bluuebunny/crossref_metadata_2025 huggingface dataset:
Intersection Modeling for Highway Alignment Optimization
Authors: Kim Eungcheol , Jha Manoj K. , Lovell David J. , Schonfeld Paul
Published: January 2004

Abstract:  When optimizing a highway alignment, it is desirable to consider new and modified intersections along it. This article develops methods for locally optimizing intersections within highway alignment optimization processes. Design and operational characteristics for intersections are reviewed from the literature. The formulation considers the major costs that are sensitive to intersection characteristics. Genetic algorithms are used for optimal search. The proposed methods are implemented on an artificial study area and on a real one through the use of geographic information systems. The results show how the methods work for local optimization of intersections as well as for optimizing entire alignments. These methods can be used for improving search flexibility, thus allowing more effective intersections. They also provide a basis for extending the alignment optimization from single highways to networks.
Object‐Oriented Model for Freeway Work Zone Capacity and Queue Delay Estimation
Authors: Jiang Xiaomo , Adeli Hojjat
Published: January 2004

Abstract:  Existing computer models used to estimate queue delay upstream of the work zone have a number of shortcomings. They do not provide any model to estimate work zone capacity, which has a significant impact on the congestion and traffic queue delays. They cannot be used to perform scenario analysis for work zones with various characteristics such as work zone layout, number of closed lanes, work intensity, and work time. In this article, an object‐oriented (OO) model is presented for freeway work zone capacity and queue delay and length estimation. The model is implemented into an interactive software system, called IntelliZone, using Microsoft Foundation Classes (MFC) and a hierarchy of multiple specialized frameworks. A three‐layer application architecture is created to separate the application functions and classes from MFC classes. The high‐level application domain layer is divided into packages. IntelliZone's capacity estimation engine is based on pattern recognition and neural network models incorporating a large number of factors impacting the work zone capacity. This research provides the foundation for a new generation of advanced decision support systems for effective management of traffic at work zones.
National Security, Terrorism and Constitutional Balance
Authors: Lustgarten Laurence
Published: January 2004

The 'war on terrorism' engages all the institutions of the state. A constitutional structure devoted to protection of liberty must place a paramount value on separation of powers, and a parliamentary democratic constitution should ensure that the ultimate locus of responsibility rests in the legislature, the only branch which has a direct connection to the citizens. However, in an ironic reversal of practice that prevailed before the coming of mass democracy, Parliament in the UK since the early twentieth century has largely accepted a supine role compared to the executive in matters of 'national security'. The judiciary, despite the enactment of legally enforceable human rights, has also manifestly failed to exercise its proper function of curbing abuses of state power. The result is an over‐mighty executive, able to draw upon the deference of other branches of government in prosecuting the 'war on terrorism' on the battlefield and in the statute book, which has trampled on individual rights with virtually no check or counte‐balance. Some principles by which the balance might be restored are suggested.
The American Right and the Framing of 9/11
Authors: Durham Martin
Published: January 2004

On September 11th, 2001, 2 hijacked airliners were crashed into the World Trade Center and a third into the Pentagon. The Bush administration's response, both in regard to civil liberties at home and the launching of military action abroad, has been the subject of considerable controversy. As we might expect, the Bush administration's framing of events met with acclaim among many on the American right But here, as elsewhere on the political spectrum, how to understand and react to 9/11 was also the subject of bitter dispute, a dispute that sheds new light on the ongoing arguments among American conservatives in the aftermath of the Cold War.
Monarchy and Democracy: A Progressive Agenda
Authors: Harvey Adrian
Published: January 2004

The Blair governments since 1997 have seen the single most significant period of constitutional reform in Britain for over a century. However, they leave the monarchy, the institution at the apex of the unwritten constitution, untouched. It is argued that neither inaction nor abolition is advisable, but that reform should be undertaken, with particular attention to the rules of succession and to the royal prerogative powers, notable examples being the powers to declare war, to dismiss parliament, to assent to legislation and to appoint the Prime Minister. Those powers now exercised by the executive should be formally and linguistically separated from the office of head of state, and put on a statutory basis. The achievement of these reforms depends, however, on political will and cannot be initiated by the monarchy itself.
Steady State or Second Order? The 2003 Elections to the National Assembly for Wales
Authors: McAllister Laura
Published: January 2004

This article examines the second National Assembly for Wales election in May 2003. It focuses on the campaign and results, examining the relationship between the process and dynamics of devolution, and identifiable significant shifts in Welsh politics. It compares the 2003 results with those in the first election in 1999 and isolates a number of phenomena, such as turnout and support for the parties most closely associated with the region, that help establish whether the second election signals a return to 'traditional' voting or whether there remains a pattern associated with so‐called 'second order' ballots.
The Complexity of ‘Political Islamism’
Authors: Mondal Anshuman A.
Published: January 2004

Books reviewed

The Future of Political Islam
, by Graham Fuller. Palgrave. 228pp. £19.99.

