bluuebunny/crossref_metadata_2025 huggingface dataset:
Developmental psychiatry and intellectual disabilities: an American perspective
Authors: Hassiotis Angela , Munir Kerim M.
Published: February 2004

The Natalie Cobbing Travelling Fellowship gives the opportunity to medical professionals trained in the Psychiatry of Intellectual Disabilities to gain experience in their field from centres overseas. This article concentrates on specialist work settings and the practice in developmental disabilities in Boston, USA. The authors conclude that such training opportunities not only are important educational milestones but also help in creating a network of professionals who can work together to improve standards of research and clinical practice across different cultural and ethnic divides.
A family at risk: multiple perspectives on parenting and child protection
Authors: Booth Wendy , Booth Tim
Published: February 2004

Parents with learning difficulties face a high risk of losing their children. This fact holds in all countries with a well‐developed child protection system. International research shows rates for the removal of children from such families varying from study to study and country to country in a range between 30 and 80%. In the UK, the evidence suggests that 40–60% of children are taken into alternative care. These bare facts reveal nothing of the process that generates them. This paper looks at how one family came to be counted among these statistics. Using material drawn from court files, social worker statements, expert reports and personal interviews, collected as part of an ongoing research study funded by the Nuffield Foundation,1 it documents the conflicting accounts from which a dominant story of parenting failure was finally translated into one of success.
Self‐consciousness, Exposure, and the Blush
Authors: Crozier W. Ray
Published: February 2004

Little is known about the circumstances that give rise to blushing and there have been no systematic attempts to classify and analyze the types of situations where it occurs. The study reported here analyzes a sample of recollections of occasions and a selection of literary episodes. The two sources of evidence yield somewhat different patterns but prominent themes in both are being the centre of attention, whether this is positive, neutral or negative, and the disclosure, or threat of exposure, of a private or sensitive topic. Inspection of example suggests that a blush is associated with self‐consciousness. More specifically, it is elicited when circumstances cause someone to take another's perspective on the self, and this generates awareness of a discrepancy between his or her position and this position as it appears to the other. A blush does not require that the other take an adverse view of the actor's position. The blush shows sensitivity to the opinions of others and it is its capacity to communicate this that makes it effective in deflecting aggressive or rejecting responses from others.
What Happened to the “Social” in Social Psychology?*
Authors: Greenwood John D.
Published: February 2004

This article describes the historical abandonment of the distinctive conception of the social dimensions of cognition, emotion and behavior embraced by American social psychologists in the early decades of the twentieth century. It is suggested that part of the reason why the original conception of the social was abandoned by American psychologists was because of its association with theories of the “group mind,” the apparent threat it posed to cherished principles of rationality and autonomy, and the impoverished conception of the social inherited from European crowd theorists that came to inform the experimental study of social groups. It is suggested that while these factors partly explain the neglect of the social in American social psychology, none represent particularly good reasons for abandoning the original conception of the social. Consequently there are in principle no impediments to the revival of the theoretical and experimental study of the social dimensions of cognition, emotion and behavior in contemporary American social psychology.
Adaptations for Nothing in Particular
Authors: Hampton Simon J.
Published: February 2004

An element of the contemporary dispute amongst evolution minded psychologists and social scientists hinges on the conception of mind as being adapted as opposed to adaptive. This dispute is not trivial. The possibility that human minds are both adapted and adaptive courtesy of selection pressures that were social in nature is of particular interest to a putative evolutionary social psychology. I suggest that the notion of an evolved psychological adaptation in social psychology can be retained only if it is accepted that this adaptation is for social interaction and has no rigidly fixed function and cannot be described in terms of algorithmic decision rules or fixed inferential procedures. What is held to be the reason for encephalisation in the Homo lineage and some of best atested ideas in social psychology offers license for such an approach.
Language Games and Natural Reactions
Authors: Rubinstein David
Published: February 2004

Ludwig Wittgenstein imagines a variety of eccentric social practices—like a tribe trained “to give no expression of feeling of any kind”. But he also speaks of “the common behavior of mankind” that is rooted in “natural/primitive reactions”. This emphasis on the uniformities of human behavior raises questions about the plausibility of some of his imagined language games. Indeed, it suggests the claim of evolutionary psychologists that there are biologically based human universals that shape social practices. But in contrast to E.O. Wilson's belief that “genes hold culture on a leash”, Wittgenstein sees culture as a mediator—rather than a conduit—of “natural reactions”. This suggests that social science can incorporate the claims of evolutionary psychology without scanting the centrality of culture in action and allows that nature can be overwhelmed by culture.
Cognition and Emotion? The Dead End in Self‐Esteem Research
Authors: Scheff Thomas J. , Fearon David S.
Published: February 2004

