bluuebunny/crossref_metadata_2025 huggingface dataset:
Enlargement and the labour market: perception, theory and fact
Authors: Ingham Mike , Ingham Hilary
Published: November 2004

Favourable labour market outcomes are essential for economic and social cohesion within the newly enlarged European Union. However, Eurobarometer evidence indicates that many in the 10 incoming countries are not convinced that membership will deliver such a result. Also, there is no unambiguous theoretical framework that suggests otherwise. A more optimistic scenario can be obtained by reference to the experiences of earlier low‐income Community entrants during their first years of membership, although long‐term convergence has remained elusive.
The German model in danger
Authors: Grahl John , Teague Paul
Published: November 2004

The German high‐skills/high value‐added economy has long been the Mecca for supporters of the European social model. So long as Model Deutschland was thriving the notion of Social Europe was a plausible political project. But Germany is facing a range of economic problems—the aftershock of reunification, high unemployment and internal and external pressures to reform its stakeholder system of economic organisation. Some of these developments strike at core assumptions of the German model. This article reviews the extent to which the German model is in danger and teases out the implications for the wider European economy.
Interviewing children and young people with learning disabilities*: guidelines for researchers and multi‐professional practice
Authors: Lewis Ann , Porter Jill
Published: November 2004

We argue that it is important for researchers and service providers to not only recognize the rights of children and young people with learning disabilities to have a ‘voice’, but also to work actively towards eliciting views from all. A set of guidelines for critical self‐evaluation by those engaged in systematically collecting the views of children and young people with learning disabilities is proposed. The guidelines are based on a series of questions concerning: research aims and ethics (encompassing access/gatekeepers; consent/assent; confidentiality/anonymity/secrecy, recognition, feedback and ownership; and social responsibility) sampling, design and communication.
Developing an approach to involving children with autistic spectrum disorders in a social care research project
Authors: Beresford Bryony , Tozer Rosemary , Rabiee Parvaneh , Sloper Patricia
Published: November 2004

A project researching user‐views on the outcomes of social care and support services for disabled children and their families presented new challenges to a research team. While the team had experience of working with other groups of disabled children, this project was the first in which the team sought to work directly with children with autistic spectrum disorders. This paper reports the process by which the research design and methods used were developed and tailored to the needs and abilities of these children. The key lesson learnt was the value of crossing disciplines, research areas and professional boundaries when trying to identify ways of working with a ‘hard to reach group’.
Ovulation induction with a starting dose of 50 IU of recombinant follicle stimulating hormone in WHO group II anovulatory women: the IO‐50 study, a prospective, observational, multicentre, open trial
Authors: Calaf Alsina Joaquim , Ruiz Balda José A. , Romeu Sarrió Alberto , Caballero Fernández Virginia , Cano Trigo Ignacio , Gómez Parga José L. , González Batres Clemente , Rodríguez Escudero Francisco J.
Published: November 2004

Objective
To assess the efficacy and safety in clinical practice of a low dose regimen of 50 IU of recombinant follicle stimulating hormone in induction of ovulation.

Design
Prospective, observational, non‐comparative, open, multicentre study.

Setting
Eighty‐eight infertility clinics and teaching hospital fertility units throughout Spain.

Population
Women with normogonadotrophic chronic anovulation (WHO group II) with or without echographic diagnosis of polycystic ovary syndrome.

Methods
Low dose step‐up protocol of recombinant follicle stimulating hormone administration (follitropin beta, Puregon) with a starting dose of 50 IU and weekly increments according to follicular response monitored prospectively by transvaginal ultrasonography. Patients were followed for a minimum of one cycle and a maximum of six.

Main outcome measures
Rate and size of follicular growth, cumulative ovulation rate, follicle stimulating hormone doses and duration of treatment, pregnancy and cycle cancellation rate, ovarian hyperstimulation syndrome and multiple pregnancy.

Results
A total of 945 treatment cycles were evaluated. In 817 cycles, ovulation was induced with human chorionic gonadotrophin (hCG) and in 501 (61.3%) unifollicular development (a follicle of ≥18 mm) was achieved. A total of 128 cycles (13.5%) were cancelled because of ovarian hyper‐responsiveness or spontaneous ovulation. The cumulative ovulation rate (confirmed by mid‐luteal serum progesterone concentrations) after six treatment cycles was 84%. There were 136 clinical pregnancies (14.4% pregnancies per cycle). The cumulative pregnancy rate after six treatment cycles was 53.1%. Eight twin pregnancies occurred. Thirteen women miscarried and there were two cases of ectopic pregnancies. The median of average daily doses of follitropin beta in all cycles was 50 IU. Between 68% and 86% of patients received treatment with follitropin beta for a maximum of 14 days. Ovarian hyperstimulation syndrome occurred in 64 (6.8%) cases but no case of severe ovarian hyperstimulation developed.

