9 A Preliminary Theory of Interorganizational Network Effectiveness: A Comparative Study of Four Community Mental Health Systems Keith G. Provan H. Brinton Milward This chapter presents the results of a comparative study of interorganizational networks, or systems, of mental health delivery in four U.S. cities, leading to a preliminary theory of network effectiveness. Extensive data were collected from surveys, interviews, documents, and observations. Network effectiveness was assessed by collecting and aggregating data on outcomes from samples of clients, their families, and their case managers at each site. Results of analyses of both quantitative and qualitative data collected at the individual, organizational, and network levels of analysis showed that network effectiveness could be explained by various structural and contextual factors, specifically, network integration, external control, system stability, and environmental resource munificence. Based on the findings, we develop testable propositions to guide theory development and future research on network effectiveness. The study of relations between organizations has been a major concern of organization theorists for at least the past 25 years. While most of the work in this area has focused on the determinants or predictors of interorganizational relations (see Oliver, 1990, for a review), as an understanding of the phenomenon has grown, the unit of analysis has gradually shifted from the dyad to the organization set, to the network. Especially in recent years, the study of organizational networks has proliferated. Much of this interest has been generated by an emerging recognition by academics that businesses, as well as organizations in the not-for-profit and public sectors, are increasingly turning to various forms of cooperative alliances as a way of enhancing competitiveness and effectiveness that would not be possible through the traditional governance mechanisms of market or hierarchy (Powell, 1990). While a good deal of what has been written about networks has been atheoretical, discussing the advantages of networks or examining issues of measurement and analysis, considerable theory-based research has also emerged (e.g., Cook, 1977; Burt, 1980; Granovetter, 1985; Jarillo, 1988; Williamson, 1991; Cook and Whitmeyer, 1992; Larson, 1992; Provan, 1993). In the organization theory literature, work on networks has been guided primarily by two theoretical perspectives: resource dependence, and related exchange perspectives, and transaction cost economics, with most recent work focusing on the latter approach. Each of these perspectives offers both complementary and contrasting views about the network form. For the most part, however, each perspective focuses essentially on the organizational antecedents and outcomes of network involvement, with little attention paid to the network as a whole, except for its governance and structure. This organizational view is understandable, sinc.
Researching Networks and Collaboration – reflections of a novice Tarry Asoka
Networks have become the flavour of our time as ‘wicked problems’ (large, messy, complex and systemic) require multi-stakeholder actors to work together to find a common solution. But how feasible are networks within the institutional contexts they are expected to function? An attempt to answer this question led one into an array of perspectives not only of networks but also about collaboration, which is seen as the ‘very essence’ of networks. Meanwhile, a developing insight is that to be successful, networks will have to be context specific, but useful learning can come from elsewhere where network implementation is advanced – since core elements of collaboration such as trust, social capital, reciprocity are human nature.
Information, Knowledge Management & Coordination Systems: Complex Systems App...CITE
Date: 4 Jun 2013
Time: 12:45pm - 2:00pm
Venue: Room 101, Runme Shaw Building, The University of Hong Kong
Speakers: Professor Liaquat Hossain, University of Sydney
------------------------------------
http://www.cite.hku.hk/news.php?id=502&category=conference
Critical evaluation of the potential of stakeholder theory to contribute to u...Kennedy Mbwette
Critical evaluation of the potential of stakeholder theory to contribute to understanding of large-scale public service IT projects and their implementation
PPT on Building Collaborative Partnerships for the the Regional Health Care Safety Net in Northeastern Illinois. Presented at the Safety Net Summit, June 23, 2009, hosted by Health & Medicine Policy Research Group (HMPRG) and the U.S. Health Resources and Services Administration (HRSA)
Researching Networks and Collaboration – reflections of a novice Tarry Asoka
Networks have become the flavour of our time as ‘wicked problems’ (large, messy, complex and systemic) require multi-stakeholder actors to work together to find a common solution. But how feasible are networks within the institutional contexts they are expected to function? An attempt to answer this question led one into an array of perspectives not only of networks but also about collaboration, which is seen as the ‘very essence’ of networks. Meanwhile, a developing insight is that to be successful, networks will have to be context specific, but useful learning can come from elsewhere where network implementation is advanced – since core elements of collaboration such as trust, social capital, reciprocity are human nature.
Information, Knowledge Management & Coordination Systems: Complex Systems App...CITE
Date: 4 Jun 2013
Time: 12:45pm - 2:00pm
Venue: Room 101, Runme Shaw Building, The University of Hong Kong
Speakers: Professor Liaquat Hossain, University of Sydney
------------------------------------
http://www.cite.hku.hk/news.php?id=502&category=conference
Critical evaluation of the potential of stakeholder theory to contribute to u...Kennedy Mbwette
Critical evaluation of the potential of stakeholder theory to contribute to understanding of large-scale public service IT projects and their implementation
PPT on Building Collaborative Partnerships for the the Regional Health Care Safety Net in Northeastern Illinois. Presented at the Safety Net Summit, June 23, 2009, hosted by Health & Medicine Policy Research Group (HMPRG) and the U.S. Health Resources and Services Administration (HRSA)
This document by Eelke Wielinga describes the FAN (Free Actor Network) approach and practical tools to promote effective networks where traditional planning is balanced with the energies, incentives and dreams of the members. Mr Wielinga was one of the speakers of the Systemic M&E webinar (Innovations in Measuring Impacts in Market and Financial Systems: rethinking the current paradigm). This webinar was organised by SEEP's MaFI in October 2012 and hosted in collaboration with USAID's Microlinks and FHI360. To know more about the FAN approach and Eelke's work go to www.toolsfornetworkers.nl
Building Collaborative Health Networks: Pat Terrell”Healthwork
PPT on Building Collaborative Partnerships for the the Regional Health Care Safety Net in Northeastern Illinois. Presented at the Safety Net Summit, June 23, 2009, hosted by Health & Medicine Policy Research Group (HMPRG) and the U.S. Health Resources and Services Administration (HRSA)
Chapter 4 Information Systems to Support Population Health Managem.docxketurahhazelhurst
Chapter 4 Information Systems to Support Population Health Management Learning Objectives To be able to understand the data and information needs of health systems in managing population health effectively under value-based payment models. To be able to discuss key health IT tools and strategies for population health management including EHRs, registries, risk stratification, patient engagement, and outreach, care coordination and management, analytics, health information exchange, and telemedicine and telehealth. To be able to discuss the application and use of data analytics to monitor, predict, and improve performance. The enactment of the Affordable Care Act (ACA) brought about sweeping legislation intended to reduce the numbers of uninsured and make health care accessible to all Americans. It also ushered in an era in which changing reimbursement and care delivery models are driving providers from the current fragmented system focused on volume-based services to an outcomes orientation. As a result, the health care system now taking shape is one in which value-based payment models financially reward patient-centered, coordinated, accountable care. Against this backdrop, providers' increasing use of evidence-based medicine and growing capabilities in managing volumes of clinical evidence through sophisticated health IT systems will mean that treatments can be tailored for the individual and interventions can be made earlier to keep patients well. Furthermore, patient engagement is fast becoming a critical component in the care process, particularly in the area of population health management (PHM). Health care providers' interest in improving population health appears to be increasing because of the sudden ubiquity of the phrase, because many are participating in accountable care organizations (ACOs), and because even hospitals not participating in an ACO increasingly have incentives to reduce their number of potentially unavoidable admissions, readmissions, and emergency department visits (Casalino, Erb, Joshi, & Shortell, 2015). In this chapter we'll not only seek a common understanding of PHM but also explore how the advent of shared accountability financial arrangements between providers and purchasers of care has created significant focus on PHM. We'll also review the core processes associated with accountable care and examine the strategic IT investments and data management capabilities required to support population health management and enable a successful transition from volume-based to value-based care. PHM: Key to Success Although the ACO model is still new and evolving, approximately 750 ACOs are in operation today, covering some 23.5 million lives under Medicare, Medicaid, and private insurers. Although not all ACOs have demonstrated success in delivering better health outcomes at a lower cost, many have achieved promising results (Houston & McGinnis, 2016). As such, significant ACO growth is expected. In fact, it is predicte ...
Towards Decision Support and Goal AchievementIdentifying Ac.docxturveycharlyn
Towards Decision Support and Goal Achievement:
Identifying Action-Outcome Relationships From Social
Media
Emre Kıcıman
Microsoft Research
[email protected]
Matthew Richardson
Microsoft Research
[email protected]
ABSTRACT
Every day, people take actions, trying to achieve their per-
sonal, high-order goals. People decide what actions to take
based on their personal experience, knowledge and gut in-
stinct. While this leads to positive outcomes for some peo-
ple, many others do not have the necessary experience, knowl-
edge and instinct to make good decisions. What if, rather
than making decisions based solely on their own personal
experience, people could take advantage of the reported ex-
periences of hundreds of millions of other people?
In this paper, we investigate the feasibility of mining the
relationship between actions and their outcomes from the
aggregated timelines of individuals posting experiential mi-
croblog reports. Our contributions include an architecture
for extracting action-outcome relationships from social me-
dia data, techniques for identifying experiential social media
messages and converting them to event timelines, and an
analysis and evaluation of action-outcome extraction in case
studies.
1. INTRODUCTION
While current structured knowledge bases (e.g., Freebase)
contain a sizeable collection of information about entities,
from celebrities and locations to concepts and common ob-
jects, there is a class of knowledge that has minimal cov-
erage: actions. Simple information about common actions,
such as the effect of eating pasta before running a marathon,
or the consequences of adopting a puppy, are missing. While
some of this information may be found within the free text of
Wikipedia articles, the lack of a structured or semi-structured
representation make it largely unavailable for computational
usage. With computing devices continuing to become more
embedded in our everyday lives, and mediating an increasing
degree of our interactions with both the digital and physical
world, knowledge bases that can enable our computing de-
vices to represent and evaluate actions and their likely out-
comes can help individuals reason about actions and their
Permission to make digital or hard copies of all or part of this work for personal or
classroom use is granted without fee provided that copies are not made or distributed
for profit or commercial advantage and that copies bear this notice and the full citation
on the first page. Copyrights for components of this work owned by others than the
author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or
republish, to post on servers or to redistribute to lists, requires prior specific permission
and/or a fee. Request permissions from [email protected]
KDD’15, August 10-13, 2015, Sydney, NSW, Australia.
Copyright is held by the owner/author(s). Publication rights licensed to ACM.
ACM 978-1-4503-3664-2/15/08 ...$15.00.
DOI: http://dx.doi.org/10.1145 ...
SYMPOSIUM CONCLUSION FUTURE RESEARCH ON THE DIMENSIONS OF.docxssuserf9c51d
SYMPOSIUM CONCLUSION: FUTURE RESEARCH
ON THE DIMENSIONS OF COLLABORATION
JOY A. CLAY
University of Memphis
As the research findings in this symposium
demonstrate, public and nonprofit managers in health and
human service agencies continue to collaborate with
multiple goals in mind. As would be anticipated, the
collaborations described in the symposium generally
addressed service gaps, enhanced services, improved
access, and expanded programs. A common underlying
expectation was that participation in the collaboration
would further an agency’s mission (Goodsell, 2011). As
cautioned by Word in her commentary, however, making
joint decisions and sharing power does not come easy when
agencies also must respond to countervailing pressures that
inherently flow from the agency’s political, social, and
economic contexts.
Overall, the symposium examines levels of
linkages, decision-making, hierarchy, autonomy, shared
administration, governance, outcomes, and more.
Reflecting their various research questions, the authors use
a variety of methods to examine the multiple dimensions of
collaboration. Clearly, the symposium’s researchers are
building on and adding to our knowledge about
cooperation, coordination, and collaboration (Keast,
Brown, & Mandell, 2007; Keast, Mandell, Brown, &
Woolcock, 2004) as well as how to assess the multiple
dimensions of collaboration. The authors effectively used
existing instruments and models to understand
collaboration dimensions but also propose new models and
test metrics/variables.
140 JHHSA SUMMER 2012
RESEARCH DIRECTIONS
The case authors and practitioner commentaries
respectively offer interesting suggestions for potentially
fruitful research directions. In reacting to the symposium,
key research directions appear to have some urgency.
Clearly, an important area of research should include a
fuller examination of collaboration impacts, beyond the
outcomes of a specific collaborative effort to community-
wide issues of equity, diversity, fairness, and
responsiveness. Mayhew’s research draws attention to the
need for more attention to how end users, not just the
collaboration participants, assess the effectiveness of the
collaboration and whether the resulting programming
actually yields innovation and effectiveness. Similarly,
Wrobel comments that assessing additional stakeholders,
especially parents, is needed to assess the impact on the
children and families served by a collaborative. These
researchers convincingly argue that there has been
insufficient attention to measure end user perceptions of
outcomes from collaborations.
Especially relevant to health and human services
sectors, research directed at improving our capacity to
identify specific indicators that pinpoint cultures of
competition vs. collaboration could enable participants and
policymakers to build more effective collaboration ...
FirstReview these assigned readings; they will serve as your .docxclydes2
First:
Review these assigned readings; they will serve as your scientific sources of accurate information:
http://www.closerlookatstemcells.org/Top_10_Stem_Cell_Treatment_Facts.html
http://www.closerlookatstemcells.org/How_Science_Becomes_Medicine.html
http://www.newvision.co.ug/news/649266-fighting-ageing-using-stem-cell-therapy.html
http://www.nature.com/news/stem-cells-in-texas-cowboy-culture-1.12404
http://www.cbc.ca/radio/whitecoat/blog/stem-cell-hype-and-risk-1.3654515
http://stm.sciencemag.org/content/7/278/278ps4.full
Next:
Use a standard Google search for this phrase: “stem cell therapy.” Do not go to Google Scholar. Select one of the websites, blogs, or other locations that offer stem cell therapies.
Save the link for your selected site.
Read the materials provided on your selected site and find out who the authors and sponsors of the site are by going to their “home” or “about us” pages.
Finally, submit your responses to the following in an essay of 500-750 words (2-3 pages of text—use a separate page for a title and for your references):
You are going to prepare a critique of the site you located and compare it to the scientific information available on this therapy.
Give the full title of the website, web blog, or other site that you selected, along with the link.
Describe the therapy that is being offered and what conditions it is designed to treat.
Who are the authors and sponsors of the site you selected?
Compare the claims about the therapy offered to what is said in the assigned readings about this type of therapy. You may have to use our library, as well, to determine what scientists and researchers have to say about the use of stem cells to treat this condition.
Would you say that the therapy you found is a well-established, proven technique for humans, or more of an experimental, unproven approach?
What about the type of language discussed in the Goldman article? Is the therapy you found using sensationalist claims and terminology that are not supported by the scientific research?
Would you recommend that a patient with this condition go ahead and participate in this treatment? Why or why not?
Literature review on how Information Technology has impacted governing bodies’ ability to align public policy with stakeholder needs
Nowadays, the governing bodies both in public and private sectors are dealing with complex systems on a day to day operations. These systems are made up of different components which present varying interactions and interrelationships with and/or among each other; therefore, making their management to be difficult or challenging. Indeed, Ruiz, Zabaleta & Elorza (2016), highlighted that public policymakers have to deal with complex systems which involve heterogeneous agents that act in non-linear behaviors making their management difficult. Neziraj & Shaqiri (2018) also stated that the policymakers are faced with problems which are complex and non-uniform due to a lot of uncertainties and risk situ.
