bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching/Learning Architectural Design based on a Virtual Learning Environment
Authors: Vecchia Luisa Dalla , da Silva Adriane , Pereira Alice
Published: August 2009

This paper describes an experiment in which a virtual learning environment was used in the context of an architectural design course. The objective was to evaluate the capability of the learning environment used to support the interactions needed, between teacher-student and between students, for the establishment of a process of discussion and development of architectural design. Some limitations were identified and also positive points, such as the possibility to register the whole design process. These registers allow the design teacher to evaluate his own teaching process and improve it and also the visualization of what kind of intervention the teacher makes and when, making it possible to identify the kind of design processes established by the student and the kind of structure of knowledge which is implicit in a process of teaching/learning architectural design according to the level of development of the design.
Augmented Reality in Architecture and Design: Potentials and Challenges for Application
Authors: Wang Xiangyu
Published: August 2009

Recent advances in computer interface and hardware power have fostered Augmented Reality (AR) prototypes for various architecture and design applications. More intuitive visualization platforms are necessary for efficient use of digital information nowadays in the architecture and design industries. As a promising visualization platform to address this need, this paper introduces the concept and associated enabling technologies of AR and also presents a survey of its existing applications in the area of architecture and design. Another focus of the paper is to discuss how the identified key technical issues could potentially be addressed in the context of architecture and design applications.
A Digital Incorporation of Ergonomics into Architectural Design
Authors: Eilouti Buthayna h.
Published: August 2009

A project that is particularly designed for digital studio settings is described. Facilitated by multiple computer modeling and animation software, the project incorporates concepts and applications of ergonomics and kinetics as two ingredients and concept generators with problem-based learning techniques into architectural designing. Reflections about the project and its outcomes are reported and discussed. The results indicate that considerations of ergonomics, flexibility, mobility and responsiveness in dynamic structures and their interactions with users can enrich and optimize generated designs. Similarly, the application of problem-based designing approach seems to foster critical thinking of participants and improve their involvement in collaborative design processing.
Policy learning and transfer: the experience of the developmental state in East Asia
Authors: Kwon Huck-ju
Published: August 2009

As late industrialisers, East Asia's developmental states – Japan, the Republic of Korea and Taiwan – assimilated the front runners’ policy innovations and experience, taking advantage of lateness. This article examines policy learning and transfer in these countries’ developmental states and their characteristics in policy learning processes; explores the rationale for policy learning and transfer, focusing on Fukuzawa's paradox; investigates policy learning and transfer patterns, applying the ‘flying geese’ hypothesis to health insurance; and considers whether the three states will adapt future challenges to their own creative policy ideas, going beyond Fukuzawa's paradox. Although policy learning is effective for development, these states should now secure their own policy vision to meet the challenges ahead.
False and frustrated policy transfer: Spanish immigration policy and Catalonia
Authors: Davis Andrew
Published: August 2009

This article questions the claim that policy transfer is ‘on the rise’, preferring instead to treat the assertion as a hypothesis to be investigated. Using the literature's own predictive categories, it investigates immigration policy making in Spain more broadly, as well as how it applies specifically to the case of Catalonia. The results of the investigation demonstrate a curious enigma: that while Spanish immigration policy making seems little influenced by policy transfer, Catalonia has made precocious, but failed efforts to create an autonomous model of immigration.
‘We nicked stuff from all over the place’: policy transfer or muddling through?
Authors: Dwyer Peter , Ellison Nick
Published: August 2009

This article explores current thinking about policy learning and transfer, using recent work on the ‘Americanisation’ of UK active labour market policies as a focus of discussion. While it is clear that the UK has learned from the US in certain respects, academic debates about the US–UK policy relationship are marked by accounts of learning and transfer that depend on a highly rational interpretation of these processes. The article reviews current debates in the policy transfer literature and applies a critical view of policy learning and transfer to key accounts of labour market activation policies before moving on to consider how useful the concept of policy transfer really is in an increasingly complex, plural and ‘de-institutionalising’ world.
International transfer of ideas in historical perspective: the New World in British economic and social debates from the late 19th century to the First World War
Authors: Rogers Edmund
Published: August 2009

Policy examples from other countries are drawn on in public debate to strengthen arguments for change or reform. Opponents of change must then de-legitimise the applicability of those examples. This article places this phenomenon in historical perspective, exploring the transfer of policy ideas to Britain from North America and Australasia in the late 19th and early 20th centuries. Land and social reformers appealed to policy examples from fellow ‘English-speaking’ societies, which as ‘new countries’ could experiment more than ‘old countries’ and therefore provide lessons for Britain. However, their opponents emphasised that the experience of new countries was inapplicable to Britain.
Learning by observing: surveying the international arena
Authors: Dolowitz David P.
Published: August 2009