Conclusions
Low dose regimen of 50 IU of recombinant follicle stimulating hormone (Puregon) is efficient, safe and well tolerated for inducing follicular development in WHO group II anovulatory women.
Differences in episiotomy technique between midwives and doctors
Authors: Tincello Douglas G. , Williams Abimbola , Fowler Gillian E. , Adams Elisabeth J. , Richmond David H. , Alfirevic Zarko
Published: November 2004

Objectives
To examine the practice of making an episiotomy and to determine any differences in practice between professional groups.

Design
A prospective survey.

Setting
A large tertiary referral obstetric hospital and the obstetric department of a district general hospital.

Population
All staff routinely involved in the care of women in labour.

Methods
A novel validated pictorial questionnaire was designed, validated and distributed to the study population. Differences in outcome measures were compared by profession and by seniority.

Main outcome measures
Measurements taken from the questionnaire: the length of episiotomy drawn; the distance from the sagittal plane at which the episiotomy was begun; and the angle of the episiotomy from the sagittal plane.

Results
Fifty doctors and 78 midwives completed the forms. Median distance of the episiotomy from the midline was 0 mm (−2 to 11). Episiotomies drawn by doctors were significantly longer and more angled than those drawn by midwives (P= 0.002 and P= 0.001). Sixteen percent of doctors and 1% of midwives drew an episiotomy longer than 20 mm (difference 15%, 95% CI 6 to 24). Twenty‐three percent of midwives and 2% of doctors drew an episiotomy angled 30° or less (difference 21%, 95% CI 9 to 34).

Conclusions
This study has demonstrated differences in the reporting of episiotomy practice by doctors and midwives. Theoretically, the differences demonstrated could predispose to a greater risk of anal sphincter injuries. These data need to be confirmed by observational studies of actual practice and by studies to investigate the mechanics of sphincter injury during childbirth.
Video self‐modelling: an effective intervention for a preschooler with language delays
Authors: Whitlow Crystal K. , Buggey Tom
Published: November 2004

The remediation of language skill deficits has a positive impact on school success. Thus, intervention methods that contribute to the acquisition maintenance and generalisation of language skills during the preschool years are of value. Researchers have studied learning from modelled behaviour for some time. The more like the individual the model was perceived to be, the more effective the results. It may be logical to assume that if an individual were to observe him/herself being successful at a task, self‐efficacy would increase. This appears to be the case in this study, in which video self‐modelling was used with a preschooler with language delays.
Microsatellite loci for the Siberian flying squirrel, Pteromys volans
Authors: Painter Jodie N. , Selonen Vesa , Hanski Ilpo K.
Published: November 2004

We report the isolation and characterization of polymorphic microsatellite loci for the Siberian flying squirrel Pteromys volans. The seven most useful loci had between six and 11 alleles and expected heterozygosities ranging from 0.477 to 0.866. We also tested the utility of these loci in other squirrel species, northern flying squirrels (Glaucomys sabrinus and G. volans) and the common red squirrel (Sciurus vulgaris). Three of the Siberian flying squirrel loci were polymorphic in other squirrel species, suggesting a limited potential for cross‐species use.
Characterization of polymorphic microsatellite markers for Microcyclus ulei, causal agent of South American leaf blight of rubber trees
Authors: Le Guen V. , Rodier‐Goud M. , Troispoux V. , Xiong T.‐C. , Brottier P. , Billot C. , Seguin M.
Published: November 2004

South American leaf blight caused by the ascomycete Microcyclus ulei is the most harmful disease of the rubber tree in Latin America and a potential threat to Asiatic and African natural rubber production. Until now, the variability of this fungus was assessed through observation of pathogenicity of isolates on a range of rubber tree clones with known resistance reactions. The present study describes the process used to design 11 microsatellite markers and evaluates their usefulness in detecting genetic polymorphism. Nine of these markers were polymorphic among six isolates from Brazil (with two to three alleles per locus) and five markers were polymorphic among four isolates from French Guiana (with two to four alleles per locus).
Polymorphic microsatellite loci in the European subterranean termite, Reticulitermes santonensis Feytaud
Authors: Dronnet Stéphanie , Bagnères Anne‐Geneviève , Juba Thomas R. , Vargo Edward L.
Published: November 2004

We report on the identification and characterization of two dinucleotide, two trinucleotide and eight tetranucleotide microsatellite DNA loci isolated from the European subterranean termite Reticulitermes santonensis. We tested the loci on 51–92 individuals from 46 colonies from different regions of France. Eleven loci were polymorphic with 2–8 alleles per locus and low observed heterozygosities (0.10–0.48). We also tested the loci on 17–20 individuals from 10 colonies in the closely related North American species R. flavipes and found significantly more alleles (2–9 alleles per locus) and higher observed heterozygosities (0.15–0.80) than in R. santonensis. The lower observed heterozygosities in R. santonensis are consistent with higher levels of inbreeding in these colonies due to the presence of numerous inbred replacement reproductives.
Diffusion of arylpropionate non‐steroidal anti‐inflammatory drugs into the cerebrospinal fluid: a quantitative structure–activity relationship approach
Authors: Péhourcq Fabienne , Matoga Myriam , Bannwarth Bernard
Published: November 2004