This article suggests that studies of self‐esteem using scales have reached a dead end, and suggest alternative directions. First we show how significance tests have obscured meager results. According to reviews, this huge body of research has yielded no substantial findings. Some sub‐fields show consistent, but trivially small, effects; reviews of the entire field show none at all. Most important, the size of effects does not seem to be increasing. Three questions are raised: 1. Are new standards needed to determine when to continue or stop a given line of research? 2. Are new approaches needed alternative to standardized scales and statistical tests? 3. Should future studies of self‐esteem emphasize feeling and social components at least as much as cognitive (self‐evaluative) components? Studies of self‐esteem using interview techniques by George Brown and his colleagues suggest the need to move closer to actual data. An exploratory study that takes this direction a step further is described. We analyze social and cognitive/emotional elements second by second in discourse about topics relevant to self‐appraisal and self‐feeling.
Arnheim and Gombrich in Social Scientific Perspective
Authors: Verstegen Ian
Published: February 2004

The two most common names to invoke for a perceptualist aesthetics are Rudolf Arnheim and E. H. Gombrich. But the similaritied and differences between them have never been explicitly drawn. This paper undertakes such an analysis based on the three categories of representation, expression and historical objectivity. Arnheim's less stringent solutions to the problems of representation and expression are applauded but Gombrich's unique attempt to ground both of these categories in a form amenable to non‐historicist approach to history are also praised. Gombrich's anti‐historicism derives from Karl Popper and Arnheim is fleshed out with the theories of Maurice Mandelbaum. The parallel comparison of Popper‐Mandelbaum helps to underscore differences and show an alternative to Gombrich and Popper's nominalism.
Reduced Alpha power associated with the recall of mentation from Stage 2 and Stage REM sleep
Authors: Esposito Maria Josè , Nielsen Tore A. , Paquette Tyna
Published: February 2004

Relationships between Alpha (8–12 Hz) activity and cognitive processes during wakefulness raise the possibility of similar relationships between Alpha and cognitive activity during sleep. We hypothesized that Alpha power decreases during both Stage 2 and REM sleep would index the presence of sleep mentation in these stages. Absolute power for six classical EEG bands and three Alpha subbands was calculated for Stage 2 and REM sleep awakenings both with and without mentation recall. In both stages, recall was associated with lower Alpha power, especially with middle Alpha power (9.5–11.5 Hz). Unexpectedly, a similar effect for Delta power (0.5–4.0 Hz) was also observed. The Alpha effect may reflect cognitive elaboration active in the minutes preceding awakening; however, attention and memory processes cannot be excluded. The Delta effect is consistent with prior observations of regular linkages between Alpha and Delta power during sleep.
Event‐related brain potentials to irrelevant auditory stimuli during selective listening: Effects of channel probability
Authors: Akai Toshiyuki
Published: February 2004

The purpose of this study was to identify the cognitive process reflected by a positive deflection to irrelevant auditory stimuli (Pdi) during selective listening. Event‐related brain potentials were recorded from 9 participants in a two‐channel (left/right ears) selective listening task. Relative event probabilities of the relevant/irrelevant channels were 25%/75%, 50%/50%, and 75%/25%. With increasing probability of the relevant channel, behavioral performances (the reaction time and hit rate) for the targets within the relevant channel improved, reflecting development of a more robust attentional trace. At the same time, the amplitude of the early Pdi (200–300 ms after stimulus onset) elicited by the stimuli in the irrelevant channel with a decreased probability was enhanced in the central region. This positive relation between the strength of the attentional trace and the amplitude of the early Pdi suggests that the early Pdi is elicited by a mismatching between an incoming irrelevant stimulus and an attentional trace.
Automatic removal of eye movement and blink artifacts from EEG data using blind component separation
Authors: Joyce Carrie A. , Gorodnitsky Irina F. , Kutas Marta
Published: February 2004

Signals from eye movements and blinks can be orders of magnitude larger than brain‐generated electrical potentials and are one of the main sources of artifacts in electroencephalographic (EEG) data. Rejecting contaminated trials causes substantial data loss, and restricting eye movements/blinks limits the experimental designs possible and may impact the cognitive processes under investigation. This article presents a method based on blind source separation (BSS) for automatic removal of electroocular artifacts from EEG data. BBS is a signal‐processing methodology that includes independent component analysis (ICA). In contrast to previously explored ICA‐based methods for artifact removal, this method is automated. Moreover, the BSS algorithm described herein can isolate correlated electroocular components with a high degree of accuracy. Although the focus is on eliminating ocular artifacts in EEG data, the approach can be extended to other sources of EEG contamination such as cardiac signals, environmental noise, and electrode drift, and adapted for use with magnetoencephalographic (MEG) data, a magnetic correlate of EEG.
Recognition of affective prosody: Continuous wavelet measures of event‐related brain potentials to emotional exclamations
Authors: Bostanov Vladimir , Kotchoubey Boris
Published: February 2004