To date, little of the transfer literatures have tried to discover if apparent similarities between systems emerge as a result of situation (simple) learning or topic (complex) learning. The issue that arises out of this is that while transfer must involve some level of learning, most studies tend to imply a much greater degree of learning and knowledge acquisition than they demonstrate. As such, the purpose of this article is to conceptualise how the policy transfer literatures can be linked to learning and knowledge generation by posing questions related to how, if and to what degree agents of transfer 'learn by observing' the action of other political systems.
So near, yet so far: connecting welfare regime research to policy learning research
Authors: Choi Young Jun , Kim Jin Wook
Published: August 2009

An increasing number of policy learning studies have provided practical suggestions for the direction of welfare developments and reforms in East Asia. However, these have been carried out without a solid theoretical basis. This article aims to analyse the issues of existing policy learning research and explore the connecting point between welfare regime research and policy learning, specifically taking the Korean case as an example. The article will argue that welfare regime research can be a useful vehicle for making policy learning studies more effective and feasible by identifying key contexts, locating a policy within a welfare regime, and reducing possible policy options.
An analytical framework for policy transfer in the EU context
Authors: Unalan Dilek
Published: August 2009

Most scholars treat policy transfer as either a dependent or an independent variable without considering discursive components of the policy process and the role of subjective definitions of policy success or failure. This study allows more space for subjective definitions and the perceptions of actors involved in the policy transfer process, and by incorporating an element of social constructivism to the analysis of policy transfer in the European Union (EU) context, it demonstrates how subjective definitions affect policy transfer outcomes and how ‘transfer success’ is subject to competing interpretations. The analytical framework is tested through empirical data from a case study investigation of an EU environmental policy's transfer in Turkey.
Policy transfer and the UK's ‘war on terror’: a political economy approach
Authors: Pantazis Christina , Pemberton Simon
Published: August 2009

Utilising a political economy perspective in examining the UK's counter-terrorist strategy since September 2001, we argue that there are observable economic and political interests influencing the development and implementation of policy. Specifically, there are significant electoral gains to be made and also lucrative contracts to be won in the new security environment. These interests have culminated in the UK being both an ‘importer’ of policy from supranational and regional organisations, and other nation states – most notably from the US – and an ‘exporter’ of policy as a result of having achieved a certain level of kudos with respect to the Northern Ireland conflict.
Personal and situational predictors of test anxiety of students in post‐compulsory education
Authors: Putwain David W. , Woods Kevin A. , Symes Wendy.
Published: August 2009

Background

Recent models of evaluation anxiety emphasize the importance of personal knowledge and self‐regulatory processes in the development of test anxiety, but do not theorize a route for situational influences.

Aim

To investigate the relationship between test anxiety and personal knowledge beliefs (achievement goals and perceived academic competence), parental pressure/support, and teachers' achievement goals.

Sample

One‐hundred and seventy five students at a sixth‐form college following pre‐degree courses in Psychology and Sociology.

Method

Self‐report data were collected for test anxiety, personal achievement goals, academic self‐concept, perceived test competence, teachers' achievement goals, and parental pressure/support. Relationships were examined through correlational and regression analyses.

Results

The relationship between test anxiety and personal knowledge beliefs differed for the various components of test anxiety. A mastery‐avoidance goal was related to worry and tension, and a performance‐approach goal to bodily symptoms. Perceived academic competence was related to worry and tension. Parental pressure was associated with stronger worry and test‐irrelevant thinking components directly, and with a stronger bodily symptoms component indirectly through a performance‐approach goal. Teachers' performance‐avoidance goals were related to worry, tension, and bodily symptoms indirectly through personal performance‐avoidance goals, and in the case of bodily symptoms additionally through a performance‐approach goal.

Conclusion

Findings provide partial support for the self‐regulatory model of test anxiety suggesting that additional routes are required to account for the role of parental pressure and teachers' performance‐avoidance goals and a re‐examination of the relationship between test anxiety and achievement goals.
Close women, distant men: Line bisection reveals sex‐dimorphic patterns of visuomotor performance in near and far space
Authors: Stancey Helen , Turner Mark
Published: August 2009

The mid‐points of a series of lines which were positioned both within hand‐reach (near space) and beyond hand‐reach (far space) were estimated by 24 women and 24 men. When using a laser pointer to perform estimations, women were more accurate in the near condition than the far, whereas men were more accurate in the far condition than the near. When using a stick pointer for the far condition, women were more accurate than when using the laser, whereas men were more accurate using the laser pointer than the stick for the far condition. There was no difference between near and far accuracy scores for either sex using the stick. These results suggest that use of a tool which provides proprioceptive feedback causes the brain to remap far‐space stimuli as if situated in near space. Possible origins and neural bases for these differences are considered. Finally, the study found evidence for pseudoneglect, but no evidence for pseudoneglect shift.
An interest in fame: Confirming the measurement and empirical conceptualization of fame interest
Authors: Maltby John
Published: August 2009

