bluuebunny/crossref_metadata_2025 huggingface dataset:
Teachers, the state and religious symbols: A question of professional ethics
Authors: McDonough Kevin , Maxwell Bruce , Waddington David
Published: September 2015

This article considers the question of whether policies that propose to forbid public officials, most notably teachers, from wearing religious clothing in the classroom can be justified by political principles of secularism – specifically, the principle of state neutrality and the principle of state autonomy from religious influence. Two prominent arguments on behalf of an affirmative answer to this question are identified and evaluated, ultimately casting doubt on the cogency of prohibitionist arguments. The claim is then advanced that secular principles are most compellingly understood in educational contexts as principles of professional ethics – that is, as grounds for teacher reflection. To support this claim, we conclude by presenting two scenarios in which teachers face difficult decisions about whether to wear or remove an otherwise obligatory religious symbol. In this discussion, the importance of balance considerations of religious conscience with the value of public trust is emphasized.
Prognostic value of forced expiratory volume in 1 second/forced vital capacity in idiopathic pulmonary fibrosis
Authors: Nishiyama Osamu , Yamazaki Ryo , Sano Akiko , Yamagata Toshiyuki , Sano Hiroyuki , Iwanaga Takashi , Higashimoto Yuji , Kume Hiroaki , Tohda Yuji
Published: September 2015

Emphysema on high-resolution computed tomography of the chest is the recent focus in the general practice in idiopathic pulmonary fibrosis (IPF). However, adequate attention has not been paid to obstructive disorder. Therefore, we retrospectively evaluated the association between the degree of airway obstruction and longevity in IPF subjects, with a hypothesis that lower forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) has an impact on prognosis. One hundred and fourteen consecutive IPF subjects who had been diagnosed with IPF and had undergone evaluation including pulmonary function test from January 2008 to May 2013 were included in the study. The relationship between baseline data and survival was examined. FEV1/FVC was widely distributed, ranging from 48.6% to 100%. On both univariate and multivariate Cox’s regression analyses, lower FEV1/FVC was significantly associated with better survival (hazard ratio of 1.07 and 1.04 and 95% confidential interval of 1.03–1.10 and 1.01–1.08, respectively). Even on analysis with backward selection, FEV1/FVC remained a significant prognostic factor. FEV1/FVC is widely distributed and negatively predicts survival in IPF. A FEV1/FVC should be assessed in “real-world” general practice. Also, the effect of smoking on the clinical course of IPF should be investigated further.
Data monitoring committees for pragmatic clinical trials
Authors: Ellenberg Susan S , Culbertson Richard , Gillen Daniel L , Goodman Steven , Schrandt Suzanne , Zirkle Maryan
Published: September 2015

In any clinical trial, it is essential to monitor the accumulating data to be sure that the trial continues to be safe for participants and that the trial is being conducted properly. Data monitoring committees, independent expert panels who undertake regular reviews of the data as the trial progresses, serve an important role in safeguarding the interests of research participants and ensuring trial integrity in many trials. Many pragmatic clinical trials, which aim to inform healthcare decisions by comparing alternate interventions in heterogeneous healthcare delivery settings, will warrant review by an independent data monitoring committee due to their potential impact on clinical practice. However, the very features that make a trial “pragmatic” may pose challenges in terms of which aspects of a trial to monitor and when it is appropriate for a data monitoring committee to intervene. Using the Pragmatic-Explanatory Continuum Indicator Summary tool that draws distinctions between pragmatic and explanatory clinical trials, we review characteristics of pragmatic clinical trials that may have implications for data monitoring committees and interim monitoring plans. These include broad eligibility criteria, a focus on subjective patient-centered outcomes, and in some cases a lack of standardized follow-up procedures across study sites. Additionally, protocol adherence is often purposefully not addressed in pragmatic trials in order to accurately represent the clinical practice setting and maintain practicability of implementation; there are differing viewpoints as to whether adherence should be assessed and acted upon by data monitoring committees in these trials. Some other issues not specifically related to the Pragmatic-Explanatory Continuum Indicator Summary criteria may also merit special consideration in pragmatic trials. Thresholds for early termination of a pragmatic clinical trial might be controversial. The distinguishing features of pragmatic clinical trials require careful consideration when developing interim data monitoring plans, and trial sponsors, investigators, and data monitoring committees should agree on a plan before trial inception. Finally, special expertise, such as an informatics, may be helpful on data monitoring committees for some pragmatic clinical trials. Patient representatives may provide particularly valuable insights in the monitoring process.
Exploring the ethical and regulatory issues in pragmatic clinical trials
Authors: Califf Robert M , Sugarman Jeremy
Published: September 2015

