bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistence of HMO Performance Measures
Authors: Swaminathan Shailender , Chernew Michael , Scanlon Dennis P.
Published: September 2008

Objective. To simplify the decision‐making process, we propose and implement an approach to assess the stability of health plan performance over time when multiple indicators of performance exist.

Data Source. National Committee for Quality Assurance Health Care Effectiveness Data and Information Set data for childhood immunization for both publicly and nonpublicly reporting health plans between 1998 and 2002.

Data/Study Design. We use longitudinal data to examine whether plan quality ratings are stable from year to year. We estimate a parametric Multiple Indicator Multiple Cause Model, a model which allows us to aggregate the multiple measures of performance. The model controls for observed characteristics of the plan and market, allowing for unmeasured heterogeneity.

Principal Findings. We find moderate persistence in plan performance over time. A plan in the upper tier of performance in the year 1999 has only a 0.47 probability of remaining in the upper tier in the year 2001. Multiple years of good performance increase the probability of good performance in the future. For example, from the subset of plans in the upper tier of performance in 1999, 63 percent continued to perform in the upper tier in 2000. However, from the subset of plans in the upper tier in both 1998 and 1999, about three‐fourths of the plans continued to perform in the upper tier in the year 2000. Finally, better performance in the more recent past is more indicative of better performance in the future than better performance in the more distant past.

Conclusions. Although there is some persistence in health plan ratings over time, it is not uncommon for ratings of plans to change between when the data are generated and when actions based on that data, such as employers' contracting decisions or consumers' enrollment decisions, may take effect. Decision makers should be cognizant of this issue and methods should be developed to mitigate its consequences.
Measuring Hospital Inefficiency: The Effects of Controlling for Quality and Patient Burden of Illness
Authors: Mutter Ryan L. , Rosko Michael D. , Wong Herbert S.
Published: September 2008

Objective.To assess the impact of employing a variety of controls for hospital quality and patient burden of illness on the mean estimated inefficiency and relative ranking of hospitals generated by stochastic frontier analysis (SFA).

Study Setting.This study included urban U.S. hospitals in 20 states operating in 2001.

Data Design/Data Collection.We took hospital data for 1,290 hospitals from the American Hospital Association Annual Survey and the Medicare Cost Reports. We employed a variety of controls for hospital quality and patient burden of illness. Among the variables we used were a subset of the quality indicators generated from the application of the Patient Safety Indicator and Inpatient Quality Indicator modules of the Agency for Healthcare Research and Quality,Quality Indicatorsoftware to the Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases. Measures of a component of patient burden of illness came from the application of theComorbidity Softwareto HCUP data.

Data Analysis.We used SFA to estimate hospital cost‐inefficiency. We tested key assumptions of the SFA model with likelihood ratio tests.

Principal Findings.The measures produced by theComorbidity Softwareappear to account for variations in patient burden of illness that had previously been masquerading as inefficiency. Outcome measures of quality can provide useful insight into a hospital's operations but may have little impact on estimated inefficiency once controls for structural quality and patient burden of illness have been employed.

Conclusions.Choices about controlling for quality and patient burden of illness can have a nontrivial impact on mean estimated hospital inefficiency and the relative ranking of hospitals generated by SFA.
Case‐Mix Adjustment of Consumer Reports about Managed Behavioral Health Care and Health Plans
Authors: Eselius Laura L. , Cleary Paul D. , Zaslavsky Alan M. , Huskamp Haiden A. , Busch Susan H.
Published: September 2008

Objective. To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO™) survey to allow for fair comparisons across health plans.

Data Source. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate=48 percent).

Study Design. Potential case‐mix adjustors were evaluated by combining information about their predictive power and the amount of within‐ and between‐plan variability. Changes in plan scores and rankings due to case‐mix adjustment were quantified.

Principal Findings. The final case‐mix adjustment model included self‐reported mental health status, self‐reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings.

Conclusions. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self‐reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.
Multilevel Analysis of the Chronic Care Model and 5A Services for Treating Tobacco Use in Urban Primary Care Clinics
Authors: Hung Dorothy Y. , Shelley Donna R.
Published: September 2008

Objective. To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services.

Methods. Cross‐sectional surveys were used to obtain data from 497 health care providers in 60 primary care clinics serving low‐income patients in New York City. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate the probability of full 5A service delivery, adjusting for provider covariates and clustering effects. We examined associations between provider delivery of 5A services, clinic implementation of CCM elements tailored for treating tobacco use, and the degree of CCM integration in clinics.

Principal Findings. Providers practicing in clinics with enhanced delivery system design, clinical information systems, and self‐management support for cessation were 2.04–5.62 times more likely to perform all 5A services ( p<.05). CCM integration in clinics was also positively associated with 5As delivery. Compared with none, implementation of one to six CCM elements corresponded with a 3.69–30.9 increased odds of providers delivering the full spectrum of 5As ( p<.01).