System Dynamics Modeling for IntellectualDisability Services.docxmabelf3
System Dynamics Modeling for Intellectual
Disability Services: A Case Studyjppi_342 112..119
Meri Duryan*,†, Dragan Nikolik‡, Godefridus van Merode§, and Leopold Curfs*,§
*Gouverneur Kremers Centrum; †University of Maastricht; ‡Maastricht School of Management; and §Maastricht University Medical
Center, Maastricht, the Netherlands
Abstract Organizations providing services to persons with intellectual disabilities (ID) are complex because of many interacting
stakeholders with often different and competing interests. The combination of increased consumer demand and diminished resources
makes organizational planning a challenge for the managers of such organizations. Such challenges are confounded by significant
demands for the optimization of resources and the goal to reduce expenses and to more effectively and efficiently use existing
resources while at the same time providing high quality services. The authors explore the possibilities of using “system dynamics
modelling” in organizational decision-making processes related to resource allocations. System dynamics suggests the application of
generic systems archetypes as a first step in interpreting complex situations in an organization. The authors illustrate the application
of this method via a case study in one provider organization in the Netherlands. The authors contend that such a modeling approach
can be used by the management of similar organizations serving people with ID as a tool to support decision making that can result
in optimal resource allocation.
Keywords: allocation of resources, intellectual disabilities, system dynamics modeling, systems thinking, waiting lists
INTRODUCTION
Healthcare organizations are complex entities as they have
multiple stakeholders with often conflicting objectives and goals
(Drucker, 1993). Provider organizations specializing in intellec-
tual disabilities (ID) are also complex because of the nature of the
care and supports they provide and how they are organized. Some
of the complexities relate to the difficulties that adults with ID
might have in expressing themselves. Moreover, the specifics of
the care often require a deeper involvement of carers with respect
to their relationships with families and other sectors of society.
Because of their complexity, ID provider organizations, com-
pared with healthcare providers, often require a higher level of
resource planning, collaboration, and cooperation among social,
health, and education services, mental health services, and other
sectors (WHO, 2010).
To manage the complexities and challenges ID provider orga-
nizations face, managers need to analyze and understand complex
interdependencies among the systems with which they are dealing.
In order to achieve that, ID provider managers need to examine
and shift their mental models regarding their role in managing
the organization and in establishing relationships with all the
stakeholders involved. However, as Forrester (1980) has noted,
traditiona.
Zoe is a second grader with autism spectrum disorders. Zoe’s father .docxransayo
Zoe is a second grader with autism spectrum disorders. Zoe’s father recently passed away in a tragic car accident. Zoe, her mom, and two older brothers have temporarily relocated from out-of-state and are now living in her grandparents’ house in a small, rural community.
Because the family had been living out-of state, Zoe has never interacted with her grandparents. She has challenges responding to social cues, including her name and in understanding gestures. She also engages in repetitive body movements. She is fond of her set of dolls and likes lining them up. When Zoe is agitated, her mother plays Mozart, which seems to have a calming effect. Zoe also enjoys macaroni and cheese.
Her grandparents do not understand Zoe’s attempts at communicating. Zoe does not respond well to crowded and noisy environments. Zoe’s mom is working outside the home for the first time.
Because of the move, Zoe has transferred to a new school, which does not currently have any students with ASD. Although her mom is generally very involved with Zoe’s education, she is away from the home much of the time due to a long commute for her new job is a neighboring city.
Zoe’s grandparents are eager and willing to help in any way they can.
Imagine you are serving as an ASD consultant at Zoe’s new school. Using the COMPASS model, create a COMPASS Action Plan for Zoe by complete the following tasks:
Identify the personal challenges for Zoe;
Identify the environmental challenges for Zoe;
Identify potential supports; and
Identify and prioritize teaching goals.
In addition, include a 250-500-word rationale that explains how your action plan for Zoe demonstrates collaboration in a respectful, culturally responsive way while promoting understanding, resolving conflicts, and building consensus around her interventions.
.
Zlatan Ibrahimović – Sports Psychology
Outline
Introduction:
· General Info
· Nationality, Birthplace, Parents
· Childhood What he wanted to do growing up?
· When did he start playing professionally?
· Which teams did he play for?
· Give some of his career statistics and maybe records?
· What trophies has he won with club football and national team of Sweden?
· Style of Play
· What is his personality like? How do people see him in the media?\
·
Body Paragraphs
Connect the following Sports Psychology Concepts (or even those not listed) to Zlatan Ibrahimović
What is his personality type? Type A, B C, or D?
Give examples through research of where he shows this.
CATASTROPHE THEORY… OCCURS WHEN? WHAT DOES THE GRAPH LOOK LIKE
· Arousal: is a blend of physiological and psychological activity in a person and it refers to the intensity dimensions of motivation at a particular moment. It ranges from not aroused, to completely aroused, to highly aroused; this is when individuals are mentally and physically activated.
· Performance increases as arousal increases but when arousal gets too high performance dramatically decreases. This is usually caused by the performer becoming anxious and sometimes making wrong decisions. Catastrophes is caused by a combination of cognitive and somatic anxieties. Cognitive is the internal worries of not performing well while somatic is the physical effects of muscle tension/butterflies and fatigue through playing.
· The graph is an inverted U where the x line is the arousal and the y is the performance. Performance peaks on the top of the inverted U and the catastrophe happens in the fall of the inverted U
HIGH TRAIT ANXIETY ATHLETES… HOW DO THEY PERCEIVE COMPETITION?
· Anxiety: is a negative emotional state in which feelings of nervousness, worry and apprehension are associated with activation or arousal of the body
· Trait Anxiety: is a behavioral disposition to perceive as threatening circumstances that objectively may not be dangerous and to then respond with disproportionate state anxiety.
· Somatic Trait Anxiety: the degree to which one typically perceived heightened physical symptoms (muscle tension)
· Cognitive Trait Anxiety: the degree to which one typically worries or has self doubt
· Concentration Disruption: the degree to which one typically has concentration disruption during competition
People usually with high trait anxiety usually have more state anxiety in highly competitive evaluative situations than do people with lower trait anxiety. Example two athletes are playing basketball and both are physically and statistically the same both have to shoot a final free throw to win the game. Athlete A is more laid back which means his trait anxiety is lower and he doesn't view the final shot as a overly threatening. Athlete B has a high trait anxiety and because of that he perceives the final shot as very threatening. This has an effect on his state anxiety much more than.
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This document by Eelke Wielinga describes the FAN (Free Actor Network) approach and practical tools to promote effective networks where traditional planning is balanced with the energies, incentives and dreams of the members. Mr Wielinga was one of the speakers of the Systemic M&E webinar (Innovations in Measuring Impacts in Market and Financial Systems: rethinking the current paradigm). This webinar was organised by SEEP's MaFI in October 2012 and hosted in collaboration with USAID's Microlinks and FHI360. To know more about the FAN approach and Eelke's work go to www.toolsfornetworkers.nl
Building Collaborative Health Networks: Pat Terrell”Healthwork
PPT on Building Collaborative Partnerships for the the Regional Health Care Safety Net in Northeastern Illinois. Presented at the Safety Net Summit, June 23, 2009, hosted by Health & Medicine Policy Research Group (HMPRG) and the U.S. Health Resources and Services Administration (HRSA)
Chapter 4 Information Systems to Support Population Health Managem.docxketurahhazelhurst
Chapter 4 Information Systems to Support Population Health Management Learning Objectives To be able to understand the data and information needs of health systems in managing population health effectively under value-based payment models. To be able to discuss key health IT tools and strategies for population health management including EHRs, registries, risk stratification, patient engagement, and outreach, care coordination and management, analytics, health information exchange, and telemedicine and telehealth. To be able to discuss the application and use of data analytics to monitor, predict, and improve performance. The enactment of the Affordable Care Act (ACA) brought about sweeping legislation intended to reduce the numbers of uninsured and make health care accessible to all Americans. It also ushered in an era in which changing reimbursement and care delivery models are driving providers from the current fragmented system focused on volume-based services to an outcomes orientation. As a result, the health care system now taking shape is one in which value-based payment models financially reward patient-centered, coordinated, accountable care. Against this backdrop, providers' increasing use of evidence-based medicine and growing capabilities in managing volumes of clinical evidence through sophisticated health IT systems will mean that treatments can be tailored for the individual and interventions can be made earlier to keep patients well. Furthermore, patient engagement is fast becoming a critical component in the care process, particularly in the area of population health management (PHM). Health care providers' interest in improving population health appears to be increasing because of the sudden ubiquity of the phrase, because many are participating in accountable care organizations (ACOs), and because even hospitals not participating in an ACO increasingly have incentives to reduce their number of potentially unavoidable admissions, readmissions, and emergency department visits (Casalino, Erb, Joshi, & Shortell, 2015). In this chapter we'll not only seek a common understanding of PHM but also explore how the advent of shared accountability financial arrangements between providers and purchasers of care has created significant focus on PHM. We'll also review the core processes associated with accountable care and examine the strategic IT investments and data management capabilities required to support population health management and enable a successful transition from volume-based to value-based care. PHM: Key to Success Although the ACO model is still new and evolving, approximately 750 ACOs are in operation today, covering some 23.5 million lives under Medicare, Medicaid, and private insurers. Although not all ACOs have demonstrated success in delivering better health outcomes at a lower cost, many have achieved promising results (Houston & McGinnis, 2016). As such, significant ACO growth is expected. In fact, it is predicte ...
Towards Decision Support and Goal AchievementIdentifying Ac.docxturveycharlyn
Towards Decision Support and Goal Achievement:
Identifying Action-Outcome Relationships From Social
Media
Emre Kıcıman
Microsoft Research
[email protected]
Matthew Richardson
Microsoft Research
[email protected]
ABSTRACT
Every day, people take actions, trying to achieve their per-
sonal, high-order goals. People decide what actions to take
based on their personal experience, knowledge and gut in-
stinct. While this leads to positive outcomes for some peo-
ple, many others do not have the necessary experience, knowl-
edge and instinct to make good decisions. What if, rather
than making decisions based solely on their own personal
experience, people could take advantage of the reported ex-
periences of hundreds of millions of other people?
In this paper, we investigate the feasibility of mining the
relationship between actions and their outcomes from the
aggregated timelines of individuals posting experiential mi-
croblog reports. Our contributions include an architecture
for extracting action-outcome relationships from social me-
dia data, techniques for identifying experiential social media
messages and converting them to event timelines, and an
analysis and evaluation of action-outcome extraction in case
studies.
1. INTRODUCTION
While current structured knowledge bases (e.g., Freebase)
contain a sizeable collection of information about entities,
from celebrities and locations to concepts and common ob-
jects, there is a class of knowledge that has minimal cov-
erage: actions. Simple information about common actions,
such as the effect of eating pasta before running a marathon,
or the consequences of adopting a puppy, are missing. While
some of this information may be found within the free text of
Wikipedia articles, the lack of a structured or semi-structured
representation make it largely unavailable for computational
usage. With computing devices continuing to become more
embedded in our everyday lives, and mediating an increasing
degree of our interactions with both the digital and physical
world, knowledge bases that can enable our computing de-
vices to represent and evaluate actions and their likely out-
comes can help individuals reason about actions and their
Permission to make digital or hard copies of all or part of this work for personal or
classroom use is granted without fee provided that copies are not made or distributed
for profit or commercial advantage and that copies bear this notice and the full citation
on the first page. Copyrights for components of this work owned by others than the
author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or
republish, to post on servers or to redistribute to lists, requires prior specific permission
and/or a fee. Request permissions from [email protected]
KDD’15, August 10-13, 2015, Sydney, NSW, Australia.
Copyright is held by the owner/author(s). Publication rights licensed to ACM.
ACM 978-1-4503-3664-2/15/08 ...$15.00.
DOI: http://dx.doi.org/10.1145 ...
SYMPOSIUM CONCLUSION FUTURE RESEARCH ON THE DIMENSIONS OF.docxssuserf9c51d
SYMPOSIUM CONCLUSION: FUTURE RESEARCH
ON THE DIMENSIONS OF COLLABORATION
JOY A. CLAY
University of Memphis
As the research findings in this symposium
demonstrate, public and nonprofit managers in health and
human service agencies continue to collaborate with
multiple goals in mind. As would be anticipated, the
collaborations described in the symposium generally
addressed service gaps, enhanced services, improved
access, and expanded programs. A common underlying
expectation was that participation in the collaboration
would further an agency’s mission (Goodsell, 2011). As
cautioned by Word in her commentary, however, making
joint decisions and sharing power does not come easy when
agencies also must respond to countervailing pressures that
inherently flow from the agency’s political, social, and
economic contexts.
Overall, the symposium examines levels of
linkages, decision-making, hierarchy, autonomy, shared
administration, governance, outcomes, and more.
Reflecting their various research questions, the authors use
a variety of methods to examine the multiple dimensions of
collaboration. Clearly, the symposium’s researchers are
building on and adding to our knowledge about
cooperation, coordination, and collaboration (Keast,
Brown, & Mandell, 2007; Keast, Mandell, Brown, &
Woolcock, 2004) as well as how to assess the multiple
dimensions of collaboration. The authors effectively used
existing instruments and models to understand
collaboration dimensions but also propose new models and
test metrics/variables.
140 JHHSA SUMMER 2012
RESEARCH DIRECTIONS
The case authors and practitioner commentaries
respectively offer interesting suggestions for potentially
fruitful research directions. In reacting to the symposium,
key research directions appear to have some urgency.
Clearly, an important area of research should include a
fuller examination of collaboration impacts, beyond the
outcomes of a specific collaborative effort to community-
wide issues of equity, diversity, fairness, and
responsiveness. Mayhew’s research draws attention to the
need for more attention to how end users, not just the
collaboration participants, assess the effectiveness of the
collaboration and whether the resulting programming
actually yields innovation and effectiveness. Similarly,
Wrobel comments that assessing additional stakeholders,
especially parents, is needed to assess the impact on the
children and families served by a collaborative. These
researchers convincingly argue that there has been
insufficient attention to measure end user perceptions of
outcomes from collaborations.
Especially relevant to health and human services
sectors, research directed at improving our capacity to
identify specific indicators that pinpoint cultures of
competition vs. collaboration could enable participants and
policymakers to build more effective collaboration ...
FirstReview these assigned readings; they will serve as your .docxclydes2
First:
Review these assigned readings; they will serve as your scientific sources of accurate information:
http://www.closerlookatstemcells.org/Top_10_Stem_Cell_Treatment_Facts.html
http://www.closerlookatstemcells.org/How_Science_Becomes_Medicine.html
http://www.newvision.co.ug/news/649266-fighting-ageing-using-stem-cell-therapy.html
http://www.nature.com/news/stem-cells-in-texas-cowboy-culture-1.12404
http://www.cbc.ca/radio/whitecoat/blog/stem-cell-hype-and-risk-1.3654515
http://stm.sciencemag.org/content/7/278/278ps4.full
Next:
Use a standard Google search for this phrase: “stem cell therapy.” Do not go to Google Scholar. Select one of the websites, blogs, or other locations that offer stem cell therapies.