The affective state of a speaker can be identified from the prosody of his or her speech. Voice quality is the most important prosodic cue for emotion recognition from short verbal utterances and nonverbal exclamations, the latter conveying pure emotion, void of all semantic meaning. We adopted two context violation paradigms—oddball and priming—to study the event‐related brain potentials (ERP) reflecting this recognition process. We found a negative wave, the N300, in the ERPs to contextually incongruous exclamations, and interpreted this component as analogous to the well‐known N400 response to semantically inappropriate words. The N300 appears to be a real‐time psychophysiological measure of spontaneous emotion recognition from vocal cues, which could prove a useful tool for the examination of affective‐prosody comprehension. In addition, we developed a new ERP component detection and estimation method that is based on the continuous wavelet transform (CWT), does not rely on visual inspection of the waveforms, and yields larger statistical difference effects than classical methods.
A comparison of several methods used to quantify prepulse inhibition of eyeblink responding
Authors: Blumenthal Terry D. , Elden Aake , Flaten Magne Arve
Published: February 2004

Several methods of quantifying prepulse inhibition (PPI) of eyeblink responding were compared in adult volunteers. Blink‐eliciting stimuli were noise bursts at 85 or 100 dB, and prepulses were also noise bursts, at 55 or 70 dB and lead intervals of 60 or 120 ms. PPI was evaluated by comparing reactivity on prepulse and control trials within participants using the following methods: (1) difference between reactivity on prepulse and control trials; (2) reactivity on prepulse trials divided by that on control trials (proportion of control); (3) difference between reactivity on prepulse and control trials, divided by that on control trials (proportion of the difference from control); (4) range correction (maximum minus minimum reactivity, divided by the range of reactivity), across all control and prepulse trials; (5) z scores across all prepulse and control trials. Prepulses inhibited eyeblink response magnitude in all cases. Proportion of difference was the method least affected by differences in control reactivity, and is the preferred method to use when quantifying PPI, both from a practical and a neurophysiological perspective.
Is motor inhibition during laughter due to emotional or respiratory influences?
Authors: Overeem Sebastiaan , Taal Walter , Öcal Gezici E. , Lammers Gert Jan , Van Dijk J. Gert
Published: February 2004

We compared the effects of laughter and several respiratory movements on spinal motor excitability to unravel their respective influences. We measured H‐reflexes in 13 healthy volunteers during 10 different tasks (including laughter, simulated laughter, and various respiratory movements). We compared the percentage that remained of the initial H‐reflex during each task with that during a neutral task. H‐reflex percentage differed between the neutral task (79.4±16.1%), true laughter (43.7±17.9%), and simulated laughter (66.6±24.3%), and between the two latter tasks. Coughing also resulted in H‐reflex suppression, but not as deeply as true laughter. During the other respiratory maneuvers, the H‐reflex increased compared to the neutral task. Our finding that true laughter evoked more H‐reflex depression than simulated laughter suggests that mirth on its own depresses the H‐reflex. This mechanism may also be involved in the pathophysiology of cataplexy, the main symptom of narcolepsy.
Thinking and hallucinating: Reciprocal changes in sleep
Authors: Fosse Roar , Stickgold Robert , Hobson J. Allan
Published: February 2004

Internal deliberations (focused thoughts) and endogenous percepts (hallucinations) vary in a reciprocal manner across the states of waking and sleep, paralleling changes in regional brain activation. As subjects go from waking through sleep onset to NREM sleep and then to REM sleep, they report progressively more hallucinoid imagery and progressively less thinking. We have investigated whether this reciprocity in cognition between NREM and REM is maintained throughout the night. To do so, we analyzed 229 REM and 165 NREM reports collected with the Nightcap sleep monitoring system from 16 participants in their homes over 14 nights. The reports were scored for the presence of hallucinations and directed thinking by external judges. As predicted, hallucinations were more frequent in REM than in NREM for each segment of the night, and directed thinking was more frequent in NREM in the first 5 h of the night. Late in the night, directed thinking was equally infrequent in NREM and REM. At the same time, hallucinations increased within both NREM and REM as the night progressed, whereas directed thinking decreased in NREM and remained at a stable, low level in REM. These findings suggest that a reciprocal shift in focused thinking and hallucinating is a general property of cognitive activity across the wake–sleep cycle. Biological evidence supports the hypothesis that these cognitive changes are governed by specific state regulatory and neurocognitive processes at several levels of the brain.
The stability of resting frontal electroencephalographic asymmetry in depression
Authors: Allen John J. B. , Urry Heather L. , Hitt Sabrina K. , Coan James A.
Published: February 2004

