bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies for controlling cassava mosaic virus disease in Africa
Authors: Thresh J. M. , Cooter R. J.
Published: September 2005

Cassava mosaic disease (CMD) is caused by whiteflyborne viruses of the genus Begomovirus (family Geminiviridae). The disease has long been regarded as the most important of those affecting cassava in sub‐Saharan Africa, and has been the subject of much research, especially since the onset of the current very damaging pandemic in eastern and central Africa. This review considers the main features of CMD and the various possible means of control. The main emphasis to date has been on the development and deployment of virus‐resistant varieties. These are widely adopted in countries where CMD has caused serious problems, and provided a powerful incentive for farmers to abandon some of the most susceptible of their traditional varieties. Only limited use has been made of phytosanitation involving CMD‐free planting material and the removal (roguing) of diseased plants. Cultural methods of control using varietal mixtures, intercrops or other cropping practices have also been neglected, and there is a need for much additional research before they can be deployed effectively. Nevertheless, the severe losses now being caused by CMD in many parts of sub‐Saharan Africa could be greatly decreased through the application of existing knowledge.
Recent insights into the Smith–Lemli–Opitz syndrome
Authors: Yu H , Patel SB
Published: September 2005

The Smith–Lemli–Opitz syndrome (SLOS) is an autosomal recessive multiple congenital anomaly/mental retardation disorder caused by an inborn error of post‐squalene cholesterol biosynthesis. Deficient cholesterol synthesis in SLOS is caused by inherited mutations of 3β‐hydroxysterol‐Δ7 reductase gene (DHCR7). DHCR7 deficiency impairs both cholesterol and desmosterol production, resulting in elevated 7DHC/8DHC levels, typically decreased cholesterol levels and, importantly, developmental dysmorphology. The discovery of SLOS has led to new questions regarding the role of the cholesterol biosynthesis pathway in human development. To date, a total of 121 different mutations have been identified in over 250 patients with SLOS who represent a continuum of clinical severity. Two genetic mouse models have been generated which recapitulate some of the developmental abnormalities of SLOS and have been useful in elucidating the pathogenesis. This mini review summarizes the recent insights into SLOS genetics, pathophysiology and potential therapeutic approaches for the treatment of SLOS.
NMDA‐receptor blockade by CPP impairs post‐training consolidation of a rapidly acquired spatial representation in rat hippocampus
Authors: McDonald Robert J. , Hong Nancy S. , Craig Laura A. , Holahan Matthew R. , Louis Meira , Muller Robert U.
Published: September 2005

Recent evidence suggests that N‐methyl‐d‐aspartate (NMDA)‐receptor mediated plasticity in hippocampus has a more subtle role in memory‐based behaviours than originally thought. One idea is that NMDA‐based plasticity is essential for the consolidation of post‐training memory but not for the initial encoding or for short‐term memory. To further test this idea we used a three‐phase variant of the hidden goal water maze task. In the first phase, rats were pretrained to an initial location. Next, intense, massed training was done in a 2‐h interval to teach the rats to go to a new location after either an injection of the NMDA receptor antagonist (6)‐3‐(2‐carboxypiperazin‐4‐yl)propyl‐1‐phosphonic acid (CPP) or of vehicle. Finally, under drug‐free conditions 24 h after new location training, a competition test was done between the original and new locations. We find that N‐methyl‐d‐aspartate (NMDA)‐receptor blockade has little or no effect on new location training. In contrast, when tested 24 h later, the strength of the trace for the new location learned during NMDA‐receptor blockade was much weaker compared with the trace for the new location learned after saline injection. Further experiments showed similar effects when NMDA‐receptors were blocked immediately after the new location training, suggesting that this is a memory consolidation effect. Our results therefore reinforce the notion that hippocampal NMDA‐receptors participate in post‐training memory consolidation but are not essential for the processes necessary to learn or retain navigational information in the short term.
RSEP1 is a novel gene with functional involvement in neuropathic pain behaviour
Authors: Wang Xidao , Zhang Yuqiu , Kong Lingwei , Xie Zhiqin , Lin Zhixin , Guo Ning , Strong Judith A. , Meij Johanna T. A. , Zhao Zhiqi , Jing Naihe , Yu Lei
Published: September 2005

Neuropathic pain from nerve injury by trauma, disease or surgery often causes prolonged suffering. To explore the molecular mechanisms that underlie neuropathic pain, we used mRNA from the L4–5 segments of the lumbar spinal cord of rats with chronic constriction injury (CCI)‐induced neuropathic pain, and differentially screened a cDNA library from the rat brain. A novel gene, termed RSEP1 (Rat Spinal cord Expression Protein 1), was identified. Northern blots revealed that RSEP1 was expressed mainly in the central nervous system including the cerebral cortex, hippocampus, brainstem and spinal cord, as well as in the kidney and ovary. In situ hybridization showed a high level of RSEP1 expression in the CA1, CA3 and dentate gyrus regions of the hippocampus and the small sensory neurons in the dorsal horn, as well as the large neurons in the ventral horn of the spinal cord. Intrathecal injection of RSEP1 antisense oligonucleotide into the spinal cord lumbar enlargement attenuated neuropathic pain behaviours in CCI rats, suggesting a functional involvement of RSEP1 in neuropathic pain.
The upper airway in Weaver syndrome
Authors: CRAWFORD MARK W. , ROHAN DENISE
Published: September 2005

