bluuebunny/crossref_metadata_2025 huggingface dataset:
Advocacy Coalitions and Elite Sport Policy Change in Canada and the United Kingdom
Authors: Green Mick , Houlihan Barrie
Published: December 2004

This paper explores the process of elite sport policy change in two sports (swimming and track and field athletics1) and their respective national sport organizations (NSOs) in Canada and national governing bodies of sport (NGBs) in the United Kingdom (UK). The nature of policy change is a complex and multifaceted process and a primary aim is to identify and analyse key sources ofpolicy change through insights provided by the advocacy coalition framework (ACF). In Canada, it is evident that the preoccupation with high performance sport over the past 30 years, at federal government level, has perceptibly altered over the past two to three years. In contrast, in the UK, from the mid-1990s onwards, there has been a noticeable shift towards supporting elite sport objectives from both Conservative and Labour administrations. Most notably, the ACF throws into sharp relief the part played by the state in using its resource control to shape the context within which debates on beliefs and values within NSOs/NGBs takes place. While the ACF has proved useful in drawing attention to the notion of changing values and belief systems as a key source of policy change, as well as highlighting the need to take into account factors external to the policy subsystem under investigation, potential additions to the framework’s logic are suggested for future applications.
Prevalence of Sexual Harassment among Norwegian Female Elite Athletes Inrelation to Sport Type
Authors: Fasting Kari , Brackenridge Celia , Sundgot-Borgen Jorunn
Published: December 2004

Although it is often assumed that the prevalence of sexual harassment is different indifferent sports, the assumption has not been empirically tested. This study considers whether the experience of sexual harassment varies by sport. The female elite athletes ( N = 553) in the study participated in 56 different sport disciplines. These were grouped as: 1) team or individual sports; 2) extent to which clothing required for competition is revealing; 3) gender structure (male- or female-dominated membership statistics); and 4) gender culture (masculine, gender-neutral or feminine). The data show that sexual harassment occurs in every sport group. Female elite athletes who participated in ‘masculine’ sports appear to experience more harassment than women in the other groups. We conclude that, when it comes to female athletes’ experiences of sexual harassment, sport type matters far less than sport participation per se.
Piezoelectric-based Fluid Bulk Modulus Sensor
Authors: Niezrecki Christopher , Schueller John K. , Balasubramanian Karthik
Published: December 2004

The absolute bulk modulus has a major effect on the position, power delivery, response time, and stability of virtually all hydraulic systems. A novel sensing technique to determine the bulk modulus of a fluid or hydraulic system is proposed. The constitutive equations of a piezoelectric actuator are coupled to a fluidic system that contains entrained air and mechanical compliance. The model can be used to extract the bulk modulus of the fluid system in real time. The results indicate that matching the stiffness of the actuator to the stiffness of the fluidic system is critical in obtaining a high sensitivity to the bulk modulus measurement.
Integrated Actuator–Sensor Placement and Hybrid Controller Design of Flexible Structures Under Worst Case Spatiotemporal Disturbance Variations
Authors: Demetriou Michael A.
Published: December 2004

The aim of this study is to propose a methodology for placing actuating devices in flexible structures that, in addition to possible modal controllability and enhanced performance, may also address spatiotemporal effects of disturbances. The resulting actuator locations enhance the controllability properties of selected modes, improve the performance of the closed-loop system by integrating the controller design and actuator location, and finally address the spatial variability of disturbances by minimizing the location-parameterized norm of an associated transfer function. When the spatial distribution of disturbances is known a priori, it should be utilized in the placement criteria, and if it is unknown, then a “worst” such distribution may be assumed and subsequently used for actuator placement in order to attain spatial robustness. To further address possible “moving” disturbances, where the spatial distribution of disturbances is changing with time and space, a supervisory scheme is proposed where both an actuator and its associated controller are chosen to be activated (switched in) from a set of candidate actuators that are optimally mounted on the flexible structure. Extensive simulation studies demonstrating the effects of spatial distributions of disturbances on the actuator locations, along with a switching actuator–controller scheme to better address the effects of spatiotemporally varying disturbances, are included.
Quality Characteristics and Oxidative Stability of Date Seed Oil During Storage
Authors: Besbes S. , Blecker C. , Deroanne C. , Lognay G. , Drira N. E. , Attia H.
Published: December 2004