Secularism, Islam and Modernity: Selected Essays of Alam Khundmiri, edited by M. T. Ansari. Sage. 308pp. £29.99.

Law and Power in the Islamic World, by Sami Zubaida. I. B. Tauris. 248pp. £35.00.

Islamic Leviathan: Islam and the Making of State Power, by Seyyed Vali Reza Nasr. Oxford University Press. 220pp. £33.99.

False Necessity: Anti‐Necessitarian Social Theory in the Service of Radical Democracy, by Roberto Mangabeira Unger. Verso. cxxix + 661pp. £28.00.

Preachers of Hate: The Rise of the Far Right, by Angus Roxburgh. Gibson Square Books. 312pp. £18.99.

A Mandarin's Tale, by Roy Denman. Politico's. 282pp. £20.00.

The Macmillan Diaries: The Cabinet Years, 1950–1957, edited with an introduction by Peter Catterall. Macmillan. 676pp. £25.00.

Memoirs from the Left, by John Saville. Merlin. 197pp. £14.95 (pb).

Zones of Conflict: US Foreign Policy in the Balkans and the Greater Middle East, by Vassilis Fouskas. Pluto Press. 177pp. £45.00 (hb), £14.99 (pb).
(In)Direct Binding
Authors: Boeckx Cedric
Published: January 2004

Abstract. This paper provides a syntactic configuration for the licensing of donkey anaphors that is common to virtually all other cases of variable binding, viz. c‐command. To achieve this, I am led to refine the notion of “adjunct”; in particular, the status of the if‐clause in conditionals. I argue for the well‐foundedness of such an attempt by establishing a detailed parallelism between donkey anaphors and parasitic gaps. It is shown that recent accounts of parasitic gaps in terms of sideward movement (Nunes 1995, 2001) can also capture the core properties of donkey anaphora. If correct, the arguments presented here strengthen the derivational approach to syntactic relations pursued in much recent work, and the recent attempts to capture rules of construal via movement operations (Hornstein 2000, Kayne 2002, Boeckx 2001).
Extreme Locality in Madurese Wh‐Questions
Authors: Davies William D.
Published: January 2004

Abstract. This article investigates the apparently three types of wh‐questions in Madurese—wh in situ, overt wh‐movement, and partial wh‐movement—and argues that the three are actually instantiations of a single wh‐in‐situ strategy and that the relation between the wh‐element and its operator obeys extreme locality. An analysis is proposed in which overt long distance and partial wh‐movement are actually reflexes of A‐movement to subject position in a proleptic‐object construction. Madurese wh‐phenomena are situated in term of Cole and Hermon's (1998) typology of wh‐movement. It is further suggested here that movement across clause boundaries is illicit in Madurese.
Theory of Multiple Intelligences: Is it a Scientific Theory?
Authors: Chen Jie-Qi
Published: January 2004

This essay discusses the status of multiple intelligences (MI) theory as a scientific theory by addressing three issues: the empirical evidence Gardner used to establish MI theory, the methodology he employed to validate MI theory, and the purpose or function of MI theory.
Multiple Intelligences: Its Tensions and Possibilities
Authors: Eisner Elliot W.
Published: January 2004

This article explores the tensions between Howard Gardner's theory of multiple intelligences and current educational policies emphasizing standardized and predictable outcomes. The article situates Gardner's theory within the historical interests among psychometricians in identifying those core processes that constitute human intelligence. Gardner's theory of multiple intelligences provides a significant contrast to the models of mind that have traditionally been used to understand how people think and make intelligent choices. The pursuit of a single G factor is contrasted with an array of specific intelligences in Gardner's conception. The implications of Gardner's view for education pertain to the cultivation of the various ways in which humans reflect intelligently and the implicit recommendation that individual proclivities, interests, and intelligences be cultivated. Such an approach to schooling would yield differences among the outcomes for children whose intelligences differed. It is this orientation to the aims of education that conflicts dramatically with a standards-driven approach to school improvement.
How MI Informs Teaching at New City School
Authors: Hoerr Tom
Published: January 2004

This paper captures the use of the theory of multiple intelligences (MI) at the New City School. The implementation began in 1988 and has been characterized by a focus on student assessment and the personal intelligences. Enhanced faculty collegiality has been a product of the MI journey.
“Can I Pick More than One Project?” Case Studies of Five Teachers who Used Mi-Based Instructional Planning
Authors: Hickey M. Gail
Published: January 2004

Five middle grades teachers developed and implemented Mi-based units of instruction. Participants experienced varying levels of collegial support for Mi-based instruction, found students both embraced and avoided learning choices, noted importance of students’ realizing their own personal learning strength(s), and reported motivation for continued MI use in instructional planning.
Mindful Curriculum Leadership for Students with Attention Deficit Hyperactivity Disorder: Leading in Elementary Schools by Using Multiple Intelligences Theory (SUMIT)
Authors: Schirduan Victoria , Case Karen
Published: January 2004