Save the link for your selected site.
Read the materials provided on your selected site and find out who the authors and sponsors of the site are by going to their “home” or “about us” pages.
Finally, submit your responses to the following in an essay of 500-750 words (2-3 pages of text—use a separate page for a title and for your references):
You are going to prepare a critique of the site you located and compare it to the scientific information available on this therapy.
Give the full title of the website, web blog, or other site that you selected, along with the link.
Describe the therapy that is being offered and what conditions it is designed to treat.
Who are the authors and sponsors of the site you selected?
Compare the claims about the therapy offered to what is said in the assigned readings about this type of therapy. You may have to use our library, as well, to determine what scientists and researchers have to say about the use of stem cells to treat this condition.
Would you say that the therapy you found is a well-established, proven technique for humans, or more of an experimental, unproven approach?
What about the type of language discussed in the Goldman article? Is the therapy you found using sensationalist claims and terminology that are not supported by the scientific research?
Would you recommend that a patient with this condition go ahead and participate in this treatment? Why or why not?
Literature review on how Information Technology has impacted governing bodies’ ability to align public policy with stakeholder needs
Nowadays, the governing bodies both in public and private sectors are dealing with complex systems on a day to day operations. These systems are made up of different components which present varying interactions and interrelationships with and/or among each other; therefore, making their management to be difficult or challenging. Indeed, Ruiz, Zabaleta & Elorza (2016), highlighted that public policymakers have to deal with complex systems which involve heterogeneous agents that act in non-linear behaviors making their management difficult. Neziraj & Shaqiri (2018) also stated that the policymakers are faced with problems which are complex and non-uniform due to a lot of uncertainties and risk situ.
System Dynamics Modeling for IntellectualDisability Services.docxmabelf3
System Dynamics Modeling for Intellectual
Disability Services: A Case Studyjppi_342 112..119
Meri Duryan*,†, Dragan Nikolik‡, Godefridus van Merode§, and Leopold Curfs*,§
*Gouverneur Kremers Centrum; †University of Maastricht; ‡Maastricht School of Management; and §Maastricht University Medical
Center, Maastricht, the Netherlands
Abstract Organizations providing services to persons with intellectual disabilities (ID) are complex because of many interacting
stakeholders with often different and competing interests. The combination of increased consumer demand and diminished resources
makes organizational planning a challenge for the managers of such organizations. Such challenges are confounded by significant
demands for the optimization of resources and the goal to reduce expenses and to more effectively and efficiently use existing
resources while at the same time providing high quality services. The authors explore the possibilities of using “system dynamics
modelling” in organizational decision-making processes related to resource allocations. System dynamics suggests the application of
generic systems archetypes as a first step in interpreting complex situations in an organization. The authors illustrate the application
of this method via a case study in one provider organization in the Netherlands. The authors contend that such a modeling approach
can be used by the management of similar organizations serving people with ID as a tool to support decision making that can result
in optimal resource allocation.
Keywords: allocation of resources, intellectual disabilities, system dynamics modeling, systems thinking, waiting lists
INTRODUCTION
Healthcare organizations are complex entities as they have
multiple stakeholders with often conflicting objectives and goals
(Drucker, 1993). Provider organizations specializing in intellec-
tual disabilities (ID) are also complex because of the nature of the
care and supports they provide and how they are organized. Some
of the complexities relate to the difficulties that adults with ID
might have in expressing themselves. Moreover, the specifics of
the care often require a deeper involvement of carers with respect
to their relationships with families and other sectors of society.
Because of their complexity, ID provider organizations, com-
pared with healthcare providers, often require a higher level of
resource planning, collaboration, and cooperation among social,
health, and education services, mental health services, and other
sectors (WHO, 2010).
To manage the complexities and challenges ID provider orga-
nizations face, managers need to analyze and understand complex
interdependencies among the systems with which they are dealing.
In order to achieve that, ID provider managers need to examine
and shift their mental models regarding their role in managing
the organization and in establishing relationships with all the
stakeholders involved. However, as Forrester (1980) has noted,
traditiona.
Zoe is a second grader with autism spectrum disorders. Zoe’s father .docxransayo
Zoe is a second grader with autism spectrum disorders. Zoe’s father recently passed away in a tragic car accident. Zoe, her mom, and two older brothers have temporarily relocated from out-of-state and are now living in her grandparents’ house in a small, rural community.
Because the family had been living out-of state, Zoe has never interacted with her grandparents. She has challenges responding to social cues, including her name and in understanding gestures. She also engages in repetitive body movements. She is fond of her set of dolls and likes lining them up. When Zoe is agitated, her mother plays Mozart, which seems to have a calming effect. Zoe also enjoys macaroni and cheese.
Her grandparents do not understand Zoe’s attempts at communicating. Zoe does not respond well to crowded and noisy environments. Zoe’s mom is working outside the home for the first time.
Because of the move, Zoe has transferred to a new school, which does not currently have any students with ASD. Although her mom is generally very involved with Zoe’s education, she is away from the home much of the time due to a long commute for her new job is a neighboring city.
Zoe’s grandparents are eager and willing to help in any way they can.
Imagine you are serving as an ASD consultant at Zoe’s new school. Using the COMPASS model, create a COMPASS Action Plan for Zoe by complete the following tasks:
Identify the personal challenges for Zoe;
Identify the environmental challenges for Zoe;
Identify potential supports; and
Identify and prioritize teaching goals.
In addition, include a 250-500-word rationale that explains how your action plan for Zoe demonstrates collaboration in a respectful, culturally responsive way while promoting understanding, resolving conflicts, and building consensus around her interventions.
.
Zlatan Ibrahimović – Sports Psychology
Outline
Introduction:
· General Info
· Nationality, Birthplace, Parents
· Childhood What he wanted to do growing up?
· When did he start playing professionally?
· Which teams did he play for?
· Give some of his career statistics and maybe records?
· What trophies has he won with club football and national team of Sweden?
· Style of Play
· What is his personality like? How do people see him in the media?\
·
Body Paragraphs
Connect the following Sports Psychology Concepts (or even those not listed) to Zlatan Ibrahimović
What is his personality type? Type A, B C, or D?
Give examples through research of where he shows this.
CATASTROPHE THEORY… OCCURS WHEN? WHAT DOES THE GRAPH LOOK LIKE
· Arousal: is a blend of physiological and psychological activity in a person and it refers to the intensity dimensions of motivation at a particular moment. It ranges from not aroused, to completely aroused, to highly aroused; this is when individuals are mentally and physically activated.
· Performance increases as arousal increases but when arousal gets too high performance dramatically decreases. This is usually caused by the performer becoming anxious and sometimes making wrong decisions. Catastrophes is caused by a combination of cognitive and somatic anxieties. Cognitive is the internal worries of not performing well while somatic is the physical effects of muscle tension/butterflies and fatigue through playing.
· The graph is an inverted U where the x line is the arousal and the y is the performance. Performance peaks on the top of the inverted U and the catastrophe happens in the fall of the inverted U
HIGH TRAIT ANXIETY ATHLETES… HOW DO THEY PERCEIVE COMPETITION?
· Anxiety: is a negative emotional state in which feelings of nervousness, worry and apprehension are associated with activation or arousal of the body
· Trait Anxiety: is a behavioral disposition to perceive as threatening circumstances that objectively may not be dangerous and to then respond with disproportionate state anxiety.
· Somatic Trait Anxiety: the degree to which one typically perceived heightened physical symptoms (muscle tension)
· Cognitive Trait Anxiety: the degree to which one typically worries or has self doubt
· Concentration Disruption: the degree to which one typically has concentration disruption during competition
People usually with high trait anxiety usually have more state anxiety in highly competitive evaluative situations than do people with lower trait anxiety. Example two athletes are playing basketball and both are physically and statistically the same both have to shoot a final free throw to win the game. Athlete A is more laid back which means his trait anxiety is lower and he doesn't view the final shot as a overly threatening. Athlete B has a high trait anxiety and because of that he perceives the final shot as very threatening. This has an effect on his state anxiety much more than.
Zia 2Do You Choose to AcceptYour mission, should you choose.docxransayo
Zia 2
Do You Choose to Accept?
Your mission, should you choose to accept it, is to go out and see Mission: Impossible-Fallout. As I sat back in my red-cushioned seat, accompanied by my brothers, I knew I was in for something special. The film takes place two years after two-thousand fifteens hit movie, Mission: Impossible-Rogue Nation. While I had no clue what to expect, I knew I was going to be in for an incredible ride as soon as the movie began with the intense dialogue between Ethan Hunt (Tom Cruise) and Solomon Lane (Sean Harris). From beginning to end, Mission: Impossible- Fallout delivers crazy action-thriller scenes, inventive special effects, and creative cinematography.
Mission: Impossible-Fallout is based on a story of an American agent who must retrieve nuclear weapons from an enemy terrorist organization with help of his specialized IMF team. The film was consistent the first hour with it involving the audience in the mission of the secret organization and trying to figure out the next move of the evil organization known as the Apostles. However, towards the middle of the movie it was revealed that one of the CIA agents was playing the role of a double spy and was on the side of the Apostles. The plot delivered intense action-packed scenes between the opposing groups that personally had me at the edge of my seat. Whether it was a chase on motorcycles, cars, speedboats, or helicopters, each scene had Ethan Hunt running for his life to save the world. Even though I was only viewing the movie from a comfortable movie theater, Hunt zigzagging through the traffic of France on a motorcycle had my fists clenched and adrenaline pumping. However, that was not even the best thriller of the movie. Ethan Hunt trailing Agent Walker in a helicopter with heavy rounds of artillery being fired at each other through the snowcapped mountains of Kashmir may very well be one of the best action scenes in cinematic history. Mission: Impossible-Fallout can be appreciated and enjoyed by all audiences because of its action-packed scenes that keep everyone extremely engaged in the plot.
Mission: Impossible-Fallout brilliantly illustrates the amazing special effects that serve to create the theme and style of the film. From creating bloody wounds to spectacular backgrounds, special effects are abundant throughout the movie. For instance, as Hunt is jumping off an airplane, the special effects of this scene include wind, rain, thunder, and clouds that make the film visually appealing and almost realistic. The thunder striking him as he is skydiving had my jaw wide open simply because of how incredible the illusion was displayed. In almost every fight between Hunt’s team and the Apostles, multiple types of special effects were utilized. Fighting sequences with Hunt angrily running towards Lane and delivering devastating punches accompanied by “POWs” and “AAAHs” seemed so realistic that it had me feeling queasy in my stomach. The gunfire during these fight.
Ziyao LiIAS 3753Dr. Manata HashemiWorking Title The Edu.docxransayo
Ziyao Li
IAS 3753
Dr. Manata Hashemi
Working Title:
The Education Gap
Research Question:
How did the youth of Iran make up the education gap resulted from the Cultural Revolution from 1980 to 1982?
This is a critical question because it involves both education and the youth of Iran. Education and the youth are both very fundamental perspectives for a society to thrive. During the cultural revolution, the education system was shut down, which would undermine the overall quality of a generation. Research of this issue will lead us to the methods used to make up the education gap. It is possible to help other countries suffering similar issues.
Thesis Statement:
After the Iran’s cultural revolution during 1980 to 1982, the youth of Iran made up the education gap caused during the revolution by promoting student movements.
Outline:
· Introduction:
· Cultural Revolution happened in Iran during 1980 to 1982. The education institutions like universities were shut down for the 3-year period. And this gap in education brought significant influence on the youth of Iran at that time. However, the education gap was made up successfully after the revolution.
· State the thesis statement:
· The education gap is made up by the youth in Iran. They promoted the student movement to help the society recover from the revolution.
· The scars left from the revolution
· The revolution lasted 3 years, young people who were supposed to be students had to quit school. The government forced schools to close. The chain of delivering knowledge was broken. And young people cannot find proper things to do when quitting school.
· Student movements
· After the cultural revolution, people in Iran realized they need to correct the current education situation recover the damages resulted from the revolution. Since Iran’s youth has a great number in the society, their power was not to be ignored. They started to fight for their own rights and profits. They were looking for ways to make up the damage has been down. Then the student movement eventually worked for recovering Iran’s education level.
· Conclusion
· The cultural revolution in Iran hurt its education continuity. However, the youth of Iran managed to make up for the damage caused by the cultural revolution. Student movements played the dominant role in this recovering process.
Bibliography:
Khosrow Sobhe (1982) Education in Revolution: is Iran duplicating the Chinese Cultural Revolution?, Comparative Education, 18:3, 271-280, DOI: 10.1080/0305006820180304
Mashayekhi M. The Revival of the Student Movement in Post-Revolutionary Iran. International Journal of Politics, Culture & Society. 2001;15(2):283. doi:10.1023/A:1012977219524.
Razavi, R. (2009). The Cultural Revolution in Iran, with Close Regard to the Universities, and its Impact on the Student Movement. Middle Eastern Studies, 45(1), 1–17. https://doi-org.ezproxy.lib.ou.edu/10.1080/00263200802547586
ZABARDAST, S. (2015). Flourishing of Occid.
Ziyan Huang (Jerry)
Assignment 4
Brand Positioning
Professor Gaur
Target audience:
HR in Ping An Bank Co., Ltd. HRs (interviewers who hire people) from Ping An Bank are usually female, aged 30-40, who look friendly and easy-going. They are sophisticated and skeptic when checking people’s resumes and asking questions during interview. Usually, HRs care about four things: 1. Graduate school ranking. 2. Working experience in bank 3. Oral expression. 4. Personal character. They prefer people who are enthusiastic, energetic and hard-working.
Q1:
Compared to other people who also look for jobs in Ping An Bank, my points of parity would be: 1. I have earned a master degree in a Top 40 U.S. graduate school. 2. I have some intern experience in another bank. My points of differentiation would be: 1. I am confidence in speaking and self-expression. I can serve both Chinese and American clients because I speak fluent Mandarin and English. 2. I am energetic and hard-working. I always have passion in learning something new, which is a key for me to develop working skills.
Q2:
My brand essence: “Energetic, hard-working and modest.”
Q3:
Positioning statement:
Ziyan Huang is for employers from bank,
Who look for excellent employees.
Ziyan Huang is an energetic, hard-working NYU graduate student,
That has passion in developing new working skills.
Because he can speak fluent Mandarin and English,
And have one year working experience in China Merchant Bank,
So that employers can trust him as a reliable candidate.
.
Zhtavius Moye
04/19/2019
BUSA 4126
SWOT Analysis
Dr. Setliff
PORSCHE
Strengths
· Brand Recognition
Not only a brand, but a status symbol for wealth and luxury
· Lean Factory Production
Manpower is low compared to the use of raw materials and supplies
· High Profit Share
The reputation is well-known for good treatment
Weaknesses
· Small automotive manufacture
Porsche has offered the same line of cars for years before extending.
· Limited Customer Sector
Not everyone can afford a Porsche
· Location
Since beginning of time, Porsche has been in Stuttgart, Germany. No space to expand
Opportunities
· Expansion
Deliveries increased in China by 12% but needs more in Asia, Japan, and Indonesia.