Studies were conducted on some quality characteristics of date seed oil from two date palm cultivars ( Phoenix dactylifera L.): Deglet Nour and Allig. The following values were obtained for Deglet Nour and Allig cultivars respectively: unsaponifiable matter 8.92-7.76%, iodine value 45.49-44.08, total phenols 520.81-220.32µg/g oil, chlorophylls 0.86-0.58µg/g oil, viscosity 18.50-20.50mPa.s, refractive index 1.457-1.462, acidity 1.06-2.10mg KOH/g oil and peroxide index 16.00-25.00meq O2/100g oil. Lipid fractionation of date seed oil yielded 98.30-97.30% neutral lipids, 97.26-96.90% triglycerides, 0.25-0.18% phospholipids and 0.36-0.31% sterols. Gas-liquid chromatography revealed that the major unsaturated fatty acid was oleic acid (39.17-42.13%) while the main saturated fatty acid was lauric acid (24.34-22.56%). Date seed oil showed high medium molecular weight triglycerides (C32-C42, about 27%). Extinction coefficients at 232nm and 270nm increased slightly during 40days in oven (60°C) showing that date seed oil could be easily stored. The production of oil from date seeds provides the use of a renewable resource, and at the same time adding value to agricultural products.
Monitoring Colour Evolution During Maturity in Fuji Apples
Authors: Marquina P. , Venturini M. E. , Oria R. , Negueruela A. I.
Published: December 2004

Colour changes in Fuji apples were monitored several days after full blooming (DAFB). Fruits were harvested at this commercial maturity (139 DAFB), 132, 146 and 153 DAFB. A new method was developed to determine the average colour of the apples by measuring the reflection spectra around the fruit to obtain a spectra weighted by the red and green areas. According to the evolution of the reflectance spectra during maturity, the proportion of chlorophyll decreased with regard to other pigments but it did not disappear. The colour obtained of those average spectra allowed a good classification of the apples according to ripeness. Values of the a* colour coordinate were well correlated to the visual evaluation of the colour assessed by a sensory trained panel, which could be used as a maturation index to optimize the marketing.
Use of Modified Starches as Thickeners of Cocoa Syrups
Authors: Sikora M. , Juszczak L. , Sady M. , Krawontka J.
Published: December 2004

Elaboration of cocoa syrups by the use of modified starches such as acetylated distarch adipate (ADA) and oxidised starch (OS) were described and analysed the influence of different amounts of ADA and OS on physical and sensory properties of cocoa syrups. The sensory, textural and rheological properties of syrups produced in the laboratory conditions were compared to the properties of commercially produced ones. The quantity of modified starch added affected textural and rheological properties of syrups. All analysed syrups showed non-Newtonian, pseudoplastic flow and thixotropy. Values of yield stresses, viscosities of Casson, and consistency coefficients of syrups prepared in laboratory conditions increased with an increase in the addition of modified starches.
Teaching Economic Thought: Landscapes After Battles
Authors: Poddiakov Alexander
Published: December 2004

Van Bavel and Gaskell’s (2004) analysis of laypeople’s and economics experts’ discourse in Chile is complemented by a look at expert-talk-based colonization of the social realities of Russia. It is demonstrated that resistance by laypeople to the acceptance of expert discourses is a buffering mechanism in a society to balance the import of deductively derived economic models from other countries. A dialogical approach is suggested for making sense of economic processes in any society.
The Many Faces of Everyday Life: Some Challenges to the Psychology of Cultural Practice
Authors: Lawrence Jeanette A. , Dodds Agnes E. , Valsiner Jaan
Published: December 2004

We address the issue of how cultural psychologies relate to human everyday life-worlds. Everyday life entails the extraordinary within the ordinary, and vice versa— often described as cultural practices. We present the case of an involuntary event—breaking a leg—with all its temporarily debilitating experiences. The person became involved in a series of new activities of meaning construction as a way of reorganizing her life during the recovery period. If cultural psychologies are to offer adequate explanations for emerging practices, the central role of personal agency needs to be restored into their general theoretical schemes. The cultural organization of human living includes the organizer—the person—who actively makes meanings in ever-new life contexts.
Racial Resentment and the Changing Partisanship of Southern Whites
Authors: Knuckey Jonathan
Published: December 2004

One of the most important developments in southern politics in recent years has been the increase in the number of whites holding Republican Party identifications. This article examines the effects of racial attitudes on changing levels of partisanship. Specifically, the article focuses on the concept of racial resentment or symbolic racism. This is an appropriate concept to examine the effects of the contemporary racial attitudes on partisanship, as racial issues have become much more diffuse in nature. It is argued that in the 1990s the southern Republican congressional leadership was especially successful in making salient issues likely to activate the racial resentment of southern whites. A multivariate analysis demonstrates that racial resentment was not a strong or significant predictor of partisanship prior to 1994; however, in 1994 and 2000 racial resentment had a large and significant effect on partisanship. These findings suggest that race and racial attitudes continue to shape southern party politics in the early twenty-first century.
Feminist Constructions of the ‘Witch’ as a Fantasmatic Other
Authors: Sempruch Justyna
Published: December 2004

This article analyses the radical feminist formulations of the ‘witch’, focusing on the second-wave feminist sense of urgency to construct a political ‘we’ and to create a common identification with the historical oppression of women. The figure of the ‘witch’ represents here a dimension of (feminist) fantasy that, retrospectively, needs to be seen as a therapeutic attempt both to break through the silence and invisibility of female history and to elevate the notion of female alterity over the complementarity of the phallogocentric system. Conveying the tension between past and present, the ‘witch’ becomes a crucial metaphor for herstory, that is, a form of feminist mythology constituting an alternative to the established male-centered master-story.
Commentary on Hobbis and Sutton
Authors: Conner Mark
Published: December 2004