Broadly based, mindful curriculum leadership encompasses a way of leading toward school improvement by taking into consideration student intelligences as an at-promise phenomenon. This research paper provides an example of how elementary school curriculum leaders can be mindful of student intelligences and use the strengths of their student populations.
Multiple Intelligences and Learning Styles: Two Complementary Dimensions
Authors: Denig Stephen J.
Published: January 2004

This paper compares the theories of multiple intelligences and learning styles to suggest ways that teachers using a combination of both theories may be able to improve student learning over the range of intelligences. The author proposes a research format for the benefit of future research.
Teacher Education and Multiple Intelligences: A Case Study of Multiple Intelligences and Teacher Efficacy in Two Teacher Preparation Courses
Authors: Shore Jane R.
Published: January 2004

This instrumental collective case study provides an in-depth description of the change that transpired in two multiple intelligence (MI)–based graduate-level teacher preparation courses. Qualitative and quantitative data were collected and analyzed. Implications for MI in teacher education are discussed.
Assessing the 20-Year Impact of Multiple Intelligences on Schooling
Authors: Cuban Larry
Published: January 2004

The article analyzes one claim that I make about Howard Gardner's work on MI: Multiple intelligences has had the greatest influence on educators’ beliefs and talk about differences in children's intelligence, moderate to high influence on the formal curriculum and instructional materials, and least influence on mainstream teaching and assessment practices. Based on that analysis, I ask and answer one question: Why has the influence of MI been highest on educators’ beliefs and language and least on classrooms practices ?
Using a Multiple Intelligences Assessment to Promote Teacher Development and Student Achievement
Authors: Shearer C. Branton
Published: January 2004

This article addresses three interrelated propositions. First, a valid and reliable assessment for the multiple intelligences (MI) can be created. Second, teachers can use this MI profile to better understand, accept and create Mi-inspired instruction and curriculum. Third, an MI profile can be used by both teachers and students to promote the use of strength-based learning activities to enhance instructional practice as well as personal development. Evidence gathered during two phases of research over a period of 7 years is supportive of these three propositions.

In contrast to a “testing society”, I think that the assessment approach and the individual-centered school constitute a more noble educational vision. I define assessment as the obtaining of information about the skills and potentials of individuals, with the dual goals of providing useful feedback to the individuals and useful data to the surrounding community. Gardner (1993, p. 183)
Learner-Centered Instruction and the Theory of Multiple Intelligences with Second Language Learners
Authors: Haley Marjorie Hall
Published: January 2004

In an effort to understand learner-centered instruction from the perspective of multiple intelligences (MI), the purpose of this second teacher action research study was to further investigate the use of MI theory in shaping and informing instructional strategies, curricula development, and alternative forms of assessment with second language learners. My premise was that given what we know about the educational needs of second language learners, all teachers must be better equipped to widen their pedagogical repertoire to accommodate linguistically, culturally, and cognitively diverse students. Results of the study indicated that students did achieve greater success rates when the MI theory was implemented.
Integrating the Revised Bloom's Taxonomy with Multiple Intelligences: A Planning Tool for Curriculum Differentiation
Authors: Noble Toni
Published: January 2004

Both the special education and gifted education literature call for a differentiated curriculum to cater for the wide range of student differences in any classroom. Gardner's theory of multiple intelligences was integrated with the revised Bloom's taxonomy to provide a planning tool for curriculum differentiation. Teachers’ progress in using the tool to plan and implement units of work through learning centers was documented over 18 months in two small elementary schools. They reported greater confidence in their ability to broaden their curriculum and cater for different students’ strengths across the multiple intelligences and intellectually challenge their students using first the original and then the revised taxonomy. The teachers saw their students as more successful learners as a result of this curriculum differentiation.
Audiences for the Theory of Multiple Intelligences*
Authors: Gardner Howard
Published: January 2004

In his closing comments, Howard Gardner discusses the various audiences that have emerged over the years for the theory of multiple intelligences. Under that rubric, he places the various papers in this issue and speculates about future lines of work on MI theory.
Rapid assessment in conservation research: a critique of avifaunal assessment techniques illustrated by Ecuadorian and Madagascan case study data
Authors: O'Dea Niall , Watson James E. M. , Whittaker Robert J.
Published: January 2004