A quantitative structure–activity relationship (QSAR) analysis of a series of arylpropionic acid non‐steroidal anti‐inflammatory drugs (NSAIDs) has been performed to determine which physicochemical properties of these compounds are involved in their diffusion into the cerebrospinal fluid (CSF). The penetration of eight arylpropionic acid derivatives into CSF was studied in male Wistar rats. After intraperitoneal administration of each compound (5 mg/kg), blood and CSF samples were collected at different times (0.5, 1, 3 and 6 h). The fraction unbound to plasma protein was determined using ultrafiltration. The areas under the curve of the free plasma (AUCF) and CSF (AUCCSF) concentrations were calculated according to the trapezoidal rule. The overall drug transit into CSF was estimated by the ratio RAUC (AUCCSF : AUCF). The lipophilicity was expressed as the chromatographic capacity factor (log kIAM) determined by high‐performance liquid chromatography on an immobilized artificial membrane (IAM) column. A significant parabolic relationship was sought between lipophilicity (log kIAM) and the capacity of diffusion across the blood–brain barrier (log RAUC) (r = 0.928; P < 0.01). The arylpropionic acid NSAIDs exhibiting a lipophilicity value between 1.1 and 1.7 entered the CSF easily (RAUC > 1). The molecular weight (MW) was included in this parabolic relationship by means of a multiple regression analysis. This physicochemical parameter improved the correlation (r = 0.976; P < 0.005). Based on our findings, diffusion of arylpropionic acid NSAIDs into CSF appears to depend primarily on their lipophilicity and MW.
Effects of atipamezole — a selective α2‐adrenoceptor antagonist — on cardiac parasympathetic regulation in human subjects
Authors: Penttilä J. , Kaila T. , Helminen A. , Anttila M. , Karhuvaara S. , Huhtala S. , Scheinin H.
Published: November 2004

1 This double‐blind, cross‐over, placebo‐controlled study on six healthy male volunteers was designed to evaluate the effects of α2‐adrenoceptor antagonism on cardiac parasympathetic regulation.

2 The subjects received atipamezole intravenously as a three‐step infusion, which aimed at steady‐state serum concentrations of 10, 30 and 90 ng ml−1 at 50‐min intervals.

3 Drug effects were assessed with repeated recordings of blood pressure and electrocardiogram, in which the high‐frequency (0.15–0.40 Hz) R‐R interval variation is supposed to reflect cardiac parasympathetic efferent neuronal activity.

4 At the end of the three steps of the infusion, the mean (±SD) concentrations of atipamezole were 10.5 (3.9), 26.8 (5.6) and 81.3 (21.1) ng ml−1.

5 Within this concentration range, atipamezole appeared to reduce slightly the high‐frequency R‐R interval fluctuations, indicating a minor vagolytic effect in the heart.

6 Atipamezole increased systolic and diastolic arterial pressure, on average by 20 and 14 mmHg (maxima at the second step of the infusion), which evidently reflects an overall sympathetic augmentation.
Comparison of noradrenaline and lysosphingolipid‐induced vasoconstriction in mouse and rat small mesenteric arteries
Authors: Hedemann J. , Fetscher C. , Michel M. C.
Published: November 2004

1 We have compared vasoconstriction responses in isolated mesenteric small arteries from mice and rats as elicited by KCl, noradrenaline and the lysosphingolipids sphingosine‐1‐phosphate (S1P) and sphingosylphosphorylcholine (SPC).

2 Contractile responses to KCl and noradrenaline, but not those of S1P or SPC, were significantly related to vessel diameter in both species.

3 When comparing vessels of similar diameter, contractile responses for KCl and the three agonists were much smaller in mice than in rats, e.g. 8.3 ± 0.4 vs. 14.7 ± 0.7 mn for noradrenaline.

4 Based upon the antagonist rank order of potency of prazosin (pKB 8.80) > B8805‐033 (pKB 7.89) > yohimbine (pKB 6.18) ≈ BMY 7378 (pA2 6.03), noradrenaline responses in mice were mediated solely via α1A‐adrenoceptors, similar to what repeatedly has been shown in rats.

5 The S1P3 receptor antagonist suramin (100 μm) significantly inhibited responses to S1P and SPC in rats but not in mice, and did not affect noradrenaline responses in either species.

