bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermomechanical-Phase Transformation Simulation of High-Strength Steel in Hot Stamping
Authors: Wu Wenhua , Hu Ping , Shen Guozhe
Published: May 2015

The thermomechanical-phase transformation coupled relationship of high-strength steel has important significance in forming the mechanism and numerical simulation of hot stamping. In this study a new numerical simulation module of hot stamping is proposed, which considers thermomechanical-transformation multifield coupled nonlinear and large deformation analysis. In terms of the general shell finite element and 3D tetrahedral finite element analysis methods related to temperature, a coupled heat transmission model for contact interfaces between blank and tools is proposed. Meanwhile, during the hot stamping process, the phase transformation latent heat is introduced into the analysis of temperature field. Next the thermomechanical-transformation coupled constitutive models of the hot stamping are considered. Static explicit finite element formulae are adopted and implemented to perform the full numerical simulations of the hot stamping process. The hot stamping process of typical U-shaped and B-pillar steel is simulated using the KMAS software, and a strong agreement comparison between temperature, equivalent stress, and fraction of martensite simulation and experimental results indicates the validity and efficiency of the hot stamping multifield coupled constitutive models and numerical simulation software KMAS. The temperature simulated results also provide the basic guide for the optimization designs of cooling channels in tools.
Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives
Authors: Shiovitz Stacey , Bansal Aasthaa , Burnett-Hartman Andrea N. , Karnopp Andrew , Adams Scott V. , Warren-Mears Victoria , Ramsey Scott D.
Published: May 2015

Background: Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/AN). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic whites (NHW) with metastatic cancer.

Methods: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed between 2001 and 2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services was compared between AI/ANs and NHWs. Minimally adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (OR) and hazard ratios (HR) for receipt of care.

Results: AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a nonurban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference [fully-adjusted HR, 0.94; 95% confidence interval (CI), 0.83–1.08]. We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR, 0.78; 95% CI, 0.61–0.99).

Conclusion: Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted.

Impact: Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services. Cancer Epidemiol Biomarkers Prev; 24(7); 1138–43. ©2015 AACR.
Management of Cytomegalovirus Seroconversion during Pregnancy in France
Authors: Carrara Julie , N'Diaye Dieynaba S. , Azria Elie , Launay Odile , Rozenberg Flore , Yazpandanah Yazdan , Tsatsaris Vassilis , Ayoubi Jean-Marc , Picone Olivier
Published: May 2015

Introduction: Guidelines for the management of cytomegalovirus (CMV) infection of the fetus are rare. Our main objective was to evaluate how health care practitioners in France manage cases of CMV seroconversion during pregnancy. Material and Methods: A questionnaire was e-mailed to health care practitioners potentially concerned by CMV seroconversion during pregnancy. They were asked if they would recommend amniocentesis, fetal cerebral MRI examination and fetal blood analysis (FBA), depending on the ultrasound results. They then had to indicate whether they would accept termination of pregnancy (TOP), depending on the results of these examinations. Results: A total of 380 health care practitioners responded, mainly obstetricians (73.9%) and midwives (20.2%). Overall, 57% of respondents recommended amniocentesis in the case of CMV seroconversion during the first trimester of pregnancy, ultrasound findings being normal. In cases of positive amniocentesis and a major ultrasound abnormality, 84.5% of respondents would perform cerebral MRI, and 44.4% would perform FBA. In this case, the rate of acceptance of TOP was not significantly different whether the examinations were normal (337/372, 90.6%) or not performed (339/374, 93.3%; p = 0.17). Discussion: Amniocentesis is too infrequently used and should be encouraged. The results of MRI and FBA are often not taken into account in the final decision concerning TOP. Guidelines are needed to clarify the management of CMV seroconversion during pregnancy.
Safety of Cryo-Transbronchial Biopsy in Diffuse Lung Diseases: Analysis of Three Hundred Cases
Authors: Gershman Evgeni , Fruchter Oren , Benjamin Fox , Nader Abed Rahman , Rosengarten Dror , Rusanov Victoria , Fridel Ludmila , Kramer Mordechai R.
Published: May 2015

Background: Transbronchial biopsy (TBB) which is performed with metal forceps (forceps TBB) has been accepted as a useful technique in establishing diagnoses of diffuse lung diseases (DLDs). The use of cryoprobes to obtain alveolar tissue (cryo-TBB) is a new method which is currently used by our institute as well as others with excellent results. Objectives: To assess the safety of cryo-TBB compared with conventional forceps TBB. Methods: We performed a retrospective data evaluation of 300 consecutive patients who underwent cryo-TBB between January 2012 and April 2014 and compared them with historical cases treated with forceps TBB between 2010 and 2012. The results of both diagnostic modalities were compared based on pathological reports. The major complications (significant bleeding and pneumothorax) were compared, along with postprocedural hospitalization. Results: Pneumothorax was observed in 15 cases (4.95%) treated with cryo-TBB versus 9 cases (3.15%) treated with forceps TBB, with no significant difference (p = 0.303). The insertion of a chest tube was necessary in 6 (2%) and 4 (1.3%) of the cases having undergone cryo-TBB or forceps TBB, respectively (p = 0.8). In the cryo-TBB group, bleeding was encountered in 16 cases (5.2%), and it occurred in 13 cases (4.5%) of the forceps TBB group, with no significant difference in rates (p = 0.706). Also, there was no significant difference in hospital admission rates between the groups [cryo-TBB: 10 (3.3%); forceps TBB: 4 (1.44%); p = 0.181]. The safety profile of cryo- and forceps TBB remained the same even when stratified according to indications for TBB, i.e. immunocompromised hosts, patients after lung transplantation and those with DLDs. Conclusion: In patients with DLDs, cryo-TBB is as safe as forceps TBB.
Smad3 Signaling Promotes Fibrosis While Preserving Cardiac and Aortic Geometry in Obese Diabetic Mice
Authors: Biernacka Anna , Cavalera Michele , Wang Junhong , Russo Ilaria , Shinde Arti , Kong Ping , Gonzalez-Quesada Carlos , Rai Vikrant , Dobaczewski Marcin , Lee Dong-Wook , Wang Xiao-Fan , Frangogiannis Nikolaos G.
Published: May 2015