The need for high-quality evidence to support decision making about health and health care by patients, physicians, care providers, and policy-makers is well documented. However, serious shortcomings in evidence persist. Pragmatic clinical trials that use novel techniques including emerging information and communication technologies to explore important research questions rapidly and at a fraction of the cost incurred by more “traditional” research methods promise to help close this gap. Nevertheless, while pragmatic clinical trials can bridge clinical practice and research, they may also raise difficult ethical and regulatory challenges. In this article, the authors briefly survey the current state of evidence that is available to inform clinical care and other health-related decisions and discuss the potential for pragmatic clinical trials to improve this state of affairs. They then propose a new working definition for pragmatic research that centers upon fitness for informing decisions about health and health care. Finally, they introduce a project, jointly undertaken by the National Institutes of Health Health Care Systems Research Collaboratory and the National Patient-Centered Clinical Research Network (PCORnet), which addresses 11 key aspects of current systems for regulatory and ethical oversight of clinical research that pose challenges to conducting pragmatic clinical trials. In the series of articles commissioned on this topic published in this issue of Clinical Trials, each of these aspects is addressed in a dedicated article, with a special focus on the interplay between ethical and regulatory considerations and pragmatic clinical research aimed at informing “real-world” choices about health and health care.
Efficacy of Warm Needle Moxibustion on Lumbar Disc Herniation
Authors: Li Xinhua , Han Yingchao , Cui Jian , Yuan Ping , Di Zhi , Li Lijun
Published: September 2015

Background.

Clinical studies on the efficacy of warm needle moxibustion to treat lumbar disc herniation are increasing, while studies on the assessment of its efficacy are still lacking.

Objective.

To assess the clinical effect of warm needle moxibustion on lumbar disc herniation.

Methods.

We searched relevant trials that compared warm needle moxibustion with other methods for lumbar disc herniation from 9 databases.

Results.

Warm needle moxibustion showed statistical significance efficiency rate compared with acupuncture and manipulation but had a similar rate with nonsteroidal anti-inflammatory drugs (NSAIDs). It showed a statistically significanty excellent rate when compared with acupuncture and manipulation but had a similar rate with NSAIDs. Regarding Japanese Orthopedic Association scores, it showed statistical significance with acupuncture and manipulation, but the rate was similar with Chinese medicine and NSAIDs. Regarding visual analog scale score, it demonstrated statistical significance when compared with acupuncture, manipulation, and NSAIDs but had a similar rate with Chinese medicine.

Conclusion.

Warm needle moxibustion is superior to acupuncture and manipulation in terms of efficiency rate, excellent rate, and controlling of pain for lumbar disc herniation, but it is similar when compared with NSAIDs and Chinese medicine.
Effect of sulphur and acid soluble aluminium content on grain oriented silicon steel
Authors: Zhou B. , Zhu C. , Li G. , Fu Y.
Published: September 2015

The effect of sulphur (S) and acid soluble aluminium (Als) content on precipitation behaviours, microstructures and textures of hot rolled grain oriented silicon steels were investigated. The results showed that precipitates were mainly MnS and a little amount of MnS–AlN composite. Similar characteristics of precipitates, microstructures and textures were found in specimens containing similarly higher S content and different Als content. More fine precipitates, less recrystallisation and more and stronger Goss texture component were presented in specimen containing lower S content. It was not Als content but S content that played a key role during hot rolling. High proportion and intensity of Goss texture component were due to the effective inhibiting effect of finely and uniformly dispersed precipitates on dynamic recrystallisation.
Effect of surfactant assisted suspension on PVD coatings
Authors: Upadhyay R. K. , Kumaraswamidhas L. A.
Published: September 2015

Both anionic and cationic surfactants are perfect examples to reduce friction by lowering surface tension. The use of surfactant based liquids gains widespread application in the field of science, where reduction of material loss is highly desirable. In this work, dispersion of ionic surfactant such as sodium dodecyl sulphate, sodium hexametaphosphate and cetyl trimethylammonium bromide in water and oil was prepared by ultrasonication technique to measure the friction properties under the action of sliding contact.
Increased ventilatory response to carbon dioxide in COPD patients following vitamin C administration
Authors: Hartmann Sara E. , Kissel Christine K. , Szabo Lian , Walker Brandie L. , Leigh Richard , Anderson Todd J. , Poulin Marc J.
Published: September 2015

Patients with chronic obstructive pulmonary disease (COPD) have decreased ventilatory and cerebrovascular responses to hypercapnia. Antioxidants increase the ventilatory response to hypercapnia in healthy humans. Cerebral blood flow is an important determinant of carbon dioxide/hydrogen ion concentration at the central chemoreceptors and may be affected by antioxidants. It is unknown whether antioxidants can improve the ventilatory and cerebral blood flow response in individuals in whom these are diminished. Thus, we aimed to determine the effect of vitamin C administration on the ventilatory and cerebrovascular responses to hypercapnia during healthy ageing and in COPD.

Using transcranial Doppler ultrasound, we measured the ventilatory and cerebral blood flow responses to hyperoxic hypercapnia before and after an intravenous vitamin C infusion in healthy young (Younger) and older (Older) subjects and in moderate COPD.

