Baptist Hospital and the State of North Carolina: Alleged Malfeasance and Whistleblowing Aftermath

Do you know what choices you would make if faced with an ethical dilemma? This fact-based case includes situations and issues that a real citizen considered when faced with the knowledge that his employer may have been overbilling the state of North Carolina for health care. Professionals, especially those in accounting and finance positions, are likely to face serious dilemmas in the course of their careers. These situations may require them to choose between honoring a confidentiality clause in an employment contract and acting according to ethical and professional values. This case provides facts gathered from an actual case in which an individual faced this particular challenge. By working through the case, students should develop an appreciation of the pressures and personal ethical challenges they are likely to face in the workplace. By engaging in discussion and role play, students will be more likely to recognize these issues when they occur, and will have already developed critical thinking skills to help them develop a plan of action.

Swiss Alps Jungfrau Aletsch UNESCO World Heritage Site - The state of this World Heritage region as a starting point for regional monitoring

The UNESCO listing as World Heritage Site confirms the outstanding qualities of the high-mountain region around the Great Aletsch Glacier. The region of the World Heritage Site now faces the responsibility to make these qualities visible and to preserve them for future generations. Consequently the qualities of the site must not be regarded in isolation but in the context of the entire region with its dynamics and developments. Regional monitoring is the observation and evaluation of temporal changes in target variables. It is thus an obligation towards UNESCO, who demands regular reports about the state of the listed World Heritage assets. It also allows statements about sustainable regional development and can be the basis for early recognition of threats to the outstanding qualities. Monitoring programmes face three major challenges: first, great care must be taken in defining the target qualities to be monitored or the monitoring would remain vague. Secondly, the selection of ideal indicators to describe these qualities is impeded by inadequate data quality and availability, compromises are inevitable. Thirdly, there is always an element of insecurity in the interpretation of the results as to what influences and determines the changes in the target qualities. The first survey of the monitoring programme confirmed the exceptional qualities of the region and also highlighted problematic issues.

Use of a State-Level Pharmaceutical Assistance Program Among Urban and Rural Elders

A number of state-level pharmaceutical assistance programs have been established as a result of the growing recognition of the role of pharmaceuticals in the long-term care of the elderly. However, existing research does not provide a coherent expectation for patterns of use by rural and urban elderly. The data for this analysis are drawn from a larger study of the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE). PACE provides prescription medicines for elderly who meet income requirements. The research project was designed to assess the characteristics of PACE program participants and non-participants on a wide range of issues. Chi-square analysis and regression models were used to assess the association between rural and urban residence and access to the PACE Program. The results indicate that rural/urban status of the elderly is not a significant predictor of the use of PACE. Other traditional variables (e.g., health self-rating and physician visits) did predict difference in the pattern of use.

State-Level Pharmaceutical Assistance Programs for the Elderly: A national survey.

In order to put Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) Program in a national context, a nationwide mail survey and telephone follow-up to each of the 58 State Unit Directors on Aging in the United States and its territories identified 10 programs. The results reported in this article are specific to the seven state-level pharmaceutical assistance programs which were in operation during the fiscal year 1984-85. In general, the programs varied on select program characteristics and on their efforts to address major policy issues. Data from the non-program states indicated support, legislative efforts, and a high interest in fiscal concerns. The findings reflect a lack of program uniformity and have implications for program development and implementation. Suggestions on how to identify the "optimum" or best combination of program and policy options are discussed.

The Effects of Privatization of State-Owned Enterprises in Poland and East Germany