6 We conclude that for any given diameter, mouse mesenteric arteries develop less contraction in response to various stimuli. Noradrenaline acts via α1A‐adrenoceptors in both species. Responses to S1P and SPC differ between both species with regard to suramin‐sensitivity indicating involvement of different receptor subtypes for lysosphingolipids in both species.
Between air and water: the plunge dive of the Cape Gannet Morus capensis
Authors: Ropert‐Coudert Yan , Grémillet David , Ryan Peter , Kato Akiko , Naito Yasuhiko , Le Maho Yvon
Published: November 2004

Gannets have one of the most spectacular prey‐capture behaviours of all marine predators, plummeting from up to 30 m into the water, where they seize fish with their razor‐sharp beaks. However, there is little detailed information on this brief behaviour. In January and December 2002, we monitored the biomechanics of plunge diving in 25 free‐ranging Cape Gannets Morus capensis using a recently developed, rapid‐sampling acceleration and depth recorder. Our data provide the first detailed description of this highly specialized foraging technique. We recorded no or a very low deceleration when Gannets entered the water, which underlines the remarkable streamlining of this large bird. Birds use their momentum to travel underwater at an average descent rate of 2.87 m/s (sd = ±1.53) before actively braking once they attain the desired depth (range 0.3–9.7 m). We show that Gannets sometimes used either their wings or feet for underwater propulsion during the course of 9.4% of the dives that had undulations in their depth profiles. After chasing prey, birds developed an upward momentum before gliding passively back to the surface, making use of their buoyancy to complete the dive at the lowest possible energy cost.
Relationships between home‐range size, sex and season with reference to the mating system of the Houbara Bustard Chlamydotis undulata undulata
Authors: Hingrat Yves , Jalme Michel Saint , Ysnel Frédéric , Lacroix Fredéric , Seabury John , Rautureau Pierrick
Published: November 2004

This paper presents observations of Houbara Bustard Chlamydotis undulata undulata home‐range, in the semi‐desert steppe of eastern Morocco. Home‐ranges were calculated from radiotagged birds using the fixed kernel method (LSCV). The mean annual home‐range of males (17 km2) was smaller than that of females (146 km2; P < 0.001). The majority of male home‐ranges had a unimodal distribution (86%), whereas 67% of female home‐ranges were multimodal. Consequently, the amplitude of female movements was larger (mean: 44 km/13 km; P < 0.002). In spring, male home‐ranges decreased in size around display sites (8 km2) and many of them overlapped considerably. Display sites show an aggregative distribution (P < 0.001) and a single female reproductive range may contain the display sites of several males. The data fulfil the definition of an exploded lek social structure. In our study, C. u. undulata appears to be sedentary with relatively limited home‐ranges. Successive years of fidelity to home‐ranges indicate that adults are not nomadic.
Local Strain Measurement within Tendon
Authors: Screen H. R. C. , Bader D. L. , Lee D. A. , Shelton J. C.
Published: November 2004

Abstract:  Tendon is a dense connective tissue, responsible for transmitting the forces generated by muscles to the skeleton. It is composed of a hierarchical arrangement of crimped collagen fibres, interspersed with proteoglycan matrix and cells, known as tenocytes. During physiological loading, tendons are subjected to strains in the region of 5–6%, which result in the straightening and realignment of the collagen fibres, generating variable local strain fields within the tendon. This study demonstrates a technique for analysing local strains within viable tendon explants, during both loading and unloading of the tissue. Samples were strained in a custom‐designed rig, allowing real‐time visualisation of cell nuclei, used as local discrete markers, on a confocal microscope. Results indicated that local strains within the fascicle are smaller than the applied strains, never exceeding 1.2%, even at 8% gross applied strain. By contrast, the sliding of adjacent collagen units was recorded at each strain increment in this study, reaching a mean maximum of 3.9% of the applied displacement. Loading–unloading studies indicated that sliding behaviour is reversible up to strains of 5%, and provides the major extension mechanism within the rat‐tail tendon. This technique can be extended to further analyse shearing behaviour within the matrix.
A combinatorial auction improves school meals in Chile: a case of OR in developing countries
Authors: Epstein Rafael , Henríquez Lysette , Catalán Jaime , Weintraub Gabriel Y. , Martínez Cristián , Espejo Francisco
Published: November 2004

The Chilean State delivers essential meal services at schools for low‐income students. Junta Nacional de Auxilio Escolar y Becas, the institution in charge of covering 1,300,000 children, leases the meal service to private enterprises. We developed an integer linear programming model to assign the meal contracts, in a process known as combinatorial auctions. The resulting model, which is NP‐hard, led to significant improvements in efficiency and also contributed to making the process more transparent. The results are apparent in substantial improvements in quality and coverage of the service, and important savings to the country, which are equivalent to feeding 300,000 children in addition. We developed techniques to solve the combinatorial models and also to analyze and compare multiple scenarios to find robust solutions. For the objective function of this problem, we analyzed several options to consider different kinds of social benefits. In this paper, we describe the problem, the methodology and the results. We also present empirical results based on 6 years of experience. Finally, we discuss the relevance and impact of using operations research in these central issues in developing countries.
Network service scheduling and routing
Authors: Groves G. , Le Roux J. , Van Vuuren J. H.
Published: November 2004

