bluuebunny/crossref_metadata_2025 huggingface dataset:
The process of hospital discharge for medical patients: a model
Authors: Pearson Pauline , Procter Susan , Wilcockson Jane , Allgar Vicki
Published: May 2004

Background.  The 1990 NHS Community Care Act established a requirement for hospital discharge policies and procedures in the United Kingdom to be developed in collaboration with local government authorities in order to ensure supported discharge for those in need.

Aims.  The aim of the study reported in this paper was to track decisions about hospital discharge in relation to outcomes for a sample of medical patients and their carers, identified as at risk of experiencing unsuccessful discharge processes.

Methods.  Themed unstructured interviews were conducted in three different hospitals with 30 patients identified as at risk of unsuccessful discharge and their carers pre‐ and postdischarge. Hospital, community and social care staff involved in the care of the patient were also interviewed.

Findings.  Patients and carers were constantly negotiating their social roles, seeking to juggle appropriate identities and limited resources to maintain their own and each others’ dignity and quality of life. When the negotiation process was destabilized (for example, by exacerbation of chronic disease, withdrawal of some resource, or the experience of additional stressors – not necessarily health‐related), then either or both parties sought a way out. In all the cases examined the result was admission to hospital – usually, but not always, mediated by community professionals.

Conclusions.  The effective discharge of patients from hospital needs to move from a functional focus on symptom management to a negotiation of quality of life that seeks to promote health for all parties involved.
Haemodialysis patients and end‐of‐life decisions: a theory of personal preservation
Authors: Calvin Amy Olivier
Published: May 2004

Background.  Lack of knowledge about the end‐of‐life treatment preferences of patients undergoing haemodialysis is problematic in the acute care setting as, often, patients are unable to communicate their treatment wishes effectively and have not previously documented their desires in the form of advance directives. Existing theoretical models offer an incomplete explanation of end‐of‐life treatment decisions in haemodialysis patients.

Aim.  This paper reports a study exploring decisions about end‐of‐life treatment (e.g. cardiopulmonary resuscitation, mechanical ventilation) in people with kidney failure undergoing haemodialysis.

Methods.  Grounded theory was used. Theoretical sampling led to selection of 20 haemodialysis patients (11 men and nine women with a mean age of 56) who attended three dialysis outpatient centres in central Texas. They were interviewed about end‐of‐life treatment plans and the use of advance directives (i.e. living wills and durable powers of attorney for health care). Interviews, transcripts and field notes from the first 12 patients were analysed by making constant comparisons. The remaining eight interviews were used for validation purposes. Data collection and analysis spanned the years 1997–2000.

Findings.  When prompted to think about and discuss end‐of‐life treatments, haemodialysis patients chose to focus on living rather than dying. A substantive theory of ‘personal preservation’ was developed. This consists of three phases: knowing the odds for survival, defining individuality (beating the odds, discovering meaning, being optimistic and having faith in a higher force) and personal preservation (being responsible and taking chances).

Conclusions.  The theory of personal preservation furthers understanding of illness behaviour and the process by which patients make decisions about end‐of‐life treatments. It can be used to sensitize health care professionals to patients’ desires and to enhance patient‐professional communication.
The pathology of phosphorus deficiency in fish – a review
Authors: Sugiura S H , Hardy R W , Roberts R J
Published: May 2004

Phosphorus (P) is an essential component of fish diets. Its deficiency affects not only hard tissues, where it is responsible for rickets, leading to skeletal malformation, but also influences various aspects of intermediary metabolism, and thus growth and feed conversion. Therefore, optimizing the dietary inclusion level is critical at all times. As the aquaculture industry has expanded, so the effects of P in farm effluents, derived from metabolic and uneaten food sources, have also become recognized. Diets are increasingly formulated on a basis that will not only provide adequate P for fish needs, but also endeavour to ensure minimal acceptable P levels in effluents at the same time. Many variables influence P requirements and P availability in fish diets, so it is inadvisable to feed diets formulated to an assumed minimum dietary requirement level, irrespective of the advantages that such a formulation may provide to environmental impact.
Infection experiments with Aphanomyces invadans in four species of estuarine fish
Authors: Johnson R A , Zabrecky J , Kiryu Y , Shields J D
Published: May 2004