Conclusions. Findings suggest that the CCM facilitates provider adherence to the Public Health Service 5A clinical guideline. Achieving the full benefits of systems change may require synergistic adoption of all model components.
Assessing the Impact of Drug Use on Hospital Costs
Authors: Stuart Bruce C. , Doshi Jalpa A. , Terza Joseph V.
Published: September 2008

Objective. To assess whether outpatient prescription drug utilization produces offsets in the cost of hospitalization for Medicare beneficiaries.

Data Sources/Study Setting. The study analyzed a sample (N=3,101) of community‐dwelling fee‐for‐service U.S. Medicare beneficiaries drawn from the 1999 and 2000 Medicare Current Beneficiary Surveys.

Study Design. Using a two‐part model specification, we regressed any hospital admission (part 1: probit) and hospital spending by those with one or more admissions (part 2: nonlinear least squares regression) on drug use in a standard model with strong covariate controls and a residual inclusion instrumental variable (IV) model using an exogenous measure of drug coverage as the instrument.

Principal Findings. The covariate control model predicted that each additional prescription drug used (mean=30) raised hospital spending by $16 (p<.001). The residual inclusion IV model prediction was that each additional prescription fill reduced hospital spending by $104 (p<.001).

Conclusions. The findings indicate that drug use is associated with cost offsets in hospitalization among Medicare beneficiaries, once omitted variable bias is corrected using an IV technique appropriate for nonlinear applications.
Maintaining Continuity of Care for Nursing Home Residents: Effect of States' Medicaid Bed‐Hold Policies and Reimbursement Rates
Authors: Intrator Orna , Schleinitz Mark , Grabowski David C. , Zinn Jacqueline , Mor Vincent
Published: September 2008

Objective.Recent public concern in response to states' intended repeal of Medicaid bed‐hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies.

Data Sources/Study Design.Minimum Data Set assessments of long‐stay nursing home residents in April–June 2000 linked to Medicare claims enabled tracking residents' hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics.

Results.Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed‐hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52–0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer.

Conclusions.Bed‐hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective.
Social Networks and Stratification in the Urban Chinese Labor Market: The Case of Laid‐Off Textile Workers and Their Officials in the Tianjin Municipality*
Authors: Johnston Michael Francis , Álvarez Rodolfo
Published: September 2008

By what mechanisms has China's developing capitalist labor market been producing stratification patterns of reemployment and wage differences among laid‐off workers in the late 1990s? Theoretical perspectives delineating state, market, and societal mechanisms are used to guide exploratory analyses of data from a sample of workers who were laid off from state‐owned textile enterprises in the Tianjin municipality. Three findings are reported. First, men with what Portes defined as downward leveling “negative social capital” are less likely to become reemployed. A second, more tenuous, finding is that workers with a higher level of education are more likely to be reemployed. Third, workers with a social network tie to at least one official from a government administrative agency are more likely to be reemployed and, among those reemployed, more likely to earn higher wages, as compared to workers with a social network tie to at least one official from a state‐owned enterprise or workers lacking a social network tie to any official. This third finding, along with reports of analogous findings culled from a review of published literature, stimulates us to go beyond the data to theoretically speculate about how Chinese officialdom has become somewhat more differentiated and consequent ramifications for understanding newly emerging changes in China's stratification order.
Disegno and desire in Pontormo's Alessandro de’ Medici
Authors: Simons Patricia
Published: September 2008

Pontormo's portrait of Alessandro de’ Medici (c. 1534–35), showing the duke drawing a portrait of his beloved, cleverly engages with the history and fictive nature of art‐making. Pliny's tale about the invention of drawing forms one resonance, Castiglione's praise of the noble art of drawing another, the theorization of disegno by Vasari and others yet a third. Poetic conventions about the picturing of the beloved inform the image of a ruler who is presented as a courtly lover, adept observer, discerning patron, Medicean loyalist, and cultivated prince. Layers of presence and absence, naturalism and idealism are at work in the image, which addresses the perspicacity of sight and the poetics of its very making. The duke adopts a mythic persona but so too does the painter endow his craft with a distinguished pedigree, ranging from Pliny, Petrarch and poets like Lorenzo de’ Medici to the era's notions of perceptual psychology, amorous imprinting and the conceptual basis of disegno.
Scholars and the Sea: A Historiography of the Indian Ocean
Authors: Prange Sebastian R.
Published: September 2008

This essay won the 2007 History Compass Graduate Essay Prize, World Section.