The following paper introduces and develops the conceptualization of Fame Interest. Study 1 (N=1,978), through the use of factor analysis techniques, introduces the Fame Interest Scale which comprises six dimensions of Fame Interest (intensity, vulnerability, celebrity life‐style, drive, perceived suitability, and altruistic) with evidence for the reliability and validity of the scale. Study 2 (N=376) examined the relationship between an interest in fame and measures of the five‐factor model of personality, narcissism, self‐esteem, curiosity, attachment style and perceived family, and peer and media influence. From this second study four findings emerge; (1) Fame Interest typified by a perceived suitability and intensity for a celebrity life‐style was associated with perceived family, peer and media influence, (2) Fame Interest that arises from a vulnerability is a reflection of neuroticism, low self‐esteem, and problematic attachments, (3) Fame Interest for altruistic reasons is associated with agreeableness, and (4) Fame Interest that reflects an overall drive is associated with conscientiousness.
An index‐based short‐form of the WISC‐IV with accompanying analysis of the reliability and abnormality of differences
Authors: Crawford John R. , Anderson Vicki , Rankin Peter M. , MacDonald Jayne
Published: August 2009

Objectives. To develop an Index‐based, seven subtest, short‐form of the Wechsler intelligence scale for children fourth edition (WISC‐IV) that offers the same comprehensive range of analytic methods available for the full‐length version.

Design and methods. Psychometric.

Results. The short‐form Indexes had high reliability and criterion validity. Scores are expressed as Index scores and as percentiles. Methods are provided that allow setting of confidence limits on scores, and analysis of the reliability and abnormality of Index score differences. The use of the short‐form is illustrated with a case example. A computer programme (that automates scoring and implements all the analytical methods) accompanies this paper and can be downloaded from the following web address: http:www.abdn.ac.uk psy086deptsf_wisc4.htm.

Conclusions. The short‐form will be useful when pressure of time or client fatigue precludes use of a full‐length WISC‐IV. The accompanying computer programme scores and analyses an individual's performance on the short‐form instantaneously and minimizes the chance of clerical error.
Maintaining the system with tokenism: Bolstering individual mobility beliefs and identification with a discriminatory organization
Authors: Danaher Kelly , Branscombe Nyla R.
Published: August 2009

Two experiments examined the effects of gender‐based token hiring practices in organizational settings. In Expt 1, women were exposed to organizational hiring practices that were open, token, or closed. Token practices served to perpetuate inequality by maintaining individual mobility beliefs and organizational identification. In Expt 2, both men and women imagined working for a corporation that planned to implement open, token, or closed hiring practices. Although women reported experiencing negative emotions in the closed and token conditions compared to the open condition, token practices maintained positive perceptions of the organization and individual mobility beliefs compared to the closed condition. Men endorsed more individual mobility beliefs as well as positive emotions in the token and closed conditions compared to the open condition. Token practices distort perceptions of fairness in both women and men. For women, token practices make group boundaries seem more negotiable than they actually are, while for men token practices legitimize their group's dominance.
Speaking of dominance, status differences, and identification: Making sense of a merger
Authors: van Vuuren Mark , Beelen Paul , de Jong Menno D. T.
Published: August 2009

This study focuses on the perceptions of faculty members involved in a merger between two South African universities that were historically a ‘white’ and a ‘black’ institution. Combining a sensemaking approach and insights from social identity theory, the study aimed for a better understanding of the dynamics that underlie the processes of identification in organizational settings. Analysis of the transcripts of interviews and a focus group showed the importance of status differences, dominance, and several foci of identification. Surprisingly, employees from both merging partners claimed to be the dominated group in the merger and faculty members described their post‐merger identification in terms of their profession rather than their membership of the organization. These findings draw attention to the dynamic relationship between salient categories of identification.
Detecting malingered memory problems in the civil and criminal arena
Authors: Van Oorsouw Kim , Merckelbach Harald
Published: August 2009