The main goal of this project was to propose appropriate methods of analysing the effects of the privatisation of state-owned enterprises, methods which were then tested on a limited sample of 16 Polish and 8 German enterprises privatised in 1992. A considerable amount of information was collected relating to the six-year period 1989-1994 relating to most aspects of the companies' activities. The effects of privatisation were taken to be those changes within the enterprises which were the result of privatisation, in such areas as production, the productivity of labour and fixed assets, investments and innovations, employment and wages, economic incentives (especially for top managers), financing (internal and external sources), bad debts and economic effects (financial analysis). A second important goal was to identify the main factors which represent methodological obstacles in surveys of the effects of privatisation during a period of fundamental transformation of the entire economic system. The list of enterprises for the research was compiled in such a way as to allow for the differentiation of ownership structures of privatised firms and to permit (at least to a certain extent) the empirical verification of some hypotheses regarding the privatisation process. The enterprises selected were divided into the following three groups representing (as far as possible) various types of ownership structures or types of control: (1) enterprises control by strategic investors (domestic or foreign), (2) enterprises controlled by employees (employee-owned companies), (3) enterprises controlled by managers. Formal methods such as econometric models with varying parameters were used to separate pure privatisation effects from other factors which influence various aspects of an enterprise's working, including policies on the productivity of labour and capital, average wages, the remuneration of top managers, etc. While the group admits that their findings and conclusions cannot be treated as representative of all privatised enterprises in Poland and Germany, they found considerable convergence with their findings and those of other surveys conducted on a wider scale. The main hypotheses that were confirmed included that privatisation (especially in companies controlled by large investors and managers) leads to a significant increase in the effectiveness of these production process, growing pay differentials between different employee groups (e.g. between executives and rank-and-file employees) and between different jobs and positions within particular professional groups. They also confirmed the growing importance in incentives to top executives of incentives linked with the company's economic effects (particularly profit-related incentives), long-term incentives and the capital market.

Teaching and aligning upper level mathematics classes to Michigan high school content expectations in an alternative education setting : approaches and issues

After teaching regular education secondary mathematics for seven years, I accepted a position in an alternative education high school. Over the next four years, the State of Michigan adopted new graduation requirements phasing in a mandate for all students to complete Geometry and Algebra 2 courses. Since many of my students were already struggling in Algebra 1, getting them through Geometry and Algebra 2 seemed like a daunting task. To better instruct my students, I wanted to know how other teachers in similar situations were addressing the new High School Content Expectations (HSCEs) in upper level mathematics. This study examines how thoroughly alternative education teachers in Michigan are addressing the HSCEs in their courses, what approaches they have found most effective, and what issues are preventing teachers and schools from successfully implementing the HSCEs. Twenty-six alternative high school educators completed an online survey that included a variety of questions regarding school characteristics, curriculum alignment, implementation approaches and issues. Follow-up phone interviews were conducted with four of these participants. The survey responses were used to categorize schools as successful, unsuccessful, and neutral schools in terms of meeting the HSCEs. Responses from schools in each category were compared to identify common approaches and issues among them and to identify significant differences between school groups. Data analysis showed that successful schools taught more of the HSCEs through a variety of instructional approaches, with an emphasis on varying the ways students learned the material. Individualized instruction was frequently mentioned by successful schools and was strikingly absent from unsuccessful school responses. The main obstacle to successful implementation of the HSCEs identified in the study was gaps in student knowledge. This caused pace of instruction to also be a significant issue. School representatives were fairly united against the belief that the Algebra 2 graduation requirement was appropriate for all alternative education students. Possible implications of these findings are discussed.

The Role of Fraternal Organisation in Migration and Informal Labour Organisations in Mining Communities: Cornwall, the Keweenaw, and California Compared

During the second half of the nineteenth century fraternal and benevolent associations of numerous descriptions grew and prospered in mining communities everywhere. They played an important, but neglected role, in assisting transatlantic migration and movement between mining districts as well as building social capital within emerging mining communities. They helped to build bridges between different ethnic communities, provided conduits between labour and management, and networked miners into the non-mining community. Their influence spread beyond the adult males that made up most of their membership to their wives and families and provided levels of social and economic support otherwise unobtainable at that time. Of course, the influence of these organisations could also be divisive where certain groups or religions were excluded and they may have worked to exacerbate, as much as ameliorate, the problems of community development. This paper will examine some of these issues by looking particularly at the role of Freemasonry and Oddfellowry in Cornwall, Calumet, and Nevada City between 1860 and 1900. Work on fraternity in the Keweenaw was undertaken in Houghton some years ago with a grant from the Copper Country Archive and has since been continued by privately funded research in California and other Western mining states. Some British aspects of this research can be found in my article on mining industrial relations in Labour History Review April 2006