Background—

Heart failure in diabetics is associated with cardiac hypertrophy, fibrosis and diastolic dysfunction. Activation of transforming growth factor-β/Smad3 signaling in the diabetic myocardium may mediate fibrosis and diastolic heart failure, while preserving matrix homeostasis. We hypothesized that Smad3 may play a key role in the pathogenesis of cardiovascular remodeling associated with diabetes mellitus and obesity.

Methods and Results—

We generated leptin-resistant db/db Smad3 null mice and db/db Smad3+/− animals. Smad3 haploinsufficiency did not affect metabolic function in db/db mice, but protected from myocardial diastolic dysfunction, while causing left ventricular chamber dilation. Improved cardiac compliance and chamber dilation in db/db Smad3+/− animals were associated with decreased cardiomyocyte hypertrophy, reduced collagen deposition, and accentuated matrix metalloproteinase activity. Attenuation of hypertrophy and fibrosis in db/db Smad3+/− hearts was associated with reduced myocardial oxidative and nitrosative stress. db/db Smad3 null mice had reduced weight gain and decreased adiposity associated with attenuated insulin resistance, but also exhibited high early mortality, in part, because of spontaneous rupture of the ascending aorta. Ultrasound studies showed that both lean and obese Smad3 null animals had significant aortic dilation. Aortic dilation in db/db Smad3 null mice occurred despite reduced hypertension and was associated with perturbed matrix balance in the vascular wall.

Conclusions—

Smad3 mediates diabetic cardiac hypertrophy, fibrosis, and diastolic dysfunction, while preserving normal cardiac geometry and maintaining the integrity of the vascular wall.
Kansas City Cardiomyopathy Questionnaire Score Is Associated With Incident Heart Failure Hospitalization in Patients With Chronic Kidney Disease Without Previously Diagnosed Heart Failure
Authors: Mishra Rakesh K. , Yang Wei , Roy Jason , Anderson Amanda H. , Bansal Nisha , Chen Jing , DeFilippi Christopher , Delafontaine Patrice , Feldman Harold I. , Kallem Radhakrishna , Kusek John W. , Lora Claudia M. , Rosas Sylvia E. , Go Alan S. , Shlipak Michael G.
Published: May 2015

Background—

Chronic kidney disease is a risk factor for heart failure (HF). Patients with chronic kidney disease without diagnosed HF have an increased burden of symptoms characteristic of HF. It is not known whether these symptoms are associated with occurrence of new onset HF.

Methods and Results—

We studied the association of a modified Kansas City Cardiomyopathy Questionnaire with newly identified cases of hospitalized HF among 3093 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study who did not report HF at baseline. The annually updated Kansas City Cardiomyopathy Questionnaire score was categorized into quartiles (Q1–4) with the lower scores representing the worse symptoms. Multivariable-adjusted repeated measure logistic regression models were adjusted for demographic characteristics, clinical risk factors for HF, N-terminal probrain natriuretic peptide level and left ventricular hypertrophy, left ventricular systolic and diastolic dysfunction. Over a mean (±SD) follow-up period of 4.3±1.6 years, there were 211 new cases of HF hospitalizations. The risk of HF hospitalization increased with increasing symptom quartiles; 2.62, 1.85, 1.14, and 0.74 events per 100 person-years, respectively. The median number of annual Kansas City Cardiomyopathy Questionnaire assessments per participant was 5 (interquartile range, 3–6). The annually updated Kansas City Cardiomyopathy Questionnaire score was independently associated with higher risk of incident HF hospitalization in multivariable-adjusted models (odds ratio, 3.30 [1.66–6.52];
P
=0.001 for Q1 compared with Q4).