Along the eastern seaboard of the US, Atlantic menhaden, Brevoortia tyrannus, develop characteristic ulcerative lesions, a condition termed ulcerative mycosis. These lesions are identical to those seen across Asia in fish affected by epizootic ulcerative syndrome, a condition caused by the fungus‐like oomycete Aphanomyces invadans. Young‐of‐the‐year menhaden inhabiting estuarine environments are the primary species affected in the USA and little is known about the factors involved in the initiation of the lesions, or why menhaden are predominantly infected. Atlantic menhaden, hogchoker, Trinectus maculatus, striped killifish, Fundulus majalis, and mummichog, Fundulus heteroclitus, were inoculated with A. invadans (80 zoospores per fish) to explore species differences in infection and lesion development. All four species developed lesions. Killifish developed frank lesions similar to those observed in menhaden but the gross lesions occurred later, approximately 5–10 days after those on menhaden. Hogchoker and mummichog did not develop gross skin ulcers; rather, their lesions appeared as reddened areas under the epidermis. Mummichogs also showed evidence of significant healing with a well‐developed granuloma and significant myocyte regeneration. These experiments show that species barriers as well as ecological barriers can explain some of the factors involved in the development of lesions in, and specificity of the water mould for, menhaden.
Diet, anthropometric measures and prostate cancer risk: a review of prospective cohort and intervention studies
Authors: Dagnelie P.C. , Schuurman A.G. , Goldbohm R.A. , Van Den Brandt P.A.
Published: May 2004

We reviewed 37 prospective cohort and four intervention studies on potential dietary risk factors for prostate cancer, published between 1966 and September 2003. Some studies were limited by small size, crude measurement of dietary exposure and limited control for confounders. Intervention and prospective cohort studies support a protective role against prostate cancer for selenium, and possibly for vitamin E, pulses and tomatoes/lycopene. Overall consumption of meat, eggs, vegetables, fruit, coffee, tea, carotenoids and vitamins A, C and D was not consistently related to prostate cancer risk. Intervention studies also indicate that supplementation with β‐carotene does not lower prostate cancer risk, except possibly in men with low β‐carotene status at baseline. For specific types of meat, alcoholic drinks, dairy products, fat and anthropometric measures, most cohort studies suggest either an increased risk or no relation with prostate cancer. For calcium, two cohort studies suggest an increased risk at very high calcium intakes (>2000 mg/day). In conclusion, prospective studies are consistent with a protective role for selenium, and possibly vitamin E, pulses and tomatoes/lycopene, in the aetiology of prostate cancer. Studies are inconclusive on the role of meat, dairy products, fat, vegetables, fruits, alcohol and anthropometric measures, whereas a very high calcium intake appears to be positively associated with prostate cancer risk.
Genes differentially expressed in prostate cancer
Authors: Eder I.E. , Bektic J. , Haag P. , Bartsch G. , Klocker H.
Published: May 2004

Because of the heterogeneity of prostate cancer knowledge about the genes involved in prostate carcinogenesis is still very limited. Previously, the use of novel high‐throughput technologies offered the possibility to investigate broad gene expression profiles and thus helped to improve understanding of the molecular basis of prostate disease. Many candidate genes have been identified so far which have a more or less strong effect on prostate cancer. This vast number of gene expression changes show that it is unlikely that only one gene promotes prostate cancer. Conversely, it seems more likely that a broad network of molecular changes is involved in the complex cascade of events which lead to tumour formation and progression, respectively. A few of these novel molecular targets are currently under clinical evaluation. This paper gives an overview of several interesting candidate genes which may be useful as improved biomarkers for diagnosis or as targets for developing novel treatment methods.
Art as an investment: risk, return and portfolio diversification in major painting markets
Authors: Worthington Andrew C. , Higgs Helen
Published: May 2004

The present paper examines risk, return and the prospects for portfolio diversification among major painting and financial markets over the period 1976–2001. The art markets examined are Contemporary Masters, French Impressionists, Modern European, 19th Century European, Old Masters, Surrealists, 20th Century English and Modern US paintings. The financial markets comprise US Treasury bills, corporate and government bonds and small and large company stocks. In common with the published literature in this area, the present study finds that the returns on paintings are much lower and the risks much higher than conventional investment markets. Moreover, while low correlations of returns suggest that opportunities for portfolio diversification in art works alone and in conjunction with equity markets exist, the construction of Markowitz mean‐variance efficient portfolios indicates that no diversification gains are provided by art in financial asset portfolios. However, diversification benefits in portfolios comprised solely of art works are possible, with Contemporary Masters, 19th Century European, Old Masters and 20th Century English paintings dominating the efficient frontier during the period in question.
A novel visual analogue scale (VAS) device: an instrument based on the VAS designed to quantify the subjective visual experience
Authors: Pointer Jonathan S.
Published: May 2004

Purpose : To evaluate a novel device intended to facilitate the direct quantification of the subjective visual experience. The design principle is based on that of the visual analogue scale (VAS) technique but obviates the need for subsequent measurement unlike the administration of the conventional paper VAS.

Methods : The visual experience of 134 normally sighted 17–40‐year‐olds was quantified using (in randomised sequence) a paper VAS and the novel VAS device. A notional 100‐point scale was utilised in either case, and the extreme descriptive anchors for both instruments were ‘dreadful’ and ‘perfect’.

Results : The degree of clinical agreement between the two alternative VAS techniques was very high. A small bias (mean = +0.7 VAS units: 95% confidence interval 0.3–1.2 units) towards the paper VAS was evident in these data, an outcome of no clinical significance or impediment as regards the substitution of the novel device for the conventional paper‐based approach.