Feigning a psychiatric or neurological disorder may be an attractive strategy to obtain all sorts of privileges or disability benefits. In the criminal arena, feigning memory loss for a crime (crime‐related amnesia) may be a way for defendants to gain sympathy or to promote a diminished capacity defence. Although crime‐related amnesia may, under some circumstances, be genuine, in many cases it is more likely to be malingered. Malingered memory problems are a subtle form of deception and what is true for deceptive behaviour in general is also true for malingering memory loss: on the basis of clinical intuition alone, it is difficult to detect. Fortunately, there are methods and tools to evaluate the authenticity of memory problems. It is important that forensic and clinical psychologists familiarize themselves with these techniques.
Pragmatic solutions to offender profiling and behavioural investigative advice
Authors: Alison Laurence , Goodwill Alasdair , Almond Louise , van den Heuvel Claudia , Winter Jan
Published: August 2009

This paper outlines a brief history of the evolutionary trajectory of offender profiling and illustrates the three broad strands (investigative, clinical, and statistical) that emerged in the 1970s–1990s. We then indicate how a more pragmatic, interdisciplinary practitioner–academic model has emerged in recent years and go on to describe the range of contributions that are now made across the criminal justice field. More recently termed ‘behavioural investigative advice’ in the UK, the paper then argues that whilst a range of potential contributions exist (from linking crimes, risk assessment, provision of bad character evidence, investigative interviewing advice, to geoprofiling), the nature of the process by which that contribution occurs is not yet well understood. The review of these potential contributions concludes with several suggestions and recommendations for further research and relevant methodologies by which to conduct that research. This includes the requirement to combine conceptual and theory‐driven models alongside empirically driven statistical approaches, as well as the requirement to more precisely delineate and describe how contributions are made by behavioural experts through cognitive task analyses and associated methods.
What really is effective in interviews with suspects? A study comparing interviewing skills against interviewing outcomes
Authors: Walsh Dave , Bull Ray
Published: August 2009

Purpose. The present study examines whether interviewing in a manner that is compatible with a recommended model of interviewing (called the ‘PEACE’ model) impacts on outcomes of the interviews examined in contrast to prior studies which have usually been concerned whether the conducted interviews were fair and not coercive or whether there had been positive effects of training upon subsequent interview performance.

Methods. This study, examining in detail 142 actual suspect interviews, is set in the barely researched area of social security benefit fraud, reflecting current trends in Britain concerning increasing numbers of interviews with suspects undertaken by public sector organizations and the pluralization of policing.

Results. It was found that good interviewing in each of the recommended stages that make up the PEACE model generally led to better interviews, indicating the importance that each stage contributes to overall interview quality. Further, the quality of interviews was compared against a range of interview outcomes and it was found that skilled PEACE interviewing was associated with the securing of full accounts, including confessions.

Conclusion. Given the few examples of skilled interviewing found in the study it is argued that further training of investigators is necessary to improve both interviewing performance and organizational outcomes.
Jury decision‐making biases and methods to counter them
Authors: Daftary‐Kapur Tarika , Dumas Rafaele , Penrod Steven D.
Published: August 2009

Purpose. The objective of this review was to give a broad overview of various biases associated with jury decision making. Specifically we review research on the impact of pretrial publicity, jury instructions, inadmissible evidence, and scientific evidence. This article elucidates various challenges jurors may face across systems around the world and remedies to counter these challenges.

Results. After 50 years of scientific research on juries and juror decision making, there are still many gaps in understanding how factors such as pretrial publicity, inadmissible evidence, scientific evidence, and jury instructions influence juries. At the same time the field has developed a level of appreciation for these problems and is making strives toward understanding them.

Conclusion. Based on this review some conclusions can be drawn regarding the areas of decision making reviewed. Jury instructions: Research shows that jurors have difficulties in understanding pattern instructions, at the same time we have developed some insights into ways instructions can be rewritten to increase comprehensibility. Inadmissible evidence: We are aware of the cognitive effort involved in attempting to disregard evidence but are at this point unclear on how to eliminate the associated problems. Scientific evidence: Research has illuminated the difficulties jurors have with comprehending scientific evidence. Better education of jurors and judges can help to address this issue. Pretrial publicity: The threats posed by pretrial publicity to the defendant's right to a fair trial are clear. At the same time (save change of venue) there is a need to develop cost‐effective remedies to help overcome media‐induced biases.
Home is where the heart lies? A study of false address giving to police
Authors: Roach Jason
Published: August 2009

Purpose. The purpose of the present paper is to identify the cognitive processes associated with the construction of a false address, and explore how this can be used to identify and trace those who give a false address to police. It is hypothesized that most people find it difficult to spontaneously fabricate an entire false address. As a consequence they provide identifiable clues as to the real address being concealed.

Methods. A quasi‐experimental research design was employed where 142 students were first asked to generate a false address and second to analyse it to ascertain how random they considered it to be.

Results. Participants, overwhelmingly, stated that the false addresses generated contained elements of truth which could be used to identify their real place of residence. Although most participants appeared capable of generating bona fide false postcodes, comparison with an official UK postcode list identified over 60% did not actually exist.

