bluuebunny/crossref_metadata_2025 huggingface dataset:
Disparities and diversities among female‐headed households in rural Malawi after 20 years of economic liberalization
Authors: Takane Tsutomu
Published: November 2009

Using data from a survey carried out in six tobacco growing villages across Malawi in 2004–5, this paper summarizes some main differences found in subsistence production and income levels between male‐ and female‐headed households and the disparities among female‐headed households in the light of economic liberalization policies of the past two decades. The disadvantaged position of female‐headed households in terms of land and labour endowment, together with the high cost of inputs since the structural adjustment programmes and removal of subsidies since the 1980s has prevented poorer female‐headed households not only from attaining maize self‐sufficiency, but also from engaging in high‐return agriculture such as tobacco production. Although livelihood diversification is adopted by both male‐ and female‐headed households, many female‐headed households still depend on low‐entry‐barrier activities such as agricultural waged labour and are unable to break out of the poverty cycle. However, female‐headed households are a heterogeneous category and factors such as the availability of nonfarm income opportunities, social networks to access labour and capital, land acquisition through flexible applications of patrilineal inheritance rules, and the existence of formal channels for credit and informal tobacco trading have enabled some to improve agricultural productivity and achieve high incomes.
The Evolved Actor in Sociology
Authors: Hopcroft Rosemary L.
Published: November 2009

In this article, I show that principles from both evolutionary biology and evolutionary psychology inform a model of the actor that is usually implicit in sociological research on the family and social stratification. Making this evolved actor model explicit can unify and explain existing empirical sociological findings in these areas, and suggest new hypotheses for future research. I suggest the same is true in many other areas of sociology as well, and that explicitly incorporating a fully developed evolved actor model into sociology can both unify the discipline and reconnect it with the other life sciences.
Culture, Personality, and Emotion in George Herbert Mead: A Critique of Empiricism in Cultural Sociology
Authors: Gould Mark
Published: November 2009

Focusing on Mind, Self and Society, I contend that George Herbert Mead's theory is incapable of explaining the interactions in a song by Oscar Brown Jr., “The Snake,” and that a satisfactory explanation of these actions, which illuminate everyday conduct familiar to us all, requires the conceptualization of personality systems grounded in affect and cultural systems understood as symbolic logics that make intelligible certain activities. My argument is important not primarily as a critique of Mead, but of rational-choice and other cognitive theories that reduce emotions to cognitions, and of the currently dominant sociological and anthropological conceptualizations that reduce culture to forms of social practice.
Toward a General Theory of Institutional Autonomy
Authors: Abrutyn Seth
Published: November 2009

Institutional differentiation has been one of the central concerns of sociology since the days of Auguste Comte. However, the overarching tendency among ***institutionalists such as Durkheim or Spencer has been to treat the process of differentiation from a macro, “outside in” perspective. Missing from this analysis is how institutional differentiation occurs from the “inside out,” or through the efforts and struggles of individual and corporate actors. Despite the recent efforts of the “new institutionalism” to fill in this gap, a closer look at the literature will uncover the fact that (1) it has tended to conflate macro-level institutions and meso-level organizations and (2) this has led to a taken for granted approach to institutional dynamics. This article seeks to develop a general theory of institutional autonomy; autonomy is a function of the degree to which specialized corporate units are structurally and symbolically independent of other corporate units. It is argued herein that the process by which these “institutional entrepreneurs” become independent can explain how institutions become differentiated from the “inside out.” Moreover, this article offers five dimensions that can be operationalized, measuring the degree to which institutions are autonomous.
Fact-Totems and the Statistical Imagination: The Public Life of a Statistic in Argentina 2001
Authors: de Santos Martin
Published: November 2009

Statistics are key elements of contemporary life. They figure prominently in the media, in political discourse, and in daily conversations. They also weigh heavily within the economic and political spheres of modern societies. Yet, the study of statistics in the public sphere has been neglected by social scientists in favor of a focus on their production and history. This article remedies this lacuna by focusing on the public life of statistics. Through a case study of a financial indicator—country risk—that exhibited a rich public life in Argentina in 2001, it argues that statistics are not simply transparent fragments of information, but rich symbols and collective representations able to condense multiple meanings and generate deep emotional reactions. Using in-depth interviews, newspaper covers, headlines, and leads, cartoons and archival materials, this article shows that country risk became a powerful collective representation and introduces a new concept, the fact-totem, to make visible the cultural life of statistics. A fact-totem is a statistic with high media presence that captures the imagination of diverse publics and becomes articulated with basic identity narratives of a collectivity. This article begins to elaborate dramatic dimensions of statistics in public.
CORPORATE SOCIAL RESPONSIBILITY AND CORPORATE GOVERNANCE1
Authors: Sternberg Elaine
Published: November 2009

Corporate social responsibility (‘CSR’) is often associated with hopes for improved corporate governance. As understood conventionally, however, CSR is conceptually incoherent, practically unworkable, and wholly unjustified. To be compatible with corporate governance, ‘CSR’ needs to be understood not as Counterproductive Stakeholder Regimentation, but as Conscientious Stakeholder Responsibility.
EVALUATING THE CRITICISMS OF FAIR TRADE1
Authors: Smith Alastair M.
Published: November 2009