Conclusions : The moving of a bead along a wire is shown to be a clinically and statistically reliable alternative procedure to the pen‐marking of a conventional paper VAS for the evaluation of the recent subjective visual experience, provided that the same minimum/maximum descriptive anchors are used for either instrument. The instant quantification of the VAS score afforded by the novel technique introduced here broadens the potential clinical application of this technique.
UTP and diadenosine tetraphosphate accelerate wound healing in the rabbit cornea
Authors: Pintor Jesús , Bautista Alfredo , Carracedo Gonzalo , Peral Assumpta
Published: May 2004

Nucleotides are naturally occurring substances present in tear film that can stimulate tear secretion in animals and humans. We investigated whether certain nucleotides can affect the rate of wound healing in the cornea of white rabbits. In the absence of any added compound, the rate of healing was 72.4 ± 2.2 μm h−1. Of all the tested nucleotides, UTP and Ap4A were the most active ones, maximally increasing the rate of healing to 121.6 ± 3.7 and 93.7 ± 3.2 μm h−1, respectively. Responses to UTP were dose dependent. UTP had a pD2 value of 8.9 ± 0.1 (EC50: 1.25 nM). P2 purinoceptor antagonists such as suramin and reactive blue‐2, inhibited the effect of UTP indicating the involvement of P2Y receptors. Mitogen‐activated protein kinase (MAPK) cascade inhibitors also abolished the effects of UTP, suggesting that P2Y receptors are coupled to the MAPK cascade, and that this is involved in controlling the rate of epithelial cell migration.
Correctable visual impairment in older people: a major unmet need
Authors: Evans Bruce J. W. , Rowlands Gillian
Published: May 2004

This review seeks to determine the prevalence of correctable visual impairment (VI) in older people in the UK, to discover what proportion of these cases are undetected, to suggest reasons for the poor detection and to make recommendations for improving the detection. To establish the context of these issues, the review will also touch on the general prevalence and causes of VI in older people in developed countries and on the impact of VI in older people. Typically, studies suggest that VI affects about 10% of people aged 65–75, and 20% of those aged 75 or older. There is a strong relationship between impaired vision in older people and both reduced quality of life and increased risk of accidents, particularly falls. The literature suggests that those with low vision are about two times more likely to have falls than fully sighted people, and the annual UK cost of treating falls directly attributable to VI is £128 million. The literature on the prevalence of undetected reduced vision in older people reveals that between 20 and 50% of older people have undetected reduced vision. The majority of these people have correctable visual problems (refractive errors or cataract). It is particularly startling that, in ‘developed countries’, between 7 and 34% of older people have VI that could simply be cured by appropriate spectacles. The reasons why so many cases of treatable VI remain untreated are discussed, and suggestions are made for improving the detection of these cases. We conclude that there should be better publicity encouraging older people to attend for regular optometric eye examinations. A complementary approach is annual visual screening of the elderly, possibly as part of GPs annual health check on people aged 75 years and older. Recommendations are made for evaluating new approaches to screening and for improving the management of cases detected by screening.
Interactions between serpentinite devolatilization, metasomatism and strike‐slip strain localization during deep‐crustal shearing in the Eastern Alps
Authors: Barnes J. D. , Selverstone J. , Sharp Z. D.
Published: May 2004

The Greiner shear zone in the Tauern Window, Eastern Alps, changes from a zone of distributed (dominantly sinistral) shear in supracrustal rocks to a series of narrow, gully forming dextral splays where it enters basement gneisses. Within these splays, granodiorite is transformed into quartz‐poor biotite and/or chlorite schists, reflecting hydration, removal of Si, Ca and Na, and concentration of Fe, Mg and Al. Stable isotope analyses show a prominent increase in δD and a decrease in δ18O from granodiorite into the shear zones. These changes indicate significant channelized flow of an externally derived, low‐δ18O, high‐δD fluid through the shear zones. The shear zone schists are chemically similar to blackwall zones developed around serpentinite bodies elsewhere in the Greiner zone and the stable isotope data support alteration via serpentinite‐derived fluid. Monazite in schist from one shear zone yields spot dates of 29–20 Ma, indicating that the fluid influx and switch from sinistral to dextral shear occurred at or shortly after the thermal peak of the Alpine orogeny (c. 30 Ma). We suggest that Alpine metamorphism of serpentinites released large amounts of high‐δD, low‐δ18O, Si‐undersaturated, Fe + Mg‐saturated fluids that became channelized along prior zones of weakness in the granodiorite. Infiltration of this fluid facilitated growth of chlorite and biotite, which in turn localized later dextral strain in the narrow splays via cleavage‐parallel slip. This dextral strain event can be linked to other structures that accommodated tectonic escape of major crustal blocks during dextral transpression in the Eastern Alps. This study shows that serpentinite devolatilization can play an important role in modifying both the chemistry and rheology of surrounding rocks during orogenesis.
Metamorphic evolution of kyanite–staurolite‐bearing epidote–amphibolite from the Early Palaeozoic Oeyama belt, SW Japan
Authors: Tsujimori T. , Liou J. G.
Published: May 2004