This article surveys the historiography of the Indian Ocean to examine the problems and opportunities of using maritime spaces as frameworks for world history studies. It first considers the problem of demarcating maritime space according to different material and mental definitions. Its second part assesses different periodizations that reflect the main themes of scholarly engagement with the Indian Ocean. The final section looks at the emerging field of network studies as a new approach to the study of interconnections across the Indian Ocean world.
Irish, Scottish, Welsh and English Worlds? A Four‐Nation Approach to the History of the British Empire
Authors: MacKenzie John M.
Published: September 2008

A four‐nation approach to the history of the British Empire is becoming increasingly necessary. For a number of years, it has been accepted that the domestic history of the British and Hibernian Isles (sometimes known as the Atlantic Archipelago) can only be understood in terms of an analysis on the basis of the four constituent ethnicities of those islands (Irish, Scottish, Welsh and English). Even these four conceal further ethnic breakdowns, but they are the main categories which help to facilitate such an approach. The British Empire was supposed to act as a solvent for these different ethnicities and identities, but it can now be suggested, from recent work, that the reality was very different. The four nations each had separate relationships with empire and each identity was developed and enhanced rather than destroyed by the imperial experience. So far there have been separate studies of aspects of Scottish, Irish, Welsh and English empires. But there is now a need to bring them together to recognise the fact that the British Empire was merely a name which obscured many more complex phenomena. Members of each ethnicity interacted with empire, and its indigenous peoples, in different ways. Moreover, simple bilateral metropole‐periphery relations can no longer be sustained as a basis for analysis: empire constituted sets of multilateral relationships which help to explain both the expansion, settlement, and patterns of dominance of the imperial connection and also the pressures towards decolonisation.
The Medical History of South Africa: An Overview
Authors: Digby Anne
Published: September 2008

The article surveys half a century of historical writing on South African medicine, which is defined widely to include discussion of health care professions, public health, hospitals and asylums, and indigenous medicine as well as the cross‐overs and hybridisation between biomedicine and indigenous medicine. A rapidly growing historiography has been influenced both by general literature in the history of medicine as well as by the more specific context of South Africa. Here the colonial and post‐colonial pasts shape the present to an unusual extent and the legacy both of apartheid and of an ongoing democratic transformation impact on the historian's choice of subject.
Grieving Cosmopolitanism in Middle East Studies
Authors: Hanley Will
Published: September 2008

Political philosophers and cultural theorists studying twenty‐first‐century globalization have found cosmopolitanism to be a productive concept. In Middle East scholarship, however, cosmopolitan has been less than effective. This review illustrates three characteristics of cosmopolitanism in Middle East historiography – elitism in formulation and content, grieving nostalgia, and the privileging of formal labels over content – with examples from nineteenth‐century cities and globalized metropolises. Scholars must confront the anti‐nationalist teleology and secularizing, bourgeois fantasy at the heart of cosmopolitanism as it is currently used if they are to produced more accurate accounts of diversity in Middle East societies past and present.
Convents and Nuns: New Approaches to the Study of Female Religious Institutions in Colonial Mexico
Authors: Chowning Margaret
Published: September 2008

This article serves as an introduction to the subject of the colonial Mexican convent for non‐experts, while surveying recent historiographical trends. In the past ten years, historical scholarship on nuns and convents has taken three broad directions. First, historians have begun to study other female religious institutions and other kinds of religious women than cloistered convents and nuns, though the number of works that explicitly compare these institutions and experiences is still disappointingly small. Second, historians have focused on the understudied sixteenth‐ and late eighteenth‐century convents, with the result that we are beginning to gain a textured understanding of how the convent changed over time and responded to changes in the world around it. Third, the older feminist scholarship that tended to characterize the convent as either ‘good’ or ‘bad’ for women – that is, either less subject to patriarchal maneuverings than the outside world, or more so – is being complicated by more subtle approaches that take nuns’ spirituality and the dynamics of community seriously. We are beginning to build a picture of a complex institution that still tells us much about women's experience in the colonial period, but also tells us a great deal about the institutional church and about the religious values of the broader society.
The Uncertain Death of Edward II?
Authors: Hamilton J.S.
Published: September 2008

The traditional account of the death of Edward II of England says that he died, probably murdered on the order of Roger Mortimer, 1st earl of March, at Berkeley Castle on September 21, 1327, and was buried at Gloucester Abbey on December 20, 1327. Rumors of his survival circulated soon after his death. Historians, particularly Ian Mortimer, have recently challenged the traditional view of the death of Edward II, suggesting that he did not die at Berkeley and was not buried at Gloucester in 1327. This article surveys the historical literature and evidence concerning the death of Edward II and concludes by endorsing the traditional view.
The Virtual and the Real: The Case of the Mysterious Documents from Naples
Authors: Andrien Kenneth
Published: September 2008

In 1996 Laura Laurencich Minelli, an archeologist at the University of Bologna announced the existence of a privately held series of documents and artifacts, known as the Naples documents,1 which claimed to undermine historical consensus about the Inca Empire, the Spanish Conquest of the Andes, and the well‐known historical sources. Most of the Naples documents were purportedly written by an enigmatic mestizo Jesuit, Blas Valera, whose works defending Inca culture and language had long been thought lost. These documents have created a series of acrimonious scholarly controversies over the authenticity of the Naples documents. The burden of proving the authenticity of the Naples documents, however, must lie with Laurencich Minelli and their other advocates, and to date, they have not done so.
The Role of Rumour in History Writing
Authors: Ghosh Anjan
Published: September 2008