· Electric Mobility
A chance to expand Porsche name to many more industries and markets with top competitors such as Tesla.
· S1, O2: Brand recognition extends the range for profitability for the 2020 fully electric Porsche Taycan.
· S3, O1: The annual profitability of the company will encourage others to become a part of the business.
· S2, O1: The cost of a Porsche effects expansion, but by expanding to China could significantly increase rates.
· S3, O1: The location in Germany is a problem for expansion due to limited space of Stuttgart.
Threats
· Technology
Modern technology is advancing to lower cost vehicles.
· Market Competition
Vehicles with similar characteristics at lower cost.
· S3, O2: Weighing heavily on the market Porsche’s reputation will continue to stand abroad its competitors.
· S2, O1: Limited labor will call for more software developers in the more modern technology, especially introducing the fully electric Porsche Taycan.
· S1, O1: Porsche is a company that believes in staying at its classic and luxury perception to their buyers. Still giving all newly updated technology certain things such as an automatic start engine will not be an asset.
· S2, O2: Combined leaves Porsche at a limitation of customers making it hard to expand the market.
VIOLATION OF CIVIL RIGHTS ACT IN ELECTIONS 1
VIOLATION OF CIVIL RIGHTS ACT IN ELECTIONS 2
Violation of Civil Rights Act in Elections
Jake Bookard
Savannah State University
Violation of Civil Rights Act in Elections
Introduction
Despite the assurance of minority voter’s rights by the constitution and the fourteenth amendment, cases of rights violation with regards to the voting process are still on the rise in the US. Minority groups are often discriminated or blocked from participating in the voting process both in ways that they can discern and through cunning plans that can involve the voting process. Some of the main reasons why minorities’ constitutional rights are violated include racial discrimination by majority races, and to manipulate the outcome of the elections so as to keep minority groups out of the political leadership structure. The fourteenth amendment and the constitution do not sufficiently safeguard the rights of minority groups during elections beca.
Zichun Gao Professor Karen Accounting 1AIBM FInancial Stat.docxransayo
Zichun Gao Professor Karen Accounting 1A
IBM FInancial Statement Analysis
Financial Ratios 2019 2018 Formula
Current Ratio 1.02 1.29 CA/CL
Profit Margin 12.22% 12.35% Net Income/Total Revenue
Receiveables Turnover 9.80 10.71 Revenue/Average AR
Average Collection Period 36.72 33.62 365/Receiveables Turnover
Inventory Turnover 25.11 25.36 COST/Average Inventory
Days in Inventory 14.53 14.39 365/Inventory Turnover
Debts to Asset Ratio 0.86 0.86 Total Debts/Total Assets
IBM's days in inventory is around two weeks and this means that goods in the inventory
as efficnetly distributed and that there is a consitantly good inventory control for the
company.
The company's debts to assets ratio is the same for two years and this means that the
company has less debt than asset. However, it is still a relatively poor ratio because this
might show that there are potential problems for the company to generate sufficient
revenue.
The current ratio of the company has decreased over the year, and this means that the
company has less liquid assets to cover its short term liabilities. Since the ratio is
currently approaching 1, the company might be having liquidation problem.
The profit margin for IBM is very stable and it has been about 12% for two years. The
company is performing the profit-generating ability at an average level and it is having
an average profit margin in the industry.
The receiveables turnover is good for the company while between these two years, there
is a decline. As the company is collecting its accounts receiveables around 10 times per
year, the collection is frequent.
The company has been collecting money from customers on credit sales approximately
once every month, and the company usually has fast credit collection, which means that
the risk for credit sales is relatively low.
Inventory turnover measures how many times a company sells and replaces inventory
during a year and for IBM, the number of times is stable and it is constantly around 25.
This means that the company has an efficient control of its goods in the inventory.
Free Cash Flow 11.90 11.90 CF_Operation-Capital Expenditures
Return on Assets 0.06 0.08 Net Income/Total Assets
Asset Turnover 0.51 0.65 Revenue/Assets
Figures From Financial Statement
From Income Statement pg.68
Net Income 9431 9828
Total Revenue 77147 79591
Cost 40657 42655
From Consolidated Balance Sheet pg.70
Current Assets 38420 49146
Current Liabilities 37701 38227
Accounts Receiveables 7870 7432
Inventory 1619 1682
Total Assets 152186 123382
Total Liabilities 131202 106452
From Cash Flow Overview pg.59
Net Cash From Op 14.3 15.6
Capital expenditures 2.4 3.7
The company currently has 11.9 billion dollars free cash flow for two years and this is a
relatively high level of free cash flow. With the high free cash flow, the company can
have more oportunity to expand, invest in new projects, pay dividends, or invest the
money into Resea.
Zheng Hes Inscription This inscription was carved on a stele erec.docxransayo
Zheng He's Inscription
This inscription was carved on a stele erected at a temple to the goddess the Celestial Spouse at Changle in Fujian province in 1431. Message written before his last voyage.
The Imperial Ming Dynasty unifying seas and continents, surpassing the three dynasties even goes beyond the Han and Tang dynasties. The countries beyond the horizon and from the ends of the earth have all become subjects and to the most western of the western or the most northern of the northern countries, however far they may be, the distance and the routes may be calculated. Thus the barbarians from beyond the seas, though their countries are truly distant, "have come to audience bearing precious objects and presents.
The Emperor, approving of their loyalty and sincerity, has ordered us (Zheng) He and others at the head of several tens of thousands of officers and flag-troops to ascend (use) more than one hundred large ships to go and confer presents on them in order to make manifest (make it happen) the transforming power of the (imperial) virtue and to treat distant people with kindness. From the third year of Yongle (1405) till now we have seven times received the commission (official permission) of ambassadors to countries of the western ocean. The barbarian countries which we have visited are: by way of Zhancheng (Champa Cambodia), Zhaowa (Java), Sanfoqi (Palembang- Indonesia) and Xianlo (Siam/Thailand) crossing straight over to Xilanshan (Ceylon- Sri Lanka) in South India, Guli (Calicut) [India], and Kezhi (Cochin India), we have gone to the western regions Hulumosi (Hormuz Between Oman and Iran), Adan (Aden), Mugudushu (Mogadishu- Somalia), altogether more than thirty countries large and small. We have traversed more than one hundred thousand li (distance of 500 meters) of immense water spaces and have beheld in the ocean huge waves like mountains rising sky-high, and we have set eyes on barbarian regions far away hidden in a blue transparency of light vapours, while our sails loftily unfurled like clouds day and night continued their course (rapid like that) of a star, traversing those savage waves as if we were treading a public thoroughfare. Truly this was due to the majesty and the good fortune of the Court and moreover we owe it to the protecting virtue of the divine Celestial Spouse.
The power of the goddess having indeed been manifested in previous times has been abundantly revealed in the present generation. When we arrived in the distant countries we captured alive those of the native kings who were not respectful and exterminated those barbarian robbers who were engaged in piracy, so that consequently the sea route was cleansed and pacified (to make someone or something peaceful) and the natives put their trust in it. All this is due to the favours of the goddess.
We have respectfully received an Imperial commemorative composition (essay/piece of writing) exalting the miraculous favours, which is the highest recompense and.
Zhou 1Time and Memory in Two Portal Fantasies An Analys.docxransayo
Zhou 1
Time and Memory in Two Portal Fantasies: An Analysis of Alice’s Adventure in Wonderland and "Windeye"
Life is a collection of moments, and some memories last forever. Brian Evenson
demonstrated this in “Windeye,”a story of a man who faces mental challenges because of the
life-long memory of his sister. In spite of the fact that his mother insists that the sister did not
exist, the protagonist stuck to this belief until his old age. The basis of the protagonist’s
problems is the intense love and unforgettable memories he shared with his imagined sister.
A great portion of his childhood memories is centered around his sister and their exploration
of the windeye. Windeye, the corruption of the word window, is a portal that causes the
disappearance of the protagonist’s sister. The popular portal fantasy, Alice’s Adventure in Wonderland, illustrates a similar story in the same sub-genre where a girl travels through a
rabbit hole and experiences a fantasy world which chronicles her changes from naive child-
like responses to more adult-like problem solving reactions. In “Windeye,” Brian Evenson
utilizes the portal trope to develop conflict and outcomes while exploring the themes of time
and memory. In both stories, the use of the portal trope creates a distinct world that is
separate from reality; however, the outcomes are different, and ultimately, Alice’s Adventure in Wonderland presents the theme of growth while “Windeye” explores time and memories.
The use of time factors allows the reader to travel back to the origin of the story in “Windeye” and experience the beginning of the central conflict. It is in his past that the
protagonist develops strong childhood memories of a sister, which is the cause of his future
mental challenges. In the present, the narrator is old and rickety as he uses a cane to walk but
is still reminiscent of the past (Evenson). He holds firm to the belief that he might have a
chance of meeting his sister again and thus contemplates the future and the sister’s
appearance. The plot of “Windeye” is composed of distinctive life moments: the past, the
present, and the future, which offer a clear and complete description of the events. The theme
Zhou 2
of time allows the reader to understand why the protagonist profoundly feels that his sister exists. In essence, it is time travel that gives the story a picture of the events that lead to the current situation.
The portal fantasy is a fictional literary device where a character enters into a
fantastical world through a portal or a hole. In Alice’s Adventures in Wonderland, Carroll
uses a rabbit hole as a physical portal to move through time. Comparably, Evenson utilizes
the windeye, a window that can only be seen from one side, as a physical portal. When the
sister touches the windeye, her brother believes that she enters into another reality through
the portal as Alice does. In contrast, the protagonist also experiences a new reality as he is.
Zhang 1
Yixiang Zhang
Tamara Kuzmenkov
English 101
June 2, 2020
Comparing Gas-Powered Cars and Electric Cars
Electric cars have become increasingly popular in the past century. These cars use
electric motors instead of conventional gasoline engines. Electric cars pollute less and utilize
energy more efficiently than gas-powered vehicles; therefore, modern research is focusing on
improving electric vehicles, such as increasing the storage capacity of the batteries. This essay
seeks to identify the differences and similarities between the two types of cars focusing on their
performance, price, and convenience.
An electric car is a car that is primarily powered by electricity. The conventional gas-
powered cars require diesel or gasoline to power the engines. These cars have gas tanks that store
fuel and the engine converts the gas to the energy that powers the motor. Similarly, electric cars
have batteries, or fuel cells that store and convert electricity to energy used to propel electric
motors (What Are Electric Cars?). Four components present in electric cars distinguish it from
the gas-powered cars (Alternative Fuels Data Center: How Do All-Electric Cars Work?). The
first is the charge port. Since electricity powers an electric car, there has to be a port to connect
to an external power source when charging the battery. The second is an electric traction motor
that propels the vehicle. The third is a traction battery pack. This battery serves the same purpose
as the gas tank; thus, it stocks electric power to propel the motor. The forth is a direct current
converter. This component converts the current to low voltage power that is needed to power the
electric engine.
Tamara Kuzmenkov
90000001730094
You need to watch the panapto session for this paper assignment and FOLLOW the instructions I give there. Your topic sentence must follow the patterns set forth by your thesis. So, this first paragraph must have a topic sentence about GAS POWERED cars and PRICE. That is what you have set forth in your thesis. Watch the panapto session. And ask me questions if you do not understand what I mean.
Tamara Kuzmenkov
90000001730094
No, you cannot 'announce' what your essay will do. And this is NOT the thesis I approved. What I approved:"Both gas-powered cars and electric cars are now in use, but their price, performance and convenience may vary, which may influence people's decisions about which type to use."
Zhang 2
Differences between gas-powered cars and electric cars
The initial purchase price of an electric car is much higher than that of a gas-powered car.
Consumers intending to own a vehicle have the option of buying or leasing. The initial cost of a
car depends on an individual's disposable income and savings. Knez et al. noted that "When it
comes to financial features, the most important thing seems to be the total price of the vehicle"
(55). The difference in price between electr.
Zhang �1
Nick Zhang
Mr. Bethea
Lyric Peotry
13 November 2018
Reputation by Taylor Swift
After Taylor Swift fell into disrepute, she was truly reborn. As a creative singer
who reveals a lot of real life emotions and details in her works, she constantly refines
and shares her emotional connection with her audience. In her new album, people find
resonance in her work, connect it with their own lives. "Reputation" is not only the
original efforts of Taylor Swift, but also means that she turned gorgeously and
dominated. This album is like a swearing word from her to the world. Revenge fantasy,
sweet love, painful growth... all the good and bad things that happened in these stages
of life, her music seems to have gone through with us all over again.
But last August, the now 28-year-old singer declared that "the old Taylor is
dead" in her eerie single "Look What You Made Me Do," the beginning of a new era for
Swift (Weatherby). The disclosure of the society, the accusations of rumor makers,
these straight-forward lyrics shred the ugly face of those unscrupulous people. Taylor
Swift did not endure the rumors in the society, but created this rock album after the
silence. If 1989 is still what Taylor hopes to gain the understanding of the public, this
album is really a matter of opening up the past concerns, saying goodbye to the past
as well as being a true Taylor Swift. No longer caring about the so-called "reputation ",
preferring to be burned to death by those ridiculous "images." This air of newfound
jadedness is one of the many ways in which Swift broadcasts her long-overdue loss of
Zhang �2
innocence on “Reputation,” an album that captures the singer during the most
turbulent but commercially successful period of her career. (Primeau)
The cover is black and white, the picture is Taylor's head, and the side is the
newspaper's article and title words. The cover of the album may be a metaphor, it
reveals that Taylor can no longer stand the report of the gossip media, and the chain on
the neck represents depression and breathlessness. The theme and style of the album
are all refined from their own lives. The emotions and themes interpreted in her songs
make the audience feel more deeply that her album is her life. Without even using any
real words, fans can surmise what this means — a reference to the endless headlines
and stories the singer has spurred in recent years. (Primeau) Reputation, come to diss
the past and all opponents.
The lyrics and MV are full of real stalks in Taylor Swift's life , with Taylor's
resentment for circles and industry since his debut. In the era of streaming singles, she
is the rare young star who still worships at the altar of the album, an old-fashioned
instinct that serves her surprisingly well. (Battan) "Look What You Made Me Do" is a
counterattack against Kanye West and Kim Kardashian, Katy Perry and numerous
online "black mold". And .
Zero trust is a security stance for networking based on not trusting.docxransayo
Zero trust is a security stance for networking based on not trusting any users, devices, or applications by default, even those that are already on the network. The zero trust model uses identity and access management (IAM) as a foundation for an organization’s security program. For this assignment:
Research the zero trust model.
Write a report that describes the following:
The purpose of zero trust and what differentiates it from other security models
An overview of how zero trust works in a network environment
How zero trust incorporates least privilege access through role-based access control (RBAC) and/or attribute-based access control (ABAC)
Need 2 pages around 600 words
.
Zero plagiarism4 referencesNature offers many examples of sp.docxransayo
Zero plagiarism
4 references
Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.
In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.
Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.
Post
a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.
.
Zero plagiarism4 referencesLearning ObjectivesStudents w.docxransayo
Zero plagiarism
4 references
Learning Objectives
Students will:
Develop diagnoses for clients receiving psychotherapy*
Analyze legal and ethical implications of counseling clients with psychiatric disorders*
* The Assignment related to this Learning Objective is introduced this week and
submitted
in
Week 4
.