Early Palaeozoic kyanite–staurolite‐bearing epidote–amphibolites including foliated epidote–amphibolite (FEA), and nonfoliated leucocratic or melanocratic metagabbros (LMG, MMG), occur in the Fuko Pass metacumulate unit (FPM) of the Oeyama belt, SW Japan. Microtextural relationships and mineral chemistry define three metamorphic stages: relict granulite facies metamorphism (M1), high‐P (HP) epidote–amphibolite facies metamorphism (M2), and retrogression (M3). M1 is preserved as relict Al‐rich diopside (up to 8.5 wt.% Al2O3) and pseudomorphs after spinel and plagioclase in the MMG, suggesting a medium‐P granulite facies condition (0.8–1.3 GPa at > 850 °C). An unusually low‐variance M2 assemblage, Hbl + Czo + Ky ± St + Pg + Rt ± Ab ± Crn, occurs in the matrix of all rock types. The presence of relict plagioclase inclusions in M2 kyanite associated with clinozoisite indicates a hydration reaction to form the kyanite‐bearing M2 assemblage during cooling. The corundum‐bearing phase equilibria constrain a qualitative metamorphic P–T condition of 1.1–1.9 GPa at 550–800 °C for M2. The M2 minerals were locally replaced by M3 margarite, paragonite, plagioclase and/or chlorite. The breakdown of M2 kyanite to produce the M3 assemblage at < 0.5 GPa and 450–500 °C suggests a greenschist facies overprint during decompression. The P–T evolution of the FPM may represent subduction of an oceanic plateau with a granulite facies lower crust and subsequent exhumation in a Pacific‐type orogen.
Privacy and Technology: Reconsidering a Crucial Public Policy Debate in the Post‐September 11 Era
Authors: Nelson Lisa
Published: May 2004

In the post September 11 era, one truism in the ongoing public policy debate surrounding technology and privacy is that there is no easy solution to the increasing presence of technology in our lives. There are, however, several long‐standing guiding principles. We must be wary of extending political authority to protect privacy without careful contemplation of the consequences. While it may appear that the idea of balancing technology and privacy is novel, the tension between them is informed by a broader theoretical framework that is inherent to democracy. Understanding this broader theoretical framework is helpful in identifying ways to advance the debate toward policy solutions rather than continuing a dogmatic discussion that juxtaposes technological innovation with the loss of privacy. The purpose of this discussion is not to settle the public policy debate. Instead, the aim is to consider how long‐standing constitutional doctrine and the theoretical framework of democracy can lend insight into the current debate surrounding privacy and technology.
Women's Jobs, Men's Jobs: Sex Segregation and Emotional Labor
Authors: Guy Mary Ellen , Newman Meredith A.
Published: May 2004

Job segregation—the tendency for men and women to work in different occupations—is often cited as the reason that women's wages lag men's. But this begs the question: What is it about women's jobs that causes them to pay less? We argue that emotional labor offers the missing link in the explanation. Tasks that require the emotive work thought natural for women, such as caring, negotiating, empathizing, smoothing troubled relationships, and working behind the scenes to enable cooperation, are required components of many women's jobs. Excluded from job descriptions and performance evaluations, the work is invisible and uncompensated. Public service relies heavily on such skills, yet civil service systems, which are designed on the assumptions of a bygone era, fail to acknowledge and compensate emotional labor.
The Paradox of Implementing the Government Performance and Results Act: Top‐Down Direction for Bottom‐Up Implementation
Authors: Long Edward , Franklin Aimee L.
Published: May 2004

Research on the implementation of the Government Performance and Results Act generally has not considered how the strategic plan, annual performance plan, and annual performance report are produced and used. Are the documents good decision and management tools, as the act intends, or are agencies internalizing them to meet the unique needs of their organization? Interviews with representatives of 14 cabinet‐level federal agencies suggest that implementation of the act is not standardized. Instead, it is influenced by the unique challenges that agencies face. Further, there is a relationship between the implementation challenges and the overall use of the documents.
The Changing Structure of American Cities: A Study of the Diffusion of Innovation
Authors: Frederickson H. George , Johnson Gary Alan , Wood Curtis
Published: May 2004