Although resting frontal electroencephalographic (EEG) alpha asymmetry has been shown to be a stable measure over time in nonclinical populations, its reliability and stability in clinically depressed individuals has not been fully investigated. The internal consistency and test–retest stability of resting EEG alpha (8–13 Hz) asymmetry were examined in 30 women diagnosed with major depression at 4‐week intervals for 8 or 16 weeks. Asymmetry scores generally displayed good internal consistency and exhibited modest stability over the 8‐ and 16‐week assessment intervals. Changes in asymmetry scores over this interval were not significantly related to changes in clinical state. These findings suggest that resting EEG alpha asymmetry can be reliably assessed in clinically depressed populations. Furthermore, intraclass correlation stability estimates suggest that although some traitlike aspects of alpha asymmetry exist in depressed individuals, there is also evidence of changes in asymmetry across assessment occasions that are not closely linked to changes in depressive severity.
Attention allocation in the dual‐task paradigm as measured through behavioral and psychophysiological responses
Authors: Karatekin Canan , Couperus Jane W. , Marcus David J.
Published: February 2004

We investigated attention allocation in a dual‐task paradigm using behavioral and pupillary measures. We used an auditory digit span (DS) and a simple visual response time (RT) task. Participants were administered four conditions in which they performed neither task (no‐task), a single task (DS or RT only), or both tasks (dual). Dependent variables were DS accuracy, RT, and task‐evoked pupillary responses (TEPRs) to digits as estimates of mental effort. Participants maintained almost the same level of DS accuracy on dual as on DS only and sacrificed speed on the RT task. As expected, TEPRs increased linearly with memory load in both DS only and dual. Although TEPRs were initially higher in dual than in DS only, the slope of the increase was shallower in dual. Results suggest that TEPRs can elucidate mechanisms of attention allocation by distinguishing between effectiveness (level of behavioral performance) and efficiency (the costs of that performance in mental effort).
Staring at one side of the face increases blood flow on that side of the face
Authors: Drummond Peter D. , Mirco Nadia
Published: February 2004

To investigate the effect of observation on blushing, an experimenter sat next to 28 participants and looked closely at one cheek while the participant sang (embarrassing) or read aloud (not embarrassing). Increases in cheek temperature were greater on the observed than the unobserved side during both tasks. Changes in cheek temperature were symmetrical when the experimenter sat next to another 23 participants and looked straight ahead, as well as when the experimenter stared at one side of the participant's face through a glass window while the participant sang. However, increases in cutaneous blood flow were greater on the observed than the unobserved side of the forehead during singing. These findings suggest that staring at one side of the face triggers an ipsilateral increase in facial blood flow.
Context dependence of the event‐related brain potential associated with reward and punishment
Authors: Holroyd Clay B. , Larsen Jeff T. , Cohen Jonathan D.
Published: February 2004

The error‐related negativity (ERN) is an event‐related brain potential elicited by error commission and by presentation of feedback stimuli indicating incorrect performance. In this study, the authors report two experiments in which participants tried to learn to select between response options by trial and error, using feedback stimuli indicating monetary gains and losses. The results demonstrate that the amplitude of the ERN is determined by the value of the eliciting outcome relative to the range of outcomes possible, rather than by the objective value of the outcome. This result is discussed in terms of a recent theory that holds that the ERN reflects a reward prediction error signal associated with a neural system for reinforcement learning.
The functional relationship between visual backward masking and prepulse inhibition
Authors: Wynn Jonathan K. , Dawson Michael E. , Schell Anne M.
Published: February 2004

This experiment demonstrated a relationship between prepulse inhibition (PPI) of the startle eyeblink and visual backward masking in college students. It was hypothesized that recovery from backward masking effects is due in part to sensory gating, as assessed by auditory and visual PPI. Visual presentations of letters served as targets or visual prepulses in an intermixed session of backward masking and PPI. Backward masking and PPI (both auditory and visual) were assessed at stimulus onset asynchronies of 30, 45, 60, 120, and 150 ms. A repeated‐measures regression revealed that there was a relationship between backward masking and PPI for both visual and auditory PPI, with higher levels of PPI being associated with greater recovery from backward masking. The data are consistent with the hypothesis that recovery from backward masking effects is affected by sensory gating acting in part to gate out the interruptive effects of the mask.
Visual encoding differentially affects auditory event‐related potentials during working memory retrieval
Authors: Golob Edward J. , Starr Arnold
Published: February 2004

Previous working memory studies using auditory stimuli at both encoding and retrieval show amplitude decreases in event‐related potentials (N100 and late positive wave, LPW) at retrieval as a function of memory load. This study tested if these effects are associated with phonological or semantic coding by presenting visual stimuli at encoding and auditory stimuli at retrieval. We hypothesized that event‐related potentials associated with phonological but not semantic coding would be affected by modality differences at encoding and retrieval. Memory sets having one, three, or five visual digits were followed by auditory probes that subjects classified as present or absent from the set. Reaction time increased and LPW amplitudes decreased with increases in memory load, but there were no significant effects of memory load on N100 amplitude. Results suggest that with respect to brain activity that covaries with memory load, probe N100 amplitude is associated with phonological coding and LPW amplitude is associated with semantic coding.
Where to Q in PEP
Authors: Berntson Gary G. , Lozano David L. , Chen Yun‐Ju , Cacioppo John T.
Published: February 2004

