilitated framework. In commercial contexts, arbitration and neutral evaluation are often used because they can provide the parties with a determination of the dispute that is factually and legally principled, but which is also private and more timely than if the parties went to court. Women, as legal personalities and citizens of society, can find themselves involved in any sort of legal dispute, and therefore all forms of ADR are relevant to women. Perhaps most commonly, however, women come into contact with facilitative ADR processes. For example, through involvement in family law disputes women will encounter family dispute resolution processes, such as mediation. In this chapter, therefore, the focus is on facilitative ADR processes and, particularly, issues for women in terms of their participation in such processes. The aim of this chapter is to provide legal practitioners with an understanding of issues for women in ADR to inform your approach to representing women clients in such processes, and to guide you in preparing women clients for their participation in ADR. The chapter begins with a consideration of the ways in which facilitative ADR processes are positive for women participants. Next, some of the disadvantages for women in ADR are explored. Finally, the chapter offers ways in which legal practitioners can effectively prepare women clients for participation in ADR. Before embarking on a discussion of issues for women in ADR, it is important to acknowledge that women’s experiences in these dispute resolution environments, whilst often sharing commonalities, are diverse and informed by a range of factors specific to each individual woman; for example, her race or socio-economic background. This discussion, therefore, addresses some common issues for women in ADR that are fundamentally gender based. It must be noted, however, that providing advice to women clients about participating in ADR processes requires legal practitioners to have a very good understanding of the client as an individual, and her particular needs and interests. Some sources of diversity are discussed in Chapters 13, 14 and 15.

Contradictions and the Appropriation of ERP Packages

Enterprise Resource Planning (ERP) software typically takes the form of a package that is licensed for use to those in a client organisation and is sold as being able to automate a wide range of processes within organisations. ERP packages have become an important feature of information and communications technology (ICT) infrastructures in organizations. However, a number of highly publicised failures have been associated with the ERP packages too. For example: Hershey, Aero Group and Snap-On have blamed the implementation of ERP packages for negative impacts upon earnings (Scott and Vessey 2000); Cadbury Schweppes implemented plans to fulfil 250 orders where normally they would fulfil 1000 due to the increased complexity and the need to re-train staff post implementation (August 1999) and FoxMeyer drug company’s implementation of an ERP package has been argued to have lead to bankruptcy proceedings resulting in litigation against SAP, the software vendor in question (Bicknell 1998). Some have even rejected a single vendor approach outright (Light et. al. 2001). ERP packages appear to work for some and not for others, they contain contradictions. Indeed, if we start from the position that technologies do not provide their own explanation, then we have to consider the direction of a technological trajectory and why it moves in one way rather than another (Bijker and Law 1994). In other words, ERP appropriation cannot be predetermined as a success, despite the persuasive attempts of vendors via their websites and other marketing channels. Moreover, just because ERP exists, we cannot presume that all will appropriate it in the same fashion, if at all. There is more to the diffusion of innovations than stages of adoption and a simple demarcation between adoption and rejection. The processes that are enacted in appropriation need to be conceptualised as a site of struggle, political and imbued with power (Hislop et. al. 2000; Howcroft and Light, 2006). ERP appropriation and rejection can therefore be seen as a paradoxical phenomenon. In this paper we examine these contradictions as a way to shed light on the presence and role of inconsistencies in ERP appropriation and rejection. We argue that much of the reasoning associated with ERP adoption is pro-innovation biased and that deterministic models of the diffusion of innovations such as Rogers (2003), do not adequately take account of contradictions in the process. Our argument is that a better theoretical understanding of these contradictions is necessary to underpin research and practice in this area. In the next section, we introduce our view of appropriation. Following this is an outline of the idea of contradiction, and the strategies employed to ‘cope’ with this. Then, we introduce a number of reasons for ERP adoption and identify their inherent contradictions using these perspectives. From this discussion, we draw a framework, which illustrates how the interpretive flexibility of reasons to adopt ERP packages leads to contradictions which fuel the enactment of appropriation and rejection.

Secure modular password authentication for the web using channel bindings

Secure protocols for password-based user authentication are well-studied in the cryptographic literature but have failed to see wide-spread adoption on the Internet; most proposals to date require extensive modifications to the Transport Layer Security (TLS) protocol, making deployment challenging. Recently, a few modular designs have been proposed in which a cryptographically secure password-based mutual authentication protocol is run inside a confidential (but not necessarily authenticated) channel such as TLS; the password protocol is bound to the established channel to prevent active attacks. Such protocols are useful in practice for a variety of reasons: security no longer relies on users' ability to validate server certificates and can potentially be implemented with no modifications to the secure channel protocol library. We provide a systematic study of such authentication protocols. Building on recent advances in modelling TLS, we give a formal definition of the intended security goal, which we call password-authenticated and confidential channel establishment (PACCE). We show generically that combining a secure channel protocol, such as TLS, with a password authentication protocol, where the two protocols are bound together using either the transcript of the secure channel's handshake or the server's certificate, results in a secure PACCE protocol. Our prototype based on TLS is available as a cross-platform client-side Firefox browser extension and a server-side web application which can easily be installed on deployed web browsers and servers.

The role of counselling in healing from sexual assault in childhood from the phenomenological perspective of men and women

Serious Childhood Sexual Assault (CSA) has the potential for a wide range of extreme difficulties, not only in childhood but for many years to come. However, the lasting negative impacts are not inevitable and with the right help, those who have experienced CSA can go on to enjoy whole and fulfilling lives. The question posed in this research is “What comprises “the right help”? The present study qualitatively investigated the narratives of men and women with regard to what was deemed important components of counselling which facilitated their healing from childhood sexual assault. Participants consisted of 21 women and 11 men who had sought both individual and group counselling to work through issues stemming from traumatic sexual assault in childhood. Findings presented here describe three superordinate themes which were essential in the healing process, incorporating abuse-specific, client-specific and practitioner-specific components. A final superordinate theme of negative experiences in counselling is also presented, describing unhelpful or negative counselling experiences. Similarities between men and women as to the important components of counselling was remarkable, however important gender differences were also observed.