The present commentary highlights and discusses two issues raised by Hobbis and Sutton (this issue): the identification of key beliefs, and the methods suggested by Cognitive Behaviour Therapy (CBT) for changing beliefs and behaviour. In relation to the first issue it is noted how the conception of key beliefs varies between the Theory of Planned Behaviour (TPB) and CBT. In relation to the second issue it is noted that CBT may well identify a number of useful techniques for changing beliefs, although a variety of other techniques may also be useful for changing beliefs.
Work-related Goal Perceptions and Affective Well-being
Authors: Ingledew David K. , Wray Josephine L. , Markland David , Hardy Lew
Published: December 2004

The aim was to clarify how perceptions of work-related goals influence affective well-being and goal commitment. Participants ( N = 201) completed a Goal Perceptions Questionnaire and affect scales. A model was refined using structural equation modelling. Value and success expectation substantially mediated the effects of other goal perceptions on affects and commitment. Both value and success expectation increased commitment, but whereas value increased positive affects, success expectation reduced negative affects. The determinants of value (e.g. personal origin) were different from those of success expectation (e.g. personal control). Through astute goal setting, it is possible to promote well-being without compromising commitment.
The Effects of Economic Disadvantage on Psychological Well-being and Quality of Life among People with Multiple Sclerosis
Authors: McCabew Marita P. , De Judicibus Margaret
Published: December 2004

This study investigated the impact of economic disadvantage among people with multiple sclerosis (MS) on their psychological well-being and quality of life. Participants were 113 people with MS (31 males, 82 females). Information was obtained on income, lost income, costs of MS, economic pressure, coping, psychological well-being and quality of life. Economic pressure, and not actual MS-related costs predicted psychological well-being. Costs, economic pressure and coping predicted quality of life. These results demonstrate that pressure due to changed economic circumstances, as well as coping with these pressures is important in the quality of life of people with MS.
Disruption, dissonance and embodiment: creativity, health and risk in music narratives
Authors: Daykin Norma
Published: December 2004

This article explores notions of creativity, health and risk, drawing on interviews with freelance musicians in the UK. The social context of insecure music work is explored along with hegemonic discourses of creativity in which hedonism, risk and sacrifice are connected. The study draws on narrative analysis in order to examine responses to disruptions that affect creative work. It also explores ongoing accounts of dissonance in music work. The research builds on the new musicology in exploring the cultural basis of creative ideals: these extend beyond the arts to influence many areas of social life. It highlights the way in which the exercise of aesthetic judgements, including judgements about the self, serve to include and exclude particular identities, valuing and diminishing their contributions. The study also builds on sociological debates concerning the regulatory functions of reflexivity and body management in the context of late modernity. Here, strategies of embodiment are also seen in relation to empowerment as challenges to hegemonic notions of creativity. Finally, the research builds on methodological debates surrounding narrative analysis, adopting a sociological approach that emphasizes the particular context of music work and identifies core narratives that reveal connections between everyday experiences and deeper cultural processes.
A Primary Care Study of the Correlates of Depressive Symptoms Among Jordanian Women
Authors: Hamid Hamada , Abu-Hijleh Nizam Saleh , Sharif Samar Lutfi , Raqab Mohammad Zayed , Mas’ad Diana , Abbas Adnan
Published: December 2004

A standardized Arabic version of the Beck Depression Inventory-II was administered to 493 randomly selected Arab women attending primary care out-patient centers in West Amman, Jordan.Women were asked about demographic data as well as questions from a negative life events questionnaire. The mean Beck score was 13.02 (± 8.13). Demographic factors and negative life events accounted for 17.1% of the variance in the total Beck score. Self-reported financial problems and health problems as well as marital separation were the strongest contributors. Family problems and work stress made smaller contributions to depressive symptoms.
Visual Culture, Transvestiture and Political Catastrophe(Or, So Is Art Queer, Then?)
Authors: Preziosi Donald
Published: December 2004

This article addresses the problem of the denial of the impossibility of representation that is the foundational support of ‘art history’ and ‘visual culture’ studies through the trope of ‘queering’, appropriated (albeit in some cases precipitously essentialized) in recent gay andlesbian studies, and emblematic there of a broader irresolvable ambivalence in cultural studies toward the entailment of people with their object-worlds, their stuff. It argues that this oscillation in visual studies, art history and criticism (and museology in particular) isneither accidental nor a failure of modern social systems but rather the very engine of modernity and its conceivable or purported ‘posts’, arguing further that this double bind itself has been rooted in a variety of post-Enlightenment secular revivals of monotheistic religiosity. It suggests that imagining a critical politics requires us to abandon addressing this core dilemma as a set of alternative polities (the aestheticization of politics versus the politicization of the aesthetic).
Polemics, Postmodernism, Immersion, Militarized Space
Authors: Foster Hal
Published: December 2004