The onset of ventricular depolarization defines the start of the preejection period (PEP), which is commonly used as an index of myocardial contractility and sympathetic control of the heart. Although the fiducial point for this onset has traditionally been the onset of the Q wave of the electrocardiogram, other measurement points have also been used in the literature, including the peak of the Q wave (i.e., the onset of the R wave). Conceptual, physiological, and empirical considerations addressing the reliability and validity of these alternative metrics support the application of the Q‐wave peak/R‐wave onset as the fiducial point for PEP measures.
Relationship of Nursing Home Staffing to Quality of Care
Authors: Schnelle John F. , Simmons Sandra F. , Harrington Charlene , Cadogan Mary , Garcia Emily , M. Bates‐Jensen Barbara
Published: February 2004

Objective. To compare nursing homes (NHs) that report different staffing statistics on quality of care.

Data Sources. Staffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes.

Study Design. Two groups of NHs (n=21) that reported significantly different and stable staffing data from all data sources were compared on quality of care measures.

Data Collection. Direct observation, resident and staff interview, and chart abstraction methods.

Principal Findings. Staff in the highest staffed homes (n=6), according to state cost reports, reported significantly lower resident care loads during onsite interviews across day and evening shifts (7.6 residents per nurse aide [NA]) compared to the remaining homes that reported between 9 to 10 residents per NA (n=15). The highest‐staffed homes performed significantly better on 13 of 16 care processes implemented by NAs compared to lower‐staffed homes.

Conclusion. The highest‐staffed NHs reported significantly lower resident care loads on all staffing reports and provided better care than all other homes.
A Longitudinal Examination of Hospital Registered Nurse Staffing and Quality of Care
Authors: Mark Barbara A. , Harless David W. , McCue Michael , Xu Yihua
Published: February 2004

Objective. To evaluate previous research findings of the relationship between nurse staffing and quality of care by examining the effects of change in registered nurse staffing on change in quality of care.

Data Sources/Study Setting. Secondary data from the American Hospital Association (AHA)(nurse staffing, hospital characteristics), InterStudy and Area Resource Files (ARF) (market characteristics), Centers for Medicare and Medicaid Services (CMS) (financial performance), and Healthcare Cost and Utilization Project (HCUP) (quality measures—in‐hospital mortality ratio and the complication ratios for decubitus ulcers, pneumonia, and urinary tract infection, which were risk‐adjusted using the Medstat® disease staging algorithm).

Study Design. Data from a longitudinal cohort of 422 hospitals were analyzed from 1990–1995 to examine the relationships between nurse staffing and quality of care.

Data Collection/Extraction Methods. A generalized method of moments estimator for dynamic panel data was used to analyze the data.

Principal Findings. Increasing registered nurse staffing had a diminishing marginal effect on reducing mortality ratio, but had no consistent effect on any of the complications. Selected hospital characteristics, market characteristics, and financial performance had other independent effects on quality measures.

Conclusions. The findings provide limited support for the prevailing notion that improving registered nurse (RN) staffing unconditionally improves quality of care.
The Impact of S‐CHIP Enrollment on Physician Participation in Medicaid in Alabama and Georgia
Authors: Bronstein Janet M. , Adams E. Kathleen , Florence Curtis S.
Published: February 2004

Objective. To assess whether increasing enrollment in State Children's Health Insurance Programs (S‐CHIPs) has an impact on the number of office physicians participating in Medicaid and the extent of their participation. Effects are measured for a freestanding S‐CHIP program with an open provider panel and an S‐CHIP program that uses the state's Medicaid provider panel.

Data Sources. Children's Medicaid claims data for primary care services were used to measure physician participation in the program; census and enrollment data were used to describe market area characteristics.

Study Design. This is a time series study of communities in two states, measuring physician Medicaid participation quarterly between 1998 and 2001, controlling for changes in community characteristics and children's program enrollment as well as other factors by quarter.

Data Collection/Extraction. Office physician participation is measured by practice site. Claims data are aggregated to the level of the community and reflect the number of limited practice sites, the ratio of Medicaid office sites to the number of primary care physicians in the community as reported by the American Medical Association (AMA), and the mean number of Medicaid office visits made to physician sites in the community in the quarter.

Findings. In Alabama, the state with a freestanding S‐CHIP program, there is little association between increased S‐CHIP enrollment and physician participation in Medicaid. In Georgia, where the same provider network serves both programs, increases in S‐CHIP enrollment are associated with a decline in office‐based physician participation in Medicaid in urban areas.

Conclusion. Linkage of S‐CHIP and Medicaid programs through the use of the same provider network, in the absence of market conditions that encourage the expansion of the network, can lead to a negative impact on access for Medicaid enrollees.
The Impact of Managed Care on Substance Abuse Treatment Services
Authors: Olmstead Todd , White William D. , Sindelar Jody
Published: February 2004

Objective. To examine the impact of managed care on the number and types of services offered by substance abuse treatment (SAT) facilities. Both the number and types of services offered are important factors to analyze, as research shows that a broad range of services increases treatment effectiveness.