The urgency of conservation concerns in the tropics, linked with the limitations imposed on research efforts by the tropical environment has resulted in the development of methods for rapid assessment of biological communities. One such method, the MacKinnon list technique, has been increasingly applied in avifaunal surveys worldwide. Using paired tropical bird data sets from Ecuadorian cloud forest and Madagascan littoral forest, we compare the performance of the MacKinnon list with that of the more standard method of point counts in indicating when a site has been adequately surveyed, estimating the magnitude of species richness, quantifying relative species abundance, and providing an α‐index of diversity. In species‐rich Ecuadorian cloud forest, neither method produced data indicating adequate survey effort, despite extensive sampling, whereas in the relatively species‐poor Madagascan littoral forests, data collected by both methods indicated that the area had been sufficiently surveyed with comparable sampling effort. Species richness estimates generated from MacKinnon list data provided a more accurate estimate of the magnitude of the species richness for the Ecuadorian avifauna, whereas estimates for the Madagascan avifauna stabilised with relatively few samples using either method. Data collected by each method reflected different patterns of relative abundance among the five most abundant species, with MacKinnon list data showing a bias towards solitary and territorial species and against monospecific flocking species relative to the point count data. As a consequence of this bias, MacKinnon list data also fail to reflect accurately the structure of communities as quantified by an index of community evenness. Point counts, on the other hand, failed to capture the full species complement of the species‐rich Ecuadorian study area. As techniques for the rapid assessment of unsurveyed areas, both methods are subject to biases that limit their value, if used alone, in collecting data of scientific and management value. We propose a hybrid rapid assessment methodology that capitalises on the strengths of both techniques while compensating for their weaknesses.
Parasite species richness in New Zealand fishes: a grossly underestimated component of biodiversity?
Authors: Poulin Robert
Published: January 2004

Estimates of total parasite species richness, for given host groups in given geographical areas, are always much higher than the numbers of known parasite species on which they are based. The discrepancy is a reflection of our limited current knowledge of parasite diversity. This is illustrated by a comparison of the parasite faunas of New Zealand fish species with those of Canadian fish; the latter have been well studied by fish parasitologists, and provide a standard for comparisons. More parasite species are known per host species for Canadian fish than for New Zealand fish, for both marine and freshwater fishes. This difference remains after correcting for differences in study effort, i.e. in the number of published studies per fish species. There are also more parasite species per fish species in Canada than in New Zealand when parasite species richness is expressed as number of species per unit of host body length. For freshwater fish, the difference can be explained by the restricted phylogenetic origins and geographical isolation of New Zealand fish species. For marine fish, however, there is no a priori reason to expect a difference in parasite species richness between fish in New Zealand and Canadian waters, and the observed difference probably results from a lack of appropriate parasitological surveys in New Zealand. If the true species richness of the parasite faunas of New Zealand marine fish species approaches that of their Canadian counterparts, then most of the diversity and ecosystem function of fish parasites in New Zealand remains unknown.
The biogeography of invasive alien plants in California: an application of GIS and spatial regression analysis
Authors: Dark Shawna J.
Published: January 2004

The spatial distribution of invasive alien plants has been poorly documented in California. However, with the increased availability of GIS software and spatially explicit data, the distribution of invasive alien plants can be explored. Using bioregions as defined in Hickman (1993), I compared the distribution of invasive alien plants (n = 78) and noninvasive alien plants (n = 1097). The distribution of both categories of alien plants was similar with the exception of a higher concentration of invasive alien plants in the North Coast bioregion. Spatial autocorrelation analysis using Moran's I indicated significant spatial dependence for both invasive and noninvasive alien plant species. I used both ordinary least squares (OLS) and spatial autoregressive (SAR) models to assess the relationship between alien plant species distribution and native plant species richness, road density, population density, elevation, area of sample unit, and precipitation. The OLS model for invasive alien plants included two significant effects; native plant species richness and elevation. The SAR model for invasive alien plants included three significant effects; elevation, road density, and native plant species richness. The SAR model for noninvasive alien plants resulted in the same significant effects as invasive alien plants. Both invasive and noninvasive alien plants are found in regions with low elevation, high road density, and high native‐plant species richness. This is in congruity with previous spatial pattern studies of alien plant species. However, the similarity in effects for both categories of alien plants alludes to the importance of autecological attributes, such as pollination system, dispersal system and differing responses to disturbance in the distribution of invasive plant species. In addition, this study emphasizes the critical importance of testing for spatial autocorrelation in spatial pattern studies and using SAR models when appropriate.
On the importance of patch attributes, environmental factors and past human impacts as determinants of perennial plant species richness and diversity in Mediterranean semiarid steppes
Authors: Maestre Fernando T.
Published: January 2004

Richness and diversity of perennial plant species were evaluated in 17Stipa tenacissimasteppes along a degradation gradient in semiarid SE Spain. The main objective of the study was to evaluate the relative importance of historical human impacts, small‐scale patch attributes and environmental factors as determinants of perennial plant species richness and diversity inS. tenacissimasteppes, where vegetation is arranged as discrete plant patches inserted on a bare ground matrix. Partial least squares regression was used to determine the amount of variation in species richness and diversity that could be significantly explained by historical human impacts, patch attributes, and environmental factors together and separately. They explained up to 89% and 69% of the variation in species richness and diversity, respectively. In both cases, the predictive power of patch attributes models was higher than that of models consisting of abiotic characteristics and variables related to human impact, suggesting that patch attributes are the major determinants of species richness and diversity in semiaridS. tenacissimasteppes. However, patch attributes alone are not enough to explain the observed variation in species richness and diversity. The area covered by late‐successional sprouting shrubs and the distance between consecutive patches were the most influencing individual variables on species richness and diversity, respectively. The implications of these results for the management ofS. tenacissimasteppes are discussed.
Older Persons' Evaluations of Health Care: The Effects of Medical Skepticism and Worry about Health
Authors: Borders Tyrone F. , Rohrer James E. , Tom Xu K. , Smith David R.
Published: January 2004

Objective.To describe how skepticism about medical care and other individual differences, including worry about health status, are associated with evaluations of health care among the noninstitutionalized elderly.