Conclusions—

Symptoms characteristic of HF are common in patients with chronic kidney disease and are associated with higher short-term risk for new hospitalization for HF, independent of level of kidney function, and other known HF risk factors.
Refractory Hypertension
Authors: Dudenbostel Tanja , Acelajado Maria C. , Pisoni Roberto , Li Peng , Oparil Suzanne , Calhoun David A.
Published: May 2015

Refractory hypertension is an extreme phenotype of treatment failure defined as uncontrolled blood pressure in spite of ≥5 classes of antihypertensive agents, including chlorthalidone and a mineralocorticoid receptor antagonist. A prospective evaluation of possible mechanisms of refractory hypertension has not been done. The goal of this study was to test for evidence of heightened sympathetic tone as indicated by 24-hour urinary normetanephrine levels, clinic and ambulatory heart rate (HR), HR variability, arterial stiffness as indexed by pulse wave velocity, and systemic vascular resistance compared with patients with controlled resistant hypertension. Forty-four consecutive patients, 15 with refractory and 29 with controlled resistant hypertension, were evaluated prospectively. Refractory hypertensive patients were younger (48±13.3 versus 56.5±14.1 years;
P
=0.038) and more likely women (80.0 versus 51.9%;
P
=0.047) compared with patients with controlled resistant hypertension. They also had higher urinary normetanephrine levels (464.4±250.2 versus 309.8±147.6 µg per 24 hours;
P
=0.03), higher clinic HR (77.8±7.7 versus 68.8±7.6 bpm;
P
=0.001) and 24-hour ambulatory HR (77.8±7.7 versus 68.8±7.6;
P
=0.0018), higher pulse wave velocity (11.8±2.2 versus 9.4±1.5 m/s;
P
=0.009), reduced HR variability (4.48 versus 6.11;
P
=0.03), and higher systemic vascular resistance (3795±1753 versus 2382±349 dyne·s·cm
5
·m
2
;
P
=0.008). These findings are consistent with heightened sympathetic tone being a major contributor to antihypertensive treatment failure and highlight the need for effective sympatholytic therapies in patients with refractory hypertension.
Elevated Endothelial Hypoxia-Inducible Factor-1α Contributes to Glomerular Injury and Promotes Hypertensive Chronic Kidney Disease
Authors: Luo Renna , Zhang Weiru , Zhao Cheng , Zhang Yujin , Wu Hongyu , Jin Jianping , Zhang Wenzheng , Grenz Almut , Eltzschig Holger K. , Tao Lijian , Kellems Rodney E. , Xia Yang
Published: May 2015

Hypertensive chronic kidney disease is one of the most prevalent medical conditions with high morbidity and mortality in the United States and worldwide. However, early events initiating the progression to hypertensive chronic kidney disease are poorly understood. We hypothesized that elevated endothelial hypoxia-inducible factor-1α (HIF-1α) is a common early insult triggering initial glomerular injury leading to hypertensive chronic kidney disease. To test our hypothesis, we used an angiotensin II infusion model of hypertensive chronic kidney disease to determine the specific cell type and mechanisms responsible for elevation of HIF-1α and its role in the progression of hypertensive chronic kidney disease. Genetic studies coupled with reverse transcription polymerase chain reaction profiling revealed that elevated endothelial HIF-1α is essential to initiate glomerular injury and progression to renal fibrosis by the transcriptional activation of genes encoding multiple vasoactive proteins. Mechanistically, we found that endothelial HIF-1α gene expression was induced by angiotensin II in a nuclear factor-κB–dependent manner. Finally, we discovered reciprocal positive transcriptional regulation of endothelial
Hif-1α
and
Nf-κb
genes is a key driving force for their persistent activation and disease progression. Overall, our findings revealed that the stimulation of
HIF-1α
gene expression in endothelial cells is detrimental to induce kidney injury, hypertension, and disease progression. Our findings highlight early diagnostic opportunities and therapeutic approaches for hypertensive chronic kidney disease.
Effect of Surface Fluxes versus Radiative Heating on Tropical Deep Convection
Authors: Anber Usama , Wang Shuguang , Sobel Adam
Published: May 2015

The effects of turbulent surface fluxes and radiative heating on tropical deep convection are compared in a series of idealized cloud-system-resolving simulations with parameterized large-scale dynamics. Two methods of parameterizing the large-scale dynamics are used: the weak temperature gradient (WTG) approximation and the damped gravity wave (DGW) method. Both surface fluxes and radiative heating are specified, with radiative heating taken as constant in the vertical in the troposphere. All simulations are run to statistical equilibrium.

In the precipitating equilibria, which result from sufficiently moist initial conditions, an increment in surface fluxes produces more precipitation than an equal increment of column-integrated radiative heating. This is straightforwardly understood in terms of the column-integrated moist static energy budget with constant normalized gross moist stability. Under both large-scale parameterizations, the gross moist stability does in fact remain close to constant over a wide range of forcings, and the small variations that occur are similar for equal increments of surface flux and radiative heating.

With completely dry initial conditions, the WTG simulations exhibit hysteresis, maintaining a dry state with no precipitation for a wide range of net energy inputs to the atmospheric column. The same boundary conditions and forcings admit a rainy state also (for moist initial conditions), and thus multiple equilibria exist under WTG. When the net forcing (surface fluxes minus radiative heating) is increased enough that simulations that begin dry eventually develop precipitation, the dry state persists longer after initialization when the surface fluxes are increased than when radiative heating is increased. The DGW method, however, shows no multiple equilibria in any of the simulations.
Origin and Flow History of Air Parcels in Orographic Banner Clouds
Authors: Schappert Sebastian , Wirth Volkmar
Published: May 2015

Banner clouds are clouds in the lee of steep mountains or sharp ridges. Previous work suggests that the main formation mechanism is vertical uplift in the lee of the mountain. On the other hand, little is known about the Lagrangian behavior of air parcels as they pass the mountain, which motivates the current investigation. Three different diagnostics are applied in the framework of large-eddy simulations of airflow past an isolated pyramid-shaped obstacle: Eulerian tracers indicating the initial positions of the parcels, streamlines along the time-averaged wind field, and online trajectories computed from the instantaneous wind field.