Data Sources. The 2000 National Survey of Substance Abuse Treatment Services (NSSATS), which is designed to collect data on service offerings and other characteristics of SAT facilities in the United States. These data are merged with data from the 2002 Area Resource File (ARF), a county‐specific database containing information on population and managed care activity. We use data on 10,513 facilities, virtually a census of all SAT facilities.

Study Design. We estimate the impact of managed care (MC) on the number and types of services offered by SAT facilities using instrumental variables (IV) techniques that account for possible endogeneity between facilities' involvement in MC and service offerings. Due to limitations of the NSSATS data, MC and specific services are modeled as binary variables.

Principal Findings. We find that managed care causes SAT facilities to offer, on average, approximately two fewer services. This effect is concentrated primarily in medical testing services (i.e., tests for TB, HIV/AIDs, and STDs). We also find that MC increases the likelihood of offering substance abuse assessment and relapse prevention groups, but decreases the likelihood of offering outcome follow‐up.

Conclusion. Our findings raise policy concerns that managed care may reduce treatment effectiveness by limiting the range of services offered to meet patient needs. Further, reduced onsite medical testing may contribute to the spread of infectious diseases that pose important public health concerns.
The Effects of HMO Penetration on Preventable Hospitalizations
Authors: Zhan Chunliu , Miller Marlene R. , Wong Herbert , Meyer Gregg S.
Published: February 2004

Objective. To examine the effects of health maintenance organization (HMO) penetration on preventable hospitalizations.

Data Source. Hospital inpatient discharge abstracts for 932 urban counties in 22 states from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), hospital data from American Hospital Association (AHA) annual survey, and population characteristics and health care capacity data from Health Resources and Services Administration (HRSA) Area Resource File (ARF) for 1998.

Methods. Preventable hospitalizations due to 14 ambulatory care sensitive conditions were identified using the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators. Multiple regressions were used to determine the association between preventable hospitalizations and HMO penetration while controlling for demographic and socioeconomic characteristics and health care capacity of the counties.

Principal Findings. A 10 percent increase in HMO penetration was associated with a 3.8 percent decrease in preventable hospitalizations (95 percent confidence interval, 2.0 percent–5.6 percent). Advanced age, female gender, poor health, poverty, more hospital beds, and fewer primary care physicians per capita were significantly associated with more preventable hospitalizations.

Conclusions. Our study suggests that HMO penetration has significant effects in reducing preventable hospitalizations due to some ambulatory care sensitive conditions.
The Combined Effects of Participatory Styles of Elderly Patients and Their Physicians on Satisfaction
Authors: Xu K. Tom
Published: February 2004

Objectives.To test whether concordance or discordance of patient participation between patients and physicians is associated with higher satisfaction, and to examine the effects of patients' and physicians' participatory styles on patients' satisfaction with their physicians.

Data.Data collected in the Texas Tech 5000 Survey of elderly patients in West Texas were used. Patient satisfaction with their physicians was measured by a single item from the Consumer Assessment of Health Plans (CAHPS), representing patients' ratings of their physicians. Patient participation was measured by an index derived from a three‐item instrument and physicians' participatory decision‐making (PDM) style was measured by a three‐item instrument developed by the Medical Outcomes Study.

Methods.An ordered logit multivariate regression was used to investigate the effects of patients' and physicians' participatory styles on satisfaction with physicians. The interaction between patients' participation and physicians' participatory styles was also included to examine the dependency of the two variables.

Results.Controlling for confounding factors, a higher PDM score was associated with a higher rating of patient satisfaction with physicians. A higher patient participation score was related to a lower physician satisfaction rating. The combined effect of patients' and physicians' participation styles indicated that for a low patient participation score, a high PDM score was not needed to produce high satisfaction. The greater the discordance in this direction, the higher the satisfaction. However, with a high patient participation score, only an extremely high PDM score would produce relatively high satisfaction.

Conclusions.The current study supports the discordance hypothesis. Participatory physicians and patient–physician communications concerning patient participation can promote higher satisfaction.
Delays in Initial Treatment Contact after First Onset of a Mental Disorder
Authors: Wang Philip S. , Berglund Patricia A. , Olfson Mark , Kessler Ronald C.
Published: February 2004

Objective. To examine nationally representative patterns and predictors of delays in contacting a professional after first onset of a mental disorder.

Data Sources. The National Comorbidity Survey, a nationally representative survey of 8,098 respondents aged 15–54.

Study Design. Cross‐sectional survey.