Data Sources/Study Setting.Data were collected through a survey of approximately 5,000 community‐dwelling elders (aged 65 and older) in a southwestern region of the United States.

Study Design.Global evaluations of health care were measured with two items from the Consumer Assessment of Health Plans Study (CAHPS) instrument, an overall care rating (OCR) and a personal doctor rating (PDR). Multivariate ordered logit regression models were tested to examine how medical skepticism and other factors were associated with ratings of 0–7, 8–9, and 10.

Principal Findings.Consumers who were skeptical of prescription drugs relative to home remedies, who held attitudes that they understand their health better than most doctors, and who worried about their health had worse OCR and PDR. Those who held attitudes that individual behavior determines how soon one gets better when sick had better PDR and OCR.

Conclusions.Health policymakers, managers, and providers may need to consider the degree to which they should attempt to satisfy skeptical consumers, many of whom may never rate their care highly. Alternatively, they may need to target skeptical consumers with educational efforts explaining the benefits of medical care.
Identifying Children with Special Health Care Needs in the National Health Interview Survey: A New Resource for Policy Analysis
Authors: Davidoff Amy J.
Published: January 2004

Objective. To test the feasibility of using the National Health Interview Survey (NHIS) to identify children with chronic illness through a noncategorical approach, as exemplified by the Children with Special Health Care Needs (CSHCN) screener. The ability to use the NHIS to identify CSHCN will permit analyses of the effects of welfare reform and public insurance eligibility expansions during the late 1990s on CSHCN.

Data Sources. The NHIS from 1997, 1999, and 2000. The NHIS is an ongoing household survey representative of the civilian, noninstitutionalized population of the United States.

Study Design. Survey items were selected from the NHIS and thresholds designated to replicate the content and logic of the CSHCN screener. The screener asks explicit questions concerning an elevated need for, or use of health care services, and about limitations in activity, both caused by a chronic health condition. The algorithm created was applied to the pooled 1999–2000 NHIS to generate national prevalence estimates. Multivariate logistic regression was estimated to determine the effect of having particular demographic characteristics on the likelihood of being identified as CSHCN. Log odds ratios were compared to those from earlier NHIS‐based estimates and from a pretest of the CSHCN screener.

Principal Findings. An estimated 12 percent of noninstitutionalized children aged 0 through 17 have a chronic condition that results in elevated service use or limitations in normal activity. This estimate is sensitive to inclusion of children with a broader array of less serious or shorter‐term conditions. The estimated effects of child characteristics on the likelihood of being identified as having special health needs are similar but not identical to other algorithms that have been used to identify CSHCN.

Conclusions. It is feasible to use existing questions in the NHIS to identify a population of CSHCN that is substantially similar to children identified through other algorithms or through use of a screening instrument imbedded in a household survey. The availability of this algorithm will permit use of the NHIS for important analyses of the effects of welfare reform and public insurance expansions on children with special health care needs.
Profile of Medical Charges for Children by Health Status Group and Severity Level in a Washington State Health Plan
Authors: Neff John M. , Sharp Virginia L. , Muldoon John , Graham Jeff , Myers Kristin
Published: January 2004

Objective. To identify children and evaluate patterns of charges for pediatric medical care, by overall health status, severity of illness, and categories of medical service.

Data Sources. Enrollment, claims, and charges data from a Washington State health plan. The study population includes all children ages 0 to 18 years during calendar year 1999.

Study Design. Children were classified into clinically defined health status groups and severity levels using Clinical Risk Groups (CRGs). Health plan charges were analyzed according to core health status group, severity level, and category of service.

Data Collection. The three secondary data sources were obtained electronically from the health plan and cleaned for unique members and data quality before analysis.

Principal Findings. Children classified as healthy (85.2 percent) had mean and median annual charges of $485 and $191. Children with one or more chronic conditions (9.5 percent) had mean and median charges increasing by status and severity group from $2,303 to $76,143 and from $1,151 to $19,456, and accounted for 45.2 percent of all charges. Distribution of charges varied across health status groups. Healthy children had 70.6 percent of their charges in outpatient and physician services. Children classified in the complex, catastrophic, and malignancy groups had 67 percent of their charges in inpatient encounters. Children with chronic conditions accounted for 31.8 percent of all physician, 41.8 percent of outpatient, 47.7 percent of pharmacy, 60.7 percent of inpatient, and 75.8 percent of all other charges.