HEALTH AND SAFETY ISSUES IN THE WORKPLACE: THE CASE OF CAMEROON TEA ESTATE (CTE), A RISK COMMUNICATION APPROACH

In 2002, motivated largely by the uncontested belief that the private sector would operate more efficiently than the government, the government of Cameroon initiated a major effort to privatize some of Cameroon’s largest, state-run industries. One of the economic sectors affected by this privatization was tea production. In October 2002, the Cameroon Tea Estate (CTE), a privately owned, tea-cultivating organization, bought the Tole Tea Estate from the Cameroon Development Corporation (CDC), a government-owned entity. This led to an increase in the quantity of tea production; however, the government and CTE management appear not to have fully considered the risks of privatization. Using classical rhetorical theory, Richard Weaver’s conception of “god terms” (or “uncontested terms”), and John Ikerd’s ethical approach to risk communication, this study examines risks to which Tole Tea Estate workers were exposed and explores rhetorical strategies that workers employed in expressing their discontent. Sources for this study include online newspapers, which were selected on the basis of their reputation and popularity in Cameroon. Analysis of the data shows that, as a consequence of privatization, Tole Tea Estate workers were exposed to three basic risks: marginalization, unfulfilled promises, and poor working conditions. Workers’ reactions to these risks tended to grow more emotional as management appeared to ignore their demands. The study recommends that respect for labor law, constructive dialogue among stakeholders, and transparency might serve as guiding principles in responding to the politics of privatization in developing countries.

Traditionen, Utopien, Dekonstruktionen - die Sozialstaatskonzepte des 'Ostblocks' (1945-1990)

The welfare state concepts in Eastern Europe under state socialism (1945-1990) were based on the conviction that only the state was responsible for solving all social problems. The 'bourgeois' manners of individual care were substituted by general measures in the field of labour- and family politics, as well as urban development. The experience showed however that this way of substitution was an illusion, because certain target groups were still in need of help (for example ill or handicapped children and adults, elderly people etc). Nevertheless, most of the Eastern European countries - with the exception of Yugoslavia - decided to abolish the existing forms of professional social work and the training for social workers. Instead, they invented 'surrogate structures' to manage the care for the 'needy': Various institutions and occupational groups (schools, hospitals and ambulances, employees groups etc.) took over the tasks of social workers and were trained to fulfil this as a kind of 'social practice'. Therefore, it is wrong to claim that social work was completely abolished under state socialism, But: as social work 'as such' did not exist any longer, it is more reasonable to speak of welfare state concepts, including social policy on one hand, and non- or paraprofessional social practice on the other. To characterize the effect of these welfare state concepts three parameter of interpretation seem to be useful: 'traditions', 'visions', and 'deconstructions' - embedded in a system of repression as well as incentives. Traditions: The huge 'social laboratory' that was installed was not a totally new one - it still carried on the heritage of the bygone: some bourgeois traces as well as elements out of the fascist heritage and -last but not least - the traditions of their own socialist movement. Visions: The socialist traditions included visions of social justice, the creation of a 'new mankind', a classless society, the end of exploitation and a peaceful living together of all people. Although the 'real existing socialism' has destroyed most of these visions, the power of these utopian ideas has outshined a lot of the every day’s misfortune and injustice for quite a long time. Deconstructions: The term of 'deconstruction' has a threefold meaning: the deconstruction of professional welfare, the deconstruction - in the sense of reinterpretation - of the socialist ideals such as social justice and social security, making an instrument of inclusion and exclusion out of it. And the deconstruction that is necessary to free the history of social work under state socialism from the prejudices and distorting practices, from both sides, the east and the west. In the contribution these three parameter of interpretation are applied on the following issues: The gaps in the 'overall system' of social security; working morale and education for work; mass organisations as an instrument of egalitarianism and general prevention; de-professionalisation by 'surrogating' social work; the 'transparent client'; church as refuge or 'state organ'; women’s politics as bio-politics.