All three methods diagnose a plume of large vertical uplift in the immediate lee of the mountain. According to the time-mean Eulerian tracers, the cloudy parcels originated within a fairly small coherent area at the inflow boundary. In contrast, the time-mean streamlines indicate a bifurcation into two distinct classes of air parcels with very different characteristics. The parcels in the first class originate at intermediate altitudes, pass the obstacle close to its summit, and proceed directly into the cloud. By contrast, the parcels in the second class start at low altitude and take a fairly long time before they reach the cloud on a spiraling path. A humidity tracer quantifies mixing, revealing partial moistening for the first class of parcels and drying for the second class of parcels. For the online trajectories, the originating location of parcels is more scattered, but the results are still consistent with the basic features revealed by the other two diagnostics.
Constraints on Cumulus Parameterization from Simulations of Observed MJO Events
Authors: Del Genio Anthony D. , Wu Jingbo , Wolf Audrey B. , Chen Yonghua , Yao Mao-Sung , Kim Daehyun
Published: May 2015

Two recent activities offer an opportunity to test general circulation model (GCM) convection and its interaction with large-scale dynamics for observed Madden–Julian oscillation (MJO) events. This study evaluates the sensitivity of the Goddard Institute for Space Studies (GISS) GCM to entrainment, rain evaporation, downdrafts, and cold pools. Single Column Model versions that restrict weakly entraining convection produce the most realistic dependence of convection depth on column water vapor (CWV) during the Atmospheric Radiation Measurement MJO Investigation Experiment at Gan Island. Differences among models are primarily at intermediate CWV where the transition from shallow to deeper convection occurs. GCM 20-day hindcasts during the Year of Tropical Convection that best capture the shallow–deep transition also produce strong MJOs, with significant predictability compared to Tropical Rainfall Measuring Mission data. The dry anomaly east of the disturbance on hindcast day 1 is a good predictor of MJO onset and evolution. Initial CWV there is near the shallow–deep transition point, implicating premature onset of deep convection as a predictor of a poor MJO simulation. Convection weakly moistens the dry region in good MJO simulations in the first week; weakening of large-scale subsidence over this time may also affect MJO onset. Longwave radiation anomalies are weakest in the worst model version, consistent with previous analyses of cloud/moisture greenhouse enhancement as the primary MJO energy source. The authors’ results suggest that both cloud-/moisture-radiative interactions and convection–moisture sensitivity are required to produce a successful MJO simulation.
The Positive North Atlantic Oscillation with Downstream Blocking and Middle East Snowstorms: The Large-Scale Environment
Authors: Luo Dehai , Yao Yao , Dai Aiguo , Feldstein Steven B.
Published: May 2015

In this study, the atmospheric conditions for the December 2013 Middle East snowstorm are examined from a case study perspective and by performing a composite analysis of extreme winter events from 1950 to 2013 using reanalysis data. It is revealed that this snowstorm arises from the occurrence of an omega (Ω)-type European blocking (EB) with a strong downstream trough that is associated with a southward-displaced positive-phase North Atlantic Oscillation (NAO+) event. In the anomaly field, the EB exhibits a northeast–southwest (NE–SW)-tilted dipole structure. The Ω-type EB transports cold air into the Middle East and produces snowfall within the trough over the Middle East.

The composite analysis shows that the location of cold temperatures depends strongly on the tilting direction and strength of the EB dipole anomaly. The NE–SW [northwest–southeast (NW–SE)]-tilted EB dipole occurs with a southward (northward)-displaced NAO+ event. The NE–SW-tilted EB dipole anomaly is associated with an arching-type low-frequency wave train that spans the North Atlantic, Europe, and the Middle East. This tilting has the most favorable structure for cold air outbreaks over the Middle East and southeastern Europe because this tilting leads to an intense downstream trough over this region. In contrast, a NW–SE-tilted EB dipole anomaly leads to cold temperatures over northwestern Africa and southwestern Europe. The analyses herein also suggest that a strong jet over the North Atlantic may be a precursor for a southward-displaced NAO+ event that is usually associated with an Ω-type EB with a NE–SW-tilted dipole in the anomaly height field that favors a cold air outbreak over the Middle East.
Estimates of Ocean Macroturbulence: Structure Function and Spectral Slope from Argo Profiling Floats
Authors: McCaffrey Katherine , Fox-Kemper Baylor , Forget Gael
Published: May 2015