Conclusions. Children with chronic conditions account for a disproportionately high percentage of children's health expenditures. They account for different percentages of expenses for different medical services. These percentages vary according to health status and severity. This analysis can be used to identify and track groups of children for various purposes.
Are Gatekeeper Requirements Associated with Cancer Screening Utilization?
Authors: Phillips Kathryn A. , Haas Jennifer S. , Liang Su‐Ying , Baker Laurence C. , Tye Sherilyn , Kerlikowske Karla , Sakowski Julie , Spetz Joanne
Published: January 2004

Objective. There is widespread debate over whether health plans should require enrollees to use “gatekeepers,” which are primary care providers that coordinate care and control access to specialists. However, little is known about whether health plan gatekeeper requirements improve or reduce quality‐of‐care. Our objective was to examine whether gatekeeper requirements are associated with the utilization of cancer screening for breast, cervical, and prostate cancer.

Data Sources. Three linked sources (N=13,534): (1) 1996 Medical Expenditure Panel Survey (MEPS) Household Survey, a nationally representative, ongoing survey sponsored by the Agency for Healthcare Research and Quality; (2) 1996 MEPS Health Insurance Plan Abstraction, which codes data from health plan booklets obtained from privately insured respondents, and (3) 1995 National Health Interview Survey.

Study Design/Data Collection. Cross‐sectional, multivariate logistic regression analysis using secondary data.

Principal Findings. We found in multivariate analyses that women in gatekeeper plans were significantly more likely to obtain mammography screening (Odds Ratio [OR]=1.22, 95 percent Confidence Interval [CI] 1.07–1.40), clinical breast examinations (OR=1.39, 95 percent CI 1.23–1.57), and Pap smears (OR=1.33, 95 percent CI 1.16–1.52) than women not in gatekeeper plans. In contrast, gatekeeper requirements were not associated with prostate cancer screening (OR=1.11, 95 percent CI 0.93–1.33). We found no association between screening utilization and aggregate plan types (HMO, POS, PPO, FFS).

Conclusions. Gatekeeper requirements are associated with higher utilization of widely recommended cancer screening procedures, but not with utilization of a less uniformly recommended cancer screening procedure. Researchers should consider the analysis of specific plan characteristics rather than aggregate plan types in conducting future research, and insurers and policymakers should consider the potential benefits of gatekeepers with respect to preventive care when designing health plans and legislation.
Moving beyond the Typologies of Managed Care: The Example of Health Plan Predictors of Screening Mammography
Authors: Tye Sherilyn , Phillips Kathryn A. , Liang Su‐Ying , Haas Jennifer S.
Published: January 2004

Objectives. To develop a framework of factors to characterize health plans, to identify how plan characteristics were measured in a national survey, and to apply our findings to an analysis of the predictors of screening mammography.

Data Source. The primary data were from the 1996 Medical Expenditure Panel Survey.

Study Design. Women ages 40+, with private insurance, and no history of breast cancer were included in the study (N=2,909). We used multivariate logistic regression to estimate mammography utilization in the past two years relative to health plan and demographic factors. Health plan measures included whether there is a defined provider network, whether coverage is restricted to a network, use of gatekeepers, level of cost containment, copayment and deductible amounts, coinsurance rate, and breadth of benefit coverage.

Principal Findings. We found no significant difference in reported mammography utilization using a dichotomous comparison of individuals enrolled in managed care versus indemnity plans. However, women in health plans with a defined provider network were more likely to report having received a mammogram in the past two years than those without networks (adjusted OR=1.21, 95 percent CI=1.07–1.36), and women in gatekeeper plans were more likely to report receiving mammography than those without gatekeepers (adjusted OR=1.18, 95 percent CI=1.03–1.36). Restricted out‐of‐network coverage, use of cost containment, enrollee cost sharing, and breadth of benefit coverage did not appear to affect mammography use.

Conclusions. It is important to examine the effect of individual health plan components on the utilization of health care, rather than use the traditional broader categorizations of managed versus nonmanaged care or simple health plan typologies.
Exhumation rates and age of metamorphism in the Sanbagawa belt: new constraints from zircon fission track analysis
Authors: Wallis S. , Moriyama Y. , Tagami T.
Published: January 2004

Zircon fission track dating and track length analysis in the high‐grade part of the Asemigawa region of the Sanbagawa belt demonstrates a simple cooling history passing through the partial annealing zone at 63.2 ± 5.8 (2 σ) Ma. Combining this age with previous results of phengite and amphibole K–Ar and 40Ar/39Ar dating gives a cooling rate of between 6 and 13 °C Myr−1, which can be converted to a maximum exhumation rate of 0.7 mm year−1 using the known shape of the P–T path. This is an order of magnitude lower than the early part of the exhumation history. In contrast, zircon fission track analyses in the low‐grade Oboke region show that this area has undergone a complex thermal history probably related to post‐orogenic secondary reheating younger than c. 30 Ma. This event may correlate with the widespread igneous activity in south‐west Japan around 15 Ma. The age of subduction‐related metamorphism in the Oboke area is probably considerably older than the generally accepted range of 77–70 Ma.
Population‐Based Door‐to‐Door Survey of Migraine in Japan: The Daisen Study
Authors: Takeshima Takao , Ishizaki Kumiko , Fukuhara Yoko , Ijiri Tamami , Kusumi Masayoshi , Wakutani Yosuke , Mori Masatada , Kawashima Mika , Kowa Hisanori , Adachi Yoshiki , Urakami Katsuya , Nakashima Kenji
Published: January 2004

Objectives.—To determine prevalence and characteristics of migraine in Japan, and to investigate use of medical care and whether food preference is associated with risk of migraine.