Vitamin C increased the ventilatory response in COPD patients (mean (95% CI) 1.1 (0.9–1.1)versus1.5 (1.1–2.0) L·min−1·mmHg−1, p<0.05) but not inYounger(2.5 (1.9–3.1)versus2.4 (1.9–2.9) L·min−1·mmHg−1, p>0.05) orOlder(1.3 (1.0–1.7)versus1.3 (1.0–1.7) L·min−1·mmHg−1, p>0.05) healthy subjects. Vitamin C did not affect the cerebral blood flow response in the young or older healthy subjects or COPD subjects (p>0.05).

Vitamin C increases the ventilatory but not cerebrovascular response to hyperoxic hypercapnia in patients with moderate COPD.
Acute myocardial infarctionversusother cardiovascular events in community-acquired pneumonia
Authors: Aliberti Stefano , Ramirez Julio , Cosentini Roberto , Valenti Vincenzo , Voza Antonio , Rossi Paolo , Stolz Daiana , Legnani Delfino , Pesci Alberto , Richeldi Luca , Peyrani Paula , Massari Fernando Maria , Blasi Francesco
Published: September 2015

The aim of the present study was to define the prevalence, characteristics, risk factors and impact on clinical outcomes of acute myocardial infarction (AMI)versusother cardiovascular events (CVEs) in patients with community-acquired pneumonia (CAP).

This was an international, multicentre, observational, prospective study of CAP patients hospitalised in eight hospitals in Italy and Switzerland. Three groups were identified: those without CVEs, those with AMI and those with other CVEs.

Among 905 patients, 21 (2.3%) patients experienced at least one AMI, while 107 (11.7%) patients experienced at least one other CVE. Patients with CAP and either AMI or other CVEs showed a higher severity of the disease than patients with CAP alone. Female sex, liver disease and the presence of severe sepsis were independent predictors for the occurrence of AMI, while female sex, age >65 years, neurological disease and the presence of pleural effusion predicted other CVEs. In-hospital mortality was significantly higher among those who experienced AMI in comparison to those experiencing other CVEs (43%versus21%, p=0.039). The presence of AMI showed an adjusted odds ratio for in-hospital mortality of 3.57 (p=0.012) and for other CVEs of 2.63 (p=0.002).

These findings on AMIversusother CVEs as complications of CAP may be important when planning interventional studies on cardioprotective medications.
Wide prevalence of hybridization in two sympatric grasshopper species may be shaped by their relative abundances
Authors: Rohde Katja , Hau Yvonne , Weyer Jessica , Hochkirch Axel
Published: September 2015

Background

Hybridization between species is of conservation concern as it might threaten the genetic integrity of species. Anthropogenic factors can alter hybridization dynamics by introducing new potentially hybridizing species or by diminishing barriers to hybridization. This may even affect sympatric species pairs through environmental change, which so far has received little attention. We studied hybridization prevalence and the underlying behavioral mechanisms in two sympatric grasshopper species, a rare specialist (Chorthippus montanus) and a common generalist (Chorthippus parallelus). We conducted a mate choice experiment with constant intraspecific density and varying heterospecific density, i.e. varying relative frequency of both species.

Results

Mate choice was frequency-dependent in both species with a higher risk of cross-mating with increasing heterospecific frequency, while conspecific mating increased linearly with increasing conspecific density. This illustrates that reproductive barriers could be altered by environmental change, if the relative frequency of species pairs is affected. Moreover, we performed a microsatellite analysis to detect hybridization in twelve syntopic populations (and four allotopic populations). Hybrids were detected in nearly all syntopic populations with hybridization rates reaching up to 8.9 %. Genetic diversity increased for both species when hybrids were included in the data set, but only in the common species a positive correlation between hybridization rate and genetic diversity was detected.

Conclusion

Our study illustrates that the relative frequency of the two species strongly determines the effectiveness of reproductive barriers and that even the more choosy species (Ch. montanus) may face a higher risk of hybridization if population size decreases and its relative frequency becomes low compared to its sister species. The asymmetric mate preferences of both species may lead to quasi-unidirectional gene flow caused by unidirectional backcrossing. This might explain why genetic diversity increased only in the common species, but not in the rare one. Altogether, the hybridization rate was much higher than expected for a widely sympatric species pair.
Limited genomic divergence between intraspecific forms of Culex pipiens under different ecological pressures
Authors: Gomes Bruno , Wilding Craig S. , Weetman David , Sousa Carla A. , Novo Maria T. , Savage Harry M. , Almeida António P. G. , Pinto João , Donnelly Martin J.
Published: September 2015

Background

Divergent selection can be a major driver of ecological speciation. In insects of medical importance, understanding the speciation process is both of academic interest and public health importance. In the West Nile virus vectorCulex pipiens, intraspecific pipiens and molestus forms vary in ecological and physiological traits. Populations of each form appear to share recent common ancestry but patterns of genetic differentiation across the genome remain unknown. Here, we undertook an AFLP genome scan on samples collected from both sympatric and allopatric populations from Europe and the USA to quantify the extent of genomic differentiation between the two forms.

