Perceived Severity of Informal Sanctions: A Case Study of Convicted DUI Offenders in Cass County, North Dakota

It Is estimated that alcohol plays a factor in between 35 and 64 c\u27-rcent of all fatal crashes and between 6 and 25 percent for non-fatal accidents, resulting in alcohol .being involved in about half of the roughly 50,000 annual traffic fatalities in the United States. Clearly, drinking-and driving is a major contributor in both the severity and the frequency of traffic accidents. The basic concept of deterrence states that people will refrain from behavior defined as socially-unaccc.ptable if the resulting perception and fear of penalties (or sanctions) against such action are adequately undesirable in comparison to the potential benefits of the behavior. Informal sanctions, those that are channeled through non- formalized media such as friends, family, or some other relevant collectivity, are oftentimes considered a much more effective deterrent for some offenses than are the formal sanctions imposed by the courts. However, the dynamics of the informal sanction have impeded research into the individual perceptions and effects of such an elusive social control mechanism. It is hypothesized that the presence of certain personal and social characteristics may be related to the severity of informal sanctioning radiated from others toward that person. This study applies this theoretical foundation to the offense of DUI. From November of 1987 through May of 1988, a questionnaire was administered to a group of 122 people convicted of DUI in Cass County, North Dakota. The offenders sampled were participants in the Cass County First Offender DUI Program, an educative/punitive program designed as an alternative to jail sentences foi- those deemed by a license addiction counselor to be free of any chemical dependency problem. Upon constructing a scale comprised of 13 Likert-type items, the following findings were conferred: social status (income, education, occupation) showed no relationship with the offenders\u27 perceptions of informal sanctioning, although the variables of occupational status and income did so moderately. Gender proved to be the most discriminating factor in the perceived severity of informal sanctions, with females markedly more likely to be sanctioned informally than males. As an example of the influence of primary ties on informal sanctions, marital status was an insignificant factor, as was the presence of an example-setting role (indicated by whether or not the respondent shared his/her current residence with a family member under the age of 18). When combined with marital status, however, those respondents responding positively to the presence of a family member under 18 did score higher than both their single and married counterparts, although not significantly so. As another example of primary ties, this time to the community, the length of residence and the size of the community were both found to be largely insignificant in the perceived severity of informal sanctions. In the case of size of community of residence, those living within metropolitan areas (100,000+) did indicate the lowest perceived severity of informal sanctions related to their DUI than did any other category. This trend, however, did not emerge consistent as community of residence increased

Gender and Perceived Severity of Informal Sanctions: A Case Study of Convicted DUI Offenders in Cass County, North Dakota

The use of informal sanctions as deterrents to socially undesirable behavior is not new. Particularly at a time when individuals (especially public figures) are subject to growing scrutinization, the breadth of public censure is expanding to envelop a seemingly wider array of moral and legal violations. Minor law-breakers, too, are being made increasingly aware of the public\u27s social monitoring role a role which functions as a dynamic reference point by which individuals, on the basis of certain actions, are deemed to be deviant or respectable (Douglas, 1970). What is relatively new, however, is the formalization of the informal sanction ; that is, for less serious crimes, the formal imposition of what Garfinkel (1956) has termed degradation ceremonies , using public recourse as the primary sanctioning agent. In colonial times, violators were publicly displayed in stocks, where social disapproval by one\u27s peers could be visibly vented. Today, courts appear to be resurrecting the informal sanction to provide a second line of defense to supplement the formal system of surveillance and punishment (Snortum, 1988). As in earlier times, the function today is essentially twofold: to sanction the offender and to reinforce existing norms. Of primary interest is the effect such sanctions have on various offenders, since each individual will be subjected to varying degrees of informal sanctioning based upon their own perception of how selected members of society (i.e, significant others, reference groups, etc.) view their offense (for a discussion of the looking glass self, see Cooley, 1902). Obviously, the nature of the violation also impacts how the actor will be perceived; situational contexts, such as the option of alternative actions, are also primary consider ations (McHugh, 1970). However, among the most influential factors which initially impact the social construction of deviance are offender characteristics (Kitsuse, 1962;Becker, 1963). Of these, respectability, age, and sex are among the most studied, perhaps because they constitute the most observable attributes which comprise one\u27s social identity (Goffman, 1963)

Main and Regional Campus Assessments of Applicants to a Rural Physician Leadership Program: A Generalizability Analysis