Real‐life vehicle routing problems generally have both routing and scheduling aspects to consider. Although this fact is well acknowledged, few heuristic methods exist that address both these complicated aspects simultaneously. We present a graph theoretic heuristic to determine an efficient service route for a single service vehicle through a transportation network that requires a subset of its edges to be serviced, each a specified (potentially different) number of times. The times at which each of these edges are to be serviced should additionally be as evenly spaced over the scheduling time window as possible, thus introducing a scheduling consideration to the problem. Our heuristic is based on the tabu search method, used in conjunction with various well‐known graph theoretic algorithms, such as those of Floyd (for determining shortest routes) and Frederickson (for solving the rural postman problem). This heuristic forms the backbone of a decision support system that prompts the user for certain parameters from the physical situation (such as the service frequencies and travel times for each network link as well as bounds in terms of acceptability of results) after which a service routing schedule is suggested as output. The decision support system is applied to a special case study, where a service routing schedule is sought for the South African national railway system by Spoornet (the semi‐privatised South African national railways authority and service provider) as part of their rationalisation effort, in order to remain a lucrative company.
Logistics of tractor distribution in an agriculture‐driven economy: an Indian case study
Authors: Raghuram G.
Published: November 2004

This paper examines critical decision areas in the context of outbound logistics and their analytical resolution (using operational research models) for a tractor company, which was among the market leaders in the tractor industry in India. Customer preferences and demands had changed in the context of the competitive environment. The challenges lay in increasing service levels to the customer through improvements in supply chain management and supporting infrastructure. Apart from value through improved service levels, cost savings of Rs 22 million per year (benchmarked against a profit before tax of Rs 1 billion per year) could be extracted through a better distribution structure involving a new central despatch yard and revised stockyard locations.
Physical and Sensory Functioning over Time and Satisfaction with Care: The Implications of Getting Better or Getting Worse
Authors: Iezzoni Lisa I. , Davis Roger B. , Soukup Jane , O'Day Bonnie
Published: November 2004

Objective. To determine whether those persons whose sensory or physical functioning improved or worsened over one year are more or less satisfied with their health care.

Data Sources. 1996 and 1997 Medicare Current Beneficiary Survey (MCBS).

Study Design. The MCBS surveys a nationally representative, longitudinal panel of Medicare beneficiaries about their sociodemographic attributes; vision, hearing, and various mobility functions; and 10 items representing satisfaction with and access to health care. Using multivariable logistic regression and controlling for sociodemographic factors, we computed adjusted odds ratios of dissatisfaction with care, examining the effects of changes in sensory or physical functioning. Analyses accounted for MCBS sampling weights.

Data Extraction Methods. We identified 9,974 community‐dwelling respondents, 18 years old and over who answered the 1996 and 1997 MCBS. We assessed five categories of sensory or physical functioning (vision; hearing; walking; reaching overhead; and grasping and writing) and compared 1996 and 1997 responses to identify those whose functioning improved or worsened.

Principal Findings. Worsened functioning was strongly associated with older age, low income, and low educational attainment. Improved functioning was rarely significantly associated with satisfaction; an exception involved substantially lower rates of dissatisfaction with “ease and convenience” of getting to physicians. Worsened functioning was often statistically significantly associated with dissatisfaction, always with adjusted odds ratios >1.0. Across all five functional categories, persons whose functioning worsened displayed significantly greater dissatisfaction with overall quality, ease, and costs or care.

Conclusions. Persons whose functioning improved rarely reported better satisfaction than did those whose functioning did not improve, while those whose functioning worsened expressed more systematic reservations about their care.
Elevated Depressive Symptoms among Caregiving Grandparents
Authors: Blustein Jan , Chan Sewin , Guanais Frederico C
Published: November 2004

Objective. To determine whether caregiving grandparents are at an increased risk for depressive symptoms.

Data Source. National sample (n=10,293) of grandparents aged 53–63 years in 1994, and their spouse/partners, who took part in the Health and Retirement Study (HRS).

Study Design. Grandparents were surveyed in 1994 and resurveyed every two years thereafter, through 2000. Over that period, 977 had a grandchild move in or out of their home. These grandparents served as their own controls to assess the impact of having a grandchild in the home.

Data Extraction. Depressive symptoms were measured using an abbreviated form of the Center for Epidemiologic Studies—Depression (CES‐D) scale, scored 1–8, with a score ≥4 associated with depression “caseness.”

Principal Findings. At the time of the 1994 interview, 8.2 percent of grandparents had a grandchild in their home. However, there was substantial variation across demographic groups (e.g., 29.4 percent of single nonwhite grandmothers, but only 2.0 percent of single white grandfathers had a grandchild in residence). The impact of having a grandchild in the home varied by grandparent demographic group, with single grandparents and those without coresident adult children experiencing the greatest probability of elevation in depressive symptoms when a grandchild was in residence. For example, single nonwhite grandmothers experienced an 8 percentage point increase in the probability of having a CES‐D score ≥4 when a grandchild was in their home, compared to when a grandchild was not in their home, controlling for changes in health care, income, and household composition over time (95 percent CI=0.1 to 15.0 percentage points).