Results

The forms were clearly differentiated but each exhibited major population sub-structuring between continents. Divergence between pipiens and molestus forms from USA was higher than in both inter- and intra-continental comparisons with European samples. The proportion of outlier loci between pipiens and molestus (≈3 %) was low but consistent in both continents, and similar to those observed between sibling species of other mosquito species which exhibit contemporary gene flow. Only two of the outlier loci were shared between inter-form comparisons made within Europe and USA.

Conclusion

This study supports the molestus and pipiens status as distinct evolutionary entities with low genomic divergence. The low number of shared divergent loci between continents suggests a relatively limited number of genomic regions determining key typological traits likely to be driving incipient speciation and/or adaptation of molestus to anthropogenic habitats.
Neurospora discreta as a model to assess adaptation of soil fungi to warming
Authors: Romero-Olivares Adriana L. , Taylor John W. , Treseder Kathleen K.
Published: September 2015

Background

Short-term experiments have indicated that warmer temperatures can alter fungal biomass production and CO2 respiration, with potential consequences for soil C storage. However, we know little about the capacity of fungi to adapt to warming in ways that may alter C dynamics. Thus, we exposed Neurospora discreta to moderately warm (16 °C) and warm (28 °C) selective temperatures for 1500 mitotic generations, and then examined changes in mycelial growth rate, biomass, spore production, and CO2 respiration. We tested the hypothesis that strains will adapt to its selective temperature. Specifically, we expected that adapted strains would grow faster, and produce more spores per unit biomass (i.e., relative spore production). In contrast, they should generate less CO2 per unit biomass due to higher efficiency in carbon use metabolism (i.e., lower mass specific respiration, MSR).

Results

Indeed, N. discreta adapted to warm temperatures, based on patterns of relative spore production. Adapted strains produced more spores per unit biomass than parental strains in the selective temperature. Contrary to our expectations, this increase in relative spore production was accompanied by an increase in MSR and a reduction in mycelial growth rate and biomass, compared to parental strains.

Conclusions

Adaptation of N. discreta to warm temperatures may have elicited a tradeoff between biomass production and relative spore production, possibly because relative spore production required higher MSR rates. Therefore, our results do not support the idea that adaptation to warm temperatures will lead to a more efficient carbon use metabolism. Our data might help improve climate change model simulations and provide more concise predictions of decomposition processes and carbon feedbacks to the atmosphere.
An action research approach to facilitating the adoption of a foot health assessment tool in India
Authors: Harrison‐Blount Michael , Cullen Michelle , Nester Christopher J. , Williams Anita E.
Published: September 2015

Background

India has a diabetes population that is growing and alongside this, the incidence of limb threatening foot problems is increasing. Foot health care provision does not yet meet this demand. In one locality in India, clinicians had an unstructured approach to foot health assessments resulting in poor adoption of evidence based guidelines from the West and a persistence of serious foot complications. There was the perception that existing assessment tools did not take into account the local cultural, organizational and professional needs and there was a lack of ownership of any potential solution to the problem. Therefore, the aim of this work was to facilitate the ownership and development of a foot health assessment tool for use in the Indian context. In order to achieve this an action research approach was chosen.

Methods

Participants were facilitated through the action and implementation phases of the action research cycle by the researchers. The action phase included generating a list of potential items for inclusion in the tool from a review of the literature to provide an evidence based foundation for the foot health assessment tool. A modified Delphi method was used to further refine the contents of the tool. Members of the Delphi Panel (n = 8) were experts in their field of medicine and experts in delivering health care within services in India.

Results

The outcome of the study was the adoption of a locally developed foot health assessment tool (Salford Indian Foot Health Assessment Tool, SIFT). It contains thirteen sections, which reflect the risk factors identified for assessing foot health agreed by the participants to fit the Indian context. The SIFT is supported with evidence based guidelines from the West and a training program was delivered by the researchers in order to support its implementation into clinical practice.