Conclusion. People generally rely on pre‐existing address knowledge as opposed to random generation, with the latter appearing more cognitively effortful. As such, they often unwittingly provide clues to the real address being concealed, therefore, affording increased possibilities in identifying them as liars at point of contact and in tracing them after the fact.
Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments
Authors: Heron Kristin E. , Smyth Joshua M.
Published: August 2009

Purpose

Psychosocial and health behaviour treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These ecological momentary interventions (EMIs) are treatments that are provided to people during their everyday lives (i.e. in real time) and in natural settings (i.e. real world). The goal of the present review is to synthesize and critique mobile technology‐based EMI aimed at improving health behaviours and psychological and physical symptoms.

Methods

Twenty‐seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified.

Results

There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviours and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed.

Conclusions

Mobile technology‐based EMI can be effectively implemented as interventions for a variety of health behaviours and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive.
Illness representations in women with fibromyalgia
Authors: Glattacker M. , Opitz U. , Jäckel W. H.
Published: August 2009

Objective.In the US population, the prevalence of fibromyalgia is about 3.4% in women. For those who are affected, fibromyalgia is associated with significant limitations relating to quality of life, activity, and participation. Furthermore, fibromyalgia leads to serious socio‐economic costs. The objective of the present paper is to describe the cognitive illness representations of women with fibromyalgia and to analyse their relationship to rehabilitation outcomes.

Methods.The outcome was measured using the SF‐36 and fibromyalgia impact questionnaire. The illness perceptions were assessed using the Illness Perception Questionnaire – revised. The prediction of outcome was done using hierarchical multiple regression analyses.

Results.N=245 patients are included in the sample. The patients attribute a multitude of symptoms to fibromyalgia and name numerous triggering factors. Illness representations are correlated with the illness impact at the beginning of rehabilitation and predict the outcome after the end of rehabilitation.

Conclusion.The fact that illness representations turn out to be predictors of outcome, even when the baseline health status is statistically controlled, highlights the relevance of the illness representations of patients with fibromyalgia. Therefore, effective and efficient methods should be developed for integrating patient's illness beliefs into the management of the illness as early as possible.
Classifying health‐related behaviours: Exploring similarities and differences amongst behaviours
Authors: McEachan Rosemary R. C. , Lawton Rebecca J. , Conner Mark
Published: August 2009

Objectives. The classification of health behaviours may provide a useful framework for understanding their characteristics and therefore the ways in which they are similar and different. However, to date, little research has attempted to identify these characteristics and explore the dimensions along which behaviours differ. This paper uses an inductive approach to explore this issue.

Design and methods. In Study 1, 25 repertory grid interviews and 3 focus groups encompassing lay public and health professionals identified 25 ways of describing health behaviours. These were refined into 11 key characteristics. In Study 2, 180 members of the general public rated 20 health behaviours on each of these characteristics.

Results. Principal components analysis indicated behaviours were perceived along three key dimensions: ‘easy immediate pay‐offs’ versus ‘effortful long‐term pay‐offs’; ‘private unproblematic’ versus ‘public and problematic’; and ‘important routines’ versus ‘unimportant one‐offs’. Risk behaviours were clearly differentiated being perceived as ‘easy immediate pay‐offs’ and ‘public–problematic’. In contrast with other approach behaviours such as diet or self‐examination, physical activity behaviours were perceived as ‘effortful long‐term pay‐offs’.

Conclusions. This research provides an useful starting point in the development of a framework that allows us to better understand differences and similarities between health behaviours. These dimensions may be important to consider when researchers set out to predict or change behaviour.
Let's look at the elephant: Metasynthesis of transference case studies for psychodynamic and cognitive psychotherapy integration
Authors: Rabinovich Merav , Kacen Lea
Published: August 2009

Objectives. Although the movement towards psychotherapy integration is gaining momentum, theoretical polarization still prevails and prevents integration from maturing. This study strives for theoretical integration, shedding light on relations between two concepts from diametrically opposed therapies: the psychodynamic concept of transference and the cognitive concept of overgeneralization.

Design. A qualitative metasynthetic study.

Method. The study maps core conflictual relationship themes transference components, codes other meaning units, and analyses relationship between categories. These procedures apply to published transference case descriptions.