Weaver syndrome is a rare disorder of unknown etiology characterized by skeletal overgrowth, distinctive craniofacial and digital abnormalities, and advanced bone age. The prime anesthetic problem reported in children with Weaver syndrome is difficulty with tracheal intubation, resulting in part from relative micrognathia, short neck, and an anterior and cephalad position of the larynx. In this report, the authors describe their experience with two children diagnosed with Weaver syndrome who presented for dental surgery. Contrary to previous reports, tracheal intubation was accomplished with relative ease, suggesting that difficulty in intubation in Weaver syndrome may be age‐related, diminishing with advancing age and growth of the mandible, as has been reported for other micrognathic syndromes such as Pierre Robin sequence.
The comparative effect of single dose mivacurium during sevoflurane or propofol anesthesia in children
Authors: HADIMIOGLU NECMIYE , ERTUGRUL FATMA , ERTUG ZEKI , YEGIN ARIF , KARAGUZEL GUNGOR , ERMAN MELIHA
Published: September 2005

Background:  We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg·kg−1) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery.

Methods:  All children were randomly allocated to receive 2 mg·kg−1 propofol iv or sevoflurane 8% inspired concentration for induction of anesthesia. Anaesthesia was maintained with 66% nitrous oxide in oxygen and 100–120 μg·kg−1 propofol or sevoflurane approximately 2–3% inspired concentration with controlled ventilation. The ulnar nerve was stimulated at the wrist by a train‐of four (TOF) stimulus every 20 s and neuromuscular function was measured at the adductor pollicis. When the response to TOF was stable, 0.2 mg·kg−1 mivacurium was given. The trachea was intubated successfully at the first attempt in all patients.

Results:  Onset time following a single dose of mivacurium was shorter in the sevoflurane group (2.99 min), than in the propofol group (4.42 min). The times to 25, 50, 75, and 90% recovery were significantly longer in the sevoflurane group (13.1, 15.7, 18.6, and 21.2 min, respectively) than in the propofol group (11.4, 13.2, 14.4, and 17.2 min respectively). TOF ratios of 50, 70, and 90% were significantly occurred later in sevoflurane group than propofol group.

Conclusions:  Our results indicate that when compared with propofol group, the sevoflurane group had an accelerated onset and a delayed recovery of neuromuscular block induced by mivacurium in children.
A comparison of three methods for estimating appropriate tracheal tube depth in children
Authors: MARIANO EDWARD R. , RAMAMOORTHY CHANDRA , CHU LARRY F. , CHEN MICHAEL , HAMMER GREGORY B.
Published: September 2005

Background:  Estimating appropriate tracheal tube (TT) depth following tracheal intubation in infants and children presents a challenge to anesthesia practitioners. We evaluated three methods commonly used by anesthesiologists to determine which one most reliably results in appropriate positioning.

Methods:  After IRB approval, 60 infants and children scheduled for fluoroscopic procedures requiring general anesthesia were enrolled. Patients were randomly assigned to one of three groups: (1) deliberate mainstem intubation with subsequent withdrawal of the TT 2 cm above the carina (‘mainstem’ method); (2) alignment of the double black line marker near the TT tip at the vocal cords (‘marker’ method); or (3) placement of the TT at a depth determined by the formula: TT depth (cm) = 3 × TT size (mmID) (‘formula’ method). TT tip position was determined to be ‘appropriate’ if located between the sternoclavicular junction (SCJ) and 0.5 cm above the carina as determined by fluoroscopy. Risk ratios were calculated, and data were analysed by the chi‐square test accepting statistical significance at P < 0.05.

Results:  The mainstem method was associated with the highest rate of appropriate TT placement (73%) compared with both the marker method (53%, P = 0.03, RR = 1.56) and the formula method (42%, P = 0.006, RR = 2.016). There was no difference between the marker and formula methods overall (P = 0.2, RR = 1.27). Analysis of age‐stratified data demonstrated higher success with the marker method compared with the formula method for patients 3–12 months (P = 0.0056, RR = 4.0).