This article critically examines some of the most common arguments used to support the view that Fair Trade should be rejected by consumers and businesses seeking to socialise their economic decisions. Overall the paper finds that the majority of such criticisms lack evidential rigour and sophisticated theory but instead rely on a high degree of rhetorical aptitude. While this does not naturally lead to the position that Fair Trade is necessarily beneficial, the conclusion reflects on a substantial amount of positive evidence to suggest that Fair Trade should not be abandoned by consumers or businesses.
HOW CAN WE CALL TRANSPORT A UTILITY?
Authors: Hibbs John
Published: November 2009

First railways, then buses and taxis and, for a time, road freight – there has for many years been a tendency to treat transport as a utility, and nowhere more so than in the provision of roads. This article calls for the return of all forms of inland surface transport to the market.
INSTITUTIONAL FAILURES OF SOCIALISM
Authors: Evangelopoulos Panagiotis
Published: November 2009

An effective economic system enlists the co‐operation of all production factors, increasing welfare and reducing transactions costs. The co‐ordination mechanism is activated through decentralisation that shifts decisions on resource control from a higher to a lower level in the institutional hierarchy. Failure to incorporate successful decentralisation into the structure of socialist economies ultimately leads to collapse. Real socialism collapsed because it did not involve decentralisation. Worker‐managed socialism collapsed because of its own inherent contradictions and the absence of properly functioning decentralised price mechanisms.
THE 1930s AND THE PRESENT DAY – CRISES COMPARED
Authors: Evangelopoulos Panagiotis
Published: November 2009

Many analysts are comparing the deep crisis of our times with the crash of 1929 and the Great Depression that followed in the 1930s. They generally argue that Barack Obama is driving the world to recovery along Roosevelt's ‘state superiority’ line. Alas, today's crisis rings alarm bells for the manner in which we must manage the future of democracy, the state and markets. Markets cannot be ‘ordered about’ and when in the face of sound logic and practice an attempt is made to do just this, markets become refractory, or – even worse – they may collapse.
THERE IS NO SUCH THING AS SOCIETY
Authors: Steele G. R.
Published: November 2009

In politics, unguarded remarks are fair game, to be ripped from their context and applied for any moment's advantage. One might have expected better from within academia. Margaret Thatcher's own explanation and the broader aspects of her ‘denial’ of society are explored.
ARE ECONOMISTS ‘MARKET FUNDAMENTALISTS’?
Authors: Carden Art , Hammock Mike
Published: November 2009

We summarise Bryan Caplan's defence of economists from The Myth of the Rational Voter, in which he argues that economists undersell the benefits of markets. We also elaborate on his conclusions and discuss applications to specific topics, such as the minimum wage, as well as how Caplan's results might affect the way economics courses are taught.
THE EMERGENCE OF LIBERAL SOCIALISM IN CONTINENTAL EUROPE1
Authors: Pejovich Svetozar
Published: November 2009

Socialism has repeatedly failed to match the accomplishments of capitalism, and yet it refuses to die. At the beginning of the twenty‐first century, a new type of socialism, ‘liberal socialism’, is growing in Europe. The rise of liberal socialism has been marked by the erosion of two key institutions of capitalism, private property rights and the freedom of exchange. Unlike communism, which used brute force to replace private property rights and free exchange with state ownership and central planning, liberal socialism focuses on redistributing wealth, creating entitlement programmes, supporting labour unions and promoting ‘fair’ trade.
Limits and Possibilities: Rights‐based Discourses in Australian Gender Pay Equity Reform 1969–2007
Authors: Smith Meg
Published: November 2009

In 1969 and 1972 Australia adopted a highly distinctive approach to equal pay. Its unusual characteristic lay in its incorporation in Australia's system of wage determination. This reform was advantageous to women in paid work but key ambiguities emerged as to how the right to equal pay would be claimed in areas of highly feminized work. In 1993 the right to equal pay was introduced in statute and conjoined to a test of sex discrimination, a construction that was ineffective, particularly in the context of a decentralizing wages system. State jurisdictions in Australia developed innovative responses to this impasse that were founded on the concept of undervaluation. These approaches addressed a persistent flaw in rights‐based approaches, the requirement for women to demonstrate they are the same as men to claim equality. These approaches, although currently proscribed, demonstrated that particular constructions of rights‐based discourses can be effective if connected to the underlying dynamics of gender pay inequity and grounded in the instruments of industry and minimum wage determination.
Participation in leisure activities by Arab adults with intellectual disabilities living in the community
Authors: Azaiza Faisal , Rimmerman Arie , Croitoru Tal , Naon Denise
Published: November 2009

Azaiza F, Rimmerman A, Croitoru T, Naon D. Participation in leisure activities by Arab adults with intellectual disabilities living in the community

Int J Soc Welfare 2011: 20: 97–103 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.