The Argo profiling float network has repeatedly sampled much of the World Ocean. This study uses Argo temperature and salinity data to form the tracer structure function of ocean variability at the macroscale (10–1000 km, mesoscale and above). Here, second-order temperature and salinity structure functions over horizontal separations are calculated along either pressure or potential density surfaces, which allows analysis of both active and passive tracer structure functions. Using Argo data, a map of global variance is created from the climatological average and each datum. When turbulence is homogeneous, the structure function slope from Argo can be related to the wavenumber spectrum slope in ocean temperature or salinity variability. This first application of structure function techniques to Argo data gives physically meaningful results based on bootstrapped confidence intervals, showing geographical dependence of the structure functions with slopes near ⅔ on average, independent of depth.
An Analysis of the Temporal Evolution of ENSO Prediction Skill in the Context of the Equatorial Pacific Ocean Observing System
Authors: Kumar Arun , Chen Mingyue , Xue Yan , Behringer David
Published: May 2015

Subsurface ocean observations in the equatorial tropical Pacific Ocean dramatically increased after the 1990s because of the completion of the TAO moored array and a steady increase in Argo floats. In this analysis the question explored is whether a steady increase in ocean observations can be discerned in improvements in skill of predicting sea surface temperature (SST) variability associated with El Niño–Southern Oscillation (ENSO)? The analysis is based on the time evolution of skill of sea surface temperatures in the equatorial tropical Pacific since 1982 based on a seasonal prediction system. It is found that for forecasts up to a 6-month lead time, a clear fingerprint of increases in subsurface ocean observations is not readily apparent in the time evolution of prediction skill that is dominated much more by the signal-to-noise consideration of SSTs to be predicted. Finding no clear relationship between an increase in ocean observations and prediction skill of SSTs, various possibilities for why it may be so are discussed. This discussion is to motivate further exploration on the question of the tropical Pacific observing system, its influence on the skill of ENSO prediction, and the capabilities of the current generation of coupled models and ocean data assimilation systems to take advantage of ocean observations.
Association Between Kidney Dysfunction and Carotid Atherosclerosis in Community-Based Older Adults in China
Authors: Gu Xiang , Fang Xianghua , Hua Yang , Tang Zhe , Ji Xunming , Guan Shaochen , Wu Xiaoguang , Liu Hongjun , Liu Beibei , Wang Chunxiu , Zhang Zhongying
Published: May 2015

We investigated the association between kidney dysfunction and carotid atherosclerosis in community-based older adults. This study consisted of 1257 participants, aged 55 years and older and free of cardiovascular disease. Kidney dysfunction was classified as mild, moderate, and severe (estimated glomerular filtration rate, 45-59, 30-44, and <30 mL/min/1.73 m2, respectively). We found that the mean common carotid artery intima–media thickness (CCA-IMT) progressively increased with decrement in kidney function ( P < .001). Even mild kidney dysfunction was significantly associated with CCA-IMT thickening (CCA-IMT ≥1.0 mm; odds ratio [OR] 1.52; 95% confidence interval [CI] 1.16-1.99) compared to normal kidney function. A significantly increased presence of heterogeneous plaque was observed in relation to decreased kidney function ( P for trend = .011), that is, even a mild kidney dysfunction was a potential independent risk factor for heterogeneous plaque (OR 1.43; 95% CI 1.04-1.98). Mild kidney dysfunction may be a predictor of early or accelerated carotid atherosclerosis in older adults.
Electoral Authoritarianism and Human Development
Authors: Miller Michael K.
Published: May 2015

Do autocratic institutions matter for the welfare of average citizens? Despite the large literature comparing democracies and autocracies, we know little about how human development outcomes differ among autocratic types. Contrary to conventional wisdom, this article argues that contested autocratic elections promote human development by improving state accountability and capacity. Using an instrumental variables setup, I show that the presence and history of multiparty autocratic elections predict significantly better outcomes on health, education, gender equality, and basic freedoms relative to non-electoral autocracy. In fact, the effects on health and education are as strong as the effects of democracy. In contrast, legislatures and parties without multiparty elections produce slightly negative outcomes because these institutions chiefly concern elite cooptation. The results have major implications for the study of autocracy, the political economy of development, and the welfare effects of international election promotion.
The Public Debate on Life and Death Choices: A Response from a Jewish Hospital Chaplain
Authors: Toback Phyllis Brooks
Published: May 2015

Addresses the issue of life and death choices from the perspective of a Jewish chaplain. Explores the tension between the law ( Halachah) and experience or story ( Aggadah) and the impact of that tension on lives and decisions. Cites persons and situations from biblical material, oral tradition, and modern times which illustrate the human struggle with these disputed issues. Explores different levels of pain and our understanding of and response to suffering. Invites reflection on the range of responses to pain that are humanly possible. Illustrates how meaning in life nurtures the desire to live. Claims this meaning aspect is not adequately addressed in the current dialogue. Focusses on the role of chaplains in listening and responding to persons and in helping to activate the impulse of hope. Suggests ways in which chaplains can be advocates for patients, prophetic voices within communities and institutions, and empowering of the gifts of others.
Objects and Idols: The Significance of Internal Object Relationships for the Religious Quest
Authors: Crosswell Arthur G.
Published: May 2015

Advances the thesis that H. R. Niebuhr's theology provides a theological context in which the landscape described by object relations theory can be placed, illustrating the thesis with case material.
Where there is Hope, there is Life: Toward a Biology of Hope
Authors: Richardson Robert L.
Published: May 2015