Conclusions:  Deliberate mainstem intubation most reliably results in appropriate TT depth in infants and children.
Trends in the state of nature and their implications for human well‐being
Authors: Balmford Andrew , Bond William
Published: September 2005

Two major international initiatives – the Convention on Biological Diversity's target to reduce the rate of biodiversity loss by 2010, and the Millennium Ecosystem Assessment – raise the profile of ecological data on the changing state of nature and its implications for human well‐being. This paper is intended to provide a broad overview of current knowledge of these issues. Information on changes in the status of species, size of populations, and extent and condition of habitats is patchy, with little data available for many of the taxa, regions and habitats of greatest importance to the delivery of ecosystem services. However, what we do know strongly suggests that, while exceptions exist, the changes currently underway are for the most part negative, anthropogenic in origin, ominously large and accelerating. The impacts of these changes on human society are idiosyncratic and patchily understood, but for the most part also appear to be negative and substantial. Forecasting future changes is limited by our poor understanding of the cascading impacts of change within communities, of threshold effects, of interactions between the drivers of change, and of linkages between the state of nature and human well‐being. In assessing future science needs, we not only see a strong role for ecological data and theory, but also believe that much closer collaboration with social and earth system scientists is essential if ecology is to have a strong bearing on policy makers.
Screening for peripheral arterial disease by means of the ankle‐brachial index in newly diagnosed Type 2 diabetic patients
Authors: Faglia E. , Caravaggi C. , Marchetti R. , Mingardi R. , Morabito A. , Piaggesi A. , Uccioli L. , Ceriello A. ,   (Coordinator) for the SCAR (SCreening for ARteriopathy) study group
Published: September 2005

Aim  To evaluate the prevalence of peripheral arterial disease (PAD) with the ankle‐brachial index (ABI) in newly diagnosed Type 2 diabetic subjects.

Methods  Between autumn 2002 and spring 2003, 2559 newly diagnosed Type 2 diabetic subjects (about 15% of the cases/year in Italy) were enrolled in 265 diabetology centres. Family history of diabetes, smoking, height, weight, waistline, fasting glycaemia, glycosylated haemoglobin, total and HDL‐cholesterol and triglyceride values were collected. Claudication, cyanosis, cold foot, foot hair anomalies, skin thinning and femoral, popliteal, posterior tibial and dorsalis pedis pulses were assessed. The ABI was measured with a portable Doppler continuous‐wave instrument.

Results  An ABI < 0.9 was found in 539 (21.1%) patients. Claudication was present in 187 (7.3%). Femoral pulse was absent in 218 (8.5%), popliteal in 316 (12.3%), tibial in 563 (22.0%) and dorsalis pedis in 578 (22.6%). Foot cyanosis was observed in 88 (3.4%), cold foot in 359 (13.9%), skin thinning in 468 (18.3%) and hair anomalies in 857 (33.5%). Multivariate analysis of the variables associated with ABI < 0.9 in the univariate analysis confirmed the independent role of age [relative risk (RR) 1.02, P < 0.001, confidence interval (CI) 1.01, 1.04], claudication (RR 4.53, P < 0.001, CI 2.97, 6.93), absence of tibial pulse (RR 3.45, P ≤ 0.001. CI 2.54, 4.68) and pedis pulse (RR 1.96, P ≤ 0.001, CI 1.4, 2.68).

Conclusions  PAD, as represented by ABI < 0.9, is common in newly diagnosed Type 2 diabetic patients.
Ulcer‐free survival following management of foot ulcers in diabetes
Authors: Pound N. , Chipchase S. , Treece K. , Game F. , Jeffcoate W.
Published: September 2005

Aims  Measures of healing rate may not give a complete indication of the effectiveness of overall management of diabetic foot ulcers. Apart from healing and speed of healing, the outcomes of greatest importance to the patient are avoidance of any amputation and remaining free from any recurrence. We have documented the number of patients presenting with diabetic foot ulcers who become ulcer free and examined the value of documenting ulcer‐free survival.

Methods  All referrals to a specialist diabetic foot clinic over a 31‐month period were analysed and outcomes were determined after a minimum follow‐up of 6 months.

Results  Three hundred and seventy patients were referred with a total of 1031 ulcers. One hundred and twenty‐one (32.7%) never became ulcer free: 56 (46.3% of 121) remained unhealed, the ulcers of 12 (9.9% of 121) had been resolved by amputation, two remained unhealed after amputation (1.7% of 121) and 51 (13.8% of 370) had died. Two hundred and thirty‐one (62.4% of 370) became ulcer free at some stage. Five of these were excluded because of an earlier amputation. Ninety‐one of the remaining 226 (40.3%) developed a recurrent or new ulcer after a median 126 days. Of the 135 who did not have a recurrence, 133 (58.8% of 226; 35.9% of 370) survived ulcer free and with limbs intact, while two died. Outcome was unknown in 18 (4.9%). Those who never became ulcer free were older (P < 0.001) and with a greater prevalence of ischaemia (P < 0.001). Those who healed but went on to suffer a new ulcer had a greater prevalence of neuropathy (P = 0.027) than those who remained ulcer free.