The present research study examined factors affecting participation in leisure activities of Arab adults with intellectual disabilities living in the community, via the conceptual frame of the ICF (International Classification of Functioning Disability and Health). The research was based on a secondary analysis of data taken from a nationwide survey, thus being the first of its kind. The factors examined were bodily functions (health condition, physical functioning and cognitive functioning); activities (activities of daily living, instrumental activities of daily living); participation in employment; and the environmental factor of service utilisation (N= 153). The findings reveal interesting patterns regarding the roles of physical functioning and cognitive functioning in participation in leisure activities. These findings are discussed in relation to previous findings and cultural characteristics with reference to socio‐economic disparities.
Soy sauce allergy
Authors: Sugiura K , Sugiura M
Published: November 2009

Background  Soy sauce is well‐known as a Japanese traditional seasoning, namely shoyu. Usually, shoyu means sauce made from soy. Shoyu does have not only benefits but also adverse effects. Soy sauce allergy which is not caused by soy or wheat allergy is rare.

Patients  Our four patients developed cellulites and dermatitis around lips with irritation after a meal with shoyu. The age of the patients was 10, 35, 46 and 51 years; they were all female.

Objectives  These inflammations can be developed by two causes; first it can be caused by allergic reactions to shoyu; the second, it can be caused by histamine poisoning. It is important to determine whether inflammation is caused by allergic reactions or histamine poisoning.

Methods  We determined the volume of histamine in some sauces and performed prick test and laboratory tests.

Results  Four patients had positive reactions by prick test after using some sauces. We suspected that histamine caused their symptoms, but nine normal volunteers had negative reactions. Patient’s specific IgE score to soy and wheat was class 0. The results showed that the sauce made from soybean and broad bean contained histamine, but histamine in other sauces was not detected.

Conclusions  In this study, we confirmed by prick test, four cases of soy sauce allergy, which was caused by some products during brewing. When patients with inflammations around mouth, after a meal containing or using soy sauce, are examined, it should be considered whether dermatitis or cellulites were developed by allergic reaction or by histamine poisoning.
The More, the Merrier: An International Analysis of the Frequency of Dividend Payment
Authors: Ferris Stephen P. , Noronha Gregory , Unlu Emre
Published: November 2009

Abstract:  The joint contributions of prospect theory and mental accounting imply that investors receive a higher utility when a given level of dividends is paid more frequently, suggesting that dividends should be paid as often as possible. We document a strong positive relationship between payment frequency and firm value, confirmed with an event study of dividend payment frequency changes. Upon examining the frequency with which dividends are paid around the world, we discover that considerable variation exists, and that dividends are not paid as often as behavioral aspects suggest they should. From our multivariate analysis, we determine that non‐behavioral factors such as the legal regime as well as the level and standard deviation of operating income exert significant influences on the payment frequency of dividends, suggesting that a tradeoff exists between behavioral and non‐behavioral factors. The relationship between payment frequency and firm value remains robust in the presence of these non‐behavioral factors.
The Diversification Effects of Initial Public Offerings
Authors: Chen Hsuan‐Chi , Ho Keng‐Yu , Hsiao Yu‐Jen , Wu Cheng‐Huan
Published: November 2009

Abstract:  A firm's stock becomes publicly tradable through an initial public offering (IPO). This study suggests a portfolio diversification perspective to explore IPOs. We examine whether investors can gain diversification benefits by adding an IPO portfolio to a set of benchmark portfolios sorted by firm size and book‐to‐market ratio. Using US IPOs from 1980‐2002, we find that adding a value‐weighted IPO portfolio does lead to a statistically and economically significant enlargement of the investment opportunity set for investors relative to investing solely in a set of benchmark portfolios. Specifically, the Sharpe ratio of the tangency portfolio increases by 5.50% on average after including IPO stocks. Furthermore, IPOs associated with prestigious lead underwriters are the main source of this augmentation of the mean‐variance investment opportunity set. Finally, our study implies that issuing IPO exchange traded funds or similar products can provide diversification gains to investors.
Functional mapping of growth and development
Authors: Li Yao , Wu Rongling
Published: November 2009

Understanding how an organism develops into a fully functioning adult from a mass of undifferentiated cells may reveal different strategies that allow the organism to survive under limiting conditions. Here, we review an analytical model for characterizing quantitative trait loci (QTLs) that underlie variation in growth trajectories and developmental timing. This model, called functional mapping, incorporates fundamental principles behind biological processes or networks that are bridged with mathematical functions into a statistical mapping framework. Functional mapping estimates parameters that determine the shape and function of a particular biological process, thus providing a flexible platform to test biologically meaningful hypotheses regarding the complex relationships between gene action and development.
Comparison of Pumps and Oxygenators With Pulsatile and Nonpulsatile Modes in an Infant Cardiopulmonary Bypass Model
Authors: Haines Nikkole M. , Wang Shigang , Kunselman Allen , Myers John L. , Ündar Akif
Published: November 2009