Conclusions. Grandparents have a greater probability of elevated depressive symptoms when a grandchild is in their home, versus when a grandchild is not in their home. Single women of color bear a disproportionate burden of the depression associated with caring for grandchildren. Since an increasing number of grandparents function as a de facto safety net keeping their grandchildren out of formal foster care, identifying strategies to support the health and well‐being of caregiving grandparents is an emerging priority.
Predicting Lawsuits against Nursing Homes in the United States, 1997–2001
Authors: Johnson Christopher E. , Dobalian Aram , Burkhard Janet , Hedgecock Deborah K. , Harman Jeffrey
Published: November 2004

Objectives. To examine how nursing home characteristics impacted the number of lawsuits filed against the facilities in the United States during 1997–2001.

Data Sources/Study Setting. A stratified random sample of 2,378 nursing home in 45 states from 1997–2001. Data were obtained from Westlaw's Adverse Filings: Lawsuits database, the Centers for Medicare and Medicaid Services' (CMS) Online Survey, Certification, and Reporting (OSCAR) database, state complaint surveys, and through primary data.

Study Design. Negative binomial regression was used to explain total lawsuit variance by year. Explanatory variables included (a) facility characteristics—including staffing, number of beds, multistate system membership, for‐profit ownership, (b) quality indicators—including total number and type of quality survey deficiencies, pressure sore development, and (c) market area—state has resident rights statutes, state complaint information. Resident acuity levels and year effects were controlled for.

Data Collection/Extraction Methods. Nursing homes were identified and linked to Westlaw data that was searched for the number of lawsuits filed against the home, and then linked to OSCAR data and a primary data analysis of multistate chain membership.

Principal Findings. Staffing levels for certified nursing assistants (CNAs) and registered nurses (RNs) and multistate chain membership were negatively related with higher numbers of lawsuits. More deficiencies on the licensing survey, larger, for‐profit nursing homes, and being located in resident rights states were positively related with higher numbers of lawsuits.

Conclusion. This study suggests that nursing homes that meet long‐stay staffing standards and minimum quality indicators, are nonprofit, smaller, and not located in resident rights states will experience fewer lawsuits.
Specificity and Sensitivity of Claims‐Based Algorithms for Identifying Members of Medicare+Choice Health Plans That Have Chronic Medical Conditions
Authors: Rector Thomas S. , Wickstrom Steven L. , Shah Mona , Thomas Greeenlee N. , Rheault Paula , Rogowski Jeannette , Freedman Vicki , Adams John , Escarce José J.
Published: November 2004

Objective. To examine the effects of varying diagnostic and pharmaceutical criteria on the performance of claims‐based algorithms for identifying beneficiaries with hypertension, heart failure, chronic lung disease, arthritis, glaucoma, and diabetes.

Study Setting. Secondary 1999–2000 data from two Medicare+Choice health plans.

Study Design. Retrospective analysis of algorithm specificity and sensitivity.

Data Collection. Physician, facility, and pharmacy claims data were extracted from electronic records for a sample of 3,633 continuously enrolled beneficiaries who responded to an independent survey that included questions about chronic diseases.

Principal Findings. Compared to an algorithm that required a single medical claim in a one‐year period that listed the diagnosis, either requiring that the diagnosis be listed on two separate claims or that the diagnosis to be listed on one claim for a face‐to‐face encounter with a health care provider significantly increased specificity for the conditions studied by 0.03 to 0.11. Specificity of algorithms was significantly improved by 0.03 to 0.17 when both a medical claim with a diagnosis and a pharmacy claim for a medication commonly used to treat the condition were required. Sensitivity improved significantly by 0.01 to 0.20 when the algorithm relied on a medical claim with a diagnosis or a pharmacy claim, and by 0.05 to 0.17 when two years rather than one year of claims data were analyzed. Algorithms that had specificity more than 0.95 were found for all six conditions. Sensitivity above 0.90 was not achieved all conditions.

Conclusions. Varying claims criteria improved the performance of case‐finding algorithms for six chronic conditions. Highly specific, and sometimes sensitive, algorithms for identifying members of health plans with several chronic conditions can be developed using claims data.
Impacts of Informal Caregiver Availability on Long‐term Care Expenditures in OECD Countries
Authors: Yoo Byung‐Kwang , Bhattacharya Jay , McDonald Kathryn M. , Garber Alan M.
Published: November 2004

Objective. To quantify the effects of informal caregiver availability and public funding on formal long‐term care (LTC) expenditures in developed countries.

Data Source/Study Setting. Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000.

Study Design. Secondary data analysis, applying fixed‐ and random‐effects models to time‐series cross‐sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population.

Data Collection/Extraction Method. Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base.

Principal Findings. Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male‐to‐female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full‐time/part‐time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country.

Conclusions. The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long‐term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.
The Impact of a Microfinance Program on Client Perceptions of the Quality of Care Provided by Private Sector Midwives in Uganda
Authors: Agha Sohail , Balal Asma , Ogojo‐Okello Francis
Published: November 2004

Objective. To assess the impact of a microfinance program that provided business skills training and revolving loans to private sector midwives on perceived quality of services and client loyalty.

