bluuebunny/crossref_metadata_2025 huggingface dataset:
BRAF Mutation Predicts a Poorer Clinical Prognosis for Papillary Thyroid Cancer
Authors: Xing Mingzhao , Westra William H. , Tufano Ralph P. , Cohen Yoram , Rosenbaum Eli , Rhoden Kerry J. , Carson Kathryn A. , Vasko Vasily , Larin Alexandr , Tallini Giovanni , Tolaney Sara , Holt Elizabeth H. , Hui Pei , Umbricht Christopher B. , Basaria Shehzad , Ewertz Marge , Tufaro Anthony P. , Califano Joseph A. , Ringel Matthew D. , Zeiger Martha A. , Sidransky David , Ladenson Paul W.
Published: December 2005

Context: Use of BRAF mutation in papillary thyroid cancer (PTC) has the potential to improve risk stratification of this cancer.

Objective: The objective of the study was to investigate the prognostic value of BRAF mutation in patients with PTC.

Design, Setting, and Subjects: In a multicenter study of 219 PTC patients, data on their clinicopathological characteristics and clinical courses between 1990 and 2004 were retrospectively collected, and their tumor BRAF mutation status was determined. Associations of BRAF mutation with initial tumor characteristics and subsequent recurrence were analyzed.

Main Outcome Measure: Relationships between the BRAF mutation status and clinicopathological outcomes, including recurrence, were measured.

Results: We found a significant association between BRAF mutation and extrathyroidal invasion (P < 0.001), lymph node metastasis (P < 0.001), and advanced tumor stage III/IV (P = 0.007) at initial surgery. This association remained significant on multivariate analysis, adjusting for conventional clinicopathological predictors of recurrence excluding the histological PTC subtype, but was lost when the tumor subtype was included in the model. BRAF mutation was also significantly associated with tumor recurrence, 25 vs. 9% with and without mutation, respectively (P = 0.004), during a median of 15 (interquartile range, 3–29) months of follow-up. This association remained significant on multivariate analysis adjusting for conventional clinicopathological predictors of recurrence, even including the PTC subtype (odds ratio, 4.0; 95% confidence interval, 1.1–14.1; P = 0.03). BRAF mutation was even an independent predictor of recurrence in patients with stage I/II disease, 22 vs. 5% with and without BRAF mutation, respectively (P = 0.002). BRAF mutation was also more frequently associated with absence of tumor I-131 avidity and treatment failure of recurrent disease.

Conclusions: In patients with PTC, BRAF mutation is associated with poorer clinicopathological outcomes and independently predicts recurrence. Therefore, BRAF mutation may be a useful molecular marker to assist in risk stratification for patients with PTC.
Tissue Thyroid Hormone Levels in Critical Illness
Authors: Peeters Robin P. , van der Geyten Serge , Wouters Pieter J. , Darras Veerle M. , van Toor Hans , Kaptein Ellen , Visser Theo J. , Van den Berghe Greet
Published: December 2005

Context: Pronounced alterations in serum thyroid hormone levels occur during critical illness. T3 decreases and rT3 increases, the magnitudes of which are related to the severity of disease. It is unclear whether these changes are associated with decreased tissue T3 concentrations and, thus, reduced thyroid hormone bioactivity.

Patients and Study Questions: We therefore investigated, in 79 patients who died after intensive care and who did or did not receive thyroid hormone treatment, whether total serum thyroid hormone levels correspond to tissue levels in liver and muscle. Furthermore, we investigated the relationship between tissue thyroid hormone levels, deiodinase activities, and monocarboxylate transporter 8 expression.

Results: Tissue iodothyronine levels were positively correlated with serum levels, indicating that the decrease in serum T3 during illness is associated with decreased levels of tissue T3. Higher serum T3 levels in patients who received thyroid hormone treatment were accompanied by higher levels of liver and muscle T3, with evidence for tissue-specific regulation. Tissue rT3 and the T3/rT3 ratio were correlated with tissue deiodinase activities. Monocarboxylate transporter 8 expression was not related to the ratio of the serum over tissue concentration of the different iodothyronines.