Conclusion

An action research approach has facilitated the development and implementation of a locally created and owned foot health assessment tool. This in turn has resulted in the integration of evidence‐based guidelines from the West with consideration to local cultural, organizational and professional needs and ultimately the needs of their patients. Further work is underway evaluating the outcomes of the SIFT in practice.
Role of Notch signaling during lipopolysaccharide-induced preterm labor
Authors: Agrawal Varkha , Jaiswal Mukesh K , Pamarthy Sahithi , Katara Gajendra K , Kulshrestha Arpita , Gilman-Sachs Alice , Hirsch Emmet , Beaman Kenneth D
Published: September 2015

Notch signaling pathways exert effects throughout pregnancy and are activated in response to TLR ligands. To investigate the role of Notch signaling in preterm labor, Notch receptors (Notch1–4), its ligand Delta-like protein-1, transcriptional repressor hairy and enhancer of split-1, and Notch deregulator Numb were assessed. Preterm labor was initiated on gestation d 14.5 by 1 of 2 methods: 1) inflammation-induced preterm labor: intrauterine injection of LPS (a TLR4 agonist) and 2) hormonally induced preterm labor: subcutaneous injection of mifepristone. Delta-like protein-1, Notch1, and hairy and enhancer of split-1 were elevated significantly, and Numb was decreased in the uterus and placenta of inflammation-induced preterm labor mice but remained unchanged in hormonally induced preterm labor compared with their respective controls. F4/80+ macrophage polarization was skewed in the uterus of inflammation-induced preterm labor toward M1-positive (CD11c+) and double-positive [CD11c+ (M1) and CD206+ (M2)] cells. This process is dependent on activation of Notch signaling, as shown by suppression of M1 and M2 macrophage-associated cytokines in decidual macrophages in response to γ-secretase inhibitor (an inhibitor of Notch receptor processing) treatment ex vivo. γ-Secretase inhibitor treatment also diminished the LPS-induced secretion of proinflammatory cytokines and chemokines in decidual and placental cells cultured ex vivo. Furthermore, treatment with recombinant Delta-like protein-1 ligand enhanced the LPS-induced proinflammatory response. Notch ligands (Jagged 1 and 2 and Delta-like protein-4) and vascular endothelial growth factor and its receptor involved in angiogenesis were reduced significantly in the uterus and placenta during inflammation-induced preterm labor. These results suggest that up-regulation of Notch-related inflammation and down-regulation of angiogenesis factors may be associated with inflammation-induced preterm labor but not with hormonally induced preterm labor.
Defensibility of New Health Professionals at Law: A Speculative Paper
Authors: Chapman Matthew W. , Record Jane Cassels
Published: September 2015

The future of physician's assistants and nurse practitioners will be shaped at least in part by whether, and on what terms, they are defensible at law. This paper explores the way in which the principles of tort law might define primary and secondary liability for these new health professionals. Among the issues discussed in substantial detail are whether a separate standard of care is appropriate, whether the new professionals might function as independent contractors, and the importance of striking an adequate social balance between improved access to health care or cost containment on the one hand and malpractice deterrence or redressment on the other.
Health Care Cost Containment in West Germany
Authors: Stone Deborah A.
Published: September 2015

The West German health care system has experienced a serious escalation of expenditures since about 1970. For a variety of reasons, many features of the national health insurance program that might have provided restraints on costs were gradually eliminated. Most notably, some restrictions on the supply of physicians and hospital facilities were ended, as was an earlier system of fixed budgeting for ambulatory care services. In addition, legislative and judicial decisions have continually expanded both the benefits and the standard of care that must be provided to publicly insured patients.

In 1977, the government passed a Health Care Cost Containment Act which ordered several measures to curb costs: prospectively negotiated ceilings on expenditures for physicians' services, dentists' services and prescription drugs; strengthening of utilization review; composition of a unified fee schedule; small increases in cost sharing and limitations on insurance benefits; and some changes in financing. The reform efforts seem to have had a significant effect, though it is still too early to tell exactly what caused the declining growth rate of health expenditures, and whether the new trend will persist.
Decisionmaking in Regional Health Planning Agencies
Authors: Luft Harold S. , Frisvold Gary A.
Published: September 2015

Health Systems Agencies (HSAs), the new regional health planning agencies established by the National Health Planning and Resources Development Act of 1974, have as their major goals quality, accessibility, continuity and cost containment. One of the tools for cost containment available to HSAs is their active participation in the statewide certificate-of-need (CON) program. To help anticipate how HSAs may play their CON roles, this article reviews the CON decisionmaking processes of two Comprehensive Health Planning (CHP) agencies, the predecessors of HSAs. While most CHPs lacked specific health plans and powers, the two California agencies examined have had both regional plans and roles in CON programs comparable to the present HSAs'.

Our focus is on the decisionmaking process rather than the effectiveness of CON programs. A simple descriptive model is developed based on the assumptions that the planners seek satisfactory, rather than optimal solutions and that the data available to them are extremely limited. The cases analyzed suggest that, while most projects exceed the bed need standards, institutions were almost always able to demonstrate a need through various special circumstances. Once a need has been shown, the agency was able to deny an application only if a better alternative were available.