Work in Progress: Social Work, the State and Europe

Social work has had varying relationships with the nation state both over time and between different countries. From its early stages the occupation had both state sanctioned and voluntary streams. Its international dimension has been enhanced in the European context through policy and funding measures over the past few decades. During this period we have also seen the rise of globalising trends leading to questions about the ongoing powers of nation states. This paper examines some aspects of the relationship between social work and the state, taking into account the emergence of European and also international policies and frameworks. The paper focuses initially on migration as an example of a common trend; an area of policy with both national and European dimensions; and a field in which social professionals are engaged to varying degrees. Secondly, it considers the progress of the ‘professional project’ in Europe, using developments in five countries to illustrate some of the issues associated with ‘professionalization’. European and international frameworks may lead to some convergence in national understandings of the key roles of social workers and an enhanced sense of professional identity across nation states, despite very different starting points and current forms of organisation.

Anomic Crime in Post-Welfarist Societies. Cult of the Individual, Integration Patterns and Delinquency

Post-Fordist economies come along with post-welfarist societies marked by intensified cultural individualism and increased structural inequalities. These conditions are commonly held to be conducive to relative deprivation and, thereby, anomic crime. At the same time, post-welfarist societies develop a new ‘balance of power’ between institutions providing for welfare regulation, such as the family, the state and the (labour) market – and also the penal system. These institutions are generally expected to improve social integration, ensure conformity and thus reduce anomic crime. Combining both perspectives, we analyse the effects of moral individualism, social inequality, and different integration strategies on crime rates in contemporary societies through the lenses of anomie theory. To test our hypotheses, we draw on time-series cross-section data compiled from different data sources (OECD, UN, WHO, WDI) for twenty developed countries in the period 1970-2004, and run multiple regressions that control for country-specific effects. Although we find some evidence that the mismatch between cultural ideal (individual inclusion) and structural reality (stratified exclusion) increases the anomic pressure, whereas conservative (i. e. family-based), social-democratic (i. e. state-based) and liberal (i. e. market-based) integration strategies to a certain extent prove effective in controlling the incidence of crime, the results are not very robust. Moreover, reservations have to be made regarding the effects of “market” income inequality as well as familialist, unionist and liberalist employment policies that are shown to have reversed effects in our sample: the former reducing, the latter occasionally increasing anomic crime. As expected, the mismatch between cultural ideal (individual inclusion) and structural reality (stratified exclusion) increases the anomic pressure, whereas conservative (i. e. family-based), social-democratic (i. e. state-based) and liberal (i. e. market-based) integration strategies generally prove effective in controlling the incidence of crime. Nevertheless, we conclude that the new cult of the individual undermines the effectiveness of conservative and social-democratic integration strategies and drives societies towards more “liberal” regimes that build on incentive as well as punitive elements.

Patterns of care and outcomes for pregnant inmates and their infants in Texas state prisons: Epidemiologic and ethnographic analyses

Female inmates make up the fastest growing segment in our criminal justice system today. The rapidly increasing trend for female prisoners calls for enhanced efforts to strategically plan the correctional facilities that address the needs of this growing population, and to work with communities to prevent crime in women. The incarcerated women in the U.S. have an estimated 145,000 minor children who are predisposed to unique psychosocial problems as a result of parental incarceration.^ This study examined the patterns of care and outcomes for pregnant inmates and their infants in Texas state prisons between 1994 and 1996. The study population consists of 202 pregnant inmates who delivered in a 2-year period, and a randomly sampled comparison cohort of 804 women from general Texas population, matched on race and educational levels. Both quantitative and qualitative data were used to elucidate the inmates' risk-factor profile, delivery/birth outcomes, and the patterns of care during pregnancy. The continuity-of-care issues for this population were also explored.^ Epidemiologic data were derived from multiple record systems to establish the comparison between two cohorts. A significantly great proportion of the inmates have prior lifestyle risk-factors (smoking, alcohol, and illicit drug abuse), poorer health status, and worse medical history. However, most of these existing risk-factors seem to show little manifestation in their current pregnancy. On the basis of maternal labor/delivery outcome and a number of neonatal indicators, this study found some evidence of a better pregnancy outcome for the inmate cohort when compared to the comparison group. Some possible explanations of this paradox were discussed. Seventeen percent of inmates gave birth to infants with suspected congenital syphilis. The placement patterns for the infants' care immediately after birth were elucidated.^ In addition to the quantitative data, an ethnographic approach was used to collect qualitative data from a subset of the inmate cohort (n = 20) and 12 care providers. The qualitative data were analyzed for their contents and themes, giving rise to a detailed description of the inmates' pregnancy experience. Eleven themes emerged from the study's thematic analysis, which provides the context for interpreting the epidemiologic data.^ Meaningful findings in this study were presented in a three-dimensional matrix to shed light on the apparent relationship between outcome indicators and their potential determinants. The suspected "linkages" between the outcome and their determinants can be used to generate hypotheses for future studies. ^