Conclusion: Our results suggest that, in addition to changes in the hypothalamus-pituitary-thyroid axis, tissue-specific mechanisms are involved in the reduced supply of bioactive thyroid hormone in critical illness.
Steroidogenesis in Aldosterone-Producing Adenoma Revisited by Transcriptome Analysis
Authors: Assié Guillaume , Auzan Colette , Gasc Jean-Marie , Baviera Erno , Balaton André , Elalouf Jean-Marc , Jeunemaitre Xavier , Plouin Pierre-François , Corvol Pierre , Clauser Eric
Published: December 2005

Context: Primary aldosteronism (PAL) is the most frequent cause of secondary arterial hypertension. In PAL, aldosterone production is chronic, excessive, and autonomous.

Objective: The objective of this study was to identify the angiotensin-II independent alterations of steroidogenesis responsible for PAL.

Design: Genomewide gene expression was compared in two tissues differentiated for aldosterone production, both nonstimulated by circulating angiotensin II and differing in their autonomy to produce aldosterone: aldosterone-producing adenoma (APA) and its adjacent dissected zona glomerulosa (ZG).

Setting: The setting of this study was the Comete Network.

Patients: Patients with APA were studied.

Intervention: Transcriptome comparison was made of one APA and its adjacent ZG by serial analysis of gene expression; validation by in situ hybridization was performed for 19 genes in 11 samples.

Outcome: The study outcome was genes differentially expressed in APA and adjacent ZG.

Results: Activation of steroidogenesis in PAL is restricted to the overexpression of the enzymes producing aldosterone-specific steroids, aldosterone synthase and also 21-hydroxylase, suggesting that upstream precursor production is not limiting. Increased expression of high-density lipoprotein receptor, adrenodoxin and P450 oxidoreductase suggests that these systems provide cholesterol and electrons to the mitochondrial steroidogenic enzymes. As for acute stimulation of aldosterone production, an activation of calcium signaling is suggested by concordant overexpression of calcium-binding proteins or effectors. Calcium activation may result from an abnormal activity of Gq protein-coupled receptors. This calcium activation may be the starting point of the other gene expression changes observed in APA. Finally, other differentially expressed genes include three genes encoding unidentified proteins.

Conclusion: This work provides an original and integrated view of the mechanisms of aldosterone production in PAL.
WHY IS ITTHE CIABUT NOT *THE NASA? ACRONYMS, INITIALISMS, AND DEFINITE DESCRIPTIONS
Authors: HARLEY HEIDI
Published: December 2005

Using 61 acronyms and initialisms culled from Web sites in May 2003, this study shows that the syntactic behavior of abbreviations from phrases is regular. When a definite description is abbreviated, its syntactic category is predictable, depending on whether the result is an acronym (ERIC,NAFTA) or an initialism (FBI, NSF). Acronyms behave like proper names and drop the definite determiner: “ERIC produces a variety of publications....” Initialisms continue to behave like common compound nouns and retain the determiner: “... the FBI has unique response capabilities....” Two frequent exceptions, university names(UCLA) and television networks (NBC), are shown to act like bare locative nominals in English (go to school). Other apparent exceptions (GE, AA) are also shown to exhibit regularity.
THE LIFE AND DEATH OF CARNIE
Authors: RUSSELL CAROL L. , MURRAY THOMAS E.
Published: December 2005

This essay examines the history and ongoing livelihood of Carnie, a subcultural argot once popular among workers in circuses, carnivals,sideshows, athletic shows, and, more recently, professional wrestling. Through the use of published sources as well as personal interviews, we trace the origins of the argot to the late nineteenth century, when it may have been used exclusively as a secret language to conceal the illicit activities of some carnival and circus employees, then illustrate the many functions it has served since: as a means of delimiting and maintaining social boundaries; as a children's play language; as a secret language among family members, among the members of various noncircus and noncarnival underworld subcultures, and among penitentiary inmates; and as the show business language of a popular rock and roll disc jockey.
Changing History in the Lienzos de Guevea and Santo Domingo Petapa
Authors: Oudijk Michel , Jansen Maarten
Published: December 2005

The Lienzo de Guevea, an important Zapotec pictographic document from 1540,contains historical information about the geographic expanse and the lords of the indigenous community of Guevea. An extensive investigation has clarified the complex relation between the di.erent copies or versions of this particular document. The iconographic analysis of the pictorial scenes and the study of several documents related to the lienzo (large cotton cloth)shed a new light on the form and contents of Zapotec historiography, on the indigenous perception of the local political structure, and particularly on the transformations caused by the Spanish colonization.
Austronesian Mortuary Ritual in History: Transformations of Secondary Burial (Famadihana) in Highland Madagascar
Authors: Larson Pier M.
Published: December 2005