Argues the thesis that where there is hope there is life. Grounds this thesis philosophically and theologically, then reviews it from the medical and nursing literature, and illustrates it in a vignette of hospital ministry. Argues that hope can enhance the quality and even the quantity of life. Proposes that hope helps people to deal with their feelings and to cope with their illness. Hope affects immunity and survival. Challenges chaplains, pastoral counselors, and parish clergy to become more effective “agents of hope.”
Agape and Moral Meaning in Pastoral Counseling
Authors: Robinson Simon J.
Published: May 2015

Argues that the essential key in authentically understanding pastoral counseling and moral meaning is the experience and concept of agape. Details four aspects of agape and illustrates them via clinical examples taken from survivors of childhood sexual abuse.
When the Caregiver Needs Care: A Review of an Interdisciplinary Team Response to Stressful Events in a Tertiary Care Setting
Authors: Haines Richard B. , Cohen Bobbye T.
Published: May 2015

Describes how a hospital established and utilized a Critical Incident Stress Management Team (CISM) and the role of the chaplain in the interdisciplinary team.
Delight: A Discourse upon the Spiritual Function of the Psyche
Authors: Denney Mike
Published: May 2015

Reflects upon a series of personal experiences of a numinous nature and how they impacted the author's traumatic childhood and led him into a life of healing as a physician.
Contexts for Understanding Forgiveness and Repentance as Discovery: A Pastoral Care Perspective
Authors: Hill E. Wayne , Mullen Paul M.
Published: May 2015

Conceptualizes forgiveness and repentance from a discovery process paradigm and examines various contexts for understanding and facilitating the forgiveness/repentance process. Suggests a “body/mind/spirit” connection with implications for pastoral care and counseling.
The Hopeful Pessimist: Christian Pastoral Theology in a Pessimistic Context
Authors: Grenz Stanley J.
Published: May 2015

Notes that contemporary caregivers minister in a situation characterized not only by cultural pessimism, but also by the decline of Christian pastoral theology. Argues that the current renewal in theology, which involves a shift to nonfoundationalism, holds promise for a corresponding renewal in pastoral theology that could lead to a retrieval of the unique grammar of the Christian practitioner; namely, the language of hope. Opines that nonfoundationalist Christian pastoral theology would set forth a hope that is particular, eschatological, and pessimistic in contrast to the foundationalist hope with its focus on the hopeful human person, a hope that is directed beyond the human toward the God of the Bible who promises life from the dead.
Vinegar and Oil: Are the Moral/Ethical Decision Processes by Professional Prison Chaplains Superior to Hospital Chaplains?
Authors: Tribe Roy M. G. , Romeril Jeannine D.
Published: May 2015

Reports research with chaplains from the Federal Bureau of Prisons and the Department of Veteran's Affairs concerning the impact a prison setting or a hospital setting may have in meeting the dilemmas often encountered in the areas or moral and ethical decision making.
Students' Perspectives: A Canadian Study of Supervised Pastoral Education
Authors: Trothen Tracy J.
Published: May 2015

Summarizes and analyses the findings of a research study that was commissioned and supported by CAPPE and The Churches' Council on Theological Education in Canada. Surveys students who were completing a basic unit in Supervised Pastoral Education (SPE) to identify the self-perceived effects of the unit on pastoral functioning. Utilizes qualitative and quantitative methods, focus group sessions, consultations, and a literature search to develop a questionnaire which was distributed to eligible students via the Internet. Draws several conclusions that suggest re-examination, further study or program changes, and validates the central focus of SPE basic units on self-awareness and experiential learning
Utilizing a JCAHO Review in the Education of Clinical Pastoral Education CPE Residents
Authors: Valentino John
Published: May 2015

Reflects on how a pastoral care department utilized a Joint Commission review in the education of five pastoral care residents enrolled in their third unit of Clinical Pastoral Education in a medical center. Outlines how residents prepared for the review, the learning opportunities for residents and medical staff, the outcomes, and the recommendations.
Pastoral Counselors, Educators, and Clowns
Authors: Gilliam W. Craig
Published: May 2015

Examines the relationship between the pastoral counselor and educator and does so by exploring a metaphor suggested by a story by Carol Rogers about the famous circus clown, Otto Griebling. Illustrates each professional's duty to “draw or lead out” of his or her client or student, just as a clown does with an audience. Contends that pastoral counseling and education include “drawing or leading out” resources that are within the client/student, which is critical to the healing and/or learning process. Notes that assisting the client/student in developing his or her ability to draw out this inner resource is fundamental to the counselor's or educator's task of empowering the client or student to become mature, responsible individuals. Suggests that seeing one's relationship to the clown, a counselor or educator can be freed to facilitate this drawing out which ultimately benefits the client, student, and community.
Care for the Caregiver: Effective Pastoral Support for Nursing Home Staff
Authors: Pullman Daryl , James-Abra Bill
Published: May 2015

Notes that the contexts in which caregivers work shape the kinds of relationships they develop with those under their care. Suggests that it is possible to map these contextual features on a continuum with detached professionalism and involved familialism representing the extremes. Claims that nursing home staff are more akin to family members in their relationships with residents than are other professional caregivers who work in acute care settings. Sketches possible implications as to how recognizing and responding to these relational dynamics may influence specific modes of care.
A Collaborative Pastoral Care and Counseling Supervisory Model
Authors: Hill E. Wayne
Published: May 2015