Data Collection. Assessed lifetime DSM‐III‐R mental disorders using a modified version of the Composite International Diagnostic Interview (CIDI). Obtained reports on age at onset of disorders and age of first treatment contact with each of six types of professionals (general medical doctors, psychiatrists, other mental health specialists, religious professionals, human services professionals, and alternative treatment professionals). Used Kaplan–Meier (KM) curves to estimate cumulative lifetime probabilities of treatment contact after first onset of a mental disorder. Used survival analysis to study the predictors of delays in making treatment contact.

Principal Findings. The vast majority (80.1 percent) of people with a lifetime DSM‐III‐R disorder eventually make treatment contact, although delays average more than a decade. The duration of delay is related to less serious disorders, younger age at onset, and older age at interview. There is no evidence that delay in initial contact with a health care professional is increased by earlier contact with other non–health‐care professionals.

Conclusions. Within the limits of recalling lifetime events, it appears that delays in initial treatment contact are an important component of the larger problem of unmet need for mental health care. Interventions are needed to decrease these delays.
Updated Variable‐Radius Measures of Hospital Competition
Authors: Gresenz Carole Roan , Rogowski Jeannette , Escarce José J.
Published: February 2004

Objective. To calculate variable‐radius measures of hospital market size and create measures of competition for hospitals' markets.

Data Sources. Discharge abstracts from the 1997 State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) linked with the American Hospital Association (AHA) Annual Survey, Area Resource File (ARF), InterStudy Regional Market Analysis database, and Medicare's Prospective Payment System Impact Files.

Study Design. Hospital radii capturing 75 and 90 percent of hospital admissions regressed against hospital and health care market characteristics and other local area characteristics, where the specification was designed to maximize predictive ability. The number of competing hospitals and the Herfindahl‐Hirschman index (HHI) of competition were calculated for each hospital's market.

Data Collection Methods. Discharge abstracts were used to create actual radii for hospitals in nine states. These data were linked with other data describing hospital, health care market, and other characteristics.

Principal Findings. We explained 44.7 and 9.6 percent of the variation among urban and rural hospitals, respectively, in radii that capture 90 percent of patients, and slightly less of the variation in radii that capture 75 percent of patients. Population density; number of other hospitals in the local area; and hospital characteristics such as medical school affiliation, percentage of admissions that are Medicaid, case mix, and service offerings are important correlates of a hospital's market size.

Conclusions. Predicted radii and associated competition measures were created (matched to AHA hospital identifiers) for all nonfederal, short‐term, general medical/surgical hospitals in the continental United States for which complete data were available in 1997 (N=4,806) and are available from the authors.
Nonstationary Brand Variables in Category Management: A Cointegration Perspective
Authors: Jiang James J. , Zhong Maosen , Klein Gary , Chen H. G.
Published: February 2004

Category‐management models serve to assist in the development of plans for pricing and promotions of individual brands. Techniques to solve the models can have problems of accuracy and interpretability because they are susceptible to spurious regression problems due to nonstationary time‐series data. Improperly stated nonstationary systems can reduce the accuracy of the forecasts and undermine the interpretation of the results. This is problematic because recent studies indicate that sales are often a nonstationary time‐series. Newly developed correction techniques can account for nonstationarity by incorporating error‐correction terms into the model when using a Bayesian Vector Error‐Correction Model. The benefit of using such a technique is that shocks to control variates can be separated into permanent and temporary effects and allow cointegration of series for analysis purposes. Analysis of a brand data set indicates that this is important even at the brand level. Thus, additional information is generated that allows a decision maker to examine controllable variables in terms of whether they influence sales over a short or long duration. Only products that are nonstationary in sales volume can be manipulated for long‐term profit gain, and promotions must be cointegrated with brand sales volume. The brand data set is used to explore the capabilities and interpretation of cointegration.
The Effect of Lead Time Uncertainty on Safety Stocks
Authors: Chopra Sunil , Reinhardt Gilles , Dada Maqbool
Published: February 2004

The pressure to reduce inventory investments in supply chains has increased as competition expands and product variety grows. Managers are looking for areas they can improve to reduce inventories without hurting the level of service provided. Two areas that managers focus on are the reduction of the replenishment lead time from suppliers and the variability of this lead time. The normal approximation of lead time demand distribution indicates that both actions reduce inventories for cycle service levels above 50%. The normal approximation also indicates that reducing lead time variability tends to have a greater impact than reducing lead times, especially when lead time variability is large. We build on the work of Eppen and Martin (1988) to show that the conclusions from the normal approximation are flawed, especially in the range of service levels where most companies operate. We show the existence of a service‐level threshold greater than 50% below which reorder points increase with a decrease in lead time variability. Thus, for a firm operating just below this threshold, reducing lead times decreases reorder points, whereas reducing lead time variability increases reorder points. For firms operating at these service levels, decreasing lead time is the right lever if they want to cut inventories, not reducing lead time variability.
Branch‐and‐Price Methods for Prescribing Profitable Upgrades of High‐Technology Products with Stochastic Demands*
Authors: Damodaran Purushothaman , Wilhelm Wilbert E.
Published: February 2004