Hal Foster is Townsend Martin, Class of 1917, Professor of Art and Archaeology at Princeton University. Internationally regarded for his provocative writings on 20th-century art practice, and as an Editor of the journal October, Professor Foster is the author of Design and Crime (and Other Diatribes) (2002), The Return of the Real (1996), Compulsive Beauty (1993), Recodings: Art, Spectacle, Cultural Politics(1985) and Prosthetic Gods (on the relation between modernism and psychoanalysis, 2004), and editor of the defining The Anti-Aesthetic: Essays on Postmodern Culture (1983), among other books. Forthcoming books include Art Since 1900, a co-authored textbook on20th-century art, as well as a survey of Pop Art. Here he speaks with Marquard Smith, Editor-in-Chief of journal of visual culture, about these and other things, including polemical thought, cultural criticism, immersion, Visual Culture Studies, and design, architecture and urbanism.
Effect of Erucic Acid Percentage on Slip Properties of Erucamide
Authors: Walp Leonard , Tomlinson Harry
Published: December 2004

Erucamide is a fatty acid amide most frequently used to reduce the coefficient of friction (increase slip) of polyolefin films. The erucic acid content of commercial erucamides varies from 80 to 94%. A project has been initiated to determine the effect, if any, that this variation has on slip properties. The performance of erucamide is measured in:

• three different butene copolymer linear low-density polyethylenes (LLDPEs) • a hexene copolymer LLDPE • three different low-density polyethylenes (LDPE)

Slip is measured on a 1.3 mil blown film. Varying the percentage of erucic acid in erucamide between 80 and 93% did not affect the coefficient of friction in the polymers tested.
A Low Peripheral Blood White Blood Cell Count in Infants Younger than 90 Days Increases the Odds of Acute Bacterial Meningitis Relative to Bacteremia
Authors: Bonsu Bema K. , Harper Marvin B.
Published: December 2004

In relying on the peripheral blood white blood cell (WBC) count to identify infants at high risk for acute bacterial meningitis and bacteremia, to the best of the authors' knowledge, it has not been reported previously whether high and low values of the test have similar implications for predicting these separate infections. Objective: To analyze the relationship between the peripheral WBC count and the odds of acute bacterial meningitis relative to bacteremia among sick infants aged 3 to 89 days. Methods: Areas under the receiver operating characteristic curve (AUCs) and likelihood ratios at various intervals of the total peripheral blood WBC count were computed. Results: A pathogen was isolated from blood or cerebrospinal fluid (CSF) from 72 infants aged 3 to 89 days. Fifty‐two infants had growth of a pathogen from the blood only, and 20 had growth from the CSF. The most common bacteria isolated were Escherichia coli (32) and group B streptococci (32). The AUC for the peripheral WBC count when differentiating between acute bacterial meningitis and bacteremia was 0.75 (95% CI = 0.63 to 0.88). The odds of acute bacterial meningitis relative to bacteremia were sevenfold higher for a peripheral WBC cutoff below 5,000 cells/mm3 and threefold lower for a peripheral WBC cutoff at or above 15,000 cells/mm3. Conclusions: In young infants, the peripheral blood WBC count is useful for estimating the odds of acute bacterial meningitis relative to isolated bacteremia. A low peripheral blood WBC count should be considered a much more worrisome laboratory finding because it is associated with a relatively high risk for acute bacterial meningitis relative to the potential for bacteremia.
Mentoring Medical Students in Academic Emergency Medicine
Authors: Garmel Gus M.
Published: December 2004

Mentoring is an important aspect of career development for medical students, residents, and junior faculty. It is vital to the professional growth and maturation of individuals early in each phase of their careers. Additionally, mentoring has a critical role throughout all career stages, because the mentor–mentee relationship provides mutual benefit to both participants. This article will describe the role of the mentor, suggest ways to increase the likelihood of successful mentoring, and identify pitfalls in the mentoring process predominantly related to medical students. In contrast to role models, mentors play an active part in the development of a young physician's career. This difference will be discussed. Finally, this article will describe the responsibilities of career guidance and recommendation letter authorship that mentors assume for medical students.
An Emergency Department–Based Nurse Discharge Coordinator for Elder Patients: Does It Make a Difference?
Authors: Guttman Alex , Afilalo Marc , Guttman Rivka , Colacone Antoinette , Robitaille Chantal , Lang Eddy , Rosenthal Stephen
Published: December 2004