While the selection of qualified applicants often relies, in part, on scores generated from a medical school pre-admission interview (MSPI), the growth of regional medical campuses (RMCs) – many with specialized rural tracks, programs, or missions – has challenged schools to accommodate a wider range of stakeholder input. This study examines the reliabilities of main (urban) and regional (rural) campus interviewers’ assessments of applicants to a Rural Physician Leadership Program (RPLP) located in the southeastern United States. Data from RPLP applicants completing MSPIs on two campuses from 2009-2017 (n = 232) were examined in a generalizability analysis. In two separate interviews on each campus (4 total), raters independently evaluated applicants’ overall acceptability and likelihood of practicing in a rural area of the state. Results provided campus-specific and combined (composite) estimates of obtained and projected reliabilities. The person-by-campus interaction accounted for 11% and 5% of the respective variance in interviewers’ ratings of overall applicant acceptability and likelihood of rural in-state practice, and the reliability of mean scores across the four independent interviews (each with a single, unique rater) was 0.73 and 0.82. Error variances were higher among main campus interviewers, but scores correlated highly between the two campuses. While broadening the universe of generalization often results in decreased reliability, reliability was shown to be enhanced with the addition of regional (rural) campus interviews. As the RPLP matures, an examination of graduates’ actual practice locations should yield insights into the predictive validity of these pre-admissions assessments. More generally, research may wish to explore the conditions under which increasing the diversity of stakeholder input can be accommodated without concomitant reductions in overall reliability

Sources of Medical Student Stress

Background: Key elements in the clinical practice of prevention, health and wellness are best cultivated in medical professionals during undergraduate medical training. This study explores students\u27 self-assessed stress relative to gender, academic expectations, and level of medical training to guide development of targeted wellness interventions. Methods: In early 2012, undergraduate (M1-M4) students in four Southeastern U.S. allopathic medical schools were surveyed about health-related attitudes and behaviors. Results: A total of 575 students returned completed questionnaires. Students in the preclinical years (M1-M2), especially females, reported significantly higher stress levels. Academic expectations and satisfaction were also significantly implicated. Discussion: These findings highlight the general areas of potential concern regarding stressors associated with medical training. Future research should guide programmatic efforts to enhance students\u27 overall health and wellness vis-à -vis curriculum, skills training, and support services

Inspiring the Next Generation of Academic Physicians: The Academic Health Careers Program

There is growing evidence in the medical education literature for the aggressive need to recruit and retain the next generation of academic physicians. In 2008, the University of Kentucky College of Medicine (UK COM) developed an academic health careers (AHCs) program for preclinical medical students as an introduction into the practice of academic medicine. The goals of this elective experience included (1) highly customized training and mentorship experiences in research, teaching, and other aspects of academic medicine; (2) information and perspectives to assist students in making informed career choices, including options for academic careers; (3) access to academic career mentors and role models related to individual faculty research interests and teaching responsibilities; and (4) opportunities to network with UK COM administrators. This short communication provides a detailed overview of the AHC experience – along with preliminary findings from a 2016–17 follow-up of program graduates exploring the program’s role in their career aspirations and decisions

University of Kentucky Rural Physician Leadership Program: A Programmatic Review

This article describes the characteristics and results of the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. RPLP is a successful example of a regional medical campus designed to train physicians at a regional medical campus to serve rural areas through local partnerships

Applicant Selection to a Regional Medical Training Program: A Structural Analysis of Interviewer Assessments

Introduction: For regional campuses with specific program foci, assessing applicant fit necessarily extends beyond academic and professional factors. Based on assessments of applicants to a regional Rural Physician Leadership Program (RPLP), this study explores the relationship of academic and socio-demographic factors with interviewers’ ratings of: (1) likelihood of eventually practicing in a rural area of the state; and (2) overall acceptability to medical school. Methods: The study population consisted of 163 first-time RPLP applicants interviewed independently from 2009-2016 by two faculty members at both main and regional medical campuses. Path analysis was used to calculate direct, indirect, and total effects of applicants’ socio-demographic and academic characteristics on interviewers’ composite ratings. This study protocol (#17-0198-X3B) was approved as exempt by the governing Institutional Review Board; the authors report no conflicts of interest. Results: The combined influence of being an in-state resident with rural Appalachian origins, combined with undergraduate GPA, explained 40.7% of the variance in applicants’ predicted likelihood of practicing in rural Kentucky. In terms of applicant acceptability, the strongest direct effects were exerted by academic factors, GPA and total MCAT score, and the sole preceding endogenous variable: likelihood of rural in-state practice. However, two other background factors were modestly but significantly directly associated with overall acceptability: (1) age; and (2) residence. Specifying likelihood of rural practice as an intervening variable explained 42.5% of the variance in applicant acceptability and provided a good fit to the sample data (X2 = 3.19, df = 4, p = .526, CFI = 1.000, RLI = 1.018, RMSEA = .000). Conclusions: Interviewers appear to be assessing programmatic, mission-specific “fit” within the broader context of applicants’ abilities to navigate a demanding professional training curriculum. Future research should examine graduates’ eventual practice locations and intermediate academic performance as empirical validity of faculty interviewers’ assessments. Similarly, pre-professional pipeline efforts should better coordinate with training programs to provide consistent opportunities to nurture interest in mission-specific outcomes