Using historical and numerical analysis and the five‐part schema, this study finds that over the past 50 years structural modifications and adaptations by American cities have generally followed the standard S curve of the diffusion of innovation. In tests of Kaufman's and Hirshman's theories of epochs of change from representativeness to administrative efficiency, this study determines that mayor‐council cities have, in a standard innovation diffusion S curve, adopted many of the key features of council‐manager cities, increasing their administrative efficiency. At the same time, council‐manager cities, again in an S curve, have adopted many of the key features of mayor‐council cities, increasing their political responsiveness. Fewer cities are now either distinctly mayor‐council or council‐manager in form, and most cities are structurally less distinct, constituting a newly merged or hybrid model of local government—the type III city.
Drivers and Consequences of Citizen Satisfaction: An Application of the American Customer Satisfaction Index Model to New York City
Authors: Van Ryzin Gregg G. , Muzzio Douglas , Immerwahr Stephen , Gulick Lisa , Martinez Eve
Published: May 2004

Using data from two telephone surveys of New York City residents conducted during 2000 and 2001, this article employs the American Customer Satisfaction Index (ACSI) model to examine the drivers—and behavioral consequences—of overall satisfaction with local government services. While the ACSI model has been widely used to analyze customer satisfaction in the private sector and, more recently, in the federal government, it has not been tried in a local government context. Applying the ACSI model to New York City, we find the perceived quality of public schools and especially the police, as well as road conditions and subway service, are the most salient drivers of satisfaction, but the significance of each service varies across income, race, and geography. For all groups in the city, overall satisfaction drives both trust in local government officials and intentions to move out of the city. Advantages and limitations of using the ACSI model to assess the quality of local government services are discussed.
Parkinson's Law and the New Public Management? Contracting Determinants and Service‐Quality Consequences in Public Education
Authors: O'Toole Laurence J. , Meier Kenneth J.
Published: May 2004

Why is contracting used more frequently under some circumstances than others? What is its impact on spending for core mission and on service quality? These questions are explored with data from more than 1,000 Texas school districts. The evidence for a recent three‐year period shows that contracting is negatively related to spending on school districts' central task and is not positively associated with district performance. Why, then, do districts contract? While several variables are associated with the degree of contracting, the most interesting is the relative size of a district's bureaucratic staff. Furthermore, the relationship between contracting and bureaucracy is reciprocal: Each is associated with subsequent growth in the other. The dynamic suggests an updated version of Parkinson's law. These findings indicate the need for researchers to probe the causes and consequences of contracting more thoroughly to help public managers assess this important option.
Network Structures: Working Differently and Changing Expectations
Authors: Keast Robyn , Mandell Myrna P. , Brown Kerry , Woolcock Geoffrey
Published: May 2004

There is a growing need for innovative methods of dealing with complex, social problems. New types of collaborative efforts have emerged as a result of the inability of more traditional bureaucratic hierarchical arrangements such as departmental programs to resolve these problems. Network structures are one such arrangement that is at the forefront of this movement. Although collaboration through network structures establishes an innovative response to dealing with social issues, there remains an expectation that outcomes and processes are based on traditional ways of working. It is necessary for practitioners and policy makers alike to begin to understand the realities of what can be expected from network structures in order to maximize the benefits of these unique mechanisms.
Are Momentum Profits Robust to Trading Costs?
Authors: Korajczyk Robert A. , Sadka Ronnie
Published: May 2004

We test whether momentum strategies remain profitable after considering market frictions induced by trading. Intraday data are used to estimate alternative measures of proportional and non‐proportional (price impact) trading costs. The price impact models imply that abnormal returns to portfolio strategies decline with portfolio size. We calculate break‐even fund sizes that lead to zero abnormal returns. In addition to equal‐ and value‐weighted momentum strategies, we derive a liquidity‐weighted strategy designed to reduce the cost of trades. Equal‐weighted strategies perform the best before trading costs and the worst after trading costs. Liquidity‐weighted and hybrid liquidity/value‐weighted strategies have the largest break‐even fund sizes: $5 billion or more (relative to December 1999 market capitalization) may be invested in these momentum strategies before the apparent profit opportunities vanish.
Executive Option Repricing, Incentives, and Retention
Authors: Chen Mark A.
Published: May 2004

While many firms grant executive stock options that can be repriced, other firms systematically restrict or prohibit repricing. This article investigates the determinants of firms' repricing policies and the consequences of such policies for executive turnover and retention. Firms that have better internal governance, that use more powerful stock‐based incentives, or that face less shareholder scrutiny are more likely to maintain repricing flexibility. Firms that restrict repricing are more vulnerable to voluntary executive turnover following stock price declines. When share price declines are severe, restricting firms appear to award unusually large numbers of new options.
Do Stock Prices and Volatility Jump? Reconciling Evidence from Spot and Option Prices
Authors: Eraker Bjørn
Published: May 2004

This paper examines the empirical performance of jump diffusion models of stock price dynamics from joint options and stock markets data. The paper introduces a model with discontinuous correlated jumps in stock prices and stock price volatility, and with state‐dependent arrival intensity. We discuss how to perform likelihood‐based inference based upon joint options/returns data and present estimates of risk premiums for jump and volatility risks. The paper finds that while complex jump specifications add little explanatory power in fitting options data, these models fare better in fitting options and returns data simultaneously.
Specification Analysis of Option Pricing Models Based on Time‐Changed Lévy Processes
Authors: Huang Jing‐zhi , Wu Liuren
Published: May 2004