As the evidence mounts in favor of pulsatile perfusion during CPB, it is necessary to investigate the effect of circuit components on the quality of pulsatility delivered throughout the circuit. We compared two bloodpumps, the Jostra HL‐20 heart‐lung machine and the MEDOS DELTASTREAM DP1 Bloodpump, and two oxygenators, the Capiox Baby RX05 and the MEDOS HILITE 800LT, in terms of mean arterial pressure, energy equivalent pressure, surplus hemodynamic energy, total hemodynamic energy, and pressure drop over the oxygenators using a blood analog. The pumps and oxygenators were combined in unique circuits and tested in nonpulsatile and pulsatile modes, at two flow rates (500 and 800 mL/min), and three rotational speed differentials when using the MEDOS DELTASTREAM DP1 Bloodpump for 144 trials in total. The Jostra Roller pump produced some pulsatility in nonpulsatile mode and better pulsatility in pulsatile mode than the MEDOS DP1 Bloodpump at a rotational speed differential of 2500 rpm, but not at 3500 or 4500 rpm. The MEDOS DP1 Bloodpump produced almost no pulsatility in nonpulsatile mode. Pressure drops over the Capiox Baby RX05 were markedly higher, at 92.5 ±  0.4 mm Hg with the MEDOS DP1 Bloodpump at 800 mL/min and 4500 rpm in pulsatile mode, than those of the MEDOS HILITE 800LT oxygenator, which was 67.0 ±  0.1 mm Hg at the same settings. These results suggest that careful selection of each circuit component, based on the individual clinical case and component specifics, are necessary to achieve the best quality of pulsatility.
Pulsatile In Vitro Simulation of the Pediatric Univentricular Circulation for Evaluation of Cardiopulmonary Assist Scenarios
Authors: Dur Onur , Lara Mikhail , Arnold Dorian , Vandenberghe Stijn , Keller Bradley B. , DeGroff Curt , Pekkan Kerem
Published: November 2009

The characteristic depressed hemodynamic state and gradually declining circulatory function in Fontan patients necessitates alternative postoperative management strategies incorporating a system level approach. In this study, the single‐ventricle Fontan circulation is modeled by constructing a practical in vitro bench‐top pulsatile pediatric flow loop which demonstrates the ability to simulate a wide range of clinical scenarios. The aim of this study is to illustrate the utility of a novel single‐ventricle flow loop to study mechanical cardiac assist to Fontan circulation to aid postoperative management and clinical decision‐making of single ventricle patients. Two different pediatric ventricular assist devices, Medos and Pediaflow Gen‐0, are anastomosed in two nontraditional configurations: systemic venous booster (SVB) and pulmonary arterial booster (PAB). Optimum ventricle assist device strategy is analyzed under normal and pathological (pulmonary hypertension) conditions. Our findings indicate that the Medos ventricular assist device in SVB configuration provided the highest increase in pulmonary (46%) and systemic (90%) venous flow under normal conditions, whereas for the hypertensive condition, highest pulmonary (28%) and systemic (55%) venous flow augmentation were observed for the Pediaflow ventricular assist device inserted as a PAB. We conclude that mechanical cardiac assist in the Fontan circulation effectively results in flow augmentation and introduces various control modalities that can facilitate patient management. Assisted circulation therapies targeting single‐ventricle circuits should consider disease state specific physiology and hemodynamics on the optimal configuration decisions.
Valve Surgery in Congenital Heart Disease
Authors: Luciani Giovanni Battista
Published: November 2009

Congenital valve disease (CVD) occurs in isolated form or as part of complex malformations and presents distinct epidemiology, including: young age at onset; high prevalence of associated pathology; history of prior operations; critical clinical presentation. Therefore, multiple interventions are often needed, highlighting the palliative character of CVD surgery. At the same time, long‐term survival and satisfactory quality of life expectations must be satisfied in a young, active patient population. The present study analyzes the unique aspects of surgery for CVD by reviewing clinical experience with 565 consecutive patients operated during a 7‐year period. Treatment options and outcome are assessed with reference to the ability of respecting the unique demands of patients with CVD. In addition, future developments of CVD management are discussed.
Primary Care Providers' Views of Challenges and Rewards of Dementia Care Relative to Other Conditions
Authors: Harris Dorothy P. , Chodosh Joshua , Vassar Stefanie D. , Vickrey Barbara G. , Shapiro Martin F.
Published: November 2009

OBJECTIVES: To compare primary care providers' (PCPs') perceptions about dementia and its care within their healthcare organization with perceptions of other common chronic conditions and to explore factors associated with differences.

DESIGN: Cross‐sectional survey.

SETTING: Three California healthcare organizations.

PARTICIPANTS: One hundred sixty‐four PCPs.

MEASUREMENTS: PCPs' views about primary care for dementia were analyzed and compared with views about care for heart disease, diabetes mellitus, and selected other conditions. Differences in views about conditions according to PCP type (internists, family physicians) were assessed. Multivariate analysis examined relationships between provider and practice characteristics and views about dementia care.

RESULTS: More PCPs strongly agreed that older patients with dementia are difficult to manage (23.8%) than for heart disease (5.0%) or diabetes mellitus (6.3%); PCPs can improve quality of life for heart disease (58.9%) and diabetes mellitus (61.6%) than for dementia (30.9%); older patients should be routinely screened for heart disease (63.8%) and diabetes mellitus (67.7%) than dementia (55.5%); and their organizations have expertise/referral resources to manage diabetes mellitus (49.4%) and heart disease (51.8%) than dementia (21.1%). More PCPs reported almost effortless organizational care coordination for heart disease (13.0%) or diabetes mellitus (13.7%) than for dementia (5.6%), and a great deal or many opportunities for improvement in their ability to manage dementia (50.6%) than incontinence, depression, or hypertension (7.4–34.0%; all P<.05). Internists' views regarding dementia care were less optimistic than those of family physicians, but PCP type was unrelated to views on diabetes mellitus or heart disease.