Results. Of the 33 case studies, 30 (about 90%) were shown to include overgeneralization thinking distortion. In all these cases, such overgeneralization concerned a central theme in the same category as Luborsky's components of transference. The results show that overgeneralization thinking errors (cognitive therapy) are the current cognitive manifestation of the transference patterns (psychoanalytic therapy). This observation maps the complementary character of the concepts and thus takes an additional significant step forward towards the consolidation of a theoretical platform for integrative intervention.
Primary Household Language and Asthma Care among Latino Children
Authors: Claudio Luz , Stingone Jeanette A.
Published: August 2009

To determine if language barriers affect the level of asthma management and quality of health care in Latino children, a cross-sectional, parent-report survey was conducted in 26 randomly selected public elementary schools in New York City. The overall response rate was 76.9%, yielding a sample of 1,847 Latino children. The prevalence of asthma among Latinos from Spanish-speaking households was 20.8%, compared with 25.8% among Latino children from English-speaking households. Although asthmatics from Spanish-speaking families were less likely to have symptoms than children from English-speaking families, they were twice as likely to be hospitalized for asthma (9.4% vs. 4.4%, p<.02). Asthmatics from Spanish-speaking households were more likely to have public health insurance and to use a community/hospital clinic for care. Spanish-speaking parents were less likely to report having access to care on weekends or to have communicated with their child’s physician about recommended components of an asthma management plan.
Adapting CAHPS ® for an American Indian Population
Authors: Weidmer-Ocampo Beverly , Johansson Patrick , Dalpoas Debbie , Wharton David , Darby Charles , Hays Ron D.
Published: August 2009

Objective . Develop a culturally appropriate, reliable, and valid survey that can be used by the Choctaw Nation Health Services (CNHS) to compare patients’ health care experiences across CNHS clinics, and to support quality improvement efforts.
Methods . We worked with CNHS staff to adapt the CAHPS Clinician and Group Survey for this purpose. We conducted cognitive interviews and a field-test to evaluate the survey.
Results . Cognitive testing yielded a survey that covered issues relevant to CNHS patients. Field testing yielded 696 surveys, (58% response rate). Analyses provided support for internal consistency of multi-item scales. Correlations among scales indicate the scales were related to one another but not redundant.
Discussion . The CAHPS American Indian Survey is useful for assessing perceptions of care at the clinic level and across different clinics. The close partnership with CNHS helped yield a survey that is scientifically sound, reflects how services are organized and delivered locally, and meets CNHS information needs.
An Ethnographic Study of Meal Programs for Homeless and Under-Housed Individuals in Toronto
Authors: Dachner Naomi , Gaetz Stephen , Poland Blake , Tarasuk Valerie
Published: August 2009

Over the past two decades, Canada has witnessed a proliferation of community-based initiatives providing charitable meals to homeless and under-housed individuals. The existing research has raised concerns about the ability of such initiatives to meet users’ nutrient needs. As part of a study of Toronto meal programs, open-ended interviews with program coordinators and observations of 16 meal programs were conducted to provide insight into the nutritional vulnerability of program users. Analysis using ethnographic methods revealed that, although charitable meal programs began in response to concerns about unmet food needs, the planning and delivery of meals are disconnected from the dietary needs of program users. Food was often a secondary service, designed to fit within the existing operations, resources, and mandate of the host agency. This work adds to calls for a rethinking of current responses to problems of hunger and food insecurity among individuals living in poverty in Canada.
Ethnically Diverse Mothers’ Views on the Acceptability of Screening for Maternal Depressive Symptoms during Pediatric Well-Child Visits
Authors: Feinberg Emily , Smith Megan V. , Naik Reshma
Published: August 2009

The under-identification of depressive symptoms among low-income, minority women contributes to disparities in mental health outcomes. Pediatric visits offer a new venue for the identification of such symptoms. We explored women’s views related to depression screening during pediatric well-child visits in interviews conducted with 42 mothers of diverse ethnicities. Women considered their child’s pediatric provider to be an appropriate person with whom to discuss their emotional health and were aware of the inter-relationship between their mood and their child’s well-being. Thus, they felt discussing their emotional health was an acceptable component of pediatric health care. Stigma and fear of child protective services were concerns. Women articulated strategies to improve acceptability of screening, including providing a clear rationale for screening, services available, and child protective service involvement. The perspectives of women of diverse ethnicities provide information that may improve identification of mothers with depressive symptoms and potentially reduce disadvantages in mental health outcomes in minority populations.
The Cost of Health Care Services Provided to Women Enrolled in a Community-Based Breast and Cervical Cancer Screening Program
Authors: Burack Robert , Lafata Jennifer Elston
Published: August 2009