Conclusions  The use of ulcer‐free survival can be used as an indication of the effectiveness of foot ulcer management. It could be adopted as a measure to compare performance between different specialist units.
Early hypoglycaemia after accidental intramuscular injection of insulin glargine
Authors: Karges B. , Boehm B. O. , Karges W.
Published: September 2005

Aim  Insulin glargine is a long‐acting insulin analogue with favourable clinical characteristics. We studied a slim 24‐year‐old female with Type 1 diabetes who repeatedly experienced severe hypoglycaemia after switching from NPH insulin to insulin glargine at identical daily doses.

Methods  Clinical examination and high‐resolution ultrasound.

Results  The patient frequently placed her injections into muscle tissue, followed by unexpected rapid insulin action. After correction of her injection technique, hypoglycaemia did not recur.

Conclusions  The long‐acting kinetics of insulin glargine require precipitation in the subcutaneous tissue. Therefore, each patient's injection technique should be carefully checked when treatment with insulin glargine is initiated, particularly in young and lean individuals.
Nicotinamide – biologic actions of an emerging cosmetic ingredient
Authors: Otte N. , Borelli C. , Korting H. C.
Published: September 2005

Synopsis

Nicotinamide, the water‐soluble amide of nicotinic acid, is a component of the two most important coenzymes – nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate. Thus nicotinamide is involved in numerous oxidation–reduction reactions in mammalian biological systems. Nicotinamide essentially acts as an antioxidant. Most effects are exerted via poly‐adenosine diphosphate‐ribose polymerase inhibition. Thus nicotinamide increasingly gains interest in the prevention and treatment of several skin diseases. It is well established in the systemic therapy of pellagra, a deficiency disease linked to nicotinic acid, but with respect to topical use there is still a need for further evidence with respect to its manifold potential uses. Currently, its local use is established in the care of acne‐prone skin.
Quantification of dandruff adherence to hair
Authors: Piérard‐Franchimont C. , Uhoda E. , Piérard G. E.
Published: September 2005

Dandruff adherence to hair shafts is a visible annoying phenomenon. The aspect can be recorded by different means including the ultraviolet light‐enhanced visualization (ULEV) method and microscopy. We present another quantitative method. Hairs were clipped from the parietal scalp area of 25 volunteers complaining of dandruff. They were firmly applied onto cyanoacrylate‐coated microscopic slides. Hairs were lifted up after 15–20 s leaving a cast in the adhesive coat. Dandruff were thus harvested from the hair shafts and remained attached to the cyanoacrylate coat. After staining, the material was submitted to image analysis to derive the dandruff density per unit length of hairs. In 11/25 subjects, a correlation was found between the width of the hair casts and the dandruff density. This method does not collect all dandruff along hair shafts, but data are likely representative of the whole corneocyte load.
A new method to evaluate lower eyelid sag using three‐dimensional image analysis
Authors: Fukuda Y. , Fujimura T. , Moriwaki S. , Kitahara T.
Published: September 2005

Synopsis

Lower eyelid sags as well as wrinkles represent age‐related morphological changes of the skin surface. However, a quantitative method to evaluate lower eyelid sagging has not been previously established. We designed a new quantitative evaluation method that uses non‐invasive skin scanning, which is based on the difference between the superficial dimension of the sagging surface of the lower eyelid and the dimension of its projection area. In 97 females, 2‐D and the 3‐D images were taken. By 3‐D image analysis, the difference between the superficial dimension of the sagging surface of the lower eyelid and the dimension of its virtual projection area was assessed, and was defined as the sag parameter. This parameter was significantly correlated with the sag score (a photographic scale to assess the degree of sagging) and with aging. The accuracy of the sag parameter was confirmed in a clinical test using a sag treatment lotion and a placebo lotion. The sag score decreased in skin treated with the sag treatment lotion, but the change was not significantly different from that of the placebo treated skin. On the contrary, the sag parameter was significantly reduced (P < 0.05) after topical application of the sag treatment lotion compared with the placebo‐treated skin. These results indicate that the sag parameter as proposed herein is useful in clinical studies to evaluate slight changes in lower eyelid sagging.
Two‐Headed Coins or Kandinskys: White Racial Identification
Authors: Wong Cara , Cho Grace E.
Published: September 2005

Racial identity means different things to members of different racial and ethnic groups in the United States. However, while the study of race and politics is often the study of White racial attitudes (Dawson & Cohen, 2003), research on racial identity almost always refers to non‐White identity. This article addresses this hole in the literature by examining the extent and effects of White identity. We compare White identification and Black identification using National Election Studies data (1972–2000) and examine the relationships between racial identity and racial and political attitudes. This study adds a missing case to the study of racial identity, tests how well the theories about the concept travel across cases, and highlights the need for more frequent studies of the racial identity of all groups.
Belonging and Doing: Political Churches and Black Political Participation
Authors: McClerking Harwood K. , McDaniel Eric L.
Published: September 2005