Ensuring Equitable Application of Interventions to Vulnerable Subpopulations in the Kentucky Consortium for Accountable Health Communities (KC-AHC)

Introduction: The Centers for Medicare and Medicaid Services (CMS) has funded the Accountable Health Communities (AHC) model to test whether systematically identifying and addressing the health-related social needs (HRSNs) of individuals would impact healthcare utilization and total cost of care for Medicare and Medicaid beneficiaries. Toward this effort, AHCs implement screening, referral, and community navigation services in their local areas. There are 28 CMS-funded AHCs nationwide, including the Kentucky Consortium for Accountable Health Communities (KC-AHC). Purpsoe: This study aims to assess the equity of KC-AHC model activities in three vulnerable sub-populations: dual enrollees, disabled individuals, and women. Methods: Twenty-eight primary care clinical sites across 19 healthcare organizations administered (in-person or telephonic) the AHC screening instrument from August 2018 to April 2021. Every six months, social needs positivity rates, navigation eligibility, service opted-in rates and delivery data were monitored among dual enrollees, disabled persons, and women. Subpopulations were compared to their comparisons (for example, non-dual enrollees) and to available benchmarked data. Results: All proportions of subpopulation in screened beneficiaries approximated or exceeded regional benchmarks. While needs among groups fluctuated over time, most reflected positivity rates in excess of comparisons: (1) rates among females ranged from 29.6% to 36.1%, but tended to narrow (relative to males) over time; (2) disabled individuals’ positivity rate ranged from 27.8% to 36.1% but also lessened over time compared with non-disabled counterparts; and (3) positive rates among the dually-enrolled ranged from 34.7% to 42.4%, with the disparity to non-dual enrollees remaining relatively stable. Rates of opt-in and receipt of navigation in dual enrollees and women did not show disparities. There was a persistent gap in opt-in rates between disabled and non-disabled beneficiaries, though one was not identified in receipt. Implications: Results suggest that the KC-AHC adequately screened dual enrollees, disabled individuals, and women during model implementation. The AHC Model may have helped to narrow gaps in social needs between sub-populations and comparison groups, with beneficiaries becoming better connected to community services

Discerning Applicants\u27 Interests in Rural Medicine: A Textual Analysis of Admission Essays

BACKGROUND: Despite efforts to construct targeted medical school admission processes using applicant-level correlates of future practice location, accurately gauging applicants\u27 interests in rural medicine remains an imperfect science. This study explores the usefulness of textual analysis to identify rural-oriented themes and values underlying applicants\u27 open-ended responses to admission essays. METHODS: The study population consisted of 75 applicants to the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. Using WordStat, a proprietary text analysis program, applicants\u27 American Medical College Application Service personal statement and an admission essay written at the time of interview were searched for predefined keywords and phrases reflecting rural medical values. From these text searches, derived scores were then examined relative to interviewers\u27 subjective ratings of applicants\u27 overall acceptability for admission to the RPLP program and likelihood of practicing in a rural area. RESULTS: The two interviewer-assigned ratings of likelihood of rural practice and overall acceptability were significantly related. A statistically significant relationship was also found between the rural medical values scores and estimated likelihood of rural practice. However, there was no association between rural medical values scores and subjective ratings of applicant acceptability. CONCLUSIONS: That applicants\u27 rural values in admission essays were not related to interviewers\u27 overall acceptability ratings indicates that other factors played a role in the interviewers\u27 assessments of applicants\u27 acceptability for admission

Should Histologic Grade Be Incorporated into the TNM Classification System for Small (T1, T2) Node-Negative Breast Adenocarcinomas?

Prognosis of invasive ductal carcinoma (IDC) strongly correlates with tumor grade as determined by Nottingham combined histologic grade. While reporting grade as low grade/favorable (G1), intermediate grade/moderately favorable (G2), and high grade/unfavorable (G3) is recommended by American Joint Committee on Cancer (AJCC) staging system, existing TNM (Primary Tumor/Regional Lymph Nodes/Distant Metastasis) classification does not directly incorporate these data. For large tumors (T3, T4), significance of histologic grade may be clinically moot as those are nearly always candidates for adjuvant therapy. However, for small (T1, T2) node-negative (N0) tumors, grade may be clinically relevant in influencing treatment decisions, but data on outcomes are sparse and controversial. This retrospective study analyzes clinical outcome in patients with small N0 IDC on the basis of tumor grade. Our results suggest that the grade does not impact clinical outcome in T1N0 tumors. In T2N0 tumors, however, it might be prognostically significant and relevant in influencing decisions regarding the need for additional adjuvant therapy and optimal management