Study Design. A quasi‐experimental study with a pretest, posttest design was used to evaluate the impact of the intervention. Exit interviews were conducted at 15 clinics that received the intervention and 7 clinics that did not. Baseline exit interviews were conducted between November and December 2000. Five days of business skills training were provided to midwives, and loans (averaging $454) were given during January and February 2001. A follow‐up clinic visit was made to assess whether midwives were implementing what was emphasized during the training. The loans were to be repaid with interest within 6 to 12 months, at an interest rate that is standard within the local commercial market. For those who repaid the first set of loans (11 clinics), a second set of loans (averaging $742) was provided after June 2001. Follow‐up exit interviews were conducted at the same clinics between February and March 2002. We assessed the effect of the intervention at both clinic and client levels. T‐tests, the analysis of variance, and multivariate logistic regression analysis were conducted.

Principal Findings. These findings should be interpreted cautiously since secular trends were observed during the study period. The intervention was associated with improvement in clients' perceptions of the quality of care received at intervention clinics. The intervention was also associated with a higher level of client loyalty.

Conclusions. The enthusiastic response of midwives and the high loan repayment rate indicate that midwives were very receptive to the microfinance program. Overall, these findings suggest that microfinance may have an important role in strengthening private sector health services by increasing private providers' business skills and clients' satisfaction with services.
Capacity in Thai Public Hospitals and the Production of Care for Poor and Nonpoor Patients
Authors: Valdmanis Vivian , Kumanarayake Lilani , Lertiendumrong Jongkol
Published: November 2004

Objective. To assess the capacity of Thai public hospitals to proportionately expand services to both the poor and the nonpoor. This is accomplished by measuring the production of services provided to poor, relative to nonpoor, patients and the plant capacity of individual public hospitals to care for the patient load.

Study Setting. Thai public hospitals operating in 1999, following the economic crisis when public hospitals were required to treat all patients irrespective of ability to pay.

Study Design and Data Collection. Input and output data for 68 hospitals were collected using databases and questionnaire surveys. A distinction was made between inpatient and outpatient services to both poor and nonpoor patients and the data were assessed statistically.

Data Analysis. Congestion and capacity indices to measure poor/nonpoor service trade‐offs and capacity utilization were estimated. The analysis was undertaken by data envelopment analysis (DEA), a nonparametric linear programming approach used to derive efficiency and productivity estimates.

Principal Findings. Increases in the amount of services provided to poor patients did not reduce the amount of services to nonpoor patients. Overall, hospitals are producing services relatively close to their capacity given fixed inputs. Possible increases in capacity utilization amounted to 5 percent of capacity.

Conclusions. Results suggest that some increased public hospital care can be accomplished by reallocation of resources to less highly utilized hospitals, given the budgetary constraints. However, further expansion and increase in access to health services will require plant investments. The study illustrates how DEA methodologies can be used in planning health services in data constrained settings.
Effects of Global Budgeting on the Distribution of Dentists and Use of Dental Care in Taiwan
Authors: Hsueh Ya‐Seng A. , Lee Shoou‐Yih D. , Huang Yu‐Tung A.
Published: November 2004

Objective. To examine the effects of global budgeting on the distribution of dentists and the use and cost of dental care in Taiwan.

Data Sources. (1) Monthly dental claim data from January 1996 to December 2001 for the entire insured population in Taiwan. (2) The 1996–2001 population information for the cities, counties and townships in Taiwan, abstracted from the Taiwan‐Fukien Demographic Fact Book.

Study Design. Longitudinal, using the autocorrelation model.

Principal Findings. Results indicated decline in dental care utilization, particularly after the implementation of dental global budgeting. With few exceptions, dental global budgeting did not improve the distribution of dental care and dentist supply.

Conclusions. The experience of the dental global budget program in Taiwan suggested that dental global budgeting might contain dental care utilization and that several conditions might have to be met in order for the reimbursement system to have effective redistributive impact on dental care and dentist supply.
Agrarian Transformation and Rural Diversity in Globalizing East Asia
Authors: Kitahara Atsushi
Published: November 2004

Abstract:  In East Asia the rural society is not a society based upon agricultural industry anymore and the peasant society with its long history has been disappearing. The occupation and income sources of rural inhabitants have diversified and among them those who specialized in farming are the minority. There is a shortage of rural labor, which used to be abundant in the past, and presently it is not as easy to hire the farm workers. The reason for the diversification of the rural occupations is, to put it simply, because people cannot live merely on farm income. Indeed the farm operation costs have become more expensive due to labor saving techniques, but the livelihood costs have become more expensive due the new uniform lifestyle standards from globalization. Electric machines and education are the typical of these increased costs. The background of this rural change is industrialization and urbanization in the context of globalization and its strong impact is penetrating into the rural society through the regional urban center as the relay point of the global mechanism. This change is different based upon the location of each rural society. Generally, rural societies around a big urban center enjoy opportunities for the younger generation, but remote areas have serious problems with few employment opportunities and a smaller youth population. To reproduce and sustain the regional society as a whole, it is necessary to attract younger people and make them stay. We should plan to develop a variety of industries and the resultant diversified work opportunities in the broader region beyond the narrowly demarcated village and community. Subsistence and commercial agriculture might merely be a part of such diversity.
Cultural Hegemony of Singapore among ASEAN Countries: Globalization and Cultural Policy
Authors: Kawasaki Kenichi
Published: November 2004