Presents a collaborative pastoral care and counseling supervisory model based on constructivism and attachment theories. Addresses issues concerning cognition, learning theory, and anxiety. Identifies the stages in the supervisory process. Discusses ways in which cognitive, emotional, and social development are linked to attachment theory and places this in the context of supervision in pastoral counseling. Reflects on the theological relevance of attachment theory utilizing the biblical parable of the prodigal son.
Self-Reported Value of Spiritual Issues among Adolescent Psychiatric Inpatients
Authors: Grossoehme Daniel H.
Published: May 2015

Reports on a survey of a prospective, uncontrolled sample of adolescent psychiatric inpatients on the importance of spiritual issues to them. Results indicated that the vast majority of adolescents in this sample indicated that spiritual beliefs are considered important. Notes that a majority reported that mental health professionals rarely asked them about their beliefs in the spiritual areas. Observes that nearly all the patients reported having a chaplain-led spiritual group that they perceived as a helpful part of the therapeutic milieu.
Using a Modification of the Classic Drama Triangle to Enhance Pastoral Care
Authors: Hasty Cathy
Published: May 2015

Describes the Drama Triangle of Victim-Persecutor-Rescuer conceptual model and suggests helpful ways to use it in order to understand and intervene in the difficult situations often encountered by pastors, pastoral counselors, and chaplains. Attempts to join this conceptual model to a theological understanding of persons to deepen self-examination, ground pastoral identity, and enhance pastoral competence.
The Congregational Setting of Pastoral Counseling: A Study of Pastoral Counseling Theorists from 1949–1999
Authors: Stone Howard W.
Published: May 2015

Examines, through content analysis, the major authors in the field of pastoral counseling since 1949 with the goal to determine the degree to which pastoral counseling theory in the second half of the twentieth century attended to the context of parish ministry. Reports on trends in the field's orientation and notes that a particular viewpoint, or range of viewpoints, has driven the core of pastoral counseling theory and methodology. Attempts to answer the question, Does the literature of pastoral counseling address the counseling situations typically encountered by congregational pastors and provide an adequate methodology suited to the context of parish ministry?
Hope and Possibility: Envisioning the Future in Pastoral Conversation
Authors: Stone Howard , Lester Andrew
Published: May 2015

Claims that engendering hope is key in all pastoral conversation, because hope is the Christian perspective on every aspect of life—its low points as well as its peaks. Argues that clergy in the pastoral caregiving role need to foster a kind of hope that recognizes actuality (past) but also steps directly into the future by exercising freedom in the present—by taking action. Opines that to do so, pastoral caregivers need to grasp the central importance of thinking about the future and of envisioning hopeful outcomes to human well-being, and they need as well to offer specific care and counseling methods that will nourish hope in troubled people. Presents a series of methods for pastoral conversation that enliven hope, that help people focus on the future and thus engender hope.
Quantity and Rigor of Qualitative Research in Four Pastoral Counseling Journals
Authors: O'Connor Thomas St. James , Meakes Elizabeth , Davis Katherine , Koning Fred , McLarnon-Sinclair Kelly , Loy Vanessa
Published: May 2015

Examines the quantity (N=26) and rigor of qualitative research in The Journal of Pastoral Care, Pastoral Sciences, Journal of Religion and Health, and Pastoral Psychology for 1993–1997. Defines qualitative research using the work of Douglas Sprenkle and Sidney Moon. Uses the eleven criteria developed by Nicholas Mays and Catherine Pope in British Medical Journal for judging rigor. Finds low quantity and mixed quality and discusses implications.
The Use of Sacred Story in a Psychiatry Spirituality Group
Authors: Kidd Robert A. , Maripolsky Virginia , Smith Patricia P.
Published: May 2015

Describes the philosophy and methodology for using sacred stories from several religious traditions with psychiatric patients. Notes how chaplains are integrated into a psychiatric unit's interdisciplinary team. Details how sacred stories are selected for use in a spirituality group, how patients are screened for participation, and how the group is facilitated. Demonstrates the benefit and value patients and staff derive from a spirituality group on a psychiatric unit.
A Pastoral Perspective on Pain Management
Authors: Ledbetter Timothy J.
Published: May 2015

Describes and illustrates the author's 5Triads of Pastoral Perspective and how it may provide a particular pastoral approach on the understanding of pain and its management. Notes as well various types of complementary resources for managing and coping with pain.
Becoming Multicultural Dancers: The Pastoral Practitioner in a Multicultural Society
Authors: Lee K. Samuel
Published: May 2015

Uses a dance metaphor in describing pastoral practice. Describes multicultural realities of the United States and argues for the multicultural competencies in the practice of ministry. Details three challenges to overcome: 1) unintentional racism, 2) making visible the invisibility of monoculturalism and “Whiteness,” and 3) embracing the complexity of multicultural lived realities.
A Death and a Community: Case Conference
Authors: Mitchell Kenneth R.
Published: May 2015

Case of a dying teen-age girl is presented. The reactions of the hospital chaplain, the local minister, the girl's family, and the home community are critiqued by four experts in pastoral care and counseling.
Memorial Service as Part of the Deeded Body Program
Authors: Belgum David
Published: May 2015