As anonymously generated, unverifiable speech that flourishes in contingent situations, rumour can be a potent source of historical representation. Associated with subaltern historiography of South Asia, its ambiguity also makes it amenable for misinformation and elite machinations.
Kanak Experiences of WWI: New Caledonia's Tirailleurs, Auxiliaries and ‘Rebels’
Authors: Muckle Adrian
Published: September 2008

Kanak, the indigenous Melanesians of New Caledonia, experienced the First World War as tirailleurs, auxiliaries and ‘rebels’. As volunteer tirailleurs, in 1916–18, Kanak fought and died in France and New Caledonia in the service of the French colonial administration. As ‘rebels’ many Kanak also died fighting against the French army and its Kanak auxiliaries in the north of New Caledonia in 1917–18 (the ‘1917’ revolt). Until the end of the twentieth century these varied experiences were largely ignored in local (New Caledonian), regional (Pacific islands) and international (French colonial) historiography. However, as New Caledonia acquires greater political autonomy and seeks to develop a local citizenship incorporating Kanak and New Caledonian identity within the French Republic, interest in New Caledonia's participation in the Great War has grown. A central issue is the extent to which recent writing and commemorations adequately take into account Kanak experiences and acknowledge the war fought in New Caledonia and its legacy.
Cerebral MRI abnormalities associated with vigabatrin therapy
Authors: Pearl Phillip L. , Vezina Louis G. , Saneto Russell P. , McCarter Robert , Molloy‐Wells Elizabeth , Heffron Ari , Trzcinski Stacey , McClintock William M. , Conry Joan A. , Elling Nancy J. , Goodkin Howard P. , De Menezes Marcio Sotero , Ferri Raymond , Gilles Elizabeth , Kadom Nadja , Gaillard William D.
Published: September 2008

Purpose: Investigate whether patients on vigabatrin demonstrated new‐onset and reversible T2‐weighted magnetic resonance imaging (MRI) abnormalities.

Methods: MRI of patients treated during vigabatrin therapy was reviewed, following detection of new basal ganglia, thalamus, and corpus callosum hyperintensities in an infant treated for infantile spasms. Patients were assessed for age at time of MRI, diagnosis, duration, and dose, MRI findings pre‐, on, and postvigabatrin, concomitant medications, and clinical correlation. These findings were compared to MRI in patients with infantile spasms who did not receive vigabatrin.

Results: Twenty‐three patients were identified as having MRI during the course of vigabatrin therapy. After excluding the index case, we detected new and reversible basal ganglia, thalamic, brainstem, or dentate nucleus abnormalities in 7 of  22  (32%) patients treated with vigabatrin. All findings were reversible following discontinuation of therapy. Diffusion‐weighted imaging (DWI) was positive with apparent diffusion coefficient (ADC) maps demonstrating restricted diffusion. Affected versus unaffected patients, respectively, had a median age of 11 months versus 5 years, therapy duration 3 months versus 12 months, and dosage  170  mg/kg/day versus 87 mg/kg/day. All affected patients were treated for infantile spasms; none of 56 patients with infantile spasms who were not treated with vigabatrin showed the same abnormalities.

Discussion: MRI abnormalities attributable to vigabatrin, characterized by new‐onset and reversible T2‐weighted hyperintensities and restricted diffusion in thalami, globus pallidus, dentate nuclei, brainstem, or corpus callosum were identified in 8 of 23 patients. Young age and relatively high dose appear to be risk factors.
The Association of ADH and ALDH Gene Variants With Alcohol Drinking Habits and Cardiovascular Disease Risk Factors
Authors: Husemoen Lise Lotte Nystrup , Fenger Mogens , Friedrich Nele , Tolstrup Janne Schurmann , Beenfeldt Fredriksen Stine , Linneberg Allan
Published: September 2008

Background:  Genetic variation in ethanol metabolism may have an influence on both alcohol drinking habits and the susceptibility to health effects of alcohol drinking. Such influences are likely to bias exposure‐disease associations in epidemiologic studies of health effects of alcohol drinking. In a Caucasian population, we examined the association of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) genetic variants with alcohol drinking habits, biomarkers of alcohol exposure, and risk factors for cardiovascular disease.

Methods:  The study population consisted of 1,216 Danish men and women aged 15–77 years participating in a health examination in 1998. The health examination included a self‐administered questionnaire (alcohol drinking habits), a physical examination (blood pressure), and various blood tests [alanine aminotransferase (ALAT), erythrocyte mean corpuscular volume (E‐MCV), and lipids]. ADH and ALDH gene variants were determined by standard techniques. Data were analyzed by regression analyses adjusted for relevant confounders.