CONCLUSION: Improving primary care management of dementia should directly address PCP concerns about expertise and referral resources, difficulty of care provision, and PCP views about prospects for patient improvement.
Racial and Ethnic Differences in the Mental Health Needs and Access to Care of Older Adults in California
Authors: Sorkin Dara H. , Pham Elizabeth , Ngo‐Metzger Quyen
Published: November 2009

Little is known about the unmet mental health needs of minority older adults. Racial and ethnic differences in the prevalence rates of psychological distress and reported need and use of mental health services were examined in a population‐based sample of older adults using the 2005 California Health Interview Survey. The sample comprised 16,974 people aged 55 and older, with 13,974 non‐Hispanic whites, 719 African Americans, 1,215 Asians, and 1,066 Latinos. Respondents were compared in terms of prevalence of symptoms of mental distress and serious mental illness, reported need for help, and access to mental health services. African Americans, Asians, and Latinos were more likely to have mental distress than whites (21.2–24.2% vs 14.4%, P<.001) and a higher prevalence of serious mental illness (4.1–7.7% vs 2.5%, P<.001). After adjustment for age, sex, birthplace, marital status, education, limited English proficiency, chronic health conditions, and insurance status, older African‐American (adjusted odds ratio (aOR)=1.37, 95% confidence interval (CI)=1.04–1.81) and Asian (aOR=1.50, CI=1.13–2.00) adults still had greater odds of mental distress than whites. Furthermore, all three groups had worse access to mental health services than whites (African American aOR=0.64, 95% CI=0.43–0.96; Asian aOR=0.32, CI=0.16–0.63; Latino aOR=0.35, CI=0.17–0.70). Clinicians caring for older individuals should be aware of their high risk for mental health needs. Given that minorities' access to mental health services is worse than whites', even after adjusting for health insurance status, providing insurance alone will not eliminate this disparity. Innovative clinical and systemic strategies are needed to better identify individuals at risk and to provide needed services.
El Consentimiento Informado Voluntario en la Investigación y la Asistencia Clínica: Una Actualización
Authors: Cahana Alex , Hurst Samia A.
Published: November 2009

El consentimiento informado es importante: en la investigación, permite que los sujetos puedan tomar una decisión informada y voluntaria de participar—o de no participar—en un proyecto en el cual se arriesgarán personalmente para beneficio de terceros. Tanto en la investigación como en la asistencia clínica, el consentimiento informado implica consentir que otros intervengan en la esfera privada de un individuo. El consentimiento informado generalmente comprende los elementos de revelación de información, capacidad de decisión, y actuación voluntaria. Para cada elemento existen dificultades y posibles mejoras. Sin embargo, la calidad del consentimiento informado y las estrategias de mejoramiento han sido objeto de investigación sólo recientemente. Este artículo presenta algunos resultados de estos recientes estudios, resumiendo su impacto sobre el consentimiento informado en los ámbitos de la investigación y la asistencia médica. Aunque muchos de los datos sufren de limitaciones, los resultados sugieren que el elemento de revelación de información ha mejorado, aún cuando sigue aplicándose en forma dispareja, a menudo con bajo entendimiento por parte de pacientes y sujetos de investigación. Es más, la confianza es importante para impulsar la participación en ensayos de investigación, de modo que las falsas expectativas, al generar desconfianza, arriesgan el esfuerzo. Aunque el mejoramiento de las planillas de consentimiento no parece tener efecto sobre el entendimiento, el mejoramiento del proceso actual de consentimiento puede tener un impacto positivo. Finalmente, disponiendo de mejor información se puede reducir la ansiedad, con muy poco impacto negativo sobre el nivel de reclutamiento de sujetos.
Resultados Basados en la Evidencia para la Investigación y Práctica Clínica del Dolor
Authors: Gatchel Robert J. , Theodore Brian R.
Published: November 2009

El crecimiento en la medicina basada en la evidencia ha creado la necesidad de obtener resultados confiables basados en evidencia para documentar reacciones a un tratamiento o para evaluar la eficacia y rendimiento económico de distintas modalidades de tratamientos. Según el modelo biopsicosocial, el dolor se conceptualiza como una compleja interacción de múltiples factores biológicos, psicológicos y sociales, que en conjunto juegan un papel en el desarrollo, agudización y prolongación del dolor. Por consiguiente, los resultados asociados con la gestión del dolor son por necesidad de naturaleza compleja y multifactorial. El presente artículo desarrolla dos categorías generales de resultados basados en la evidencia en la gestión del dolor: resultados reportados por pacientes y resultados objetivos. Los resultados reportados por pacientes se explican en el ámbito de las medidas de dolor, la calidad de vida relacionada con la salud, y los modelos psico‐sociales. Los resultados objetivos se desarrollan en el ámbito ocupacional y el grado de utilización de los servicios de salud. Cada sección elabora singulares modelos de cada una de las medida de resultados y destaca su concordancia con normas actuales de evidencia y con el estado actual de conocimiento en la investigación del dolor.
IMMUNOHEMATOLOGY: Identification and evaluation of false‐negative antibody screens
Authors: Powers Amy , Chandrashekar Sarayu , Mohammed Monique , Uhl Lynne
Published: November 2009