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is a state-federal partnership that provides breast and cervical cancer-related services for low-income women but does not address other health care needs. We describe the annual cost and reimbursement associated with all services delivered to 483 program enrollees at one health care system during 2001–03. The average per-enrollee cost for all clinical services provided was $1,056. However, average revenue was $533 per enrollee ($138 from NBCCEDP and $395 from other sources); the cost of uncompensated care thus averaged $523 per year per enrollee (approximately 50% of total cost). The net cost to the health system was nearly four dollars for each dollar of NBCCEDP revenue. The public health benefit of the NBCCEDP may extend beyond breast and cervical cancer but at a cost of increased uncompensated care borne by participating providers.
Dually Eligible and Colorectal Cancer Screening: Too Little, Too Late?
Authors: Carcaise-Edinboro Patricia , Bradley Cathy J. , Dahman Bassam
Published: August 2009

Background . Cancer screening reduces late-stage diagnosis. Medicare and Medicaid dually eligible patients receive more late stage colorectal cancer (CRC) diagnoses.
Methods . Characteristics of CRC patients diagnosed between 1997 and 2000 were extracted from the Michigan Tumor Registry and Medicare administrative data, Area Resource File, and U.S. Census to assess CRC screening (fecal occult blood testing (FOBT), barium enema, colonoscopy, and sigmoidoscopy) and late stage CRC diagnosis.
Results . Adjusted logistic regression models indicated dually eligible patients received less CRC screening (OR 0.68, 95% CI 0.59–0.78, p<.001). There was less late-stage diagnosis with colonoscopy receipt (OR 0.60, 95% CI 0.53–0.69, p<.001), sigmoidoscopy (OR 0.77, 95% CI 0.67–0.89, p<.001), and FOBT (OR 0.77, 95% CI 0.70–0.86, p<.01), but more if patients were dually eligible (OR 1.28, 95% CI=1.12–1.46, p<0.001).
Conclusions. Dually eligible CRC patients were screened less and diagnosed later than Medicare patients. Fecal occult blood testing remains a less invasive and less costly screening option that may reduce late-stage diagnosis in lowincome populations.
Medical Education in the 21st Century
Authors: Walker Bailus , Mouton Charles
Published: August 2009

This commentary is a reaction of medical educators and health practitioners to the Josiah Macy Jr. Foundation’s recently released report, Revisiting the Medical School Mission at a Time of Expansion . The report is a fresh assessment of what more medical schools must do to prepare students for 21st century challenges and opportunities to improve the health status of the population including underserved groups.
The BRAVE (Building Resiliency and Vocational Excellence) Program: Evaluation Findings for a Career-Oriented Substance Abuse and Violence Preventive Intervention
Authors: Griffin James P. , Holliday Rhonda C. , Frazier Emma , Braithwaite Ronald L.
Published: August 2009

This article examines the effectiveness of a career-oriented intervention for preventing involvement with alcohol, tobacco, and other drugs (ATODs) and violence and for promoting resilient behavior among eighth-grade, African American middle school students (N=178; n=92 intervention and n=86 comparison) through the implementation of the Building Resiliency and Vocational Excellence (BRAVE) Program. Students were randomly assigned to either the intervention or control group. Students in the evaluation participated in the school-based BRAVE Program intervention and the standard public school curriculum. Comparison students participated only in the standard curriculum. Alcohol, tobacco, and other drug use and violent behavior were assessed for 178 students at baseline, post-test, and one-year follow up (one year after baseline). Results revealed a beneficial effect of the intervention on participants’ frequency of use of alcohol (p<.04) and marijuana (p<.05), but no effect for violent behavior.
Exploring the Financial Impact of Breast Cancer for African American Medically Underserved Women: A Qualitative Study
Authors: Darby Kathleen , Davis Cindy , Likes Wendy , Bell John
Published: August 2009

In addition to the physical suffering experienced by cancer survivors, there are considerable financial hardships and access barriers to quality health care. The current study explored the financial burden of breast cancer on African American medically underserved women. Four focus groups were conducted in three major cities across Tennessee. Research participants (N=36) were recruited by the staff of cancer support and treatment programs in the area. Findings revealed that participants’ lack of insurance or inadequate insurance resulted in missed, delayed, or fewer treatment opportunities. The financial burden of cancer was not limited to the acute treatment phase. The women in the current study reported extreme economic hardship resulting from this disease into long-term survivorship. This exploratory study confirms the importance of providing care across the continuum to address the complex needs of low-income cancer survivors.
Transforming Administrative and Clinical Practice in a Public Behavioral Health System: An Ethnographic Assessment of the Context of Change
Authors: Willging Cathleen E. , Waitzkin Howard , Lamphere Louise
Published: August 2009