Select a client whom you observed or counseled this week. Then, address the following in your Practicum Journal:
Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
Using the
Diagnostic and Statistical Manual of Mental Health Disorders
, 5th edition (DSM-5), explain and justify your diagnosis for this client.
Explain any legal and/or ethical implications related to counseling this client.
Support your approach with evidence-based literature.
.
Zero Plagiarism or receive a grade of a 0.Choose one important p.docxransayo
Zero Plagiarism or receive a grade of a 0.
Choose one important police function: Law enforcement, order maintenance or service, etc.
OR
Choose one important police strategy: Traditional Policing, Community Policing, Data Driven Policing, etc.
Write a research paper describing the strateugy or function in detail and discussing the significance of the strategy or function with respect to the roles in society.
Format: Title Page, Outline, Text, and References
Must have 3 sources
You can use your textbook: Cox, Steven M., et al. (2020). Introduction to Policing. Fourth Edition. Thousand Oaks, CA: SAGE Publications, Inc.
Paper must by 6 pages long
APA Style
.
ZACHARY SHEMTOB AND DAVID LATZachary Shemtob, formerly editor in.docxransayo
ZACHARY SHEMTOB AND DAVID LAT
Zachary Shemtob, formerly editor in chief of the Georgetown Law Review, is a clerk in the US District Court for the Southern District of New York. David Lat is a former federal prosecutor. Their essay originally appeared in the New York Times in 2011.
Executions Should Be Televised
Earlier this month, Georgia conducted its third execution this year. This would have passed relatively unnoticed if not for a controversy surrounding its videotaping. Lawyers for the condemned inmate, Andrew Grant DeYoung, had persuaded a judge to allow the recording of his last moments as part of an effort to obtain evidence on whether lethal injection caused unnecessary suffering.
Though he argued for videotaping, one of Mr. DeYoung’s defense lawyers, Brian Kammer, spoke out against releasing the footage to the public. “It’s a horrible thing that Andrew DeYoung had to go through,” Mr. Kammer said, “and it’s not for the public to see that.”
We respectfully disagree. Executions in the United States ought to be made public.
Right now, executions are generally open only to the press and a few select witnesses. For the rest of us, the vague contours are provided in the morning paper. Yet a functioning democracy demands maximum accountability and transparency. As long as executions remain behind closed doors, those are impossible. The people should have the right to see what is being done in their name and with their tax dollars.
This is particularly relevant given the current debate on whether specific methods of lethal injection constitute cruel and unusual punishment and therefore violate the Constitution.
There is a dramatic difference between reading or hearing of such an event and observing it through image and sound. (This is obvious to those who saw the footage of Saddam Hussein’s hanging in 2006 or the death of Neda Agha-Soltan during the protests in Iran in 2009.) We are not calling for opening executions completely to the public — conducting them before a live crowd — but rather for broadcasting them live or recording them for future release, on the web or TV.
When another Georgia inmate, Roy Blankenship, was executed in June, the prisoner jerked his head, grimaced, gasped, and lurched, according to a medical expert’s affidavit. The Atlanta Journal-Constitution reported that Mr. DeYoung, executed in the same manner, “showed no violent signs in death.” Voters should not have to rely on media accounts to understand what takes place when a man is put to death.
Cameras record legislative sessions and presidential debates, and courtrooms are allowing greater television access. When he was an Illinois state senator, President Obama successfully pressed for the videotaping of homicide interrogations and confessions. The most serious penalty of all surely demands equal if not greater scrutiny.
Opponents of our proposal offer many objections. State lawyers argued that making Mr. DeYoung’s execution public raised safety concerns..
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Zeng Jiawen ZengChenxia Zhu English 3001-015292017Refl.docxransayo
Zeng
Jiawen Zeng
Chenxia Zhu
English 3001-01
5/29/2017
Reflective Essay
Becoming a good writer is a challenging and continuous process that need to constantly improving your writing skills in different area as same as constructive reflection for identification of both progress and directions for further development. My writing competence has improved significantly during the ten weeks of English 3001 Writing Proficiency course in such areas as grammar, use of verb tenses, and content quality.
The most serious problems I faced in writing process previously were grammar issues and poor content of the essays. To be more precise, I used to lack empirical competence in proper use of verb tenses. My confusions of tense forms destroyed all the sense of the essay, and often improper sentence structure made the result of the writing process insufficient to meet the University Writing Skills Requirements. Initially, when I tried to improve my skills in the given area, I only paid attention to the highlighted mistakes and comments of the tutor. Nonetheless, I realized it was not enough. Therefore, I changed this strategy to a more constructive one. To be more precise, I started reading more books in English and wrote essays diverse topics apart from the course tasks. It was an effective type of training since in several weeks my essays revealed particular progress which I took into consideration and continued.
I realize that it does not suffice to finally meet the University Writing Skills Requirements since this is only a fraction of real competence in writing. The next step of self-improvement the given sphere is editing that also has numerous issues and challenges to be dealt with. It means that there are two domains within the notion of writing competence, and both of them have no limits and require constant self-improvement. Therefore, my goal to meet academic requirements is only one more step in the course of acquisition of linguistic competence and capacity to master English in terms of writing essays and academic papers.
Moreover, I know that currently I need to focus more on content issues, persuasive capacity and proper use of diverse materials employed to support evidence which are crucial elements of writing papers per University requirements. On the other hand, I see that all the core problems with linguistic competence which I have faced earlier, are solved, which means that I need to focus on further self-improvement and keep constructive work in order to achieve my next targets in the field of concern. Furthermore, I have considerable progress in such important dimensions of academic paper construction as thesis development, use of testimony and personal observations, and alignment of different ideas into a coherent, justified and credible academic entity. Now I do not permit run-ons, excessive use of articles or comma splices to emerge in my works. It means that flaws of basic and medium level are dealt with, and further self-de.
zClass 44.8.19§ Announcements§ Go over quiz #1.docxransayo
z
Class 4
4.8.19
§ Announcements
§ Go over quiz #1
§ Practice listening quiz
§ Lecture on social organization of Hindustani music
z
Announcements
§ Aashish Khan recital on April 28
§ Assignment #1 will be posted this week
§ Summer course on Indian rhythm
z
Practice listening quiz
z
Terms
§ Socio-musical identity – the connection of social rank to musical
status; prevalent throughout musical communities in South and
Central Asia
§ Soloist – the lead musical role
§ Accompanist – the supporting musical role(s)
§ Heterophony – style of music in which a melody is closely
imitated by another instrument or voice
z
Questions to keep in mind
§ What does social class have to do with music performance?
§ How is authority created and controlled?
§ How is it challenged?
§ What is the relationship between soloist and accompanist?
§ How does this affect music performance?
§ What is the relationship between student and teacher?
z
Social class and caste in South Asia
§ Societies were stratified in a social hierarchy
§ High caste – rulers, priests, elite
§ Low caste – manual laborers
§ Dalits – “untouchables”
§ Caste specialization of artisan trades common among Muslim communities
§ Carpentry, pastoralism, leather making, jewelry making, and music!
§ The community to which you were born determined your social rank and the
opportunities that would be available to you
§ People could ”change” their class through certain strategies
§ Marriage, contesting the hegemony of the upper classes
z
Organization of specialist knowledge
§ Music is a practice of specialized communities
§ Music is your life!
§ No word for “musician”
§ Rather, terms denoting the specialty of the performer are used
§ This categorization indicates musical identity (the instrument one
performs) as well as that person’s social rank and roles
z
Organization of specialist knowledge
§ Dhrupadiya – singer of dhrupad
§ Gawaiya – vocalist
§ Binkar – bin (veena) player
§ Khayalia – singer of khyāl
§ Sitariya – sitar player
§ Sarodiya – sarod player
§ Tabliya – tabla player
§ Sarangiya – sarangi player
§ Rubabi – rubab player
§ Qawwal - singer of Qawwali
z
Instrument association
Soloist
Vocal
Sitar
Rudra veena
Sarod
Dance
Rubab
Surbahar
Bansuri
Accompanist
Sarangi
Tabla
Harmonium
z
Social roles and ranks
§ Relationship between occupation and social identity is very
close
§ Soloists are venerated and have great prestige
§ Accompanists have lower social and musical status
§ They are subservient to soloists in both roles
z
Performance structure
§ Soloist (Dhrupad, khyāl, thumri, ghazal
§ Vocal
§ Instrumental
§ Accompanist
§ Melodic
§ Sarangi
§ Harmonium
§ Student
§ Heterophony
§ Rhythmic
§ Tabla
§ Dholak
§ Drone
§ Tanpura
z
Social roles and ranks
§ Soloists and accompanists belonged to different social class
§ Never intermarried
§ Cousin marriages
§ Soloist class – kalawant
§ Accompanist classes – mirasi, dhari (dhadhi).
zClass 185.13.19§ Announcements§ Review of last .docxransayo
z
Class 18
5.13.19
§ Announcements
§ Review of last class
§ Finish lecture on Qawwali, begin intro to Pakistan
z
Announcements
§ Keshav Batish senior recital, June 5 – Extra credit
§ Exam #1 results posted
§ 2 perfect scores, 25 A’s, 46 B’s, 37 C’s, 17 D and lower
§ Summer course on Indian rhythm (second session)
§ Learn tabla and dholak!
§ Enrollment open now!
z
Last class review
§ Qawwali – “Food for the soul”
§ Sufi devotional poetry set to music
§ Performed at dargah
§ ‘Urs
z
Terms
§ Mehfil – small, intimate gatherings that involve entertainment of
various sorts, including music, poetry, dance etc.
z
Tum Ek Gorakh Dhandha Ho
§ “You are a baffling puzzle”
§ Written by Naz Khialvi (1947-2010)
§ Pakistani lyricist and radio broadcaster
§ Popularized by Ustad Nusrat Fateh Ali Khan (1948-1997)
z
Tum Ek Gorakh Dhandha Ho
kabhi yahaan tumhein dhoonda
kabhi wahaan pohancha
tumhaari deed ki khaatir kahaan
kahaan pohancha
ghareeb mit gaye paamaal ho
gaye lekin
kisi talak na tera aaj tak nishaan
pohancha
ho bhi naheen aur har ja ho
tum ik gorakh dhanda ho
At times I searched for you here,
at times I traveled there
For the sake of seeing You, how
far I have come!
Similar wanderers wiped away
and ruined, but
Your sign has still not reached
anyone
You are not, yet You are
everywhere
You are a baffling puzzle
z
Bhar Do Jholi Meri
§ Traditional song
§ Popularized in movie “Bajrangi Bhaijaan” (2015)
z
Bhar Do Jholi Meri
Tere Darbaar Mein
Dil Thaam Ke Woh Aata Hai
Jisko Tu Chaahe
Hey Nabi Tu Bhulata Hai
Tere Dar Pe Sar Jhukaaye
Main Bhi Aaya Hoon
Jiski Bigdi Haye
Nabi Chaahe Tu Banata Hai
Bhar Do Jholi Meri Ya Mohammad
Lautkar Main Naa Jaunga Khaali
They come into Your court
clenching their hearts
Those people whom You desire to
see , O Prophet!
I’ve also come to Your door with
my head bowed down
You’re the One who can fix
broken fates, O Prophet!
Please fill my lap, O Prophet!
I won’t go back empty handed
z
Ustad Nusrat Fateh Ali Khan
(1948-1997)
§ Pakistani vocalist
§ Sang classical (khyāl) but more famous as a Qawwali singer
§ Brought classical performance techniques to Qawwali
§ Visiting artist at University of Washington from 1992-93
§ Legacy carried on through his nephew, Rahat Fateh Ali Khan
z
Introduction to Pakistan
Badshahi Mosque, Lahore
Built in 1671 by Emperor Aurangzeb
z
Pakistan
§ Prominent Bronze Age (3000-1500BCE) settlements of Mohenjo
Daro and Harrapa along Indus River Valley
§ Hinduism widespread during Vedic Age (1500-500BCE)
§ Ruled by series of Hindu, Buddhist, and eventually Muslim
(Persian) dynasties
§ Islam introduced by Sufi missionaries from 7th to 13th centuries
§ Ethnically and linguistically diverse
z
Indus Valley civilization
z
Pakistan ethnicities
z
Modern India and Pakistan
§ By the end of 19th century British rule was in effect over much of
old Mughal Empire territory
§ The Hindu and Muslim divide among this territory was be.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Overview on Edible Vaccine: Pros & Cons with Mechanism
9 A Preliminary Theory of Interorganizational Network Effectivenes.docx
1. 9 A Preliminary Theory of Interorganizational Network
Effectiveness: A Comparative Study of Four Community Mental
Health Systems Keith G. Provan H. Brinton Milward This
chapter presents the results of a comparative study of
interorganizational networks, or systems, of mental health
delivery in four U.S. cities, leading to a preliminary theory of
network effectiveness. Extensive data were collected from
surveys, interviews, documents, and observations. Network
effectiveness was assessed by collecting and aggregating data
on outcomes from samples of clients, their families, and their
case managers at each site. Results of analyses of both
quantitative and qualitative data collected at the individual,
organizational, and network levels of analysis showed that
network effectiveness could be explained by various structural
and contextual factors, specifically, network integration,
external control, system stability, and environmental resource
munificence. Based on the findings, we develop testable
propositions to guide theory development and future research on
network effectiveness. The study of relations between
organizations has been a major concern of organization theorists
for at least the past 25 years. While most of the work in this
area has focused on the determinants or predictors of
interorganizational relations (see Oliver, 1990, for a review), as
an understanding of the phenomenon has grown, the unit of
analysis has gradually shifted from the dyad to the organization
set, to the network. Especially in recent years, the study of
organizational networks has proliferated. Much of this interest
has been generated by an emerging recognition by academics
that businesses, as well as organizations in the not-for-profit
and public sectors, are increasingly turning to various forms of
cooperative alliances as a way of enhancing competitiveness
and effectiveness that would not be possible through the
traditional governance mechanisms of market or hierarchy
(Powell, 1990). While a good deal of what has been written
2. about networks has been atheoretical, discussing the advantages
of networks or examining issues of measurement and analysis,
considerable theory-based research has also emerged (e.g.,
Cook, 1977; Burt, 1980; Granovetter, 1985; Jarillo, 1988;
Williamson, 1991; Cook and Whitmeyer, 1992; Larson, 1992;
Provan, 1993). In the organization theory literature, work on
networks has been guided primarily by two theoretical
perspectives: resource dependence, and related exchange
perspectives, and transaction cost economics, with most recent
work focusing on the latter approach. Each of these perspectives
offers both complementary and contrasting views about the
network form. For the most part, however, each perspective
focuses essentially on the organizational antecedents and
outcomes of network involvement, with little attention paid to
the network as a whole, except for its governance and structure.