Results:  Self‐reported alcohol drinking was significantly associated with increasing levels of ALAT, E‐MCV, high‐density lipoprotein cholesterol, and blood pressure. The ALDH1b ala69val variant was associated with nondrinking and total alcohol intake. The ALDH2 promoter variant was associated with binge‐drinking, and the ALDH1b1 ala69val polymorphism was associated with diastolic blood pressure. We did not find any statistically significant interactions between any of the gene variants and alcohol consumption in relation to the various outcomes.

Conclusions:  In this Caucasian population sample, we found evidence to support that genetic variation in ethanol metabolism may influence drinking habits, but no statistically significant gene‐environment interactions. More large‐scale epidemiologic studies are needed to confirm theses results and to further investigate genetic susceptibility to the effects of alcohol drinking.
Ferroportin q248h, Dietary Iron, and Serum Ferritin in Community African‐Americans With Low to High Alcohol Consumption
Authors: Gordeuk Victor R. , Diaz Sharmin F. , Onojobi Gladys O. , Kasvosve Ishmael , Debebe Zufan , Edossa Amanuel , Pantin Jeremy M. , Xiong Shigang , Nekhai Sergei , Nouraie Mehdi , Tsukamoto Hidekazu , Taylor Robert E.
Published: September 2008

Background:  Alcohol consumption is associated with increased iron stores. In sub‐Saharan Africa, high dietary ionic iron and the ferroportin Q248H allele have also been implicated in iron accumulation. We examined the associations of ferroportin Q248H, alcohol and dietary iron with serum ferritin, aspartate aminotransaminase (AST) and alanine aminotransaminase (ALT) concentrations in African‐Americans.

Methods:  Inner‐city African‐Americans (103 men, 40 women) were recruited from the community according to reported ingestion of >4 alcoholic drinks/d or <2/wk. Typical daily heme iron, nonheme iron and alcohol were estimated using University of Hawaii’s multiethnic dietary questionnaire. Based on dietary questionnaire estimates we established categories of < versus ≥56 g alcohol/d, equivalent to 4 alcoholic drinks/d assuming 14 g alcohol per drink.

Results:  Among 143 participants, 77% drank <56 g alcohol/d and 23%≥56 g/d as estimated by the questionnaire. The prevalence of ferroportin Q248H was 23.3% with alcohol >56 g/d versus 7.5% with lower amounts (p = 0.014). Among subjects with no history of HIV disease, serum ferritin concentration had positive relationships with male gender (p = 0.041), alcohol consumption (p = 0.021) and ALT concentration (p = 0.0001) but not with dietary iron intake or ferroportin Q248H. Serum AST and ALT concentrations had significant positive associations with male gender and hepatitis C seropositivity but not with alcohol or dietary iron intake or ferroportin Q248H.

Conclusions:  Our findings suggest a higher prevalence of ferroportin Q248H with greater alcohol consumption, and this higher prevalence raises the possibility that the allele might ameliorate the toxicity of alcohol. Our results suggest that alcohol but not dietary iron contributes to higher body iron stores in African‐Americans. Studies with larger numbers of participants are needed to further clarify the relationship of ferroportin Q248H with the toxicity of alcohol consumption.
Aripiprazole Effects on Alcohol Consumption and Subjective Reports in a Clinical Laboratory Paradigm—Possible Influence of Self‐Control
Authors: Voronin Konstantin , Randall Patrick , Myrick Hugh , Anton Raymond
Published: September 2008

Introduction:  There has been increasing interest in the use of medications that affect the dopamine receptor in the treatment of alcoholism. Aripiprazole has the unique pharmacology of being a partial dopamine agonist serving to stabilize brain dopamine systems in both frontal cortical and subcortical areas. As such, it might act to dampen alcohol reinforcement and craving and/or alter control over alcohol use. The current clinical laboratory study was conducted to evaluate the safety and efficacy of aripiprazole as a potential agent to alter drinking and objective effects of alcohol.

Methods:  Thirty nontreatment seeking alcoholics were enrolled in a subacute human laboratory study and received double‐blind treatment with up to 15 mg of aripiprazole (n = 15) or identical placebo (n = 15) for 8 days. Tolerability and utility of aripiprazole was monitored during natural drinking over the first 6 days of medication treatment and also during a free choice limited access alcohol consumption paradigm following an initial drink of alcohol in a bar‐lab setting on Day 8.

Results:  Aripiprazole was well tolerated and reduced drinking in nontreatment seeking alcoholics over 6 days of natural drinking—especially in those with lower self control (more impulsive). It also reduced drinks in the bar‐lab after a priming drink and broke the link between priming drink induced stimulation and further drinking. During the bar‐lab drinking session, there were no differences in subjective high, intoxication, or craving between subjects treated with aripiprazole or placebo.