This article identifies historical transformations in the fluid and regionally varied secondary burials, or famadihana, of highland Madagascar. While secondary burials were known during the early nineteenth century, most mortuary ritual at that time focused on primary interment. From the 1820s practices of secondary burial re-emerged from long-distance repatriation of soldiers' remains and from ceremonies of tomb-to-tomb transfer as kin built new sepulchres of stone. Because they consumed time, energy, significant financial resources and tended to strengthen local networks of loyalty and authority, famadihana and the persons who practiced them came into conflict with highland Malagasy royalty from the reign of Radama I.
“It Is Impossible to Make a Step without the Indians”: Nineteenth-Century Geographical Exploration and the Amerindians of British Guiana
Authors: Burnett D. Graham
Published: December 2005

An effort is made to reveal the multiple functions of early nineteenth-century geographic expeditions into the interior of lowland South America, with an emphasis on the subtle and pervasive ways that“scientific” knowledge (natural historical, gregraphic,ethnographic) was consistently entangled with colonial reconnaissance and administration. The work of Robert H. Schomburgk and William Hilhouse in British Guiana receives close scrutiny. Particular efforts are made to show the ways that their hybrid expeditions—hybrid in the composition of the exploring party itself, as well as hybrid in purpose—shaped European conceptions of the Amerindians of the region, and were in turn shaped by their presence. Also considered: the impact of abolition on conceptions of Amerindian character.
The Sambo and Tawira Miskitu: The Colonial Origins and Geography of Intra-Miskitu Differentiation in Eastern Nicaragua and Honduras
Authors: Offen Karl H.
Published: December 2005

Identity differentiation between the Sambo and Tawira Miskitu in eastern Nicaragua and northeastern Honduras is examined with respect to African integration, settlement geography, differential relations with British settlers and Spanish officials, neighboring Indians, and market economies for the period 1620 to 1790. Research draws from sixteen months of fieldwork in the Mosquitia from 1994-7 and documentary research among British, Spanish,Moravian church, Nicaraguan, and U.S. archival sources. Findings suggest that a salient yet paradoxically overlooked dynamic of Miskitu ethnohistory was the geographically circumscribed animosity between the Sambo and Tawira Miskitu.
Infidels, Virgins, and the Black-Robed Priest: A Backwoods History of Ecuador's Montaña Region
Authors: Kohn Eduardo O.
Published: December 2005

In this article I compare the Quichua oral history of Oyacachi—one of the last autochthonous settlements of the cloud forest of Amazonian Ecuador—with written and iconographic ecclesiastical traditions regarding colonial-era events. This offers a unique opportunity to understand momentous political, economic, and religious change and how it is experienced locally. It also reveals the ways in which different histories are constructed out of shared memories, events, and spaces. Rather than viewing native histories as present-day constructions, I try to see how oral traditions make history meaningful in ways that do not necessarily obviate their fundamental connection to the past.
Fixing History: A Contemporary Examination of an Arctic Journal from the 1850s
Authors: Fogel-Chance Nancy
Published: December 2005

Early records of Western encounters with Native peoples have fixed history within the conventional views of their time. This article examines such a perspective inscribed in a journal written by a British naval commander during an Arctic assignment in the mid-nineteenth century. Over a two-year period he chronicled daily interactions between the crew of his ship and members of a nearby Iñupiaq Eskimo village on the North Slope of Alaska. His categorizations of native aggression and gender differences are examined within the context of contemporary knowledge about Iñupiaq ethnohistory. Additionally, his entries expose another dimension of this encounter—the dependency of this British enclave upon local people for resources, knowledge, and other forms of assistance. The Admiralty's restriction on the use of force during this mission makes their need all the more apparent. I propose that British dependency was a critical element in the dynamics of power between the two groups and has implications for other early encounters as well.
Haciendas, Ranchos, and Indian Towns: A Case from the Late Colonial Valley of Puebla
Authors: Chance John K.
Published: December 2005