This paper develops a model that can be used as a decision support aid, helping manufacturers make profitable decisions in upgrading the features of a family of high‐technology products over its life cycle. The model integrates various organizations in the enterprise: product design, marketing, manufacturing, production planning, and supply chain management. Customer demand is assumed random and this uncertainty is addressed using scenario analysis. A branch‐and‐price (B&P) solution approach is devised to optimize the stochastic problem effectively. Sets of random instances are generated to evaluate the effectiveness of our solution approach in comparison with that of commercial software on the basis of run time. Computational results indicate that our approach outperforms commercial software on all of our test problems and is capable of solving practical problems in reasonable run time. We present several examples to demonstrate how managers can use our models to answer “what if” questions.
SME Entry Mode Choice and Performance: A Transaction Cost Perspective
Authors: Brouthers Keith D. , Nakos George
Published: February 2004

Although small and medium sized enterprises (SMEs) account for a significant portion of international trade, little is know about how they make international entry mode decisions. Transaction cost theory has been widely used to study entry mode selection for large firms. Here we apply the theory to SME mode choices. Further, we set out to determine if SME transaction cost mode choices provide superior performance to other mode choices. We found that transaction cost theory did a good job of explaining SME mode choice and that SMEs that used transaction cost–predicted mode choices performed significantly better than firms using other modes.
Proceedo: Finding the Right CEO for Future Growth
Authors: de Koning Alice , Maravanyika Edward
Published: February 2004

The founders and employees at Proceedo, an eProcurement firm based in Stockholm, were looking for a new CEO, an older, experienced executive with a track record in sales to mature companies. They had achieved many of their early growth and product development goals; now they need a new CEO to expand their customer base. The founders wanted to create a large, international company, and they believed new leadership was needed to push to the next level of growth.
A possible role of the cytochrome P450c17α gene (CYP17) polymorphism in the pathobiology of uterine leiomyomas from black South African women: a pilot study
Authors: Amant Frédéric , Dorfling Cecilia M. , De Brabanter Jos , Vandewalle Joos , Vergote Ignace , Lindeque B. G. , Van Rensburg Elizabeth J.
Published: February 2004

Background.  To investigate the role of the CYP17 gene promoter polymorphism in the pathobiology of uterine leiomyomas in African and Caucasian women.

Methods.  During a 6‐month period, 145 Caucasian and black South African women undergoing hysterectomy were included prospectively. Blood samples were obtained for DNA analysis. Factors modifying the risk for uterine leiomyoma growth such as age, parity, age at last birth, weight, body mass index, menopausal status, cigarette smoking and oral contraceptive use were determined.

Results.  The risk for leiomyoma development among black South African homozygous carriers of the CYP17 A2 allele was shown to be significantly increased when compared to women homozygous for the CYP17 A1 allele or to heterozygous women. Logistic regression analysis disclosed age, parity and CYP17 polymorphism to have an impact on the presence of uterine leiomyomas (p‐values are, respectively, 0.0006, 0.0001 and 0.03) in black South African women. However, among Caucasian women, logistic regression analysis showed only intake of oral contraceptives to influence the formation of uterine leiomyomas (p = 0.03).

Conclusion.  This exploratory trial suggests that among African women, homozygous carriers of the CYP17 A2 allele expose their myometrium to a stronger estrogenic stimulation contributing to the pathobiology of uterine leiomyomas.
Saturday Morning at the Jail: Implications of Incarceration for Families and Children*
Authors: Arditti Joyce A. , Lambert‐Shute Jennifer , Joest Karen
Published: February 2004

Little is known about the experience of families affected by incarceration, yet current trends indicate that millions of children have a parent who is imprisoned. Using a conceptual framework that acknowledges the losses associated with a parent's incarceration, 56 caregivers visiting an incarcerated family member during children's visiting hours were interviewed. The interview gathered information about family, health, economics, and the legal aspects of the inmate's situation. Overall, families were at risk economically before incarceration, and the most vulnerable became even more financially strained afterward. Other problems believed to be created by incarceration included parenting strain, emotional stress, and concerns about children's loss of involvement with their incarcerated parent. Implications for family practice and policy are discussed.
Sister‐to‐Sister Talk: Transcending Boundaries and Challenges in Qualitative Research With Black Women*
Authors: Few April L. , Stephens Dionne P. , Rouse‐Arnett Marlo
Published: February 2004

Our purpose is to discuss the challenges that Black women researchers face when doing qualitative research with Black women on sensitive topics. From a Black feminist perspective, we explore the dynamics of race, class, and gender in the informant‐researcher relationship between Black women. We also share five recommendations for conducting ethical qualitative research with Black women: contextualizing research, contextualizing subjectivity, triangulating multiple sources, monitoring symbolic power, and caring in the research process.