Background: Non‐ABO alloantibodies are frequently implicated in hemolytic transfusion reactions and are a leading cause of transfusion‐related mortality. Detection of clinically significant non‐ABO alloantibodies is reliant on an antibody screen, which is prone to clerical, technical, and reagent error. Data on the frequency of false‐negative antibody screens due to the occurrence of these errors are scarce, and the true incidence of false‐negative antibody screens in everyday practice is unknown.

STUDY DESIGN AND METHODS: Monitoring for false‐negative antibody screens is routinely performed in our institution. All cases of false‐negative antibody screens involving clinically significant antibodies were identified through review of the blood bank quality assurance records from 2004 to 2007. The clinical impact was recorded in each case.

RESULTS: Twenty‐one cases of false‐negative antibody screens due to clinically significant antibodies were detected. Sources of error included testing error (12 cases), reagent red blood cell (RBC) failure (one case), and reagent limitations (one case). The cause of error was inconclusive in seven cases. Nine patients were found to have received antigen‐incompatible blood as a consequence of these errors, resulting in a single nonfatal hemolytic transfusion reaction.

CONCLUSIONS: The identification and investigation of false‐negative antibody screens is a valuable quality assurance measure which can serve to monitor staff performance, identify cases of reagent RBC failure, and identify patients who have received antigen‐incompatible blood at risk for hemolytic transfusion reactions.
On the Complex Definition of Risk: A Systems‐Based Approach
Authors: Haimes Yacov Y.
Published: November 2009

The premise of this article is that risk to a system, as well as its vulnerability and resilience, can be understood, defined, and quantified most effectively through a systems‐based philosophical and methodological approach, and by recognizing the central role of the system states in this process. A universally agreed‐upon definition of risk has been difficult to develop; one reason is that the concept is multidimensional and nuanced. It requires an understanding that risk to a system is inherently and fundamentally a function of the initiating event, the states of the system and of its environment, and the time frame. In defining risk, this article posits that: (a) the performance capabilities of a system are a function of its state vector; (b) a system's vulnerability and resilience vectors are each a function of the input (e.g., initiating event), its time of occurrence, and the states of the system; (c) the consequences are a function of the specificity and time of the event, the vector of the states, the vulnerability, and the resilience of the system; (d) the states of a system are time‐dependent and commonly fraught with variability uncertainties and knowledge uncertainties; and (e) risk is a measure of the probability and severity of consequences. The above implies that modeling must evaluate consequences for each risk scenario as functions of the threat (initiating event), the vulnerability and resilience of the system, and the time of the event. This fundamentally complex modeling and analysis process cannot be performed correctly and effectively without relying on the states of the system being studied.
Design and Analysis of Crossover Trials for Absorbing Binary Endpoints
Authors: Nason Martha , Follmann Dean
Published: November 2009

Summary The crossover is a popular and efficient trial design used in the context of patient heterogeneity to assess the effect of treatments that act relatively quickly and whose benefit disappears with discontinuation. Each patient can serve as her own control as within‐individual treatment and placebo responses are compared. Conventional wisdom is that these designs are not appropriate for absorbing binary endpoints, such as death or HIV infection. We explore the use of crossover designs in the context of these absorbing binary endpoints and show that they can be more efficient than the standard parallel group design when there is heterogeneity in individuals' risks. We also introduce a new two‐period design where first period “survivors” are rerandomized for the second period. This design combines the crossover design with the parallel design and achieves some of the efficiency advantages of the crossover design while ensuring that the second period groups are comparable by randomization. We discuss the validity of the new designs and evaluate both a mixture model and a modified Mantel–Haenszel test for inference. The mixture model assumes no carryover or period effects while the Mantel–Haenszel approach conditions out period effects. Simulations are used to compare the different designs and an example is provided to explore practical issues in implementation.
Assessing Toxicities in a Clinical Trial: Bayesian Inference for Ordinal Data Nested within Categories
Authors: Leon‐Novelo L.G. , Zhou X. , Bekele B. Nebiyou , Müller P.
Published: November 2009

SummaryThis article addresses modeling and inference for ordinal outcomes nested within categorical responses. We propose a mixture of normal distributions for latent variables associated with the ordinal data. This mixture model allows us to fix without loss of generality the cutpoint parameters that link the latent variable with the observed ordinal outcome. Moreover, the mixture model is shown to be more flexible in estimating cell probabilities when compared to the traditional Bayesian ordinal probit regression model with random cutpoint parameters. We extend our model to take into account possible dependence among the outcomes in different categories. We apply the model to a randomized phase III study to compare treatments on the basis of toxicities recorded by type of toxicity and grade within type. The data include the different (categorical) toxicity types exhibited in each patient. Each type of toxicity has an (ordinal) grade associated to it. The dependence among the different types of toxicity exhibited by the same patient is modeled by introducing patient‐specific random effects.
Open Capture–Recapture Models with Heterogeneity: II. Jolly–Seber Model
Authors: Pledger Shirley , Pollock Kenneth H. , Norris James L.
Published: November 2009