Discussion:  This study joins several others in demonstrating the utility of subacute dosing laboratory paradigms for evaluating medication effects in alcoholics. Aripiprazole was well tolerated and lowered alcohol use, especially in those with lower impulse control. Further study is needed to determine the safety and utility of aripiprazole in the treatment of alcoholism and if subgroups of alcoholics are more likely to respond.
An Ecological Assessment of the Population and Environmental Correlates of Childhood Accident, Assault, and Child Abuse Injuries
Authors: Freisthler Bridget , Gruenewald Paul J. , Ring Lori , LaScala Elizabeth A.
Published: September 2008

Background:  This study examines the relationships of population and environmental characteristics to hospital discharges for childhood accident, assault, and child abuse injuries among youth from 0 to 17 years of age.

Methods:  The analysis uses aggregate data on populations and environments in 1,646 California zip code areas that were collected for the year 2000. Zero inflated negative binomial models were used to assess ecological relationships between these characteristics and numbers of hospital discharges for childhood injuries from accidents and assaults; negative binomial models were used to assess these relationships for injuries related to child abuse.

Results:  A number of different characteristics were related to the different injury outcomes. Childhood accident injuries were related to measures female headed households, adult to child ratio, and nonalcohol retail establishments (e.g., numbers of gas stations). Assault injuries were related to measures of poverty and vacant housing. All 3 outcomes were directly related to percent of female‐headed households, percent African American residents, and density of off‐premise alcohol outlets.

Conclusions:  The results demonstrate that both population and environmental characteristics are significantly correlated with rates of childhood injuries. These results suggest that some environmental characteristics, in particular the presence of many off‐premise alcohol outlets in neighborhoods, may reduce the overall level of guardianship of children’s activities in zip code areas, resulting in harm to their children.
Ethanol Self‐Administration Is Regulated by CB1 Receptors in the Nucleus Accumbens and Ventral Tegmental Area in Alcohol‐Preferring AA Rats
Authors: Malinen Hanna , Hyytiä Petri
Published: September 2008

Background:  Endogenous cannabinoids and their receptors, CB1 receptors in particular, have been implicated in mediation of ethanol reinforcement. Previously, suppression of ethanol drinking by CB1 antagonists has been demonstrated in many experimental paradigms. However, the exact mechanism by which CB1 antagonists modulate ethanol drinking remains elusive. In the present study, we assessed the role of CB1 receptors within the key regions of the mesolimbic dopamine pathway, the nucleus accumbens (NAcc) and ventral tegmental area (VTA), in regulation of ethanol self‐administration.

Methods:  Adult male alcohol‐prefer AA rats were trained to self‐administer either 10% (w/v) ethanol or 0.1% (w/v) saccharin under an FR1 schedule during daily 30‐minute sessions. Following stable baseline responding, rats were tested after systemic administration of the CB1 antagonist SR141716A (0 to 10 mg/kg) and the agonist WIN55,212‐2 (0 to 2 mg/kg). Separate groups of rats were implanted with bilateral cannulas aimed at the NAcc or VTA, and tested after microinjections of SR141716A (0 to 3 μg) and WIN55,212‐2 (0 to 5 μg) into the NAcc or VTA. The highest intracerebral doses were tested also in rats responding for a 0.1% saccharin solution.

Results:  SR141617A dose‐dependently suppressed ethanol responding after systemic administration. Microinjections of SR141617A both into NAcc and VTA attenuated ethanol responding. In addition, intra‐NAcc injections of SR141617A suppressed saccharin intake. Although low doses of systemically given WIN55,212‐2 increased ethanol responding, no effects were seen after WIN55,212‐2 microinjections into NAcc or VTA.

Conclusions:  Bidirectional changes in ethanol self‐administration by the systematically administered CB1 agonist and antagonist show that ethanol reinforcement is controlled by CB1 receptors in alcohol‐preferring AA rats. Replication of the suppressive effects by CB1 antagonism in the NAcc and VTA suggests that endocannabinoids and their receptors mediate ethanol reinforcement through interaction with the mesolimbic dopamine pathway.
Acute Effects of Acamprosate and MPEP on Ethanol Drinking‐in‐the‐Dark in Male C57BL/6J Mice
Authors: Gupta Tripta , Syed Yaqoob M. , Revis Andrew A. , Miller Samantha A. , Martinez Marina , Cohn Kellen A. , Demeyer Michael R. , Patel Kevin Y. , Brzezinska Weronika J. , Rhodes Justin S.
Published: September 2008

Background:  Recently, a simple procedure in mice, Drinking‐in‐the‐Dark (DID), was hypothesized to have value for medication development for human alcoholism. In DID, mice are offered intermittent, limited access to ethanol over a series of days during the dark phase that results in rapid drinking to intoxication in predisposed genotypes.

Methods:  We measured the effects of acamprosate or MPEP, metabotropic glutamate 5 receptor (mGluR5) antagonist, on intake of 20% ethanol, plain tap water or 10% sugar water using the DID procedure in male C57BL/6J mice.