Traditional views of rural central Mexico during the colonial period commonly overlook the role of the small, subsistence-oriented Spanish ranchos,which in the vicinity of Santiago Tecali, Puebla, far outnumbered the larger hacienda estates. In Tecali, dealings of the local Nahua elite with the ranchos and their proprietors were of greater social and economic import than those with the haciendas. This case study raises questions about the timeworn opposition between the hacienda and the Indian community and suggests that we need to work toward more differentiated models of Spanish agrarian enterprise,on the one hand, and colonial Indian society, on the other.
Architecture, Haciendas, and Economic Change in Yaxcabá, Yucatán, Mexico
Authors: Alexander Rani T.
Published: December 2005

During the late eighteenth and early nineteenth centuries in Yaxcabá, Yucatán, Mexico, the expansion of Spanish-American-owned cattle estates occurred in response to indigenous population growth and the implementation of the Bourbon political reforms. Although clearly described as haciendas in documentary sources, the estates demonstrate an architectural poverty that casts doubt on their ability to generate profits and their role in the transition to a market economy. This article proposes that architectural investment in rural areas may signal changes in entrepreneurial strategies before and after Mexican independence. When architecture is considered an independent variable, its economic role usefully may distinguish processes of market integration from storage of capital under tribute-based economies.
The Native Aristocracy and the Evolution of the Latifundio in the Teotihuacán Valley, 1521-1917
Authors: Sanders William T. , Price Barbara J.
Published: December 2005

Latifundismo, representing a variety of jural types, has characterized land tenure in the Teotihuacán Valley since Aztec, very probably pre-Aztec, times. Throughout the colonia and until the inception of the Republic, the largest single landholder in the valley remained the cacique of Teotihuacán. While much extant literature contrasts the hacienda as a type with the estates of the native aristocracy, we suggest a functional similarity based on comparability of market articulation (including commodities produced and the land itself as commodity), of export work, of control of labor.
“White & Clean” & Contested: Creek Towns and Trading Paths in the Aftermath of the Seven Years' War
Authors: Piker Joshua A.
Published: December 2005

In the last generation, scholars intent on removing “tribe”from their narratives of colonial-era Native American history have repeatedly invoked “community” in its place. This development notwithstanding, community-centered projects are rare; Indian towns now appear in the literature, but not as the driving force behind the action being chronicled. This article focuses on the debate among Upper Creek towns as they struggled to define the nature of their relationship to the British between 1763 and the early 1780s. In so doing, it traces the limits of regional and national alliances in the colonial era while arguing for the centrality of the local in Native life. In the eighteenth century, Creek history was community history.
Milpa As an Ideological Weapon: Tourism and Maya Migration to Cancún
Authors: Cruz Alicia Re
Published: December 2005

The article analyzes the phenomenon of tourism within the current globalizing and postmodern contexts. It is based on the cultural relationship between Chan Kom, a Maya community in the Yucatán Peninsula, and Cancún, the international tourist emporium. The tourist culture of Cancún embeds rules of production and consumption radically different from those encapsulated in the milpa or cornfield ideology that Maya experience in their communities. The study presents a dialogue between Chan Kom's social fragmentation due to out-migration to Cancún and the Mayanization of the socioeconomic and cultural landscape of the international Cancún. The goal is to discover the kaleidoscopic representations of Cancún as a tourist market product through the prism of the Maya ideological and socioeconomic presence.
Transcending the Debate over the Ecologically Noble Indian: Indigenous Peoples and Environmentalism
Authors: Nadasdy Paul
Published: December 2005

Recent debates over the stereotype of the “ecologically noble Indian” have helped illuminate some of the ambiguities and complexities that characterize the relationship between indigenous peoples and environmentalism. But, while scholars engaged in this debate have examined the cultural assumptions underlying Euro-American notions ofindigenousness, they have paid relatively little attention to the equally problematic concepts of environmentalism andconservation, and how use of these terms necessarily frames indigenous people's beliefs and values in Euro-North American cultural terms. This essay examines the cultural assumptions underlying these concepts and highlights political consequences of their use.
A Proposal for a “European Currency” in 1861: The Forgotten Contribution of Carlos Morato Roma
Authors: Cardoso José Luís
Published: December 2005