The importance of the political church in Black political participation has brought to the attention of scholars the differences among Black churches and their effect on Black mobilization. The Black church has on many occasions transformed itself into a politicized organization. These political churches become settings that encourage political knowledge and skills (Tate, 1993) and communicate political activity as a norm (Calhoun‐Brown, 1996). The earlier work on political churches has established the importance of these organizations for voter turnout and other forms of political participation. What has been left unexamined is the nature of the political churches themselves. This project disentangles these churches by looking at the heterogeneity within the structures of the political churches. In general, we seek to understand which of the internal activities of the political church tend to foster acts of political participation. We hypothesize that cost‐ underwriting activities and obligation‐creating activities within the church setting have the greatest impact on participation. By examining a robust and expansive operationalization of the political church construct, we find that these types of political church activities matter more than other activities. In specifying how churches may work to directly affect the participation of their members, we seek to expand the scope of general comprehension of political churches.
Psychological Correlates of Support for Compromise: A Polling Study of Jewish‐Israeli Attitudes toward Solutions to the Israeli‐Palestinian Conflict
Authors: Maoz Ifat , McCauley Clark
Published: September 2005

A representative national sampling of Israeli Jewish adults (n = 550) reported attitudes toward solutions of the Israeli‐Palestinian conflict that were salient in Israeli public discourse in 2002. Negative attitudes toward compromise were associated with zero‐sum threat perceptions of the conflict with Palestinians, such that improvement for the Palestinian side can only come at the expense of the Israeli side. Positive attitudes toward compromise were associated with feelings of sympathy toward Palestinians, but, surprisingly, attitudes toward compromise were not associated with feelings of fear toward Palestinians. The possibility is advanced that it is fear of harm to the group, not fear of harm to self and family, that is related to willingness to compromise. Zero‐sum perceptions of collective threat were not strongly related to affective reactions, and, contrary to a realist analysis of intergroup conflict, sympathy for Palestinians predicted support for compromise beyond what zero‐sum perceptions of threat could predict.
The visibility of agricultural subsidies and market illusions in the Common Agricultural Policy: Some evidence from farmers’ views in Germany, Portugal and the United Kingdom
Authors: DAUGBJERG CARSTEN , TRANTER RICHARD , JONES PHILIP , LITTLE JONATHAN , COSTA LEONARDO , KNAPP THOMAS , SOTTOMAYOR MIGUEL , SWINBANK ALAN
Published: September 2005

Abstract.  This article demonstrates that the design and nature of agricultural support schemes has an influence on farmers’ perception of their level of dependence on agricultural support. While direct aid payments inform farmers about the extent to which they are subsidised, indirect support mechanisms veil the level of subsidisation, and therefore they are not fully aware of the extent to which they are supported. To test this hypothesis, we applied data from a survey of 4,500 farmers in three countries: the United Kingdom, Germany and Portugal. It is demonstrated that indirect support, such as that provided through artificially high consumer prices, gives an illusion of free and competitive markets among farmers. This ‘visibility’ hypothesis is evaluated against an alternative hypothesis that assumes farmers have complete, or at least a fairly comprehensive level of, information on agricultural support schemes. Our findings show that this alternative hypothesis can be ruled out.
Sand in the machinery? Comparing bureaucrats’ and politicians’ attitudes toward public sector reform
Authors: JACOBSEN DAG INGVAR
Published: September 2005

Abstract. This article addresses the general notion that bureaucrats may oppose the introduction of reforms in the public sector, and that their views concerning reform will differ from that of politicians. Such a situation may create a sense of conflict between the two spheres, but different views on public sector reform can also follow other conflict dimensions. Two such dimensions are outlined: the one between political parties, and the one between a political‐administrative elite and a group of more peripheral politicians and administrators. The hypotheses set forward are tested by comparing local authority politicians’ and administrative leaders’ views on public sector reform. The data does not support the notion of general conflict between politicians and administrators, or that of conflict of interest between an elite and a more peripheral group. In general, politicians and administrators have rather similar views, but there is a wide difference between political parties. The administration places itself somewhat in the middle between political extremes, being moderately positive towards most reforms.
What drives democratisation in Asia and Africa?
Authors: LINDER WOLF , BÄCHTIGER ANDRÉ
Published: September 2005

Abstract.  With many developing countries stuck in an uneasy middle ground between full‐fledged democracy and outright dictatorship, the question of favourable and unfavourable conditions for democratisation is dramatically brought back into focus. Yet, systematic comparative analysis that analyses a range of favourable and unfavourable political, economic and cultural factors is rare, particularly as far as African and Asian countries are concerned. This article addresses these shortcomings and at the same time introduces two conceptual innovations. Building on a structural and socio‐anthropological conception of the term, we measure and test culture cross‐nationally in a way that overcomes the conceptual limitations of the ‘political culture’ approach. We further develop an index of power sharing for 62 African and Asian countries, allowing us statistically to test Arend Lijphart's ‘consociational’ model of democratic emergence and consolidation. In our statistical examination of these countries between 1965 and 1995, power sharing and the cultural element of low familism turn out to be the strongest predictors of democratisation, while economic factors – often viewed as the most important variables shaping democratisation – have only limited effects.
Candidates’ policy platforms and election outcomes: The three faces of policy representation
Authors: ADAMS JAMES , MERRILL SAMUEL
Published: September 2005