State of the art of integrated therapy approaches in the treatment of schizophrenia: empirical evidence and clinical relevance

Objective: Integrated behavior therapy approaches are defined by the combination of behavioral and or cognitive interventions targeting neurocognition combined with other goal-oriented treatment targets such as social cognition, social skills, or educational issues. The Integrated Psychological Therapy Program (IPT) represents one of the very first behavior therapy approaches combining interventions of neurocognition, social cognition, and social competence. This comprehensive group-based bottom-up and top-down approach consists of five subprograms, each with incremental steps. IPT has been successfully implemented in several countries in Europe, America, Australia and in Asia. IPT worked as a model for some other approaches designed in the USA. IPT was undergone two further developments: based on the social competence part of IPT, the three specific therapy programs focusing residential, occupational or recreational topics were developed. Recently, the cognitive part of INT was rigorously expanded into the Integrated Neurocognitive Therapy (INT) designed exclusively for outpatient treatment: INT includes interventions targeting all neurocognitive and social cognitive domains defined by the NIMH-MATRICS initiative. These group and partially PC-based exercises are structured into four therapy modules, each starting with exercises on neurocognitive domains followed by social cognitive targets. Efficacy: The evidence of integrated therapy approaches and its advantage compared to of one-track interventions was becoming a discussion tool in therapy research as well as in mental health systems. Results of meta-analyses support superiority of integrated approaches compared to one-track interventions in more distal outcome areas such as social functioning. These results are in line with the large body of 37 independent IPT studies in 12 countries. Moreover, IPT research indicates the maintenance of therapy effects after the end of therapy and some evidence generalization effects. Additionally, the international randomized multi-center study on INT with 169 outpatients strongly supports the successful therapy of integrated therapy in proximal and distal outcome such as significant effects in cognition, functioning and negative symptoms. Clinical implication: therapy research as well as expert’s clinical experience recommends integrated therapy approaches such as IPT to be successful agents within multimodal psychiatric treatment concepts. Finally, integrated group therapy based on cognitive remediation seems to motivate and stimulate schizophrenia inpatients and outpatients to more successful and independent life also demanded by the recovery movement.

State of the art: Reproduction and pregnancy in rheumatic diseases

Throughout the last decade, increasing awareness has been raised on issues related to reproduction in rheumatic diseases including basic research to clarify the important role of estrogens in the etiology and pathophysiology of immune/inflammatory diseases. Sub- or infertility is a heterogeneous condition that can be related to immunological mechanisms, to pregnancy loss, to disease burden, to therapy, and to choices in regard to family size. Progress in reproductive medicine has made it possible for more patients with rheumatic disease to have children. Active disease in women with rheumatoid arthritis (RA) affects their children's birth weight and may have long-term effects on their future health status. Pregnancy complications as preeclampsia and intrauterine growth restriction are still increased in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), however, biomarkers can monitor adverse events, and several new therapies may improve outcomes. Pregnancies in women with APS remain a challenge, and better therapies for the obstetric APS are needed. New prospective studies indicate improved outcomes for pregnancies in women with rare diseases like systemic sclerosis and vasculitis. TNF inhibitors hold promise for maintaining remission in rheumatological patients and may be continued at least in the first half of pregnancy. Pre-conceptional counseling and interdisciplinary management of pregnancies are essential for ensuring optimal pregnancy outcomes.