This study suggests two approaches to improving regional health planning decisionmaking. First, identified needs can be better met either by increasing the agency's ability to generate alternatives or by encouraging health facilities to submit competing applications. Second, a regional health care budget would force the agency to make choices among competing needs.
Statistical and Other Data-Analytic Techniques for the Evaluation Researcher: An Identification, Classification, and Description of Methods and Resources
Authors: Parker Barnett R.
Published: September 2015

The goal of any social/health intervention program is to improve the lot of the people it is designed to serve. Of critical importance in the development and implementation of programs able to achieve such a goal is evaluation research (ER)—a process representing an interface between the generic notion of evaluation and the rigor of social research methodology. The evaluation researcher should be familiar with, and be capable of using, any of a number of (statistical and non-statistical) data-analytic techniques. The objectives of this discussion, therefore, are to (1) identify, categorize, and briefly describe statistical and other data-analytic techniques of potential use to the evaluation researchers; and (2) identify currently available resources, i.e., texts, books of readings, monographs, etc., that offer discussions and analyses of these techniques. It is hoped that such an exposition will lead to a wider understanding, acceptance, and use of these procedures, which can only enhance the quality of subsequent program policy and decisionmaking.
Long-Term Care Standards: Enforcement and Compliance
Authors: Christianson Jon B.
Published: September 2015

This paper discusses the regulation of long-term care in the United States. First, it addresses alternate models of regulation that potentially could explain both enforcer and provider actions. Then it describes in more detail the incentives for enforcement of regulatory standards. Empirical eivdence concerning the effect of regulation on provider incomes and the relationship between reported compliance with standards and provider operating costs is examined. In the latter case, the evidence is consistent with a self-interest theory of behavior for regulatory agencies and inspectors. Ideas for reform of the long-term care marketplace are summarized in the concluding section, with emphasis on their probable impact on enforcement of standards.
The Politics of Hospital Payment
Authors: Feder Judith , Spitz Bruce
Published: September 2015

This paper analyzes the politics of hospital payment over the last decade. The authors explain how provider interests and judgments became a standard for appropriate hospital payment; the impact of that standard on hospital costs; and the political obstacles to imposing an alternative standard and controlling hospital costs. The authors draw lessons from this experience, here and in other countries, to propose an alternative approach to hospital payment that would allow policymakers, accountable to the public, to make explicit choices about the level and nature of hospital expenditures.
How Do We Measure the Impact of Intergovernmental Programs? Some Problems and Examples from the Health Area
Authors: Rocheleau Bruce
Published: September 2015

It is difficult to evaluate public programs of any kind but the task is particularly complex when the programs are intergovernmental in nature. Such programs often necessitate a long developmental period before they are likely to have measurable impact. The early stages are often devoted to developing support from local power structures. These programs have many unintended consequences—both positive and negative—that short-term evaluations will usually fail to note. An exploratory study of the Federal Health Planning and Community Mental Health programs is used to illustrate the importance of the “time dimension” in evaluation research.
Advertising and the Health Care Professions
Authors: Bloom Paul N. , Stiff Ronald
Published: September 2015

The amount of advertising done by health-care professionals appears likely to increase. This article examines some of the legal constraints on such advertising, the likely extent of this advertising and the expected consumer response. Predictions are made about how competition, fees, quality and variety in the health care industry will be affected by increased advertising.
State Health Care Policymaking: The Tennessee Primary Care Act of 1973
Authors: Crawford R. Vincent
Published: September 2015

∗ Departments of public health have played a relatively limited direct role in providing primary care to medically underserved areas, a function which has long been the province of the private medical practitioner. This article reports on the personal experiences of the author in investigating the circumstances which led the state of Tennessee to deviate from this norm with its Primary Care Act of 1973. The limited scope of the measure and the timing of its introduction, together with careful attention to the dynamics of health care politics, were critical to the passage of the Act. Even though considerable time has elapsed since this article was written, and increased interest in primary care is evident in other areas and at various levels of government, the obstacles and issues involved in providing care to underserved areas remain topics of debate in Tennessee and elsewhere.
The Legality of Nursing Associations Serving as Collective Bargaining Agents: The Arundel Case
Authors: Dolan Andrew K.
Published: September 2015

Several recent legal developments have been analyzed which call into question the appropriateness of state nursing associations as collective bargaining agents for working nurses. A federal case ruled that because some state nursing associations are dominated by supervisors, they are inappropriate collective bargaining agents for nonsupervisory nurses. A review of the pertinent history and literature reveals that collective bargaining has tended to be a secondary concern of nursing leaders who have more resolutely pursued what they regard as a professional route to elevating the status of nurses. Therefore, the highly stratified nature of nursing practice and the highly disparate roads to improving the status of nursing held by various sectors within nursing have resulted in conflicts of interests which call into serious question whether umbrella groups like nursing associations can represent working nurses.
Terminal and Safe
Authors: Zucker Arthur
Published: September 2015