Abstract.  Recent empirical studies by Alvarez and Nagler, Erikson and Romero, and others conclude that candidates’ and parties’ policy platforms only modestly affect their electoral support. This suggests that candidates/parties can win elections even when their policies differ sharply from the policy beliefs of the constituencies that elect them. This raises the question: How can voters exercise control over government policies via elections? We report applications to American and French presidential election data that suggest three paradoxical conclusions. On the one hand, we find that presidential candidates can moderate their policies with at most a modest change in vote share, but if they move by the same amount to a more extreme position, they face severe vote losses that could cripple their election prospects. Alternatively, movement by both candidates in the same direction or a policy shift by the voters may have a major effect on the outcome.
Putting Smart Money to Work for Quality Improvement
Authors: Beaulieu Nancy Dean , Horrigan Dennis R.
Published: September 2005

Objective. To investigate the effects of paying physicians for performance on quality measures of diabetes care when combined with other care management tools.

Data Sources/Study Setting. In 2001, a managed care organization in upstate New York designed and implemented a pilot program to financially reward doctors for the quality of care delivered to diabetic patients. In addition to paying a performance bonus, physicians were also supplied with a diabetic registry and met in groups to discuss progress in meeting goals for diabetic care. Primary data on diabetes care at the patient level were collected from each physician during the 8‐month period, April 2001–January 2002.

Study Design. Physicians were scored on individual process and outcome measures of diabetes care on three separate occasions; these individual scores were combined into a composite score on which the financial reward was allocated. The study design is pre/post for the patients whose physicians participated in the performance pay program. The control group is a large sample of the health plan's diabetic members.

Data Collection. Data on patient outcomes were self‐reported by physicians participating in the study. These data were audited with spot checks of medical charts. Data for the control group were collected as part of the health plan's annual HEDIS data collection.

Principal Findings. Physicians and patients achieved significant improvement on five out of six process measures, and on two out of three outcome measures (HbA1c control and LDL control). Thirteen out of 21 physicians improved their average composite score enough to earn some level of financial reward. Of the eight physicians not receiving any of the three levels of reward, six improved their composite scores.

Conclusions. Financial incentives for physicians, bundled with other care management tools, led to improvement on objectively measured quality of care for diabetic patients. Self‐selection by physicians into the pay pilot and the small sample size of participating physicians limit the generalizability of the results.
Employer Health Insurance Offerings and Employee Enrollment Decisions
Authors: Polsky Daniel , Stein Rebecca , Nicholson Sean , Bundorf M. Kate
Published: September 2005

Objective. To determine how the characteristics of the health benefits offered by employers affect worker insurance coverage decisions.

Data Sources. The 1996–1997 and the 1998–1999 rounds of the nationally representative Community Tracking Study Household Survey.

Study Design. We use multinomial logistic regression to analyze the choice between own‐employer coverage, alternative source coverage, and no coverage among employees offered health insurance by their employer. The key explanatory variables are the types of health plans offered and the net premium offered. The models include controls for personal, health plan, and job characteristics.

Principal Findings. When an employer offers only a health maintenance organization married employees are more likely to decline coverage from their employer and take‐up another offer (odds ratio (OR)=1.27, p<.001), while singles are more likely to accept the coverage offered by their employer and less likely to be uninsured (OR=0.650, p<.001). Higher net premiums increase the odds of declining the coverage offered by an employer and remaining uninsured for both married (OR=1.023, p<.01) and single (OR=1.035, p<.001) workers.

Conclusions. The type of health plan coverage an employer offers affects whether its employees take‐up insurance, but has a smaller effect on overall coverage rates for workers and their families because of the availability of alternative sources of coverage. Relative to offering only a non‐HMO plan, employers offering only an HMO may reduce take‐up among those with alternative sources of coverage, but increase take‐up among those who would otherwise go uninsured. By modeling the possibility of take‐up through the health insurance offers from the employer of the spouse, the decline in coverage rates from higher net premiums is less than previous estimates.
The Effect of Income Question Design in Health Surveys on Family Income, Poverty and Eligibility Estimates
Authors: Davern Michael , Rodin Holly , Beebe Timothy J. , Call Kathleen Thiede
Published: September 2005

Objective. To compare systematic differences between an “omnibus” income measure that asks for total family income amounts with a central survey item and an aggregated income measure that sums specific amounts of income obtained from multiple income sources from everyone within a family.

Data Source. The 2001 Current Population Survey‐Demographic Supplement (CPS‐DS). Data were collected from 78,000 households from February through April 2001.

Study Design. First, we compare the omnibus family income to the aggregated family income amounts for each family. Second, we use the various aggregated family income sources to predict whether there is a mismatch between the omnibus and aggregated family income amounts. Finally, we assign a new aggregated amount of income that is restricted to be within the range of the omnibus amount to observe differences in poverty rates.