Methods.—Structured questionnaires were given to all adult residents (N = 5758; 2681 men and 3077 women) in Daisen, a rural community in western Japan. Second questionnaires, specific to headache, were given to 1628 residents with headache. A telephone survey was also carried out. Statistical Packages for the Social Sciences analyzed the data.

Results.—The 1‐year prevalence of migraine was 2.3% (migraine with aura, 0.4% and without aura, 1.9%) in men and 9.1% (migraine with aura, 1.0% and migraine without aura, 8.1%) in women. Overall prevalence of migraine in Daisen was 6.0% (95% confidence interval [CI], 5.4% to 6.6%). Women observed a 5.9‐fold higher risk of migraine than men (odds ratio, 5.9; 95% CI, 4.5 to 8.0; P < .0001, after age adjustment, by logistic analysis). Fatigue and loss of vigor were predominant premonitory symptoms of migraine. Fatigue, mental stress, and lack of sleep were the main headache triggers. Over a 3‐month period, 20.3% of migraineurs experienced time or days off work due to headache. Only 7.3% of those with migraine with aura and 5.3% of those with migraine without aura had consulted a physician, and of those with migraine, 61.0% with aura and 71.8% without aura had never visited a medical doctor for their headache.

Consumption of alcohol and cigarette smoking did not influence the risk for migraine or tension‐type headache, after age and gender adjustment (logistic analysis).

Migraineurs consume significantly more fatty/oily foods, coffee, and tea than nonheadache subjects of the same community. Migraineurs consume significantly fewer fish than nonheadache residents.

Conclusions.—Only a few Japanese migraineurs receive benefits of medical services and recent advances of headache medicine. Public education concerning headaches is one of the most urgent issues in Japan.
Lifetime Prevalence of Migraine and Other Headaches Lasting 4 or More Hours: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Perry Carson April L. , Rose Kathryn M. , Sanford Catherine P. , Ephross Sara A. , Stang Paul E. , Hunt Kelly J. , Brown C. Andrew , Szklo Moyses
Published: January 2004

Objective.—To evaluate the lifetime prevalence of migraine and other headaches lasting 4 or more hours in a population‐based study of older adults.

Background.—Migraine and other headaches not fulfilling migraine criteria are common afflictions. Yet the health and social effects of these conditions have not been fully appreciated, particularly among older adults.

Methods.—The study included 12 750 participants in the Atherosclerosis Risk in Communities (ARIC) Study from 4 US communities. Prevalence estimates of a lifetime history of migraine and other headaches lasting 4 or more hours were obtained for race and gender groups. A cross‐sectional analysis was done to assess the relationship between headache type, by aura status, and various sociodemographic and health‐related indices.

Results.—Compared to education beyond high school, having completed less than 12 years of education was significantly associated with an increased occurrence of migraine with aura (prevalence odds ratio [POR], 1.47; 95% confidence interval [CI], 1.08 to 2.01). Family income less than $16 000, compared to family income of $75 000 or greater, was significantly associated with migraine with aura (POR, 1.68; 95% CI, 1.07 to 2.64), migraine without aura (POR, 1.56; 95% CI, 1.14 to 2.14), and other headaches with aura (POR, 1.89; 95% CI, 1.14 to 3.13). The prevalence odds ratio was higher in each headache category, particularly for those with an aura, for those with hypertension versus normotension and for those who perceived their general health as poor compared to those whose perception was excellent.

Conclusions.—A lifetime history of migraine with aura and other headaches with aura was more common among whites, women, and younger participants. Further investigation of headaches lasting 4 or more hours, particularly by aura status, is warranted.
Basilar and Middle Cerebral Artery Reactivity in Patients With Migraine
Authors: Silvestrini Mauro , Baruffaldi Roberto , Bartolini Marco , Vernieri Fabrizio , Lanciotti Chiara , Matteis Maria , Troisi Elio , Provinciali Leandro
Published: January 2004

Background.—Migraine has been reported as a possible risk factor for ischemic stroke. The mechanisms underlying this association are unknown.

Objective.—To evaluate cerebrovascular reactivity to hypercapnia in the anterior and posterior circulation of patients with migraine, as reduced cerebrovascular reactivity is associated with a predisposition to stroke in various clinical conditions.

Methods.—Using transcranial Doppler ultrasonography, changes in flow velocity during apnea were measured in both middle cerebral arteries and in the basilar artery of 15 control subjects and 30 patients with migraine (15 with aura and 15 without aura) during an attack‐free period. Cerebrovascular reactivity was evaluated using the breath‐holding index, which is calculated by dividing the percent increase in mean flow velocity recorded during a breath‐holding episode by its duration (in seconds) after a normal inspiration.