Objectives: To evaluate the impact of an emergency department (ED)–based nurse discharge plan coordinator (NDPC) on unscheduled return visits within 14 days of discharge, satisfaction with discharge recommendations, adherence with discharge instructions, and perception of well‐being of elder patients discharged from the ED. Methods: Patients aged 75 years and older discharged from the ED of the Sir Mortimer B. Davis–Jewish General Hospital were recruited in a pre/post study. During the pre (control) phase, study patients (n= 905) received standard discharge care. Patients in the post (intervention) phase (n= 819) received the intervention of an ED‐based NDPC. The intervention included patient education, coordination of appointments, patient education, telephone follow‐up, and access to the NDPC for up to seven days following discharge. Results: Patients in the two groups were similar with respect to gender and age. However, the patients managed by the ED NDPC appeared to be, at baseline, less autonomous, frailer, and sicker. The unadjusted relative risk for unscheduled return visits within 14 days of discharge was 0.79 (95% confidence interval [95% CI] = 0.62 to 1.02). A relative risk reduction of 27% (95% CI = 0% to 44%) for unscheduled return visits was observed for up to eight days postdischarge, and a relative risk reduction of 19% (95% CI =−2% to 36%) for unscheduled return visits was observed for up to 14 days postdischarge. Significant increases in satisfaction with the clarity of discharge information and perceived well‐being were also noted. Conclusions: An ED‐based NDPC, dedicated specifically to the discharge planning care of elder patients, reduces the proportion of unscheduled ED return visits and facilitates the transition from ED back home and into the community health care network.
Factors Affecting Emergency Department Opioid Administration to Severely Injured Patients
Authors: Neighbor Martha L. , Honner Samantha , Kohn Michael A.
Published: December 2004

Objectives: Studies of emergency department (ED) pain management in patients with trauma have been mostly restricted to patients with fractures, yet the potential for undertreatment of more severely injured patients is great. The authors sought to identify factors associated with failure to receive ED opioid administration in patients with acute trauma who subsequently required hospitalization. Methods: At an urban Level 1 trauma center and teaching hospital, a retrospective cohort study of trauma team activation patients requiring hospitalization between January 1 and December 31, 1999, was conducted. The authors excluded patients receiving opioids only within ten minutes of chest tube insertion or fracture manipulation. The main outcome measure was ED opioid administration. Results: A total of 540 charts of hospitalized first‐tier trauma team activation patients were reviewed. A total of 258 (47.8%) received intravenous opioid analgesia within three hours of ED arrival. The median time to receiving the first dose of opioids was 95 minutes. Patients were independently less likely to receive opioids if they were younger or older, were intubated, had a lower Revised Trauma Score, or did not require fracture manipulation. Patients with these factors were less likely to receive opioids independent of the amount of time they spent in the ED. Conclusions: Many trauma activation patients requiring hospitalization do not receive opioid analgesia in the ED. Patients at particular risk for oligoanalgesia include those who are younger or older and those who are more seriously injured, as defined by a lower Revised Trauma Score, lower Glasgow Coma Scale score, and intubation.
Emergency Nurses' Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult‐access Patients
Authors: Brannam Larry , Blaivas Michael , Lyon Matthew , Flake Michael
Published: December 2004

Objectives: Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. The authors describe the patient population for which ultrasound (US)‐guided peripheral IVs are used and evaluate the success rates for such lines by ENs. Methods: This was a prospective observational study of ENs in a Level I trauma center with a census of 75,000, performing US‐guided IV line placement on difficult‐to‐stick patients (repeated blind IV placement failure or established history). ENs were trained on an inanimate model after a 45‐minute lecture. Surveys were filled out after each US‐guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded the reason for use of US, type of patient, and success. Successful cannulation was confirmed by drawing blood and flushing fluids. Descriptive statistics were used to evaluated data. Results: A total of 321 surveys were collected in a five‐month period no ENs declined to participate. There were 280 (87%) successful attempts. Twelve (29%) of the 41 failure patients required central lines, 9 (22%) received external jugular IVs, and 20 (49%) had peripheral IV access placed under US guidance by another nurse or physician. Twenty‐eight percent (90) of all patients were obese, 18% (57) had sickle cell anemia, 10% (31) were renal dialysis patients, 12% (40) were IV drug abusers, and 19% (61) had unspecified chronic illness. The remainder had no reason for difficult access given. There were four arterial punctures. Conclusions: ENs had a high success rate and few complications with use of US guidance for vascular access in a variety of difficult‐access patients.
Nonurgent Emergency Department Patient Characteristics and Barriers to Primary Care
Authors: Afilalo Jonathan , Marinovich Adrian , Afilalo Marc , Colacone Antoinette , Léger Ruth , Unger Bernard , Giguère Claudine
Published: December 2004