Data Collection. Data were extracted from University of Michigan's ICPSR website.

Principal Findings. There is a great deal of variation between the omnibus family income measure and the aggregated family income measure, with the omnibus amount generally being lower than the aggregated. As a result, the percent of people estimated to be in poverty is higher using the omnibus income item.

Conclusions. Health surveys generally rely on an omnibus income measure and analysts should be aware that the income estimates derived from it are limited with respect to poverty determination, and the related concept of eligibility estimation. Analysts of health surveys should also consider matching respondents or multiple imputation to improve the usability of the data.
Factors Affecting Plan Choice and Unmet Need among Supplemental Security Income Eligible Children with Disabilities
Authors: Mitchell Jean M. , Gaskin Darrell J.
Published: September 2005

Objective. To evaluate factors affecting plan choice (partially capitated managed care [MC] option versus the fee‐for‐service [FFS] system) and unmet needs for health care services among children who qualified for supplemental security income (SSI) because of a disability.

Data Sources. We conducted telephone interviews during the summer and fall of 2002 with a random sample of close to 1,088 caregivers of SSI eligible children who resided in the District of Columbia.

Research Design. We employed a two‐step procedure where we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias associated with plan choice. We included the selectivity correction, the dummy variable indicating plan choice and other exogenous regressors in the second stage equations predicting unmet need. The dependent variables in the second stage equations include: (1) having an unmet need for any service or equipment; (2) having an unmet need for physician or hospital services; (3) having an unmet need for medical equipment; (4) having an unmet need for prescription drugs; (5) having an unmet need for dental care.

Principal Findings. More disabled children (those with birth defects, chronic conditions, and/or more limitations in activities of daily living) were more likely to enroll in FFS. Children of caregivers with some college education were more likely to opt for FFS, whereas children from higher income households were more prone to enroll in the partially capitated MC plan. Children in FFS were 9.9 percentage points more likely than children enrolled in partially capitated MC to experience an unmet need for any type of health care services (p<.01), while FFS children were 4.5 percentage points more likely than partially capitated MC enrollees to incur a medical equipment unmet need (p<.05). FFS children were also more likely than partially capitated MC enrollees to experience unmet needs for prescription drugs and dental care, however these differences were only marginally significant.

Conclusions. We speculate that the case management services available under the MC option, low Medicaid FFS reimbursements and provider availability account for some of the differences in unmet need that exist between partially capitated MC and FFS enrollees.
Managed Care and Gender Disparities in Problematic Health Care Experiences
Authors: Mitchell Shannon , Schlesinger Mark
Published: September 2005

Objective. To determine whether gender differences in reports of problematic health care experiences are associated with characteristics of managed care.

Data Sources. The 2002 Yale Consumer Experiences Survey (N=5,000), a nationally representative sample of persons over 18 years of age with private health insurance, Interstudy Competitive Edge HMO Industry Report 2001, Area Resource File 2002, and the American Hospital Association Annual Survey of Hospitals 2002.

Study Design. Independent and interactive effects of gender and managed care on reports of problematic health care experiences were modeled using weighted multivariate logistic regression.

Principal Findings. Women were significantly more likely to report problems with their health care compared with men, even after controlling for gendered differences in expectations about medical care. Gender disparities in problem reporting were larger in plans that used certain managed care techniques, but smaller in plans using other methods. Some health plan managed care practices, including closed networks of providers and gatekeepers to specialty care, were associated with greater problem reporting among women, while others, such as requirements for primary care providers, were associated with greater problem reporting among men. Markets with higher HMO competition and penetration were associated with greater problem reporting among women, but reduced problem reporting among men. Women reported more problems in states that had enacted regulations governing access to OB/GYNs, while men reported more problems in states with regulations allowing specialists to act as primary care providers in health plans.

Conclusions. There are nontrivial gender disparities in reports of problematic health care experiences. The differential consequences of managed care at both the plan and market levels explain a portion of these gender disparities in problem reporting.
A Self‐Report Measure of Clinicians' Orientation toward Integrative Medicine
Authors: Hsiao An‐Fu , Hays Ron D. , Ryan Gery W. , Coulter Ian D. , Andersen Ronald M. , Hardy Mary L. , Diehl David L. , Hui Ka‐Kit , Wenger Neil S.
Published: September 2005

Objective. Patients in the U.S. often turn to complementary and alternative medicine (CAM) and may use it concurrently with conventional medicine to treat illness and promote wellness. However, clinicians vary in their openness to the merging of treatment paradigms. Because integration of CAM with conventional medicine can have important implications for health care, we developed a survey instrument to assess clinicians' orientation toward integrative medicine.

Study Setting. A convenience sample of 294 acupuncturists, chiropractors, primary care physicians, and physician acupuncturists in academic and community settings in California.