Decisions regarding the legislation of drugs such as laetrile require a careful analysis of the concept of terminal. If “terminal” is characterized to allow for a time span between diagnosis and death, and if cure is not taken as a paramount goal of a drug, then safety and effectiveness may apply to drugs used for the terminal. If this is so, then arguments for allowing laetrile use will have to appeal to principles of freedom and medical sociology and not to a traditional analysis of safety and effectiveness.
Child Health in the Workplace: The Supreme Court in Hammer V. Dagenhart (1918)
Authors: Berger Lawrence R. , Johansson S. Ryan
Published: September 2015

Exploitation of children in the labor force at the beginning of this century gave rise to a national campaign leading to congressional passage of the Keating-Owen Act in 1916. The act prohibited from interstate commerce goods produced in factories or mines that employed children who either were under fourteen years of age or who were under sixteen years of age and worked more than eight hours a day. Despite its popular support, the Act was declared unconstitutional by the Supreme Court in Hammer v. Dagenhart (1918). The Court's decision involved several major issues: interpretation of the Fifth and Fourteenth Amendments to the Constitution, freedom of contract, police power of the states, and the interstate commerce clause. Review of previous Court decisions suggests that the justices were on less than solid legal ground in reaching their decision. Examination of the historical context of the decision, however, suggests other factors that may have played a more important role than judicial precedents. The debate prompted by Hammer v. Dagenhart has much relevance to such current issues as young agricultural workers, sex discrimination in industry, and the powers of the federal government vis-a-vis states and individual citizens.
Institutional Vs. Noninstitutional Care for the Elderly
Authors: Pegels C. Carl
Published: September 2015

The question of institutionalization vs. home care of the aged in need of medical care has been debated extensively. The arguments for deinstitutionalization have stressed the issue of cost. Home care is felt to be more cost efficient than institutional care. In this paper, both sides of the issue are investigated in detail by drawing on published conference proceedings and empirical studies reported in the literature.
A Survey of Mental Health Policy Options
Authors: Rubin Jeffrey
Published: September 2015

A confusing array of options to reform mental health care is now under consideration by policymakers. To clarify the implications of these options, five categories of actions are distinguished. These reforms are: federal program change, litigation, state commitment statute reform, alterations in private market variables and efforts to change attitudes. The overlaps among them are discussed as is the importance of knowing more about the relative effectiveness of each action. Wide-ranging reforms have been underway on and hoc basis for some time. This paper argues that before further major initiatives are undertaken, the establishment of a better information base and an improved understanding of the interrelationships of the numerous mental health policies are necessary.
Functional Redundancy and the Process of Professionalization: The Case of Registered Nurses in the United States
Authors: Levi Margaret
Published: September 2015

Registered nurses have been attempting to achieve professional status for nearly a century. Historical investigation of their efforts in the United States and a case study of the 1976 Seattle Nurses' strike indicate major obstacles to the professionalizing project. The most important of these are the inability of the nurses to control the labor supply, and their failure to define or monopolize a distinct set of tasks. One result is functional redundancy: there is no job nurses perform that is not also performed by some other occupation.
The Impact of Hmos: Evidence and Research Issues
Authors: Christianson Jon B.
Published: September 2015

This paper reviews the evidence concerning the impact of HMO growth on traditional providers. Primary emphasis is placed on the results of three case studies conducted by the author. Based on the case studies, five factors are hypothesized to be important in determining the extent of HMO impact on a community: employer attitudes, hospital capacity, physician supply, planning and regulatory decisions, and comprehensiveness of health benefit coverage. Since research on this general topic is in its infancy, several important questions deserving future research effort also are identified.
The Determinants of Canadian Health Policy
Authors: Weller Geoffrey R.
Published: September 2015

Because health policy is the result of a tremendous variety of shifting forces, it is necessary to be eclectic in the approach used to study it. Analyzing the Canadian case in this broad perspective reveals that the influence of ideological and institutional forces, and principal actors is more important than most commentators believe, and that the dynamism in health policy formulation has resulted in a great deal of internal conflict as well as politicization and provincialization.
Health Policy Implications of the Holistic Health Movement
Authors: Salmon J. Warren , Berliner Howard S.
Published: September 2015

A forthright rebellion against the philosophical and clinical orientations of scientific medicine has occurred in the United States during the 1970s. This rebellion includes a growing number of people engaged in self-care practices in attempts to alter their health status through “lifestyle” adjustments, as well as a diverse amalgamation of practitioners (both medical and otherwise), who offer a wide range of therapies outside the mainstream of modern medical practice. Holistic health care has lately become the rubric under which these therapies are grouped.
A Full-Price Approach to the Dental Market: Implications for Price Determination
Authors: House Donald R.
Published: September 2015

Policy initiated in the 1970s follows the contention that competitive forces do not work and new types of regulation are warranted. This article presents an expanded demand-supply theory introducing patient waiting time as a component of full price. Equilibrium is reached through adjustments in both fee levels and waiting time. Competitive markets require unequal fee levels among providers in the same community and differing provider-to-population ratios across communities.