Objective: Nonurgent (NU) emergency department (ED) use is at the forefront of medico‐political agendas, and diversion of NU patients has been entertained as a management strategy. Before policy changes are implemented, this population should be better understood with respect to their characteristics and reasons for not presenting to primary care providers (PCPs) instead of EDs. This study compares NU with urgent and semiurgent (USU) patients and describes the NU patients' reasons for not seeking care with a PCP before presenting to the ED. Methods: This was a secondary analysis from a cross‐sectional study with sequential sampling in the EDs of five Quebec tertiary care hospitals (October 19, 1999, to May 26, 2000). Data on medical history, social support, awareness and utilization of health care, ED visits, referrals, activities of daily living, and sociodemographics were obtained. The NU group included patients with triage code 5 and the USU group included patients with triage codes 2, 3, and 4 using the Canadian Triage and Acuity Scale. Patient characteristics were structured into the Andersen behavioral model for health care utilization. Results: Of 2,348 patients approached, 1,783 patients (77%) were eligible and agreed to participate. NU patients (n= 454) were younger than USU patients (n= 1,329) (mean age, 43 [SD ± 18.1] vs. 49 [SD ± 20.1] years). Patients in the NU group had better health (number of prior conditions, 3.1 vs. 3.9), were less likely to arrive by ambulance (5% vs. 22%), and were less often admitted from the ED (4% vs. 24%). While 70% of NU compared with 75% of USU patients were followed up by a PCP, only 22% of NU and 27% of USU patients sought PCP care before presenting to the ED. The reasons given by NU patients for not seeking PCP care were accessibility (32%), perception of need (22%), referral/follow‐up to the ED (20%), familiarity with the ED (11%), trust of the ED (7%), and no reason (7%). Conclusions: NU ED patients are different from USU patients and have multiple reasons for not seeking primary care before going to the ED. This may help explain why various diversion strategies have been unsuccessful and indicate that a multifaceted approach may be better suited to this group of patients. The design of new interventions, however, will benefit from further research that clarifies the impact of NU patients on the health care system.
Feedback
Authors: Richardson Barbara K.
Published: December 2004

The emergency department provides a rich environment for diverse patient encounters, rapid clinical decision making, and opportunities to hone procedural skills. Well‐prepared faculty can utilize this environment to teach residents and medical students and gain institutional recognition for their incomparable role and teamwork. Giving effective feedback is an essential skill for all teaching faculty. Feedback is ongoing appraisal of performance based on direct observation aimed at changing or sustaining a behavior. Tips from the literature and the author's experience are reviewed to provide formats for feedback, review of objectives, and elements of professionalism and how to deal with poorly performing students. Although the following examples pertain to medical student education, these techniques are applicable to the education of all adult learners, including residents and colleagues. Specific examples of redirection and reflection are offered, and pitfalls are reviewed. Suggestions for streamlining verbal and written feedback and obtaining feedback from others in a fast‐paced environment are given. Ideas for further individual and group faculty development are presented.
The acoustic emission technique in orthopaedics - a review
Authors: Browne M , Roques A , Taylor A
Published: December 2004

Traditionally, orthopaedic research has focused upon the assessment of individual components in an implanted construct. A great deal of research has investigated the durability of the metallic stem, even though this is the most robust component in the implanted system. Standards have been developed for the structural assessment of the implant and even the bone cement which holds the implant in place in the bone. However, the construct as a whole, and its short- and long-term structural integrity, are rarely assessed, and few methods have been established to monitor and predict the mechanisms leading to failure. These are necessary to ensure that any new implants entering the market will perform satisfactorily and prevent premature revision surgery.

The acoustic emission (AE) technique offers the capability of monitoring structural degradation passively and in real time, and can distinguish failure mechanisms and their location through the analysis of AE parameters. In the present paper, the use of acoustic emission in orthopaedics, in particular for the evaluation of hip replacement constructs, is reviewed. Following this, three case studies undertaken at the University of Southampton are presented, in which acoustic emission on-line monitoring has been used to evaluate the performance of simulated artificial hip replacement constructs and their constituents during static and fatigue testing. In Case Study 1, the fatigue behaviour of bone cement is characterized; in Case Study 2, the residual stresses induced in the construct as a result of bone cement cure are investigated; in Case Study 3, the mechanisms leading to failure of a carbon fibre reinforced plastic hip stem during fatigue testing are characterized.
Diagnosis and categorization of acral melanocytic lesions using teledermoscopy
Authors: Piccolo Domenico , Soyer H Peter , Chimenti Sergio , Argenziano Giuseppe , Bartenjev Igor , Hofmann-Wellenhof Rainer , Marchetti Raffaele , Oguchi Shinji , Pagnanelli Gianluca , Pizzichetta Maria Antonietta , Saida Toshiaki , Salvemini Isabella , Tanaka Masaru , Wolf Ingrid H , Zgavec Borut , Peris Ketty
Published: December 2004

We performed a multicentre study to test the validity of teledermoscopy for diagnosing acral melanoma and to evaluate inter-observer agreement on the classification of acral melanocytic lesions. Dermoscopic images of 77 acral melanocytic lesions (71 common melanocytic naevi and 6 melanomas) were sent by email to 11 dermatologists with different degrees of experience in dermoscopy. The observers analysed the images on a computer monitor to diagnose acral melanoma or atypical lesions and to categorize all lesions. All 11 observers, regardless of their degree of experience, obtained high values for sensitivity (mean 0.91, SD 0.09) and specificity (mean 0.95, SD 0.04) with regard to the diagnosis of melanoma. The inter-observer agreement was good to excellent (kappa 0.49–0.88) for the categorization of acral melanocytic lesions. All six melanomas were correctly classified as 'atypical pattern' and all observers recommended surgical excision. Teledermoscopy represents a useful tool for the diagnosis of acral melanoma and for the categorization of patterns that suggest benign or potentially malignant acral melanocytic lesions.
Benefits of multidisciplinary case conferencing using audiovisual compared with telephone communication: a randomized controlled trial
Authors: Wilson S F , Marks R , Collins N , Warner B , Frick L
Published: December 2004