Summary Estimation of abundance is important in both open and closed population capture–recapture analysis, but unmodeled heterogeneity of capture probability leads to negative bias in abundance estimates. This article defines and develops a suite of open population capture–recapture models using finite mixtures to model heterogeneity of capture and survival probabilities. Model comparisons and parameter estimation use likelihood‐based methods. A real example is analyzed, and simulations are used to check the main features of the heterogeneous models, especially the quality of estimation of abundance, survival, recruitment, and turnover. The two major advances in this article are the provision of realistic abundance estimates that take account of heterogenetiy of capture, and an appraisal of the amount of overestimation of survival arising from conditioning on the first capture when heterogeneity of survival is present.
Coparenting and Toddler's Interactive Styles in Family Coalitions
Authors: FIVAZ–DEPEURSINGE ELISABETH , LOPES FRANCESCO , PYTHON MARYLINE , FAVEZ NICOLAS
Published: November 2009

The current study examined the coparenting and toddler's interactive styles in family coalitions. According to structural family theory, boundaries between generations are clear in alliances, but disturbed in coalitions: the parents look to the child to regulate their conflictual relationship and the child attempts to meet this need. In a normative sample studied longitudinally during the Lausanne Trilogue Play situation (LTP, N=38), 15 coalition cases were detected. Styles of coparenting and of child's interactions were determined and compared in coalition and alliance cases at 18 months. Findings confirm the structural family model by showing the specific ways in which the coparenting and the toddler's interactive styles are associated in 3 different patterns of coalitions: binding, detouring, and triangulation. They illustrate how the child's triangular capacity, or her ability to simultaneously communicate with both parents, is used to regulate the parents' relationship. They suggest that the LTP observational paradigm is a promising assessment method of early family interactions. They point to the importance of assessing early the child's contribution to family coalitions.
Posttraumatic Stress Disorder and Marital Adjustment: The Mediating Role of Forgiveness
Authors: SOLOMON ZAHAVA , DEKEL RACHEL , ZERACH GADI
Published: November 2009

The study assessed the effects of war captivity on posttraumatic stress symptoms and marital adjustment among Prisoners of War (POWs) from the Yom Kippur War. It was hypothesized that men's perception of level of forgiveness mediates the relation between posttraumatic symptoms and marital adjustment. The sample consisted of 157 Israeli veterans divided into 3 groups: 21 POWs with Posttraumatic Stress Disorder (PTSD), 58 former POWs without PTSD, and 70 control veterans. The findings indicated that former POWs with PTSD reported lower levels of marital satisfaction and forgiveness than veterans in the other 2 groups. In addition, men's perception of level of forgiveness mediated the relationship between their posttraumatic symptoms and their marital adjustment. The theoretical and clinical implications of these results are discussed.
Characteristics of Work Interruptions During Medication Administration
Authors: Biron Alain D. , Lavoie‐Tremblay Mélanie , Loiselle Carmen G.
Published: November 2009

Objective: To document characteristics of nurses’ work interruptions (WIs) during medication administration.

Design: A descriptive observational study design was used along with a sample of 102 medication administration rounds. Data were collected on a single medical unit using a unit dose distribution system during fall 2007.

Method: Data collection on WIs relied on direct structured observation. The following WI characteristics were recorded: source, secondary task, location, management strategies, and duration.

Results: 374 WIs were observed over 59 hours 2 minutes of medication administration time (6.3 WI/hr). During the preparation phase, nurse colleagues (n= 36; 29.3%) followed by system failures such as missing medication or equipment (n= 28; 22.8%) were the most frequent source of WIs. Nurses were interrupted during the preparation phase mostly to solve system failures (n= 33; 26.8%) or for care coordination (n= 30; 24.4%). During the administration phase, the most frequent sources of WIs were self‐initiation (n= 41; 16.9%) and patients (n= 39; 16.0%). The most frequent secondary task undertaken during the administration phase was direct patient care (n= 105; 43.9%). WIs lasted 1 min 32 s on average, and were mostly handled immediately (n= 357; 98.3%).

Conclusions: The process of medication administration is not protected against WIs, which poses significant risks.

Clinical Relevance: Interventions to reduce WIs during the medication administration process should target nurses and system failures to maximize medication administration safety.
Depressive Symptoms Among HIV‐Positive Pregnant Women in Thailand
Authors: Ross Ratchneewan , Sawatphanit Wilaiphan , Zeller Richard
Published: November 2009

Purpose: To examine predictors of depressive symptoms among human immunodeficiency virus (HIV)‐positive, pregnant women in Thailand.

Design: Correlational, cross‐sectional study.

