L’état des hôpitaux psychiatriques publics aux États-Unis en 1996

Objectifs : Cette revue analytique a pour objectif de mettre à jour les écrits précédents de l'auteure sur la place des hôpitaux psychiatriques publics dans l'éventail des services pour personnes souffrant de troubles mentaux chroniques, et de fournir une perspective à la prochaine génération de planificateurs des services. Méthodes : les résultats et les commentaires sont organisés autour de quatre grandes questions. 1) Quel est actuellement le point de vue dominant au sein des hôpitaux psychiatriques publics, et comment se compare-t-il à celui qui prévalait au cours de la première moitié du siècle? 2) Quel genre d'individus a tendance à être desservi par ces hôpitaux aujourd'hui ? 3) Quel a été le sort des personnes qui n'ont plus accès aux services des hôpitaux psychiatriques d'État ? 4) Quel serait un rôle approprié de l'hôpital psychiatrique au sein d'un dispositif de soins incertain et en constante évolution ? Résultats et conclusions : les hôpitaux psychiatriques varient dans la composition de leur population, le contenu de leurs services et la qualité générale de leurs soins. Bien qu'ils aient été remplacés à certains endroits par des structures à orientation plus communautaire, ils continuent en général, à cause de leur caractère multifonctionnel, d'occuper une place centrale dans les systèmes de soins. Des efforts soutenus s'avèrent nécessaires afin d'intégrer les hôpitaux psychiatriques publics comme partenaire à part entière au sein de ces systèmes.Objectives: This analytical review is intended to update the author's earlier writings on the position of the state mental hospital within the spectrum of services for long-term mental patients and to provide a perspective for the next generation of service planners. Methods: Findings and commentary are organized around four major questions. First, what is the prevailing view of state mental hospitals today, and how does it compare with the view that existed in the first half of this century? Second, what individuals tend to be served in state mental hospitals today? Third, what has been the fate of mentally ill persons who are no longer served in state mental hospitals? Fourth, what is an appropriate role for the state mental hospital in today's uncertain and rapidly changing systems of care? Results and conclusions: Individual state mental hospitals vary in the composition of their resident populations, the content of their services, and the overall quality of their care. Although they have been superseded by community-based service structures in some places, they continue in general, as the result of their multifunctionality, to occupy a critical place in systems of care. Renewed efforts to integrate them as full partners within those systems must be undertaken

The Inverse Shapley Value Problem

For $f$ a weighted voting scheme used by $n$ voters to choose between two candidates, the $n$ \emph{Shapley-Shubik Indices} (or {\em Shapley values}) of $f$ provide a measure of how much control each voter can exert over the overall outcome of the vote. Shapley-Shubik indices were introduced by Lloyd Shapley and Martin Shubik in 1954 \cite{SS54} and are widely studied in social choice theory as a measure of the "influence" of voters. The \emph{Inverse Shapley Value Problem} is the problem of designing a weighted voting scheme which (approximately) achieves a desired input vector of values for the Shapley-Shubik indices. Despite much interest in this problem no provably correct and efficient algorithm was known prior to our work. We give the first efficient algorithm with provable performance guarantees for the Inverse Shapley Value Problem. For any constant \eps > 0 our algorithm runs in fixed poly$(n)$ time (the degree of the polynomial is independent of \eps) and has the following performance guarantee: given as input a vector of desired Shapley values, if any "reasonable" weighted voting scheme (roughly, one in which the threshold is not too skewed) approximately matches the desired vector of values to within some small error, then our algorithm explicitly outputs a weighted voting scheme that achieves this vector of Shapley values to within error \eps. If there is a "reasonable" voting scheme in which all voting weights are integers at most \poly(n) that approximately achieves the desired Shapley values, then our algorithm runs in time \poly(n) and outputs a weighted voting scheme that achieves the target vector of Shapley values to within error $\eps=n^{-1/8}.

False-Name Manipulation in Weighted Voting Games is Hard for Probabilistic Polynomial Time

False-name manipulation refers to the question of whether a player in a weighted voting game can increase her power by splitting into several players and distributing her weight among these false identities. Analogously to this splitting problem, the beneficial merging problem asks whether a coalition of players can increase their power in a weighted voting game by merging their weights. Aziz et al. [ABEP11] analyze the problem of whether merging or splitting players in weighted voting games is beneficial in terms of the Shapley-Shubik and the normalized Banzhaf index, and so do Rey and Rothe [RR10] for the probabilistic Banzhaf index. All these results provide merely NP-hardness lower bounds for these problems, leaving the question about their exact complexity open. For the Shapley--Shubik and the probabilistic Banzhaf index, we raise these lower bounds to hardness for PP, "probabilistic polynomial time", and provide matching upper bounds for beneficial merging and, whenever the number of false identities is fixed, also for beneficial splitting, thus resolving previous conjectures in the affirmative. It follows from our results that beneficial merging and splitting for these two power indices cannot be solved in NP, unless the polynomial hierarchy collapses, which is considered highly unlikely

Using Group Model Building to Understand Factors That Influence Childhood Obesity in an Urban Environment

Background: Despite increased attention, conventional views of obesity are based upon individual behaviors, and children and parents living with obesity are assumed to be the primary problem solvers. Instead of focusing exclusively on individual reduction behaviors for childhood obesity, greater focus should be placed on better understanding existing community systems and their effects on obesity. The Milwaukee Childhood Obesity Prevention Project is a community-based coalition established to develop policy and environmental change strategies to impact childhood obesity in Milwaukee, Wisconsin. The coalition conducted a Group Model Building exercise to better understand root causes of childhood obesity in its community. Methods: Group Model Building is a process by which a group systematically engages in model construction to better understand the systems that are in place. It helps participants make their mental models explicit through a careful and consistent process to test assumptions. This process has 3 main components: (1) assembling a team of participants; (2) conducting a behavior-over-time graphs exercise; and (3) drawing the causal loop diagram exercise. Results: The behavior-over-time graph portion produced 61 graphs in 10 categories. The causal loop diagram yielded 5 major themes and 7 subthemes. Conclusions: Factors that influence childhood obesity are varied, and it is important to recognize that no single solution exists. The perspectives from this exercise provided a means to create a process for dialogue and commitment by stakeholders and partnerships to build capacity for change within the community

Developing a framework for the analysis of power through depotentia

Stakeholder participation in tourism policy-making is usually perceived as providing a means of empowerment. However participatory processes drawing upon stakeholders from traditionally empowered backgrounds may provide the means of removing empowerment from stakeholders. Such an outcome would be in contradiction to the claims that participatory processes improve both inclusivity and sustainability. In order to form an understanding of the sources through which empowerment may be removed, an analytical perspective has been developed deriving from Lukes�s views of power dating from 1974. This perspective considers the concept of depotentia as the removal of �power to� without speculating upon the underlying intent and also provides for the multidimensionality of power to be examined within a single study. The application of this analytical perspective has been tested upon findings of the government-commissioned report of the Countryside and Community Research Unit in 2005. The survey and report investigated the progress of Local Access Forums in England created in response to the Countryside and Rights of Way Act 2000. Consideration of the data from this perspective permits the classification of individual sources of depotentia which can each be addressed and potentially enable stakeholder groups to reverse loss of empowerment where it has occurred