The evidence from dentistry presented supports this expanded theory. Fees and waiting time are inversely related and full price is apparently insensitive to dentist density. Communities seeking higher fees and shorter waits attract more dentists per capita. Two additional studies cited further support this expanded approach. Patient waiting time is an important component of price.
State Dental Practice Acts: Implications for Competition
Authors: Conrad Douglas A. , Emerson Marie L.
Published: September 2015

This article analyzes the effects of state dental practice acts on competition in the market for dental services. Three types of practice act provisions are examined: (1) restraints on advertising and soliciting of patients; (2) limits on scope of practice and number of dental hygienists per dentist; and (3) restrictions on the form of organization and ownership of dental practices.

The empirical results suggest that limits on number of offices per dentist and absence of reciprocal licensing arrangements are associated with higher fees and net incomes among dentists. Restraints on number of hygienists per dentist are positively associated with dental fees, but not with net income. Restrictions on commercial advertising are related to higher net income, but not fees. There is no significant intercorrelation among the various practice act provisions.

The analysis concludes with a discussion of policy implications for competition in dentistry and a suggestion that practice act changes are both a cause and an effect of the general metamorphosis observed in the dental marketplace. The potential indirect effects of national health insurance and altered reimbursement policy are discussed.
A Critique of Market Reform in Health Care: The “Consumer-Choice Health Plan”
Authors: Rushefsky Mark E.
Published: September 2015

Government intervention in health care, as in other areas, is generally justified on the basis of market failure (deviations from the perfectly competitive model) and merit wants. Such intervention has usually taken the form of regulatory programs. Lately, a number of analysts have suggested that such programs are defective and have recommended several policies designed to establish the conditions for a competitive market in health care. Alain Enthoven's Consumer-Choice Health Plan (CCHP), combines many of the elements of market reform and, as such, provides an opportunity to examine the overall approach. This article describes and criticizes the plan's underlying analysis, theory, ability to control rising health care costs, and implementation problems, and questions the political foundation of market reform.
Effect of Glass Transition Temperature of Stabilizing Polymer of Air-Stable Gelatin-Stabilized Copper Fine Particles during Redox Two-Step Low-Temperature Sintering Process
Authors: Matsubara Masaki , Yonezawa Tetsu , Tsukamoto Hiroki
Published: September 2015

It has been found in this study that the glass transition temperatures can be considered as the lowest temperature for sintering metal fine particles to obtain electro-conductive metallic layers from the differential scanning calorimetry measurement of the fine particles. Gelatin-stabilized copper fine particles could be sintered to form an electrically conductive copper layer with a resistivity of 1.9 × 10−5 Ω cm at as low as 150 °C using oxidation–reduction two-step sintering.
Audits and agrarianism: The moral economy of an alternative food network
Authors: Carlisle Liz
Published: September 2015

With consumers and producers seeking alternatives to corporate, industrial food, systems of provision that promise greater ecological and social sustainability have gained in popularity. As these Alternative Food Networks (AFNs) scale up and go mainstream, both scholars and the general public want to know who is holding them accountable to their purported goals. In response to such questions, previously informal designations - such as organic - have become formalized, standardized, and institutionalized, and new certifications and business models promise improved traceability and transparency. I suggest, however, that successful alternative food networks - those that deliver on their promises of social and ecological sustainability – may be governed primarily by broad-based moral economies and support networks, and only secondarily by specific certification schemes or value chain quality control. Drawing on ethnographic research with a values-based supply chain on the northern Great Plains, I find that what creates incentives for sustainable practices and holds farmers accountable is less the regulatory component of certification or contractual stipulations of the value chain than the peer review aspect of belonging to the self-organized community that participates in these initiatives. While the organic certification process and values-based supply chain provide vehicles through which the moral economy of sustainable agriculture can operate, the moral economy itself precedes the notion of organic standards, dating back three generations to early twentieth century wheat pools. Since community formation and standard formation are achieved in very different ways, these findings have significant implications for policies aimed at encouraging transitions to more sustainable agricultural practices.
Childcaring from A to Z
Authors: Helme Tina
Published: September 2015

We tend to focus on one aspect of childminding in our features, but sometimes it is a good idea to take a broader look at the roles, responsibilities and possibilities of the profession.
Makers and shakers
Authors: Doyle Phoebe
Published: September 2015

Fine motor skills are essential in many day-to-day activities such as writing, painting and making. Phoebe Doyle suggests activities to help promote their development.
Trimethoprim-Sulfamethoxazole–Induced Rhabdomyolysis; Gabapentin-Induced Hypoglycemia in Diabetic and Nondiabetic Patients; Purple Glove Syndrome after Oral Phenytoin Administration; Acute Dystonic Reaction after Methylphenidate Initiation; Serotonin Syndrome with Vilazodone Monotherapy; Cabozantinib-Associated Dermatologic Adverse Reactions
Authors: Mancano Michael A.
Published: September 2015

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.