Data Collection Methods. We used a qualitative analysis of structured interviews to develop a conceptual model of integrative medicine at the provider level. Based on this conceptual model, we developed a 30‐item survey (IM‐30) to assess five domains of clinicians' orientation toward integrative medicine: openness, readiness to refer, learning from alternate paradigms, patient‐centered care, and safety of integration.

Principal Findings. Two hundred and two clinicians (69 percent response rate) returned the survey. The internal consistency reliability for the 30‐item total scale and the five subscales ranged from 0.71 to 0.90. Item‐scale correlations for the five subscales were higher for the hypothesized subscale than other subscales 75 percent or more of the time. Construct validity was supported by the association of the IM‐30 total scale score (0–100 possible range, with a higher score indicative of greater orientation toward integrative medicine) with hypothesized constructs: physician acupuncturists scored higher than physicians (71 versus 50, p<.001), dual‐trained practitioners scored higher than single‐trained practitioners (71 versus 62, p<.001), and practitioners' self‐perceived “integrativeness” was significantly correlated (r=0.60, p<.001) with the IM‐30 total score.

Conclusion. This study provides support for the reliability and validity of the IM‐30 as a measure of clinicians' orientation toward integrative medicine. The IM‐30 survey, which we estimate as requiring 5 minutes to complete, can be administered to both conventional and CAM clinicians.
Factors Associated with Interorganizational Relationships among Outpatient Drug Treatment Organizations 1990–2000
Authors: Wells Rebecca , Lemak Christy Harris , D'Aunno Thomas A.
Published: September 2005

Objective.To identify the factors associated with drug abuse treatment center participation in interorganizational relationships (IORs).

Data Sources.Three nationally representative samples of outpatient drug abuse treatment units surveyed in 1990, 1995, and 1999/2000 as part of the National Drug Abuse Treatment System Survey (NDATSS), stratified by public/private status, treatment modality (methadone or nonmethadone), and organizational affiliation.

Study Design.Probit analyses on 647 lagged treatment center‐year observations from the years 1990 to 1995 with outcomes in 1995 and 2000, respectively. Standard errors were adjusted for clustering of center‐year observations within centers.

Principal Findings.Centers with greater motivation to form IORs (e.g., as a result of client diversity or government revenue) were more likely to do so, as were centers with greater opportunities to form IORs (e.g., centers whose directors participated in policy making).

Conclusions.Both motivating and enabling factors promoted the formation of IORs by drug abuse treatment centers. Managed care also played a distinct role, in this case appearing to undermine interorganizational cooperation. Because IORs can improve access to care and quality, policy makers should consider using both incentives and support such as management training to promote IOR formation.
Medicaid Managed Care and Health Care for Children
Authors: Baker Laurence C. , Afendulis Christopher
Published: September 2005

Objective. Many states expanded their Medicaid managed care programs during the 1990s, causing concern about impacts on health care for affected populations. We investigate the relationship between Medicaid managed care enrollment and health care for children.

Data Sources and Measures. Repeated cross‐sections of Medicaid‐covered children under 18 years of age from the 1996/1997 and 1998/1999 Community Tracking Study Household Surveys (n=2,602) matched to state‐year CMS Medicaid managed care enrollment data. For each individual, we constructed measures of health care utilization (provider and emergency department visits, hospitalizations, surgeries); health care access (usual source of care, unmet medical needs, put‐off needed care); and satisfaction (satisfaction overall, with doctor choice, and with last visit).

Study Design. Regression analysis of the relationship between within‐state changes in Medicaid managed care enrollment rates and changes in mean utilization, access, and satisfaction measures for children covered by Medicaid, controlling for a range of potentially confounding factors.

Principal Findings. Increases in Medicaid health maintenance organization (HMO) enrollment are associated with less emergency room use, more outpatient visits, fewer hospitalizations, higher rates of reporting having put off care, and lower satisfaction with the most recent visit. Medicaid primary care case management (PCCM) plans are associated with increases in outpatient visits, but also with higher rates of reporting unmet medical needs, putting off care, and having no usual source of care.

Conclusions. Both Medicaid HMO and PCCM plans can have important impacts on health care utilization, access, and satisfaction. Some impacts may be positive (e.g., less ED use and more outpatient provider use), although concern about increasing challenges in access to care and satisfaction is also warranted.
Carrot or Stick? Contract Frame and Use of Decision‐Influencing Information in a Principal‐Agent Setting
Authors: FREDERICKSON JAMES R. , WALLER WILLIAM
Published: September 2005

A fundamental management accounting issue is how to incorporate decision‐influencing information (e.g., an ex post state signal) into employment contracts. Our experiment examines the effects of contract framing on such information use in a principal‐agent setting. In each of 40 rounds, participants (as employer and worker) negotiate a contract that specifies pay depending on an ex post state signal. State‐signal pay is framed as either a bonus or a penalty over two groups. The results show that the bonus frame facilitates information use, because of worker loss aversion. Although both groups initially underweigh the state signal, the bonus group quickly converges toward the optimal weight, whereas the penalty group persistently underweighs the state signal.