We analyze the specifications of option pricing models based on time‐changed Lévy processes. We classify option pricing models based on the structure of the jump component in the underlying return process, the source of stochastic volatility, and the specification of the volatility process itself. Our estimation of a variety of model specifications indicates that to better capture the behavior of the S&P 500 index options, we need to incorporate a high frequency jump component in the return process and generate stochastic volatilities from two different sources, the jump component and the diffusion component.
Difficulty in Implementing a Family Intervention for Bipolar Disorder: The Predictive Role of Patient and Family Attributes*
Authors: Tompson Martha C. , Rea Margaret M. , Goldstein Michael J. , Miklowitz David J. , Weisman Amy G.
Published: May 2004

Family affect was examined as a predictor of difficulty implementing a 9‐month, manual‐based, psychoeducational family therapy for recently manic bipolar patients. Prior to therapy, family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task. Following family treatment, both therapists and independent observers rated the overall difficulty of treating the family, and therapists also rated each participant's problem behaviors during treatment, in the areas of affect, communication, and resistance. Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' critical behavior toward patients during the pretreatment interaction task predicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatment. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' resistance to the family intervention. Results suggest that difficulties in conducting a manual‐based family intervention can be predicted from systematic, pretreatment family and clinical assessment.
“Factor Analyses of the Family Assessment Device,” by Ridenour, Daley, & Reich
Authors: Miller Ivan W. , Ryan Christine E. , Keitner Gabor I. , Bishop Duane S. , Epstein Nathan B.
Published: May 2004

Ridenour, Daley, and Reich conducted a series of factor analyses using the correlational matrix of the subscale scores of the Family Assessment Device (FAD), published in Family Process, December, 1999. They conclude that “the FAD subscales be reorganized from their current seven‐subscale format” (p. 507). We propose that this suggestion for reorganization is premature and based on the inappropriate application of an “internal consistency” model of scale construction to the FAD. We further suggest that the most important criteria regarding an assessment instrument are those of reliability, validity, and clinical utility. In the absence of this kind of data regarding alternative organizations of the FAD, we believe that the original subscales remain the best choice.
Ethical Decision Making among Family Therapists and Individual Therapists*
Authors: Newfield Susan A. , Newfield Neal A. , Sperry Jeannie A. , Smith Thomas Edward
Published: May 2004

In this study, we investigated the ethical decision making of 30 individual and 30 family therapists in order to detect the types of decision making used by practicing therapists. Informants responded to three ethical dilemmas. Two of the situations were hypothetical. The third dilemma was a situation the informant had experienced in practice. Each interview was assessed for decision‐making style, using content analysis. Kohlberg's justice reasoning and Gilligan's care reasoning provided the conceptual foundations for this analysis. The results suggest that both family and individual therapists prefer care reasoning on all dilemma types. There was significantly more care reasoning demonstrated on the personal dilemma than on the hypothetical dilemmas. Characteristics of informants did not provide clear explanations for the differences found in reasoning.
“Lesbians, Gay Men, and Their Parents”: A Critique of LaSala and the Prevailing Clinical “Wisdom”
Authors: Green Robert‐Jay
Published: May 2004

This article challenges the popular assumption that coming out to family of origin is important for lesbians and gay men's mental health and couple relationships. First, I present theory emphasizing the unique position of lesbians/gays in families of origin and the significance of “families of choice.” Second, I review the quantitative research on social support received by lesbians/gays from family of origin, friends, and other social network sources. Third, I demonstrate how the dominant clinical opinion about coming out to family is based on an unwarranted use of theory developed for heterosexuals and on overgeneralization of findings from studies of white, upper‐middle‐class, North American lesbians/gays. Fourth, I propose five determinants of lesbian/gay persons' decisions to come out to family‐of‐origin members. Fifth, I argue that such decisions are constrained by “realistic” costs/benefits in various sociocultural niches rather than being a simple function of individuals' levels of differentiation. Lastly, I offer an expanded contextual stance for the family therapist working with lesbian/gay clients.
Tales Full of Sound and Fury: A Cultural Approach to Family Therapeutic Work and Research in Rural Scandinavia*
Authors: Seltzer Michael R. , Seltzer Wencke J. , Homb Nils , Midtstigen Per , Vik Geir
Published: May 2004

The concept of “culture” figured prominently in the development of family therapy. Recent conceptualizations, however, have tended to focus primarily on the ideational dimensions of culture. While not disputing that meanings and other ideas constitute significant features of group lifeways, this article proposes a return to earlier anthropological framings that incorporate material and ideational dimensions of cultures. To illustrate how his expanded concept may serve as a guide for therapeutic work, the article describes therapy with one family at a clinic in rural Scandinavia. We especially focus on the place of key symbols as historical links between the ideational and material dimensions of cultures. The perspective developed here is one of seeing cultures as sets of interpenetrating actions and ideas shaped by as well as shaping their practitioners.
Empathy in Families of Women with Borderline Personality Disorder, Anorexia Nervosa, and a Control Group*
Authors: Guttman Herta A. , Laporte Lise
Published: May 2004