This organizational view is understandable, since it is
organizations that make up a network and organizations that
stand either to lose or benefit by network involvement. In both
the transaction cost and resource dependence literatures, for
instance, the motivation and rationale for cooperative,
interorganizational integration of activities and services is at
the organizational level, either for reasons of efficiency related
to reduced transaction costs (Williamson, 1985) or to gain
resources and power (Pfeffer and Salancik, 1978). Individual
organizations make strategic choices to form or become part of
a cooperative network of other organizations when it appears
that the advantages to such an arrangement, especially enhanced
survival capacity (Uzzi, 1994), outweigh the costs of
maintaining the relationship, including any potential loss of
operating and decision autonomy. Thus, much of what is known
about the rationale for network involvement is based on an
extension of the literature on interorganizational relations.
Absent from these views, however, is a focus on nonstructural
outcomes of the network as a whole. Even in the general
network literature, which places a heavy emphasis on network-
level properties and structures (Aldrich and Whetten, 1981;
3. Knoke and Kuklinski, 1982; Marsden, 1990; Scott, 1991), issues
of network outcomes and effectiveness are mostly ignored.
While focus on organizational effectiveness is clearly
appropriate when outcomes can readily be attributed to the
activities of individual organizations, not all problems can be
solved by the actions of individual organizations. Particularly in
the area of community-based health care and social services for
such groups as the homeless, people with severe mental illness,
drug and alcohol abusers, and the elderly, a focus on
organizational outcomes is insufficient, because such outcomes
reflect only how well individual providers are performing their
particular component of the many services needed by their
clients. If the overall well-being of clients is a goal, then
effectiveness must be assessed at the network level, since client
well-being depends on the integrated and coordinated actions of
many different agencies separately providing shelter,
transportation, food and health, mental health, legal, vocational,
recreational, family, and income support services. Although
individual agencies obviously have an important role to play in
service delivery, and some agencies will clearly be more
involved and provide higher-quality services than others, if
overall client well-being depends on receiving different services
provided by multiple agencies, client outcomes should be
explainable by focusing on network-level activities and
structure. The critical issue, both for clients and system-level
planners and funders, is the effectiveness of the entire network
of service providers, not whether some agencies that are part of
the network do a better job than others in providing a particular
component of service. Obviously, a network may be well
integrated and still be ineffective if individual provider
agencies do a poor job. At the opposite extreme, even though
the agencies in a system may provide excellent services, overall
outcomes may be quite low if clients can only gain access to
some of these services. The prevailing view among many
service professionals, policymakers, and researchers is that by
integrating services through a network of provider agencies
4. linked through referrals, case management, and joint programs,
clients will gain the benefits of reduced fragmentation and
greater coordination of services, leading to a more effective
system (Warren, Rose, and Bergunder, 1974; Rogers and
Whetten, 1982; Department of Health and Human Services,
1991; Goldman et al., 1992; Alter and Hage, 1993). In the
public and not-for-profit sectors, where a public interest motive
is involved, network outcomes are especially salient, and the
rationale for organizations cooperating to accomplish system
goals rather than organizational ends is often stronger than in
the private sector, even when specific incentives to integrate
and cooperate are weak. For key external groups like
policymakers and funders, as well as for service professionals
and clients themselves, emphasis is often on achieving
outcomes that enhance the overall well-being of clients, without
regard to whether the goals of individual provider organizations
are met. Such outcomes may or may not have any direct impact
on the effectiveness of many of the organizations that make up
the network and may even result in a reduction in the number of
organizations that provide services to a particular clientele if
services are provided more efficiently. Arguments for the
effectiveness of integrated networks of organizations have been
particularly prevalent in discussions of the community-based
care of people with severe mental illness (Windle and Scully,
1976; Turner and TenHoor, 1978; Tessler and Goldman, 1982;
Grusky et al., 1985; Morrissey, Tausig, and Lindsey, 1985;
Goldman et al., 1992; Alter and Hage, 1993). Much of the
rationale for the need for integrated, coordinated services for
these individuals stems from the failure of efforts to serve the
many patients released from state mental hospitals since the
1960s. Deinstitutionalized patients were to draw on the services
offered by community health and human service organizations,
but little effort or money was expended to ensure that needed
services were available or that clients would be able to move
among community agencies to get these services. Since long-
term hospitalization was no longer socially acceptable or
5. politically feasible, the alternative treatment ideology that
emerged was based on the integration of services into a system
or network of providers (Bassuk and Gerson, 1978; Weiss,
1990). Integrated systems of community agencies can provide
the full range of health and human services needed by severely
mentally ill adults in a way that ensures continuity of care (Dill
and Rochefort, 1989). Such continuity is particularly critical for
this illness, which is estimated to afflict between 1.7 and 4
million Americans (National Institute of Mental Health, 1991),
not only because of clients' multiple needs but because of the
disorienting nature of the illness itself. This latter problem
makes it extremely difficult for clients to be responsible for
ensuring that their own treatment is effectively coordinated
across a variety of autonomous agencies that are often scattered
geographically. In addition, through coordination, an integrated
system supposedly minimizes duplication of services by
multiple provider agencies while increasing the probability that
all essential services are provided somewhere in the system and
that clients will have access to these needed services. Thus,
system structure, particularly integration among service
providers, is presumed to have a strong impact on outcomes for
the mentally ill. Many of the original ideas behind services
integration for the mentally ill were incorporated under the
National Institute of Mental Health's (NIMH) Community
Support Program, begun in 1977, although the specific form that
integration was to take was purposely left vague (Grusky et al.,
1985). Because funding for implementing this program was
limited and no mandates were imposed, mental health
professional groups and NIMH frequently relied on normative
pressures (supported by some demonstration grants) to influence
local integration behavior through establishment of a so-called
community service ethic (Weiss, 1990). NIMH continues to call
for research on the topic (Steinwachs et al., 1992), firmly
believing that integration of the broad range of services needed
by the severely mentally ill is critical for favorable client
outcomes. Unfortunately, although the rationale for network
6. involvement may be strong, there is almost no empirical
evidence to support the presumed relationship between
integration and network effectiveness or to indicate what
network characteristics are associated with effective outcomes.
Consistent with the ideas discussed above, our study was
organized around a single fundamental research question: What,
if any, is the relationship between the structure and context of
mental health networks and their effectiveness? We
operationalized effectiveness using a multitrait,
multiperspective methodology designed to assess the overall
well-being of severely mentally ill clients collectively served by
the agencies that make up the health and human service delivery
system in each of four mid-sized U.S. cities. From the study, we
draw conclusions for theory and research on the effectiveness of
organizational networks and for issues of health care policy that
apply to service delivery through integrated and coordinated
networks of organizations. Research Methods This study uses
what Yin (1984) has described as a case survey approach, in
which multiple levels of analysis (individual, agency, and
network levels) are used to develop an in-depth picture of a
single case. We used this approach in each of four systems, so
that our study has a comparative case research design. We draw
on extensive qualitative and questionnaire data collected from
hundreds of individuals and organizations that we first
aggregate by system to reflect the properties of that system and
then compare. Research Sites and Criteria for Selection The
community mental health systems in four U.S. cities were
studied: Tucson, Arizona; Albuquerque, New Mexico;
Providence, Rhode Island; and Akron, Ohio. Our choice of city
was guided by three selection criteria. First, we wanted to
choose cities of roughly comparable size that would be large
enough to contain the full range of organizations, clients, and
services existing in nearly all medium to large cities while not
being so large that data collection and analysis would be
unmanageable. Our cities ranged in size from 369,000
(Providence) to 667,000 (Tucson), using 1990 census data from
7. the 1991 Statistical Abstract of the United States. Second, we
wanted to choose cities having at least one core mental health
agency whose role it was to provide services and to coordinate
the services of other community agencies, if only through case
management. These dual roles are typical of the core agency in
most medium- to large-sized communities, although significant
variance exists in funding, structure, actual services provided,
and coordination emphasis. Finally, we used a most
similar/most different research design (Przeworski and Teune,
1970), selecting two cities from states with relatively high
levels of per capita mental health spending and two from states
with low mental health spending. This would allow comparisons
based on the relative resource munificence of the broader state
system in which our community systems were embedded. We
chose this approach because the majority of funding for
community mental health flows to localities through the state
(Mechanic and Surles, 1992). Using data reported by Torrey et
al. (1990), resource munificence was operationalized as per
capita mental health spending by each state's mental health
authority. Spending was high in Rhode Island ($52.34) and Ohio
($45.33) and low in New Mexico ($23.79) and Arizona
($19.76). Author's Note: This chapter is a reprint from
Administrative Science Quarterly, 40(1), 1–33, 1995. This
research was funded by a grant from the National Institute of
Mental Health (R01-MH43783). The authors would like to thank
Mike Berren, Dick Bootzin, A. J. Figueredo, Julie Sebastian,
Lee Sechrest, and Ken Sublett for their contributions to this
project and Terry Anfiburgey, Rob Burns, Christine Oliver,
Chuck Windle, and three anonymous ASO reviewers for their
many valuable comments on various drafts of the paper.
Network Data Collection Procedures In each of the four cites,
we used identical data and data collection procedures, based on
a modified version of methods used in a pilot study (Provan and
Milward, 1991). Data were collected in 1991 and early 1992.
After each site was identified and we had confirmed initial
cooperation by the core mental health agency, we traveled to
8. each site and met with system leaders, including heads of key
mental health providers, funders, and support groups. At this
meeting, we explained procedures, sought further cooperation,
and presented, discussed, and refined a list of organizations in
the system. It was our intent to develop a comprehensive list of
all agencies in the community that provided services to adults
with severe mental illness. Our primary method for determining
inclusion was what Laumann, Marsden, and Prensky (1983)
referred to as positional, where an agency had to provide actual
services or funding to our target population. Besides agencies
having mental health as a prime goal, the mental health system
at each site included agencies providing permanent and
temporary housing and shelter, counseling, legal, food,
transportation, income assistance, employment, rehabilitation,
medical, drug and alcohol abuse, and recreation services. For
many of these agencies, severely mentally ill (SMI) adults made
up only a fraction of the total clientele served, but each agency
and its services were an important piece of the entire
community mental health system in that city. Consistent with
the positional selection criterion, agencies were selected
because of their involvement with SMI clients and not because
they were already linked to other service providers for the SMI.
Thus, we made every possible attempt to avoid including only
those agencies that were already well integrated into the mental
health network. From the list of mental health provider agencies
that we generated and refined at each site, we developed a
questionnaire for use at all four sites, with identical questions
related to agency characteristics and network involvement. The
main network question listed all agencies initially identified as
being part of the system, at each site (43–55 agencies,
depending on the site). The questionnaire was then mailed to
each agency, addressed to the agency head or a key staff
member, depending on who would be most knowledgeable about
SMI adult services. The survey was accompanied by a cover
letter from us as well as a letter of support signed by the head
of the city's core agency, primary mental health funder, or both.
9. About 10 days after mailing, we telephoned each agency to
resolve any initial problems and set up an interview. At this
point, a number of agencies at each site were eliminated when it
became apparent that their level of involvement with the target
population was so minimal that inclusion in the study made
little sense. We then visited each site, jointly interviewing
members of every agency in the system. One purpose of these
in-depth meetings was to review questionnaire items and
responses to ensure that respondents were interpreting them as
we intended. The interviews also allowed us to eliminate
several more agencies that should not have been included in the
first place and to add additional ones, if mentioned by three or
more respondents. This modified snowball procedure (Knoke
and Kuklinski, 1982: 23) ensured capturing of any network
agencies we might otherwise have missed. Finally, and most
important, the interviews enabled us to collect much qualitative
information on respondents' views and impressions of the city's
mental health system, its history and functioning, and the
agency's role in that system. We took extensive notes at each
interview, which we discussed and compared and compiled into
a final set of field notes. We made no attempt to structure these
interviews, except that we made every effort to pursue issues
that respondents frequently mentioned as important at each site.
Questionnaires were either collected after the interview or
returned by mail. We followed up with telephoning and
additional interviewing to collect missing data and check data
that appeared to be inaccurate when we compared questionnaire
responses with field notes. In addition, we collected extensive
mental health funding data from documents provided by state
agencies and through interviews with state agency officials
responsible for community mental health funding. Overall, the
comprehensive data collection procedure took one year to
complete but resulted in final response rates of 92 percent in
Albuquerque (N = 35) and Providence (N = 35), 97 percent in
Tucson (N = 32), and 100 percent in Akron (N = 36), with few
missing data. Nearly two years after initial data collection
10. began, as a final step in the process, we visited each of the sites
once again, after all data were collected and initially analyzed,
to present and discuss findings with system members. We did
this as a reality check to ensure that our major conclusions were
not inconsistent with their understanding of system operation.
Client Data Collection Procedures: Network Effectiveness
Network effectiveness was assessed using data collected from a
5 percent random sample of adult SMI clients in each
community: 64 in Tucson, 59 in Albuquerque, 62 in Providence,
and 80 in Akron. SMI clients were defined as adults (over 18)
whose emotional or behavioral functioning is severely and
persistently impaired in a way that interferes with their capacity
to remain in the community without supportive treatment.
Decisions about who qualified for this designation were made
by mental health professionals at each site using standard
evaluation criteria published in the Diagnostic and Statistical
Manual of the American Psychiatric Association (3rd ed.),
commonly referred to as the DSM-III-R. By using a random
sample and by focusing only on individuals whose illness was
severe and chronic, yet whose current problems were not
sufficiently acute to warrant institutionalization, we were
confident that our client populations would be comparable,
although not identical in illness severity across sites. The
limited data on severity we were able to collect in Tucson and
Akron showed no significant differences in clients at these two
sites. Clients were selected directly from the coded rosters of
the core agency in each city and were only identified by name
once they were actually selected for the sample. Clients were
then contacted, through their case manager, and asked to
participate in the study. Those who agreed met individually
with our trained personnel who, through structured interviews,
recorded clients' responses to questions concerning quality of
life, adjustment, psychopathology, and satisfaction with
services. The same information was obtained about the clients
from a family member, if one was available, and from the
clients' case manager or therapist. A clinical psychologist who
11. was part of the research team, and had conducted such work
previously, trained the interviewers and coordinated the client
data collection effort. Measurement Network effectiveness.
Comparative research on the effectiveness of organizational
networks is virtually nonexistent, except for recent work by
Morrissey et al. (1994) that relied on global perceptions of
network performance and work by Lehman et al. (1994) that was
inconclusive. As noted earlier, part of the problem is that most
researchers are more concerned with organizational outcomes,
even when the organizations studied are part of a network. In
addition, actual assessment of network effectiveness, like
organizational effectiveness, is extremely problematic (see
Goodman and Pennings, 1977, and Cameron and Whetten, 1983,
for reviews of organization-level problems). The early
effectiveness literature often focused on the accomplishment of
predetermined organizational goals that were ill-defined and
often in conflict or on the receipt of scarce and valued resources
(Yuchtman and Seashore, 1967) with minimal concern for
process, outcomes, or a diversity of views. A more recent
alternative has been to consider the views of an organization's
multiple constituencies, or key stakeholders (Zammuto, 1984).