Abstract:  Singapore had been called a Cultural Desert since its independence in 1965, but from the beginning of 1990s, there has been a significant change. The Singapore Government started to call their city a “Global City for the Arts”, making numerous cultural policy changes. They also worked on various cultural experiments to establish their cultural leadership or hegemony among Association of South East Asian Nations (ASEAN) countries. The development of arts policies, cultural industries and people's positive commitment towards cultural exchanges are examples of this change. Singapore therefore is now playing the role of the cultural hub among the ASEAN countries. As an example of this, the present study discusses “Esplanade”, which opened as a huge cultural complex in October 2002. Then the paper will also discuss both bright and dark sides of the cultural development in Singapore. As a conclusion, this paper discusses the possibility of the cultural contribution of Singapore to ASEAN countries, in spite of having serious epistemological discontinuity among ASEAN.
Effect of Educational Expansion on Educational Inequality in Post‐industrialized Societies: A Cross‐cultural Comparison of Japan and the United States of America
Authors: Kikkawa Toru
Published: November 2004

Abstract:  This paper analyzes the relationship between educational expansion and educational inequality. I first reconsider the conceptual basis of educational expansion, noting that in post‐industrialized societies, people's educational attainment is no longer measurable in a simple temporal increase because of the recent leveling‐off in the younger generation. I then review the theoretical framework of educational inequality. After presenting a summary of related studies, I provide a multilevel regression model that examines the macro/cohort influence of educational expansion on educational inequality in Japan and the United States. The following propositions are derived from my analyses:

Educational expansion has functioned to dissolve both the socio‐economic and the cultural‐educational reproduction processes in Japan; meanwhile, inequality in terms of micro coefficients remains.

In the United States, both the magnitude of gender inequality and the influence of the socio‐economic reproduction process are smaller than in Japan. The macro/cohort effects of educational expansion are generally smaller in the United States. This is true despite the fact that educational expansion significantly dissolves gender inequality in the United States, while educational expansion has little to do with gender equalization in Japan.

My comparison of the model's fit concludes that the trajectory of educational equalization follows the two‐fold consequence of educational expansion.

In sum, these results show that in conjunction with the non‐linear sequence of educational attainment in the post‐industrialized phase of development, the macro/cohort influence of educational expansion as well as the micro structure of educational inequality undergo gradual transformations.
Validation of a Self‐Administered Questionnaire in Chinese in the Assessment of Eczema Severity
Authors: Hon Kam Lun , Ma Kwok Chiu , Wong Eric , Leung Ting Fan , Wong Yin , Fok Tai Fai
Published: November 2004

Abstract:  The purpose of this study was to validate the Chinese version of the Nottingham Eczema Severity Score (NESS) in determining the severity of atopic dermatitis (AD). Each parent or patient filled out a questionnaire in Chinese based on the NESS. A physician then repeated the NESS independently. Finally, the severity of AD was evaluated according to the Scoring Atopic Dermatitis (SCORAD) scale. The NESSs, severity grades, and SCORAD were analyzed for agreement and correlation. The severity grading agreed with the physician's grading in 38 of 52 parents (73%) and in 16 of 18 children (89%) who self‐evaluated the severity of their AD. The weighted kappa (95% confidence interval [CI]) for parents with children less than 10 years old, parents with children ≥10 years old, and patients who self‐evaluated their AD were 0.79 (0.66–0.91), 0.85 (0.69–1.00), and 0.74 (0.36–1.00), respectively. The R2 for the NESS by parents, the NESS by patients, and the SCORAD scores was 42.1%, 47.5%, and 49.8%, respectively. When compared with the parents, the older children who self‐evaluated their AD showed a better correlation of the NESS with the SCORAD index. The self‐administered questionnaire appears to be useful in assessing AD severity in Chinese children.
Urticarial Lesions in a Child with Acute Lymphoblastic Leukemia and Eosinophilia
Authors: Hill Alicia , Metry Denise
Published: November 2004

Abstract:  The hypereosinophilic syndrome (HES) is defined by a longer than 6‐month history of peripheral blood hypereosinophilia (greater than 1.5 × 109/L), with signs and symptoms of internal organ involvement, in the absence of an identifiable cause. HES is therefore a diagnosis of exclusion. Patients have been reported who initially met the criteria for HES but subsequently developed a rare hematologic malignancy known as acute lymphoblastic leukemia with eosinophilia (ALL‐Eo). We report such a case in a 10‐year‐old boy who presented to the pediatric dermatology clinic with unusual, urticarial skin lesions. Although skin involvement is often reported in cases of HES and ALL‐Eo, such findings are variable and reports in the dermatology literature are few. We emphasize the importance of continuous monitoring for underlying malignancy in children with urticarial skin lesions in the setting of unexplained hypereosinophilia.