Multidisciplinary case conferencing using a video-link was compared with multidisciplinary case conferencing by telephone. One hundred patients were randomized to either videoconferencing (intervention group, 50 patients) or audioconferencing (control group, 50 patients). The effectiveness of the intervention compared with the control was evaluated in terms of: the number of conferences per patient, average length of conference, length of treatment, number of occasions of service, degree of multidisciplinary team involvement, recorded level of communication, quality of the management plan (in terms of the number of points contained in it) and staff satisfaction. The intervention and control groups showed significant differences on only two of the outcome measures: the mean number of case conferences per patient was less for the intervention group, and the intervention group had a shorter length of treatment (6 days) than the control group (10 days). The study did not demonstrate any significant differences in occasions of service or time commitment, which might have resulted in lower costs. However, the introduction of case conferencing by video-link was accompanied by a high level of satisfaction on the part of the 14 team members who were interviewed.
Study quality and evidence of benefit in recent assessments of telemedicine
Authors: Hailey David , Ohinmaa Arto , Roine Risto
Published: December 2004

We carried out a systematic review of recent telemedicine assessments to identify scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes or the results of an economic assessment. From 605 publications identified in the literature search, 44 papers met the selection criteria and were included in the review. Four other publications were identified through references cited in one of the retrieved papers and from a separate project to give a total of 48 papers for consideration, which referred to 42 telemedicine programmes and 46 studies. Some kind of economic analysis was included in 25 (52%) of the papers. In considering the studies, we used a quality appraisal approach that took account of both study design and study performance. For those studies that included an economic analysis, a further quality-scoring approach was applied to indicate how well the economic aspects had been addressed. Twenty-four of the studies were judged to be of high or good quality and 11 of fair to good quality but with some limitations. Seven studies were regarded as having limited validity and a further four as being unacceptable for decision makers. New evidence on the efficacy and effectiveness of telemedicine was given by studies on geriatric care, intensive care and some of those on home care. For a number of other applications, reports of clinical or economic benefits essentially confirmed previous findings. Although further useful clinical and economic outcomes data have been obtained for some telemedicine applications, good-quality studies are still scarce.
Improving the quality of eye care with tele-ophthalmology: shared-care glaucoma screening
Authors: de Mul Marleen , de Bont Antoinette A , Reus Nicolaas J , Lemij Hans G , Berg Marc
Published: December 2004

We evaluated a shared-care tele-ophthalmology service initiated by the Rotterdam Eye Hospital and 10 optometrists working in retail optician stores. The optometrists screened their clients with a nerve fibre analyser and the resulting images were then further assessed by trained technicians at the hospital. We analysed data from 1729 patients and measured several indicators of the quality of the work as well as its efficiency and effectiveness. The quality of the images was at least satisfactory in most cases (89%), and the agreement between the optometrists and the hospital about normal or suspect test results was high (81%). Only 27% of the patients were called for additional testing at the hospital department and 11% consulted an ophthalmologist. Eighty new cases of glaucoma were detected. The combination of task redesign and telemedicine accounted for the success of the screening service. Task redesign was needed to transfer screening from the hospital to primary care in a safe and responsible way. Telemedicine was crucial for assuring quality, facilitating information exchange and for coordination.
Uncoupling of RNAi from active translation in mammalian cells
Authors: GU SHUO , ROSSI JOHN J.
Published: December 2004

Small inhibitory RNAs (siRNAs) are produced from longer RNA duplexes by the RNAse III family member Dicer. The siRNAs function as sequence-specific guides for RNA cleavage or translational inhibition. The precise mechanism by which siRNAs direct the RNA-induced silencing complex (RISC) to find the complementary target mRNA remains a mystery. Some biochemical evidence connects RNAi with translation making attractive the hypothesis that RISC is coupled with the translational apparatus for scanning mRNAs. Such coupling would facilitate rapid alignment of the siRNA antisense with the complementary target sequence. To test this hypothesis we took advantage of a well-characterized translational switch afforded by the ferritin IRE-IRP to analyze RNAi mediated cleavage of a target mRNA in the presence and absence of translation. Our results demonstrate that neither active translation nor unidirectional scanning is required for siRNA mediated target degradation. Our findings demonstrate that nontranslated mRNAs are highly susceptible to RNAi, and blocking scanning from both the 5′ and 3′ ends of an mRNA does not impede RNAi. Interestingly, RNAi is about threefold more active in the absence of translation.
Coordinating Inventory Control and Pricing Strategies with Random Demand and Fixed Ordering Cost: The Finite Horizon Case
Authors: Chen Xin , Simchi-Levi David
Published: December 2004