This approach has been a considerable advance in thinking
about effectiveness, although actual measurement has still
proved troublesome, owing primarily to problems in
determining how to evaluate the needs of key constituent groups
and how they should be weighted, relative to those of other
groups. Despite problems, it is this approach that we have
adopted here. In community mental health networks, as in any
publicly funded system, there are many constituencies whose
views must be considered in policy decisions. These include
clients, families, service professionals, state-level
policymakers, funders, agency staff and administrators, and
taxpayers, just to name the most prominent ones. For this
research, we felt it was critical to tie effectiveness measures to
enhanced client well-being. This outcome reflects what is most
certainly a top priority of these constituent groups. While it is
12. reasonable to argue that these groups will have additional goals
that are perhaps more self-serving (e.g., maximizing career
opportunities, enhanced influence, increased resources), and
each may have different beliefs as to the means of treatment and
service, disagreement over the fundamental goal of improved
client outcomes is unlikely. In addition, and of substantial
importance for this study, we had to choose a measure of
effectiveness that reflected the outcomes of network-level
activities and structures. To assess client outcomes, we selected
a series of items from several standard assessment instruments,
most notably, the Colorado Client Assessment Record and the
New York Functioning Scale, and modified them to fit our
study. Pretesting of methods and measures was done as part of
an earlier project (Bootzin et al., 1989). Items focused on
quality of life, client satisfaction, psychopathology, and level of
functioning. Consistent with a multiple-constituency approach,
we collected outcome data from three different groups: the
clients themselves, their families (if available), and the clients'
case managers or therapists. We believed these three groups
would have the most complete understanding of client
outcomes, although each might have a somewhat different
perspective (Bootzin and Sadish, 1986). Hence, we used a
multimeasure, multiperspective approach. Once data collection
was complete, we pooled results from all subjects from all four
sites and did factor analyses to test for the existence of
similarities in perspectives both within and across the three
groups. Initial analyses showed that each group maintained its
own perspective, having only modest overlap with the other two
groups. When each group was analyzed separately, four distinct
perspectives ultimately emerged. The clients themselves
assessed their outcomes in two different ways: One factor
comprised items related to their quality of life, including
various economic, social, and daily living services, while a
second factor was made up of items related to their
psychopathology and physiological status. These factors,
labeled QofL/satisfaction and psychiatric/medical status,
13. respectively, explained 48 percent of the variance in all the
client-reported items. In contrast to client self-assessment, only
one factor emerged for the family perspective (42 percent of
variance) and one factor for that of the case manager (53
percent of variance). These were labeled overall quality of life.
As a final step in the analysis of outcome data, we computed
factor scores for each of the four factors. We then regrouped
respondents by city and computed mean factor scores for each
site so that each system could be compared according to its
factor score for each of the two clients, one family, and one
case manager perspectives. These final factor scores, which we
used as our measures of network effectiveness, are reported in
Table 9.1. In general, both families and the clients themselves
considered the network to be most effective in meeting client
needs in Providence and least effective in Tucson and Akron.
Scores for Albuquerque were more equivocal but generally fell
in the mid-range. In contrast, case managers/therapists felt best
about client outcomes in Albuquerque and Tucson and worst in
Akron, with Providence being slightly negative. As shown in
Table 9.1, most of these differences were statistically
significant. It is important to keep in mind, however, that these
scores only reflect relative differences in effectiveness across
the sites, not absolute evaluations of client well-being. Outcome
scores were statistically unrelated to differences in client age,
gender, race, and ethnicity. Demographic data for clients across
all four sites were as follows: mean age = 42.3 years (range =
19 to 78); gender = 50.9 percent female; race = 64.9 percent
white, 18.5 percent Afro-American, 14 percent Hispanic, and
2.6 percent other. We originally hoped to develop a single
measure of network effectiveness, combining the perspectives
of clients, families, and case managers, but the multiple-
constituency approach resulted in multiple views of
effectiveness. Nonetheless, the pattern of factor scores across
sites made it possible to group findings so as to make
comparisons and draw conclusions. The patterns of results for
the two client factors and the single family factor were
14. sufficiently similar to warrant combining them into a single
dimension of network effectiveness. We averaged the three
factor scores for clients and families for each site to enable us
to place that site on a continuum of relative effectiveness. This
method showed Tucson to be the least effective system (mean =
−.19), followed by Akron (−.12), then Albuquerque (−.02), and
then Providence (+.42), which was rated as significantly more
effective than the other sites, especially Tucson and Akron.
While all predictors of network effectiveness are presented and
discussed below in terms of their relationship to both the
client/family and case manager views of effectiveness, our
primary discussion and interpretation of results focuses on the
combined client and family perspective. Client and family views
were generally consistent across sites, offering convergent
validity for the measures used. In addition, it is the experiences
of families and, particularly, the clients themselves that
ultimately matter the most, since they are the ones who actually
receive the system's services, are most knowledgeable about the
client's overall well-being, and must live with the results. It is
this combined client and family view that agency and program
heads were most concerned with in the follow-up site visits we
made to report our findings. Table 9.1 Network Effectiveness
Comparisons: Factor Scores of Client Outcome Scales (N =
265)* *Sample size indicates the total number of clients from
and about whom outcome data were collected at each site.
†When a mean factor score from a particular constituent group
is significantly different (p < .05) from the score from that
group at another site, a letter (or letters) follows the score,
indicating the significantly different comparison site (i.e., P =
Providence). A letter in parentheses indicates p < .10. Network
integration. As discussed earlier, the basic question underlying
our research is whether network structure, particularly
integration and related issues of coordination, is related to
network effectiveness. Unfortunately, the concept of integration
is ill-defined, making operationalization difficult and
interpretation of outcomes confusing (Aldrich, 1978; Bolland
15. and Wilson, 1994). Because the research was exploratory, we
chose to consider integration rather broadly, in an attempt to
determine which aspects, if any, were related to network
effectiveness. Integration was generally considered to focus on
issues of both interconnectedness among provider agencies and
the extent to which provider agencies are integrated and
coordinated through a central authority (Morrissey et al., 1994).
Our operationalization is consistent with the general network
structure concepts of density and overall centralization.
According to Scott (1991: 92), these concepts “refer to differing
aspects of the overall ‘compactness’ of a graph (i.e., a network).
Density describes the general level of cohesion in a graph;
centralization describes the extent to which this cohesion is
organized around particular focal points. Centralization and
density, therefore, are important complementary measures.” In
more general terms, density is simply a measure of the extent to
which all network organizations are interconnected, or linked to
one another, and reflects network cohesiveness. Centralization
refers to the power and control structure of the network, or
whether network links and activities are organized around any
particular or a small group of organizations. Overall
centralization of the network is an extension of Freeman's
(1979) concept of point centrality, which refers to the centrality
of individual network members. Our density and centralization
measures of network integration and coordination are reported
below, as are our findings on the relationship between these
measures and network effectiveness. The basic building block
of any network study is the linkages among the organizations
that make up the network. To develop measures of agency
integration through both density and centralization, every
agency in each system was first listed alphabetically on a
questionnaire insert that was unique to that system. Key
informants from each agency surveyed were asked to indicate
whether their agency was involved over the previous year with
every other agency listed, through each of five different types
of service links: referrals sent, referrals received, case
16. coordination, joint programs, and service contracts.
Respondents were not asked about frequency of involvement
except for referrals sent and received, where they were asked to
consider only referral activity occurring “with some regularity.”
While other types of links, such as friendship ties or
information links, were possible, our concern was solely with
links specifically related to service delivery. In addition, the
questionnaire and the face-to-face interviews continually
emphasized reporting only those links involving SMI adults.
Thus, our results exclude non-SMI-service linkages among
agencies that may provide SMI services. For instance, a hospital
and a community center may refer clients to one another and
provide important services to the mentally ill, but their referral
activity might not involve the mentally ill clients they serve.
The distinction we make between construction of a general
organizational linkage network and a more focused service
implementation network represents what we believe to be an
important advance in network methodology, which in the past
has often focused on organizational links without fully
considering whether or not the type of linkage measured is
relevant for the particular question being researched (see also
Hjern and Porter, 1981). We validated the reported linkages in
two ways. First, whenever possible, at least two agency
respondents were asked to attend the data collection interview.
Discrepancies in opinions about the link were discussed and
resolved, usually in favor of the service professional at the
meeting rather than the head administrator, who might have
only limited knowledge concerning operating-level links such as
referrals. Second, after data were collected, we confirmed each
link (Marsden, 1990). Thus, for instance, a joint program for
SMI adults listed by Agency A with Agency B would only be
counted as a viable link if Agency B also indicated that the link
existed. Results of Network Analysis Network Density The
overall density of each network was computed in two ways.
First, we computed a mean agency service link score by adding
confirmed scores for each of the five types of linkages for all
17. agencies in each system and dividing by the total number of
agencies in that system. While this service link density score
reflects the depth, strength, or durability of network integration
(what network analysts refer to as multiplicity), moderately
high scores may be achieved by relatively few agencies
integrating all or most of their SMI services. Thus, we
computed a second score, organizational link density, that
indicates the mean number of agency links of any of the five
types that occurred in each system. This second score is a
measure of organizational integration through SMI service links
rather than a measure of the strength of this integration across
the network. Dividing the total number of linkages in each
network by the number of agencies in that network, the
maximum service link score for any network is 5(n − 1), while
the maximum organizational link score is n − 1. Service and
organizational link density scores for the entire network at each
site and their relationship to each of the two perspectives for
network effectiveness are reported in Table 9.2. Table 9.2
Relationships Between Network Effectiveness and Services
Integration Measured by Overall Network Density* *Numbers
in parentheses after each city's name refer to the client-
outcome-based effectiveness score for that site and for the
particular perspective listed. The mean density scores for each
network were first statistically compared with the scores at each
of the other sites, using t-tests. Despite apparent differences
between Providence and the other three sites, the only
significant finding was that organizational link scores for
Albuquerque were marginally higher than for Providence (p <
.10 for a two-tailed test). Most revealing, however, was that
there was little relationship between density-based integration
and network effectiveness, regardless of the measures of density
or effectiveness used. Network density scores for Tucson,
Albuquerque, and Akron were all extremely close, despite
differences in effectiveness at each site. The one strong
relationship found was that the most effective network based on
client and family views, Providence, was also by far the least
18. integrated system, a finding that is completely contrary to the
prevailing assumptions and beliefs of mental health
professionals about the value of integrating services. While
these findings were unexpected in view of prevailing
assumptions about integration, we resisted attempts to draw
conclusions without first considering findings from our
centrality-based measures of integration described below.
Network Centralization We next shifted our attention to issues
of integration through centralized control of the network. A real
problem with integration through decentralized linkages among
providers is that system coordination can be exceptionally
complex, unless the network is quite small (Provan, 1983).
Because there are limits to how many links an organization can
handle effectively, the number of service linkages per
organization in moderate to large networks may well be no
greater than the number per organization in small networks.
Large networks with many decentralized links will have
difficulty organizing and effectively operating as a complete
system, depriving clients of the potential benefits of integration
across the full range of agencies and services offered in a large
community. As an alternative, centralized control of integration
within larger networks allows the coordination of integration
across many agencies as well as closer monitoring of services.
This is the logic behind the formation of a federation structure
(Provan, 1983; D'Aunno and Zuckerman, 1987). With this in
mind, we examined two aspects of overall network
centralization: core agency centrality and concentration of
influence. Core agency centrality. As the primary organizer and
integrator of services in most communities, a core mental health
agency, often a community mental health center, is typically at
the center of all activities relating to services for individuals
with severe mental illness. When the core agency is central in
the flow of services, the network can operate more efficiently,
as the other providers need not devote much time and effort to
the task of coordinating the services they provide with the many
other agencies in the network. Whether such a centralized
19. system of integration is particularly effective, however, and
whether highly centralized networks are more effective than
relatively decentralized ones is not known. To measure core
agency centrality, we computed service and organizational link
density scores for only the core agency (see Table 9.3).
Network density scores, excluding the core agency, were also
recomputed for all agencies in each system. These calculations
revealed some important differences across sites, as shown in
Table 9.3. Statistical comparisons of means using two-tailed t-
tests revealed significant differences between the core agency
centralization scores (via service links) for Tucson and
Providence (p < .001), Akron (p < .001), and Albuquerque (p <
.05) and between Albuquerque and both Providence (p < .05)
and Akron (p < .10). In contrast to the findings reported in
Table 9.2, when the core agency was excluded from this
analysis, we also found significant differences in network
density when we compared across sites. Significant differences
were found for service link density scores between Providence
and Tucson (p < .10), Albuquerque (p < .10), and Akron (p <
.10) and for organizational link density scores between
Providence and Tucson (p < .10), Albuquerque (p < .05), and
Akron (p < .05). Table 9.3 Comparisons of the Structure of
Integration: Network Centralization Through the Core Agency
and Core-Excluded Density Scores* *Sample size indicates the
number of agencies from which data were collected at each site.
Figures in parentheses indicate links of each type expressed as a
percentage of the maximum possible number of links of that
type within each system. Most important, the pattern of scores
across sites for network centralization through the core agency
were substantially different than density scores. Providence had
the highest core agency linkage scores (97 percent of all
agencies in the system were linked to the core through an
average of 2.41 types of service links) but the lowest level of
linkages, or density, among all agencies other than the core,
indicating a highly centralized control system. Akron's core
agency was also highly central in its network, though somewhat
20. less so than Providence (94 percent of all agencies were linked
to the core through an average of 2.31 links). Akron's network
density scores were far closer to those of Tucson and
Albuquerque than to Providence, however, reflecting a system
integrated in two ways; Albuquerque's core agency centrality
score was lower than the two eastern sites (88 percent of
agencies linked to the core through an average of only 1.82
links), while density-based integration among the other agencies
was quite high. Finally, Tucson exhibited characteristics of a
highly decentralized but integrated system, with the lowest core
agency linkage scores of any site (only 65 percent of all
agencies linked to the core through an average of 1.12 links),
coupled with the highest core-excluded network density score
through service links. Concentration of influence. We also
assessed integration through centralization by examining the
network influence structure. We speculated that integration and
coordination of services across the network would be enhanced
when influence over decisions related to SMI clients was
concentrated in a single organization. Under this condition,
whether agencies were actually linked to the highly influential
organization, agency actions would likely reflect the influential
organization's preferences and policies about SMI services.
When agencies in a system act in ways consistent with the
views and expectations of a single organization, centrally
controlled, coordinated actions are attainable. Although past
studies of networks have relied on linkage-based measures of
centrality to assess power within the network (Cook, 1977;
Cook and Yamagishi, 1992), this approach assumes that
structural position is equivalent to actual influence, which may
not be true. To determine influence in each system, respondents
at each agency were first asked to list up to six other
organizations in the system “whose needs, goals, decisions,
and/or expectations… are generally taken into consideration by
your agency” when major decisions are made concerning
services to SMI adults. Responses from all agencies in each
system were then totaled, and each agency received an influence
21. score indicating the number of times it was mentioned by
others. Scores were converted to reflect the number of mentions
as a percentage of total possible mentions in each system,
thereby allowing comparisons across systems. To assess
concentration of influence, we examined the percentage scores
of the five most influential agencies in each system. We then
considered two separate aspects of influence, consistent with
the approach used by Eisenhardt and Bourgeois (1988: 743) in
their case study of firms in high-velocity environments. First,
we determined the most influential agency in each system. As
shown in Table 9.4, in Tucson, Akron, and Providence this
agency received mentions by between 71 and 76 percent of
respondents. In contrast, the most influential agency in
Albuquerque received only 56 percent of possible mentions.