In July 2005, New Mexico placed all publicly funded behavioral health services under the management of one private corporation. This reform emphasized the provision of evidence-based, culturally competent services.
Methods . Participant observation and semi-structured interviews with 189 administrators, staff, and providers were carried out in 14 behavioral health safety-net institutions (SNIs) during the transition period.
Results . New administrative requirements led to substantial paperwork demands, payment problems, and financial stress within SNIs. Personnel at the SNIs often lacked knowledge about and training in evidence-based practices and culturally competent care, and viewed the costs of delivering such services as prohibitive.
Discussion . Policymakers must account for the challenges that SNIs face as the reform continues to unfold. The financial stability of SNIs is of critical importance. Efforts are needed to increase training and development opportunities in evidence-based care and cultural competency; SNIs typically lack resources to pursue these opportunities on their own.
Do Patients Bypass Rural Hospitals?: Determinants of Inpatient Hospital Choice in Rural California
Authors: Escarce José J. , Kapur Kanika
Published: August 2009

Rural hospitals play a crucial role in providing health care to rural Americans, a vulnerable and underserved population; however, rural hospitals have faced threats to their financial viability and many have closed as a result. This paper examines the hospital characteristics that are associated with patients choosing rural hospitals, and sheds light on the types of patients who depend on rural hospitals for care and, hence, may be the most harmed by the closure of rural hospitals. Using data from California hospitals, the paper shows that patients were more likely to choose nearby hospitals, larger hospitals, and hospitals that offered more services and technologies. However, even after adjusting for these factors, patients had a propensity to bypass rural hospitals in favor of large urban hospitals. Offering additional services and technologies would increase the share of rural residents choosing rural hospitals only slightly.
The Health Status of Black Canadians: Do Aggregated Racial and Ethnic Variables Hide Health Disparities?
Authors: Rodney Patricia , Copeland Esker
Published: August 2009

This paper examines the importance of collecting and reporting data on race and ethnicity in public health and biomedical research in Canada. Literature and available statistics related to social determinants of health were reviewed and analyzed to illustrate that minority populations in Canada, especially Blacks, are likely to experience poorer health outcomes. Statistics Canada in its commitment to multiculturalism uses broad categories such as visible minorities and racialised groups as surrogates for race and ethnicity. These categories, when used in health literature may conceal underlying inequities in health between population groups. Blacks and minority groups in Canada have higher rates of unemployment, lower rates of educational attainment, and lower socioeconomic status. Whenever Canadian data based on race and ethnic categories are reported, disparities are observed. The lack of disaggregated data may hide health disparities.
Cost of Racial Disparity in Preterm Birth: Evidence from Michigan
Authors: Xu Xiao , Grigorescu Violanda , Siefert Kristine A. , Lori Jody R. , Ransom Scott B.
Published: August 2009

This study examined the economic costs associated with racial disparity in preterm birth and preterm fetal death in Michigan. Linked 2003 Michigan vital statistics and hospital discharge data were used for data analysis. Thirteen percent of the singleton births among non-Hispanic Blacks were before 37 completed weeks of gestation, compared with only 7.7% among non-Hispanic Whites (risk ratio = 1.66, 95% confidence interval: 1.59–1.72; p<.0001). One thousand one hundred and eighty four (1,184) non-Hispanic Black, singleton preterm births and preterm fetal deaths would have been avoided in 2003 had their preterm birth rate been the same as Michigan non-Hispanic Whites. Economic costs associated with these excess Black preterm births and preterm fetal deaths amounted to $329 million (range: $148 million–$598 million) across their lifespan over and above the costs if they were born at term, including costs associated with the initial hospitalization, productivity loss due to perinatal death, and major developmental disabilities. Hence, racial disparity in preterm birth and preterm fetal death has substantial cost implications for society. Improving pregnancy outcomes for African American women and reducing the disparity between Blacks and Whites should continue to be a focus of future research and interventions.
Can Quality Reports Help Address Health Care Disparities?: Use and Awareness of Comparative Quality Information by African Americans
Authors: SteelFisher Gillian K. , Schneider Eric C. , Zaslavsky Alan M. , Blendon Robert J.
Published: August 2009

Comparative quality information (CQInfo) might help ameliorate racial disparities in health care. However, barriers such as low literacy and non-representative materials may make African Americans less likely than Whites to use CQInfo, thus diminishing its effect. Therefore, this analysis sought to evaluate racial differences in awareness and use of CQInfo using a national, random digit dial telephone survey. Results show that African Americans were less likely than Whites to have seen CQInfo concerning hospitals and doctors (not health plans), but were not less likely to have used it. Conditional on awareness, African Americans were more likely than Whites to have used this information. In logistic regressions controlling for other demographic characteristics, racial differences in awareness remained marginally significant statistically and differences in conditional use disappeared. Findings suggest a demand for CQInfo among African Americans, and support the idea that such information could help ameliorate racial disparities, if efforts also address educational and other related barriers.