We analyze a finite horizon, single product, periodic review model in which pricing and production/inventory decisions are made simultaneously. Demands in different periods are random variables that are independent of each other and their distributions depend on the product price. Pricing and ordering decisions are made at the beginning of each period and all shortages are backlogged. Ordering cost includes both a fixed cost and a variable cost proportional to the amount ordered. The objective is to find an inventory policy and a pricing strategy maximizing expected profit over the finite horizon. We show that when the demand model is additive, the profit-to-go functions are k-concave and hence an (s, S, p) policy is optimal. In such a policy, the period inventory is managed based on the classical (s, S) policy and price is determined based on the inventory position at the beginning of each period. For more general demand functions, i.e., multiplicative plus additive functions, we demonstrate that the profit-to-go function is not necessarily k-concave and an (s, S, p) policy is not necessarily optimal. We introduce a new concept, the symmetric k-concave functions, and apply it to provide a characterization of the optimal policy.
Cutting Planes for Low-Rank-Like Concave Minimization Problems
Authors: Porembski Marcus
Published: December 2004

Concavity cuts play an important role in several algorithms for concave minimization, such as pure cutting plane algorithms, conical algorithms, and branch-and-bound algorithms. For concave quadratic minimization problems Konno et al. (1998) have demonstrated that the lower the rank of the problem, i.e., the smaller the number of nonlinear variables, the deeper the concavity cuts usually turn out to be. In this paper we examine the case where the number of nonlinear variables of a concave minimization problem is large, but most of the objective value of a good solution is determined by a small number of variables only. We will discuss ways to exploit such a situation to derive deep cutting planes. To this end we apply concepts usually applied for efficiently solving low-rank concave minimization problems.
Scheduling Flexible Servers with Convex Delay Costs: Heavy-Traffic Optimality of the Generalized cμ-Rule
Authors: Mandelbaum Avishai , Stolyar Alexander L.
Published: December 2004

We consider a queueing system with multitype customers and flexible (multiskilled) servers that work in parallel. If Qi is the queue length of type i customers, this queue incurs cost at the rate of Ci(Qi), where Ci(·) is increasing and convex. We analyze the system in heavy traffic (Harrison and Lopez 1999) and show that a very simple generalized cμ-rule (Van Mieghem 1995) minimizes both instantaneous and cumulative queueing costs, asymptotically, over essentially all scheduling disciplines, preemptive or non-preemptive. This rule aims at myopically maximizing the rate of decrease of the instantaneous cost at all times, which translates into the following: when becoming free, server j chooses for service a type i customer such that i ε arg maxi Cμi(Qi)μij, where μij is the average service rate of type i customers by server j.

An analogous version of the generalized cμ-rule asymptotically minimizes delay costs. To this end, let the cost incurred by a type i customer be an increasing convex function Ci(D) of its sojourn time D. Then, server j always chooses for service a customer for which the value of C′i(D) μij is maximal, where D and i are the customer's sojourn time and type, respectively.
All-or-Nothing Ordering Under a Capacity Constraint
Authors: Gallego Guillermo , Toktay L. Beril
Published: December 2004

We consider a special case of the single-item, periodic-review inventory control problem with fixed plus linear ordering costs and an upper bound on production capacity. We assume that the fixed cost is large relative to the variable cost and restrict our analysis to full-capacity orders. We show that the optimal policy is a threshold policy, with respect to the inventory position, for a class of cost-to-go functions that include the class of convex functions.
Crisis and Competition in Expert Organizational Decision Making: Credit-Rating Agencies and Their Response to Turbulence in Emerging Economies
Authors: Vaaler Paul M. , McNamara Gerry
Published: December 2004

Firms often delegate elements of strategic decisions to outside experts who promise objective assessments, which are especially valuable in unstable environments. However experts themselves may be prone to skewed decision making as the stability of their own industry environment changes and as their positioning within the industry shifts. We examine this possibility in the context of expert credit-rating agencies (“agencies”) and their risk ratings of emerging-market sovereign borrowers (“ratings”) published from 1987 to 1998, a period that includes both industry stability (1987–1996) and industry turbulence set off by financial crises in several emerging-market countries (1997–1998). After controlling for macroeconomic and related objective risk factors linked to the sovereigns themselves, we find several points: (1) agency ratings during crisis-induced industry turbulence are negatively skewed, indicating undue pessimism among these experts, in line with decision-making perspectives predicting negative reaction by experts in an effort to retain legitimacy with salient stakeholders, in this case, investors and public regulators; (2) this negative shift is greater for incumbent firms and regionally focused firms, possibly because of the loss of previous informational advantages; and (3) this negative shift during crisis-induced turbulence is greater as industry rivalry among these experts increases in particular market segments, possibly indicating the development of competitive bandwagons among experts. Together, our results suggest that objective assessments by expert organizations are vulnerable to substantial distortion from the confluent effects of industry instability and expert positioning within the industry, particularly positioning affecting rivalry among experts. Ironically, experts may be most likely to mislead clients in unstable industry environments when experts command greater attention and should show greater fidelity to disinterested objectivity.