Results.—Vascular reactivity in the middle cerebral arteries was similar in patients and controls and significantly lower in the basilar artery of patients with migraine with aura compared with the other 2 groups (P < .0001).

Conclusions.—These findings show that in patients with migraine with aura, there is an impairment in the adaptive cerebral hemodynamic mechanisms in the posterior circulation. This fact could have pathogenetic implications since the association between migraine and stroke frequently regards patients with migraine with aura, and cerebral infarcts occur more commonly in the vertebrobasilar district.
Laboratory Monitoring of OxyContin (Oxycodone): Clinical Pitfalls
Authors: Von Seggern Randal L. , Fitzgerald Charles P. , Adelman Leon C. , Adelman James U.
Published: January 2004

Some patients have headaches that are refractory to standard treatments, and they require chronic administration of opioid analgesics. The use of opioids in a clinical setting must be closely monitored due to the medications' potential for addiction, abuse, and fatal interactions.

Limited access to opioids and the demand for them outside the clinical setting leads to another danger. Patients can mislead their providers into prescribing opioids, intending to sell the medications instead of using them to alleviate their own pain. For protection of the patient, as well as the community, it is vital that such activity be prevented.

We recently encountered a patient we suspected of abusing or misusing OxyContin (oxycodone). In order to determine whether the patient was taking the medication as prescribed, we ordered a urine‐based immunoassay drug screen. The results were negative; the patient appeared to not have oxycodone in his system. Based on these results, we dismissed the patient from our practice.

At the patient's request, a second test was performed, this time using gas chromatography‐mass spectrometry. It indicated that the patient did indeed have sufficiently high levels of oxycodone in the urine. The minimum level threshold was too high to detect the presence of oxycodone in the immunoassay.

We would like to help prevent future misunderstandings such as we experienced. To do so, we will first present the case of our patient, followed by a discussion of the actions taken. Finally, we will provide an overview of analgesic monitoring systems.
Pituitary Apoplexy Masquerading as Meningoencephalitis
Authors: Jassal Davinder S. , McGinn Gregory , Embil John M.
Published: January 2004

Background.—Pituitary apoplexy, a rare but life‐threatening disorder, is characterized by the abrupt destruction of pituitary tissue secondary to infarction or hemorrhage of the gland itself. Its clinical features include severe headache, stiff neck, fever, visual disturbances, and symptoms of hypoadrenalism.

Objective.—To assess how pituitary apoplexy may mimic the clinical findings of an infectious meningoencephalitis.

Methods and Results.—We describe 3 individuals whose clinical profile and paraclinical studies were consistent with a diagnosis of presumed infectious meningoencephalitis. With minimal improvement on antimicrobial therapy, however, an extensive clinical and radiographic reevaluation yielded pituitary apoplexy as the etiology of their acute neurologic event.

Conclusion.—Pituitary apoplexy is often misdiagnosed as meningitis or subarachnoid hemorrhage due to the presence of leukocytes and erythrocytes in the cerebrospinal fluid. These cases serve to highlight the importance of maintaining a broad differential diagnosis when evaluating patients presenting with an acute headache.
Water‐Deprivation Headache: A New Headache With Two Variants
Authors: Blau Joseph Norman , Kell Christian Alexander , Sperling Julia Maria
Published: January 2004

Objective.—To describe a new type of headache induced by water deprivation.

Background.—Two medical students experienced headache over the previous 7 (C.A.K.) and 9 (J.M.S.) years when deprived of drinking water. In a tutorial on headache, they mentioned this precipitant, not recognized by the tutor (J.N.B.) or described in the medical literature. Dialysis and post‐alcohol headaches are widely attributed to dehydration, but simple water deprivation has not been documented as a headache precipitant.

Methods.—Family members, colleagues, and acquaintances were asked whether they experienced a headache when deprived of fluids. If they had, information was obtained regarding the location and quality of the headache, whether activity or posture influenced the pain, and what amount of fluid and time was needed to relieve symptoms.

Results.—Approximately 1 in 10 interrogated subjects experienced water‐deprivation headache, aching in the majority and accentuated by head movement, bending down, or walking. The 34 subjects were divided into 2 groups according to the time taken to relieve the headache by drinking water: total relief within 30 minutes by drinking 200 to 1500 mL (mean, 500) occurred in 22 subjects, and within 1 to 3 hours by drinking 500 to 1000 mL (mean, 750) in 11 subjects; 1 subject required sleep in addition to fluid intake. Surprisingly, the Internet revealed many references to water deprivation inducing headaches.

Conclusions.—Water‐deprivation headache is common, recognized by the public, but not described in the medical literature. Here we delineate it as a primary headache, postulating that the pain arises from the meninges; that the brain is also involved is indicated by impaired concentration and irritability, although not studied in detail in this preliminary survey. We speculate that water deprivation may play a role in migraine, particularly in prolonging attacks. Further studies of serum osmolality could prove illuminating.