A special service is offered for people who have willed their bodies to medical facilities. The service is designed to show respect for the deceased and meet the emotional needs of the family.
Reverence for the Humanity of the Dying: The Hospice Prescription*
Authors: Franco Vincent W.
Published: May 2015

Presents a rationale for the hospice program as a service program attempting to help dying patients in the spiritual quest for wholeness and dignity. Gives the historic origins of the hospice movement, its philosophy and its adoption in North America. Describes the hospice team and the functions of its members.
The High Priest, the Day of Atonement and the Preparation for Psychotherapy
Authors: Charry Dana
Published: May 2015

Four aspects of the Jewish High Priest's preparation for the Day of Atonement are examined and parallels suggested for the psychotherapist in preparation for working with her or his patient. The purpose of the Day of Atonement was for purifying from sin and restoration of harmony with God. Sees psychotherapy as having similar purposes which can be facilitated with similar preparations.
The Positive Contribution of Black Cultural Values to Pastoral Counseling
Authors: Lattimore Vergel L.
Published: May 2015

Argues that pastoral counseling with black persons requires cultural adaptations at several crucial points. Understanding of the positive contribution of black persons' collective identity, family life, work orientation, and improvisation as a life style is essential for an adequate pastoral counseling method. Pastoral counseling demands a commitment to understanding and sharing the struggles of individuals within the context of their culture and community.
Babel—Legion—Pentecost
Authors: Ashbrook James B.
Published: May 2015

Describes the practice of pastoral counseling as a language game through the use of three biblical symbols: Babel, Legion, and Pentecost. The first two images describe the human problem; the latter, the possibility of salvation. The salvation image, Pentecost, suggests that communicating the positive dimensions of human wholeness is always a kind of madness which must be communicated in “odd” or indirect ways.
A Woman on the Docks
Authors: Lammers Ann Conrad
Published: May 2015

Reflects on an experience by a woman chaplain who worked for a summer at the Seamen's Church Institute in New York and New Jersey. First she experienced humiliation, rejection, sexist sterotypes. Later she wrestled with the tension of being a woman in a male dominated dock area. The world aboard ship presented a more polite yet equally difficult situation. Shares several vignettes of shipboard encounters.
Mental Health and the Care of the Soul in Mid-Life
Authors: Chessick Richard D.
Published: May 2015

Presents the case of a forty-eight year old woman to illustrate the dynamics frequently found in middle-life depressions which often form the basis for the so-called mid-life crisis. Drawing on notions of the soul found in the writings of Plato and Aristotle, it is argued that these concepts are particularly important in orienting both psychotherapist and patient to a vital perspective especially helpful in dealing with midlife issues.
Hearing and Doing the Word: An Integrated Approach to Bible Study in a Maximum Security Prison
Authors: Phillipy David A.
Published: May 2015

Describes a Bible study approach being used with prison inmates. Utilizing Meichen-baum's theory of cognitive restructuring and Ellis' theory of Rational-Emotive Therapy, scriptural readings are presented in ways that increase their functional values in real life situations.
Desensitization: Using Classical Conditioning in Pastoral Counseling
Authors: George Rickey L.
Published: May 2015

Describes and illustrates the use of desensitization with a variety of clients. Outlines training in deep muscle relaxation, the construction of anxiety hierarchies, and the simultaneous presentation of relaxing and anxiety-eliciting stimuli.
Clinical Pastoral Counseling: An Australian Model
Authors: Sotheren Douglas I.
Published: May 2015

Describes a model of clinical pastoral counseling developed in a rural area of Australia. Levels of functions in the model include those of pastoral care, pastoral counseling, clinical pastoral counselor, and psychotherapist. Notes the tensions between evangelical theology and humanistic therapy and how these are expressed in supervision.
International Conferences on Pastoral Care and Counseling
Authors: Becher Werner
Published: May 2015

Summarizes the major themes and spirit of the international conferences which were held in Arnoldshain in 1972, Rüschlikon in 1975, Eisenach in 1977, and Edinburgh in 1979.
Pastoral Psychology: Group and Symbol
Authors: Scharfenberg Joachim
Published: May 2015

Offers a personal reflection on the European Conference of Pastoral Care and Counselling held in Lublin, Poland, in 1981; and suggests how the depthful meanings experienced there helped to define the theme, “Story Telling and Symbol in Pastoral Care,” for the Internation Conference to be held in San Francisco in 1983.
The AAPC: The Beginning Years, 1963–1965
Authors: Vanwagner Charles A.
Published: May 2015

Tells the story of the first three years of the development of the American Association of Pastoral Counselors (AAPC) during which the organizational structure, standards, code of ethics, and position statements were hammered out through vigorous debate and intense committee activity.
Toward a Cosmological Foundation for Pastoral Care
Authors: Schmidt William S.
Published: May 2015

Examines the cosmologies of classical science and indicates their limitations as foundational for contemporary pastoral care. Describes the idea of an interconnected universe as envisioned by modern physics and claims that it is a new order which is ably expressed by David Bohm's notion of “undivided wholeness in flowing movement.” Claims that this new order brings with it different meanings to such terms as matter, consciousness, and spirit. Notes implications for modern pastoral care.