Results:  Acamprosate (100, 200, 300, or 400 mg/kg) dose dependently decreased ethanol drinking with 300 mg/kg reducing ethanol intake by approximately 20% without affecting intake of plain water or 10% sugar water. MPEP (1, 3, 5, 10, 20, or 40 mg/kg) was more potent than acamprosate with 20 mg/kg reducing ethanol intake by approximately 20% and for longer duration without affecting intake of plain water or 10% sugar water.

Conclusions:  These results support the hypothesis that mGluR5 signaling plays a role in excessive ethanol intake in DID and suggest DID may have value for screening novel compounds that reduce overactive glutamate signaling for potential pharmaceutical treatment of excessive ethanol drinking behavior.
The Pain Associates' International Network Initiative: A Novel Practical Approach to the Challenge of Chronic Pain Management in Europe
Authors: Morlion Bart , Walch Heribert , Yihune Gabriel , Vielvoye‐Kerkmeer Ans , De Jong Zuzana , Castro‐Lopes José , Stanton‐Hicks Michael
Published: September 2008

Chronic pain is a debilitating condition with a multidimensional impact on the lives of patients, their families and communities. The public health burden of chronic pain is gathering recognition as a major healthcare problem in its own right and deserves closer attention. The challenge in treating chronic pain is to provide effective clinical management of a complex, multifaceted set of conditions that require a coordinated strategy of care. Epidemiological data and patient surveys have highlighted the areas of pain management that might be improved. These include a need for better understanding and documentation of the symptoms of chronic pain, standardized levels of care, improved communication among clinical personnel and with patients, and an updated education program for clinicians. For these reasons, new strategies aimed at improving the standards of pain management are needed. The Pain Associates' International Network (P.A.I.N.) Initiative was set up to devise practical methods for improving the quality of pain management for patients. These strategies have recently been put into practice through a number of activities: P.A.I.N. Workshops are meetings of international pain management professionals dedicated to discussing current management strategies and producing consensus recommendations for improving standards of care; P.A.I.N. Quality is a unique software program designed to help treating clinicians to document patient data and derive effective treatment plans; P.A.I.N. Online provides a web site forum for discussion of pain management topics; and P.A.I.N. Management is a clinician education program providing up‐to‐date training in pain management.
Factorial and Construct Validity of the Revised Short Form Integrative Psychotherapy Alliance Scales for Family, Couple, and Individual Therapy
Authors: PINSOF WILLIAM M. , ZINBARG RICHARD , KNOBLOCH‐FEDDERS LYNNE M.
Published: September 2008

The Integrative Psychotherapy Alliance model brought an interpersonal and systemic perspective to bear on theory, research, and practice on the psychotherapeutic alliance. Questions have been raised about the independence of the theoretical factors in the model and their operationalization in the Individual, Couple, and Family Therapy Alliance Scales. This paper presents results of a confirmatory factor analysis of the scales that delineated at least three distinct interpersonal factors as well as shorter versions of the three scales to facilitate their use in research and practice. The paper also presents the results of a study testing each factor's association with client retention and progress over the first eight sessions in individual and couple therapy. At least two of the interpersonal factors were uniquely associated with progress in individual and couple functioning. Implications of the results for theory, research, practice, and training in individual, couple, and family therapy are elaborated.
Maternal Distress and Women's Reentry into Family and Community Life
Authors: ARDITTI JOYCE , FEW APRIL
Published: September 2008

This paper advances conceptualization of maternal distress following incarceration. We utilized a multiple case study methodology based on interviews with 10 mothers who demonstrated various permutations of “the triple threat” (depression, domestic violence, and substance abuse; Arditti & Few, 2006). Findings suggest that depressive symptomology persisted and worsened for mothers in our study and that maternal distress was indicative not only of women's psychological state, but also a relational and situational construct that embodied women's core experience. Maternal distress was largely characterized by health challenges, dysfunctional intimate relationships, loss related trauma, guilt and worry over children, and economic inadequacy. Further, maternal distress seemed to be intensified by the punitive traumatic context of prison and lessened by rehabilitation opportunities as well as support by kin and probation officers after reentry. Recommendations for clinicians and professionals who work with reentry mothers center around the need to alleviate maternal distress and better address women's emotional and physical health needs during incarceration and reentry.
“Motherhood Starts in Prison”: The Experience of Motherhood Among Women in Prison
Authors: SHAMAI MICHAL , KOCHAL RINAT‐BILLY
Published: September 2008