Methods: Data were collected at prenatal clinics in five hospitals in Thailand from January 2004 to January 2006. One hundred twenty‐seven HIV‐positive pregnant women completed questionnaires in Thai on depressive symptoms, self‐esteem, emotional support, physical symptoms, and demographics. Simultaneous multiple regression was used to analyze predictors of depressive symptoms.

Findings: Seventy‐eight percent of the 127 participants reported depressive symptoms to some degree. Physical symptoms (β= .192, p<.05) were positively associated with depressive symptoms, but self‐esteem (β=−.442, p<.001), emotional support (β=−.193, p<.01), and financial status (β=−.209, p<.01) were negatively correlated with depressive symptoms.

Conclusions: The study results have added new knowledge about depressive symptoms and their predictors in HIV‐positive pregnant women in Thailand.

Clinical Relevance: Depressive symptoms have been associated with faster progression to acquired immunodeficiency syndrome among HIV‐positive individuals. The high rate of depression in our study suggests that HIV‐positive pregnant women in Thailand should all be screened for depressive symptoms. Causes of physical symptoms should be identified and treated. Emotional support and self‐esteem should be strengthened for HIV‐positive pregnant Thai women.
Evaluation of a Patient Care Delivery Model: Patient Outcomes in Acute Cardiac Care
Authors: Meyer Raquel M. , Wang Sping , Li Xiaoqiang , Thomson Donna , O’Brien‐Pallas Linda
Published: November 2009

Purpose: To evaluate the influence of nurse staffing and work environment variables on patient outcomes by testing a conceptual model.

Design: A prospective, correlational design with cross‐sectional and longitudinal components was conducted in Canadian cardiac and cardiovascular care inpatient units.

Methods: Data were collected from multiple sources. Hierarchical linear modeling was used to examine relationships among variables.

Conclusions: The findings indicate that patient outcomes are influenced not only by patient and nurse characteristics, but also by organizational staffing practices. Organizations that manage the complexity of work conditions and target staffing utilization levels between 80% and 88% at the unit level can optimize patient outcomes.

Clinical Relevance: Empirical validation of the model provides evidence to inform management decisions about hospital nurse staffing.
Chemical and Piezoresistive Microanalyses at the Interface of RuO2–Glass Diffusion Pairs
Authors: Totokawa Masashi , Tani Toshihiko , Yoshimura Masamichi , Yamashita Syuichi , Morikawa Kenji , Mitsuoka Yoshihito , Nonaka Takamasa
Published: November 2009

Diffusion pairs of RuO2 and glass were prepared as model specimens for composite thick‐film resistors and chemical and electrical microanalyses were carried out at the interface to clarify the piezoresistive mechanism of the resistors. The diffusion of ruthenium into glass was examined with SIMS and the chemical structure was analyzed with EELS. In situ measurement of resistance change was conducted as a function of applied load with a microprobe on the RuO2–glass interfaces locally by conductive AFM. The glass with higher piezoresistive sensitivity was found to have larger amount of diffused ruthenium, which has trivalent and tetravalent states in the glass. The originally insulative glass showed electrical conductivity by the diffusion of ruthenium. Furthermore, load‐dependent conductivity change was observed near the interface. The analysis suggests that the conduction mechanism is variable range hopping and that the strain‐derived electronic state changes must be the origin of the piezoresistive effect of the thick film resistors.
The Emergence of Intergranular Precipitates in TiO2‐Doped α‐Al2O3 Ceramics
Authors: Qian Pengxiang , Gu Hui , Chi Miaofang
Published: November 2009

The minor phase accumulated at intergranular regions in ceramics is usually associated with the global doping level of additives; however, such simplification often undermines the local variation in liquid composition that leads to the emergence of precipitation. In this paper the correlation between precipitation and intergranular liquid was investigated in a TiO2‐doped Al2O3 ceramic system. The discrepancy between XRD and SEM in detection of the intergranular Al2TiO5 phase was rationalized by their difference in sensitivity that corresponds to a change from the casual to general mode of local liquid variation. Analytical TEM in addition revealed Ti‐rich nanoprecipitates aligning along grain boundary (GB). The two intergranular phases were associated with separate processes of intergranular liquid, as clarified via a representative case that exhibited the extra grain growth from annealing. The nanoprecipitates were created from a binary liquid in local equilibration with segregation to GB, which served as transporting routes to form ternary liquid at the multigrain junctions to initiate the main intergranular phase Al2TiO5.
Voltage‐Dependent Low‐Field Bulk Resistivity in BaTiO3:Zn Ceramics
Authors: Beltrán Héctor , Prades Marta , Masó Nahum , Cordoncillo Eloisa , West Anthony R.
Published: November 2009

Ceramics of composition Ba(Ti1−xZnx)O3−x: 0.00003≤x≤0.01 exhibit modest semiconductivity, whose value is increased by up to two orders of magnitude under the action of a small dc bias voltage. The effect, which is not observed in undoped BaTiO3, occurs in both grain and grain boundary regions and is attributed to the nature of the defect structure, which contains highly polarized clusters. It is proposed that internal electron transfer within the clusters under the action of a dc bias voltage leads to a more conductive excited state, which gradually returns to the ground state when the dc bias is removed.