This is a study of empathy in the families of 27 women with borderline personality disorder (BPD), 28 women with restricting anorexia nervosa (AN), and 27 women without a clinical diagnosis (NC). The daughters and both parents responded to the Interpersonal Reactivity Index (IRI), an instrument for assessing four dimensions of empathy. In addition, they were personally interviewed, with the Family Interview for Protectiveness and Empathy (FIPE), about the extent of empathy expressed by the parents to their daughter during her development. On the IRI, women with BPD scored highest on the immature and lowest on the mature aspects of empathy, whereas scores of AN and NC women were all within normal limits. Parents of BPDs had the lowest IRI scores, while parents of AN and NC groups were similar to each other and to criterion group scores. IRI scores of AN daughters were positively correlated with their parents' scores whereas BPDs' scores were negatively correlated with those of their parents. There were no correlations between the IRI scores of NC subjects and their parents. On the FIPE, borderline daughters and parents agreed about the relative absence of empathic parenting, whereas AN and NC daughters and parents agreed as to the presence of empathic parenting. The theoretical and clinical implications of these contrasting findings are discussed.
A Child's Experience of Parental Depression: Encouraging Relational Resilience in Families with Affective Illness*
Authors: Focht‐Birkerts Lynn , Beardslee William R.
Published: May 2004

In this article, we describe an approach that parents with affective illness can use to foster the emotional resilience of their children. Building on current research that emphasizes the need to formulate concepts of risk and resilience in terms of family or relational processes, we propose that affectively ill parents can promote resilience in their children by helping them express the affect they experience as a result of parental illness‐related behavior. Risk and resilience are conceptualized in terms of a family's ability to process emotion or affect: a family's need to constrict affect is a risk factor, while the family's ability to elaborate affect encourages relational resilience. An object relations model is used to discuss the ways in which encouraging this elaboration of affect, especially negative affect, contributes to resilience in children. We describe ways in which a preventive intervention helps to increase parents' emotional responsiveness to their children. Using extensive narrative data from followup interviews with families and children, constriction and expansion of emotion in children concerning affectively ill parents are documented, by multiple interviewers, over a span of more than 5 years.

Where danger threatens, there also grows the saving power.

—J.C.F. Hölderlin1Patmos
Posttraumatic Stress Disorder Symptoms, Psychological Distress, Personal Resources, and Quality of Life in Four Groups of Holocaust Child Survivors*
Authors: Lev‐Wiesel Rachel , Amir Marianne
Published: May 2004

The objective of the present study was to inquire into the long‐term effects of child survivors' Holocaust experience. To this end, 170 Holocaust survivors who were born after 1926 completed questionnaires with regard to psychological distress, Posttraumatic Stress Disorder (PTSD), Quality of Life (QoL), Self‐identity, and Potency. The survivors were divided into four groups based on the setting of their experience during the Holocaust: Catholic Institutions, Christian foster families, concentration camps, and hiding in the woods and/or with partisans. Results showed that survivors who had been with foster families scored significantly higher on several of the measures of distress, whereas survivors who had been in the woods and/or with partisans scored significantly higher on several of the positive measures, QoL, potency, and self‐identity. The discussion focuses on understanding the different experiences according to developmental theory and sense of control. It was concluded that there are group differences between child survivors according to their Holocaust experience.
Chronic Illness: Trauma, Language, and Writing: Breaking the Silence*
Authors: Penn Peggy
Published: May 2004

In our work with families that struggle with a chronic illness, we have relied on three ideas. First, we regard illness as a relationally traumatizing experience, not just for the person with the illness, but for other members of the family as well. We use the phrase “relational trauma” because of its effects on members of a wider system who also show signs of physical stress, isolation, and helplessness (Sheinberg & Fraenkel, 2000). Our second concern is how the conversation that leads to new stories is expanded through the development of voice and the use of writing. Looking at language, we are particularly attentive to the social prevalence of negative metaphors that surround and engulf the ill person and her family: dependence, poor genes, repressed personalities, weak constitutions, et cetera (Sontag, 1984). These negative metaphors, or outside voices, join with the inner voices of the ill person and result in a silence that disconnects people at a time when connections must be relied on and above question. Our third emphasis is on the use of writing as the means to create new voices, metaphors, and multiple descriptions that can reinvigorate the conversations silenced by the illness. Once the family's voices are reconstituted through writing, the emotions that have been displaced by the illness are restored to their conversation. I have included new research from JAMA detailing the treatment of patients with chronic illness through their use of writing.