This study aims to explore the way in which women prisoners in Israel experience motherhood in prison and construct their motherhood after being released. In‐depth interviews were conducted with 9 women, and the data were analyzed according to the phenomenological approach. The qualitative methodology generated 5 main themes: (a) motherhood in prison as a motive for survival; (b) the sense of failure experienced by mothers in prison; (c) coping versus avoidance in the mother‐child relationship during imprisonment; (d) motherhood in prison as a motive for change; and (e) the transition from questioning the right to be a mother to redeeming motherhood. The 5 themes were organized into a model that depicts the process of becoming a mother in prison and the move toward mending the experience of motherhood. The findings indicate that side by side with the traumatic experiences of prison are other aspects that allow for growth and rehabilitation. The discussion focuses on 2 main issues that evolved from the findings: the reasons for the change in motherhood that occurs during imprisonment and the aspects of prison that enable this change.
Involving Caregiving Grandmothers in Family Interventions when Mothers with Substance Use Problems are Incarcerated
Authors: ENGSTROM MALITTA
Published: September 2008

The alarming rate of incarceration of women disproportionately affects women of color, frequently intersects with the women's substance use problems, and often results in grandmothers providing care for their grandchildren during their daughters' incarceration. Numerous factors complicate the grandmothers' caregiving experiences and contribute to strains that exceed those typically associated with grandparent caregiving. Such complicating factors include the stresses associated with their daughters' substance use problems and incarceration; the complex biopsychosocial needs of many of their grandchildren; the challenging relational issues they must address; and often, the long‐term, multifaceted effects of poverty. Despite the critical roles they play, the multiple vulnerabilities they face, and the potential for multigenerational, culturally relevant family interventions to yield gains for all three generations, grandmothers have received little attention in intervention research with this group of families. This paper provides a theoretical and empirical rationale for the inclusion of caregiving grandmothers in interventions and research with families affected by maternal incarceration and substance use problems, in general, and for the promise of multifamily groups, in particular. Strategies for tailoring multifamily groups with this population of families are also included.
Learning From the Past, Altering the Future: A Tentative Theory of the Effect of Past Relationships on Couples Who Remarry
Authors: BRIMHALL ANDREW , WAMPLER KAREN , KIMBALL THOMAS
Published: September 2008

Using grounded theory methodology 16 participants, each in a second marriage as a result of divorce, were interviewed individually and with their partner. Participants were asked to describe how their first marriages were currently affecting their second. Trust was the central category that emerged. From this central category 3 additional categories surfaced: lack of trust in the previous relationship, attempts to increase trust while dating, and presence of trust in the current relationship. Participant feedback, internal and external auditors, and the existing literature were all used to validate the results. A tentative theory, complete with provisional hypotheses, was developed that could help clinicians address some of the challenges described by couples who remarry.
An Exploration of Lived Religion in Same‐Sex Couples from Judeo‐Christian Traditions
Authors: ROSTOSKY SHARON SCALES , RIGGLE ELLEN D. B. , BRODNICKI CAROLYN , OLSON AMBER
Published: September 2008

Religious involvement has been found to be associated with higher levels of commitment and relationship satisfaction among heterosexually married individuals (Mahoney et al., 1999). Little is known, however, about the religiosity of gay, lesbian, bisexual (GLB) individuals, and virtually nothing is known about religious involvement in same‐sex couples. The purpose of this qualitative interview study was to examine couples' experiences of incorporating religious involvement into their committed relationships. In a sample of 14 same‐sex couples, we found that couples used their spiritual/religious values to understand and undergird their relationships. In this process, they negotiated intra‐couple differences in religious practices, involved themselves in activities that have religious or spiritual meaning to them, created religious social support for their relationships, and experienced some non‐supportive or rejecting interpersonal interactions with religious family members, congregants, and strangers. These findings are instructive to therapists who work with same‐sex couples and the family members of GLB individuals. We conclude with specific suggestions for practitioners.
Coarsening Behavior of Round‐Edged Cubic Grains in the Na1/2Bi1/2TiO3–BaTiO3System
Authors: Moon Kyoung‐Seok , Kang Suk‐Joong L.
Published: September 2008

The coarsening behavior of 0.95Na1/2Bi1/2TiO3–0.05BaTiO3(mole fraction, NBT–5BT) grains has been investigated with respect to the grain shape and compared with a calculation based on crystal growth theories. The powder compacts of NBT–5BT were sintered at 1200°C for various times up to 96 h. The shape of growing grains was a cube with flat {100} faces and rounded edges. The coarsening behavior during sintering up to a few hours was quite normal. However, with an increased sintering time, the relative grain size distribution broadened and apparently abnormal grains appeared. The abnormal grain coarsening behavior intensified and then decreased during extended sintering. This result shows that the coarsening behavior of partially faceted grains changes continuously with sintering time. Grain size distributions were also calculated under the assumption that the growth of grains was governed by the growth of facet planes with a low step free energy. The calculation showed the broadening of relative size distribution, the formation of abnormal grains, and then eventually narrowing of the distribution. This agreement between the measured and calculated distributions suggests the growth of round‐edged polyhedral grains to be governed by the growth of facet planes, which can occur via step formation and growth on the facets.