Second, we examined the distribution of influence among the
top players, focusing on the distance between the scores of the
most influential agency and the one (ones) in second place. If
the second-place agency did not have more than half the
influence score of the top agency, then we considered that
system to have concentrated influence, as was the case in
Providence and Albuquerque. Because Albuquerque's top score
was so much lower than the most influential agency at the other
three sites, however, we labeled that system concentrated/weak
and Providence as concentrated/strong. Akron was labeled as
moderately dispersed, since its two second-place (tied) agencies
received relatively high influence scores (mentioned by 54
percent of respondents). Tucson was labeled as dispersed since
four other agencies in the system were two thirds as influential
as the most influential player. Table 9.4 Concentration of
Influence Over Mental Health Decisions (Top Five Most
Influential Agencies at Each Site)* Notes: MH, mental health;
HS, human service; AMI, Alliance for the Mentally Ill.
*Influence scores reflect the number of times each agency was
reported as being influential in mental health decisions as a
percentage of the total number of agencies in that network.
Combining findings on the two centrality-based measures of
22. network integration with the effectiveness results allows us to
make some conclusions that go beyond what could be said from
a consideration of density-based measures only, at least for
client and family assessments of effectiveness. As discussed
earlier, density measures were unrelated to effectiveness, except
that Providence, the least cohesive system, had the highest
effectiveness score. In contrast, when focusing on integration
through network centralization, a distinct pattern emerged.
When influence over mental health decisions was highly
concentrated in a single core agency, as in Providence, client
outcomes were highest. At the other extreme, when influence
was widely dispersed among a number of agencies, as in
Tucson, effectiveness was lowest. Akron's influence structure,
which was more dispersed than any system other than Tucson's,
had outcomes that were also lower than all but Tucson's.
Finally, influence in Albuquerque, while far weaker than in
Providence, was more concentrated than either Tucson or
Akron, and consistent with this finding, its network
effectiveness score on client and family assessment of outcomes
was higher than Tucson and Akron but lower than Providence.
Conclusions from the linkage-based measure of centralization
were consistent with this pattern, with the exception of Akron:
We found the highest effectiveness in Providence, which was
highly centralized through the core agency, and the lowest
effectiveness in Tucson, which was decentralized, while
Albuquerque, a moderately decentralized system, had a mid-
range effectiveness score. Akron, the anomaly, was a
centralized system with low effectiveness. Discussion Network
Effectiveness: Client and Family Perspective The clear linear
relationship between our influence-based measure of
centralization and client and family assessments of network
effectiveness, coupled with the findings for the linkage-based
measure of centralization, which seemed to explain
effectiveness for all systems except Akron, might lead to the
conclusion that a positive tie between network integration and
effectiveness is most likely when integration and coordination
23. occur from the top down but not when agencies take it upon
themselves to integrate their services. This conclusion is
consistent with those of Goldman, Morrissey, and colleagues
from their research on mental health systems funded by the
Robert Wood Johnson Foundation (Goldman, Morrissey, and
Ridgely, 1994; Morrissey et al., 1994). While such a conclusion
would not be inaccurate, it is based only on partial information
about the systems under study. Using our interviews and
observations, we were able to supplement the quantitative
network findings with qualitative insights, allowing us a deeper
understanding of why some mental health networks are more
effective than others. Our qualitative data from Providence were
entirely consistent with the network structure results. The city's
core mental health agency was easily the most powerful player
in the system. It was the focus of discussion in nearly all our
interviews with other agencies in the system, although many
viewed its powerful role in an uncomplimentary way, variously
describing the center as “bureaucratic,” “insensitive,” and
“arrogant.” As described by its director, the primary mission of
the core agency was to provide psychiatric and case
management services to all individuals with severe mental
illness. In fact, unlike any of the other systems, the core agency
in Providence provided its own psychiatrists to staff the
psychiatric beds of several area hospitals, thereby controlling
patient treatment even during institutionalization. Through
control of both case management and outpatient psychiatric
services, the core agency could also control which services
offered by the other community agencies the SMI clients
received and when they received them. Perhaps of greatest
importance, Providence's core agency had had for many years a
unique and direct relationship with the state's mental health
authority, in which all funding for the needs of the severely
mentally ill would be paid directly to the core agency. In
addition, if services were needed that the core agency did not
provide, such as housing or vocational rehabilitation, the state
could contract with other agencies for such services only after
24. core agency approval. Agencies not having such approved
contracts might provide certain services to the SMI, but these
agencies would not receive state funding expressly for that
purpose. This “monopoly model,” as we referred to the
Providence system, made integration among the various
providers largely unnecessary. Integration and coordination of
the system was still critical for attaining effective client
outcomes, since the core agency did not provide many of the
services needed by clients. Where integration occurred, it was
through the core agency, which controlled access to mental
health funding and clients and was the obvious focal point for
mental health services throughout the community. An
explanation of why network centralization through the core
agency had a positive impact on client effectiveness was
perhaps best stated by the head of the state's department of
vocational rehabilitation, who said that because “[the core
agency's] clients already have their housing, medication, and
most other needs met when they come to us, it is easier to
effectively rehabilitate them.” Providence also had the
advantage of relatively high state funding, enabling the system
to provide a level of services that might not be possible in
Tucson or Albuquerque. This high funding was allocated to a
local system that, because of its strong central control, could
function relatively efficiently with little duplication and little
questioning of decisions. In addition, direct control over
funding to a single core provider allowed the state to monitor
closely the outcomes of the core agency, while the core could
closely monitor the activities of the other agencies in the
network through its role as network gatekeeper. Finally, the
Providence system was highly stable. The core agency had been
in place as a mental health center for over 20 years, and its
director had been in place since its founding. Most of the
directors of the other key agencies had known each other for
years and had longstanding working relationships with the core
agency. As a result, the system and its operation were well-
known to agency professionals, resulting in little uncertainty for
25. them or their clients. The situation in Tucson, the least effective
system, was substantially different. Unlike the stable system in
Providence, the system in Tucson was undergoing rapid and
substantial change at the time we collected data. The changes
were brought about in large part by what was referred to by one
respondent as “a revolution from below,” in which a key system
leader joined forces with the local chapter of the Alliance for
the Mentally Ill (AMI), a client advocacy group formed by
families of the SMI, to put pressure on the state to change
Tucson into a case-managed, capitated system headed by a
single agency responsible for both funding and service delivery.
The revolution was only partially successful, resulting in
formation of a new but scaled-back core agency, primarily
responsible for case management. Although it contracted with
local doctors and the psychiatric unit of a local hospital to
provide psychiatric treatment for its clients, the core agency
provided few substantive mental health services on its own.
Thus, while it served as a key coordinator of SMI services in
the community, it had no monopoly on services. In fact, even
the core agency's role in Tucson was spread among several
other agencies, most notably a traditional community mental
health center and another multiservice mental health provider
that was set up primarily to serve the city's large Hispanic
population. The most powerful local agency in Tucson was a
private not-for-profit agency that was the local funding entity.
Unlike Providence, where funding was direct from the state to
the core provider agency, all treatment dollars flowed from the
state's department of health services to Tucson's funding entity,
which made all local funding decisions. Instead of working
closely with local providers, however, especially the new core
and the two other mental health agencies, the funding entity
used its control over resources to build its own power, both in
Tucson and at the state level. Treatment dollars were provided,
but the system was poorly funded, and little if any monitoring
of services took place. One respondent described the fund
allocation and monitoring system as being akin to “leaving
26. money on a tree stump and seeing who claimed it.” That the
funding entity and its president were not strongly committed to
goals of client service was amply demonstrated by a scandal
that erupted shortly after our data collection. It was discovered
that the entity's president was diverting precious treatment
dollars to a fund to purchase a new building, something that
outraged the mental health community but was perfectly legal
under the state's poorly specified system of contracting.1
Because of these problems, the mental health system in Tucson
operated largely on the goodwill and professionalism of those
who operated the key provider agencies. The director of one of
these providers pointed this out to us, noting that the heads of
the three main providers described above were all good friends
and were willing to work together. The other main integrating
force in Tucson was the local chapter of the Alliance for the
Mentally Ill. Because of the interpersonal skills and visibility of
its president and the presence of several powerful people on its
board, AMI was able to organize local provider agencies and
client families into an effective force for lobbying the state.
AMI also published a regular newsletter that further helped to
knit together both providers and families and to point out
problems with the new system. All this decentralized integration
of the network was critical to maintain minimal levels of
acceptable services in a system that was underfunded and had
no strong central authority to pull things together. Our
observations and interviews in Tucson led us to the conclusion
that decentralized integration was critical for helping a weak
system limp along but was not sufficient to result in the high
levels of client outcomes that were observed in Providence.
Based on the quantitative findings, Albuquerque fell between
the highly centralized and effective Providence system and the
decentralized and ineffective Tucson system. Albuquerque's
network effectiveness was particularly surprising in light of the
state's weak funding of and commitment to care for the severely
mentally ill. The simplistic, structural explanation for this is
that effectiveness is enhanced with greater levels of network
27. integration through centralization but not through decentralized
links among providers. Since Albuquerque's centralization was
between Tucson's and Providence's, its effectiveness should also
be intermediate, as we found. Yet this explanation says nothing
about why Albuquerque's system was structured as it was, how
effectiveness might have been causally related to structure, and
what other factors may have contributed to the relative
effectiveness of the Albuquerque system. Unlike any of the
other three systems we studied, case management, a key
service-level integration mechanism, was formally provided to
severely mentally ill individuals by four different agencies.
Although the core agency was by far the largest of these
agencies and served an estimated “90 percent of the city's adult
SMI population at one time or another,” centralized integration
and coordination of the system through the core agency was not
really possible, since the core agency did not manage the
treatment plans of many of these clients. Thus, while the other
three case management agencies and many other agencies both
sent and received clients to and from the core, each also
developed its own subnetwork of linkage partners. The agencies
in Albuquerque were dependent on and thus linked to the core
for many of the services it offered, including most emergency
and inpatient care, but the core agency did little to actively
integrate the system. It is telling that only one agency
maintained four or more of the five types of service links we
measured with the core agency, as opposed to six agencies in
Akron and eight in Providence (see Table 9.3). As one agency
head told us, “The [core agency] isn't the glue that holds the
system together. They are unresponsive to the community, aren't
protective, and do only what will be funded.” System
decentralization was enhanced by the state's mechanism for
funding. Unlike any of the other three systems, the four main
case management agencies in Albuquerque received state mental
health funds from three primary sources, and any agency in the
city could apply for these funds. Because funding was direct,
with no local intermediary as in Tucson, the state had somewhat
28. greater control over how resources were spent than in Tucson.
Because funding was fragmented, however, with each fund
source having its own priorities and funding preferences, the
state was unable to centralize mental health activities and
services around a single agency by concentrating resources on
that agency, as in Providence. The largest share of state funding
did go to the core agency, giving it resources and subsequent
services that other agencies could not provide in a poorly
funded system. The core agency thus became a central player in
the system, even though its management did not seek out a
strong integrative role. The integrative shortcomings of the core
agency appeared to be made up for by other agencies in the
system, several of which viewed the idea of an integrated and
coordinated system of services far more seriously than the core
agency. Thus, Albuquerque displayed some of the decentralized
elements of Tucson while still having a single, large,
multiservice core agency. Albuquerque also had a system that,
despite its poor funding and integrative shortcomings, had not
undergone any significant changes in many years. Clients,
families, and agency professionals thus understood the system
and could work around its shortcomings. A good example of
this was offered by one respondent at the city's jail, who told
us, Because evaluation and intake at [the core agency] can take
five hours of a police officer's time on weekend nights, the
officer will slap a mentally ill person with a petty offense like
disorderly conduct to get them into the jail's psychiatric unit.
Because it takes so much less time to “book” the person at the
jail, it is often the mental health facility of first resort, rather
than the last. After the person's emergency needs are taken care
of, they are sent on to [the core agency] or another agency.
Agency service professionals in Albuquerque knew how the
system operated and were able to work with the core agency
when its services were needed or around the core agency when
it could be avoided. The findings in Akron are somewhat more
difficult to explain. Structurally, the system was closest to
Providence, having service linkages that were centralized
29. through a core agency. In addition, both systems were in states
that provided relatively munificent resource environments. Yet
in terms of client and family assessments of effectiveness, the
system was closer to Tucson. Only concentration of influence,
which was moderately dispersed in Akron, seems to fit the
linear relationship between aspects of network structure and
effectiveness found with the other three systems. Using our
qualitative data, however, we can offer several explanations,
primarily centered around the issue of stability, to help make
sense of the discrepancy in findings for Akron. Like Tucson, the
community mental health system in Akron was new. Passage of
Ohio's Mental Health Act of 1988 significantly altered system
funding and structures in Ohio's cities. In Akron, three mental
health centers had served the community in each of three
separate catchment areas, each competing for clients and state
funding. After passage of the Mental Health Act, an Alcohol,
Drug Abuse, and Mental Health Board was established as the
local contracting, monitoring, and integrative entity for all
state- and local-government-funded services for mental health,
as well as for drug and alcohol abuse. Thus, like Tucson, but
unlike the other two systems, fiscal control by the state was
indirect, in this case, through a public rather than a private not-
for-profit entity. The ADM board, as it was known, hired as its
president an outsider activist who was a self-described
“tinkerer.” Within a year, he stopped all government funding to
two of the three mental health centers, effectively shutting them
down, while revising the role of the third center to focus on
clients with acute, rather than severe, mental illness and to
perform intake evaluations for all clients. He then created and
funded a new core agency as the sole provider of and case
manager for those with severe mental illness. While the new
core agency was very much at the center of service delivery to
the SMI population in Akron, it was apparent that effective
integration and coordination of services was still very much
evolving and that there was considerable confusion about the
new system. As one agency director told us, “The major changes
30. in the mental health system in the past few years means we
don't really have a handle on how the system works.” Another
said, “The system here is confusing to understand, and I don't
see how people with mental illness can comprehend it.” One
problem was that the system for handling emergency services
was not only confusing, involving different agencies at different
times of the day, but was creating animosity among the agencies
involved, particularly between the acute-care agency and its
supporters and the new core agency. Another problem was that
there was still considerable underlying resentment stemming
from the recent system restructuring. Not only was there a
change in the organizations that provided key services and
funding, creating uncertainty and loss of resources for some
agencies, but there was also a shift in treatment philosophy.
This shift was a conscious effort by the ADM president first to
emphasize the community-based care and treatment of all but
the most severely mentally ill, as opposed to emphasizing acute-
care patients, and, second, to place less emphasis on a
traditional psychiatric/medical orientation and more emphasis
on a psychosocial, community support philosophy exemplified
by the case management approach of the core agency. Agencies
not supporting the new approach still established service links
to the core agency, not just because of its services but also
because the core (through the ADM board) formally controlled
and managed the treatment plans of and funding for all
officially designated SMI clients. Thus, while the system in
Akron was structurally nearly as centralized through the core
agency as Providence, uncertainty about the system was still
high, and many agencies were not yet committed to a system
dominated by the new core agency. This interview-based
conclusion is consistent with the quantitative finding that while
Akron was centralized through the core agency, it al