I was 43 years old, a practicing, licensed psychologist for over 25 years, and happily married to the man with whom I was raising a 14‐year‐old son and an 11‐year‐old daughter. I had just finished one year of treatment for cancer, a treatment the noted surgeon, Dr. Susan Love [citation omitted] refers to as “slash, cut, and burn.” My life was bleak and lonely because I lived in silence: certain that no one could bear to hear the feelings and thoughts I had following my year of treatment; unwilling to find out if I was right; certain that I needed to protect people from my experiences; and failing in those few times that I tried to put into words the chaos of my emotions and the terror that lived in my flesh.

—Kaethe Weingarten (2000, p. 390)
Helping Parents Deal With Children's Acute Disciplinary Problems Without Escalation: The Principle of Nonviolent Resistance*
Authors: Omer Haim
Published: May 2004

There are two kinds of escalation between parents and children with acute discipline problems: (a) complementary escalation, in which parental giving‐in leads to a progressive increase in the child's demands, and (b) reciprocal escalation, in which hostility begets hostility. Extant programs for helping parents deal with children with such problems focus mainly on one kind of escalation to the neglect of the other. The systematic use of Gandhi's principle of “nonviolent resistance” allows for a parental attitude that counters both kinds of escalation. An intervention is described, which allows parents to put this principle into practice.
The Self‐Characterization as a Narrative Tool: Applications in Therapy with Individuals and Families
Authors: Androutsopoulou Athena
Published: May 2004

In this article, I argue that the use of Kelly's self‐characterization can aid story telling in therapy. It describes the use of the tool's original instructions, and of two other versions (the ideal self in 5 years time and the family characterization sketch), with individuals and families. In contrast to Kelly's practice, clients' written self‐descriptions are not stripped to uncover cognitive schemata, but are treated as whole narratives. The texts are collaboratively analyzed, by looking at both their form and content. The cases presented illustrate ways in which these narratives can be read to help therapists recognize a person's/family's language “codes” and transgenerational family themes. “Warded off areas of feeling” are opened up, and differentiation from dominant family voices is facilitated. The whole technique process reveals the great importance people place on negotiating, editing, and finally presenting a narrative 1 that portrays the way the self and the family are experienced at that particular time (see Endnotes).
Engaging Refugee Families in Therapy: Exploring the Benefits of Including Referring Professionals in First Family Interviews*
Authors: Sveaass Nora , Reichelt Sissel
Published: May 2004

The possible benefits of including referring professionals in the first family interviews are being explored as a way to engage refugee families in therapy. Families in exile confront a number of problems related both to premigration traumatic exposures and to present adaptation processes. Refugee clients and the referring professionals in the larger system frequently see the problems and their solutions quite differently. This situation may often result in unclear working alliances in a context of therapy. We will describe first family interviews in which referring professionals are interviewed about their reasons for referrals, and where the families are invited to discuss these considerations. The conversations permit families, referrers, and therapists to reflect upon differences in positions and perspectives. Their experiences suggest that agreements or contracts based on these joint interviews are less ambiguous and more clearly formulated than contracts based on interviews with families alone. Finally, these experiences are discussed as a potentially valuable approach in a cross‐cultural context.
Introduction to the Technical Series: What is Science, and How Does It Help Us?*
Authors: Greeno Catherine G.
Published: May 2004

Editor's Note: Readers trained in research have no need of a series of articles that introduce the value of the scientific method and the basic factors that comprise good research methodology. But readers who are primarily trained to do clinical work with families will find that today's healthcare environment increasingly requires that they be good consumers of research, as well as an increasing need for them to participate in studies of the models we wish to preserve. At a recent NIMH‐sponsored conference, a speaker lamented the probable demise of some of our more interesting family approaches because third‐party payers tend to support only evidence‐based interventions. Clearly, we need to be able to defend our practices, and understanding the value and essential components of scientific methodology and research studies is likely to become even more important in the future. This new series will attempt to provide an orientation for those of our readers who are interested. We welcome your response to these articles and your suggestions for future segments.
Attributions and Emotional Reactions to the Identity Disclosure (“Coming Out”) of a Homosexual Child*
Authors: Armesto Jorge C. , Weisman Amy G.
Published: May 2004

This study examined factors that contribute to parental rejection of gay and lesbian youth. College students (N = 356) were asked to imagine being the parent of an adolescent son who recently disclosed that he was gay. Consistent with study hypotheses and based on attribution and moral affect theory, results of regression analyses indicated that greater perceptions of control over homosexuality, higher proneness to experience shame, and lower proneness to experience guilt were associated with increasing negative reactions toward an imagined homosexual child. Also in line with study hypotheses, greater willingness to offer help to the hypothetical child was predicted by lower perceptions of control over homosexuality, less intensely unfavorable emotional reactions, less proneness to experience guilt, and greater reported likelihood of experiencing affection toward him. Theoretical and clinical implications of this research are discussed.