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So I reached out to David, for whom I had developed some respect, and communicated our unease I expressed our feeling that this looked like a con ict of interest on its face, and while the appearance of con ict doesn t always mean con ict, we certainly felt vulnerable in this instance We argued back and forth David saw it much like hiring a national law rm to help select a regional counsel I saw it more like hiring one tobacco farmer to help you choose who to buy tobacco from, even though he grew tobacco.

This lack of feature overlap is also important for creating categories that are mutually exclusive For example, paranoid ideation is a symptom of schizotypal personality disorder, paranoid personality disorder, borderline personality disorder, paranoid schizophrenia, schizoaffective disorder, delusional disorder, brief psychotic disorder, shared psychotic disorder, psychotic disorder due to a medical condition, substance-induced psychotic disorder, and psychotic disorder NOS Because paranoid ideation is a feature of all of those categories, these categories are not mutually exclusive Moreover, this collection of categories (ie, borderline personality disorder + delusional disorder + schizoaffective disorder) does not create a useful contrast set that a clinician can use when making a diagnosis A last important feature of hierarchical systems from the perspective of biological classification is that the categories should be exhaustive (Bailey, 1994).

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This property requires that categories exist at all of the required ranks so that any individual organism can be identified in terms of these categories Therefore, if a paleontologist discovers the skeleton of a cat that is sufficiently different from any other known species of cats, then a new taxonomic category can be created This new taxonomic category is also included in a genus, a family,.

Most managed care systems attempt to manage escalating costs of medical care by providing increases in services to underserved populations, determining the basic criteria for medical need, setting fair prices for services, emphasizing the role of primary care, and monitoring public health through nationally funded research programs (Regier, 1994). I have proposed that addressing these missions could be greatly enhanced with systematic and valid methods for assessing physical and psychological status of the patients making use of health care services. Improved screening and assessment is relevant for identifying underserved populations who could benefit from enhanced services, determining whether a patient meets criteria for one medical procedure or another, and surveying the usual and customary costs for services and their relative cost-effectiveness. Cost-effective primary care can be realized by understanding the factors that predict patients decisions to utilize early screening and detection services, detecting physical and mental disorders in adults at the earliest possible stage, and predicting and monitoring the effects of medical decisions on recovery and rehabilitation rates, as well as the quality of life of the patients receiving care. In most health care settings, the amount and level of psychosocial /mental health assessment may be grossly disproportionate to the amount of effort and resources spent on hightechnology biomedical assessments. In fact, in many cases, psychosocial assessment may be totally absent from the screening, intake, and follow-up procedures, despite the remarkably low cost / high payoff potential of these tests. Where psychosocial assessments have been incorporated into health care protocols, psychologists are often unable to obtain reimbursement from third-party payers for such assessments (Eisen et al., 1998). This has placed at risk the use of psychological assessment for referral and decision making pertaining to level of care, the best mode of treatment delivery, and risk for early termination from treatment

behavior was maladaptive but ignored the patient when behavior was adaptive ( normal ) thereby serving to reinforce symptomatic behavior and to extinguish normal behavior Rewarding normal behavior would provide a more rational approach to eliminating symptoms Studies directed toward eliminating eating problems, mutism, and other symptoms, reported successes (eg, Allyon, 1963, Allyon & Haughton, 1962) and led some public hospitals to develop large-scale token reinforcement programs Behavioral methods of this kind ran into criticism One criticism was that they turned the professional ethical imperative to provide care and attention to the sick on its head and therefore compromised patients rights Another was that patient improvements often were speci c to the hospital setting and failed to persist after the patient was discharged But the main factor in limiting the spread of this approach was the success of the new medications.

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