An earlier version of this article was presented at the History of Economics Society meetings, University of California at Davis, 5-8 July 2002. I would like to thank Rui Pedro Esteves, Marc Flandreau, David Laidler, Jorge Braga de Macedo, Perry Mehrling, Jaime Reis, and two anonymous referees of this journal for their useful and insightful comments and suggestions. I am responsible for any remaining errors and omissions. Unless otherwise stated,all translations are mine.
The Woolfs in the Jungle: Intertextuality, Sexuality, and the Emergence of Female Modernism in The Voyage Out, the Village in the Jungle, Andheart of Darkness
Authors: Wollaeger Mark A.
Published: December 2005

Mark A. Wollaeger is associate professor of English at Vanderbilt University. He is author of Joseph Conrad and the Fictions of Skepticism (1990), coeditor of Joyce and the Subject of History(1996), and editor of James Joyce's “A Portrait of the Artist As a Young Man”: A Casebook (forthcoming). His work in progress includes a study of British modernism and the new media. His essay “Killing Stevie: Modernity, Modernism, and Mastery in Conrad and Hitchcock”appeared in MLQ 58:3 (September 1997).
T. S. Eliot and the Lost Youth of Modern Poetry
Authors: Rosen David
Published: December 2005

David Rosen is assistant professor of English at Trinity College. He is completing a book on modern poetry and plain language.
Marble Paper: Toward a Feminist “History of Poetry”
Authors: DuPlessis Rachel Blau
Published: December 2005

Rachel Blau DuPlessis is professor of English at Temple University. Her most recent books in criticism and poetry are Genders, Races, and Religious Cultures in Modern American Poetry, 1908-1934 (2001) and Drafts 1-38, Toll (2001). In 2002 she was awarded a Pew Fellowship in the Arts for poetry, and she was named the third recipient of the Roy Harvey Pearce/Archive for New Poetry Award for lifetime contributions to American poetry as a poet-scholar.
Race, Periodicity, and the (Neo-) Middle Ages
Authors: Lampert Lisa
Published: December 2005

Lisa Lampert teaches in the Department of Literature at the University of California, San Diego. Her book, Gender and Jewish Difference from Paul to Shakespeare (2004), examines the relationship between representations of Jews and women in medieval and early modern English texts.
The Last of the Rogue States: The “Democracy to Come,” Opening in Two Turns
Authors: Derrida Jacques
Published: December 2005

Translated by Pascale-Anne Brault and Michael Naas
Merely Telling Stories? Narrative and Knowledge in the Human Sciences
Authors: Kreiswirth Martin
Published: December 2005

This essay is part of a long-term cross-disciplinary research project,entitled “Narrative between the Disciplines,” which looks at the way narrative is used within and between different disciplinary formations. Its goal is to say something about narrative itself as a form of redescription, a mode of knowledge, and how the claims made for it by the various disciplines say something about their own opera-tions, limitations,and presuppositions. By examining the diverse ways narrative is inflected in different institutional settings, we might also discover something about our concern for narrative now and our notions of disciplinarity and the compartmentalization of knowledge. Elsewhere, I have already sketched out some of the basic questions regarding the recent explosion of interest in narrative and in theorizing about narrative across the disciplines: Why narrative? And why narrative now? Why have we decided to trust the tale? This essay develops some of the questions that my earlier work left open; more specifically, it deals with the inherent “bivalency” of narrative—its dependency on the temporalities both of the telling and of the told—and charts the history of the recent “narrativist turn.” It attempts to present a genealogy of the different ways in which disciplines in the human sciences have formulated and employed narrative and narrative theory,particularly in those fields that make truth claims: history or political science, for example. Why have political scientists now decided to“trust the tale”? Is their sense of narrative the same as say,literary theorists'? And what might these things say about their own discipline and the relations between it and other disciplines in the human sciences?
Received Ideas and Literary Reception: The Functions of Doxa in the Understanding and Evaluation of Texts
Authors: Dufays Jean-Louis
Published: December 2005

This essay starts by surveying different approaches to the concept of doxa–those developed by Roland Barthes, Charles Grivel, Marc Angenot,but also Daniel Castillogy Durante–and by showing that the termdoxa is used to designate a system of beliefs as well as a specific ideological maxim. It proceeds to emphasize the connection of doxa to the question of stereotype and its crucial role in the process of reading. Doxa can be assimilated to ideological stereotypes and, as such, does not reduce to content inscribed in the text; it also functions as a tool in meaning construction and in evaluation if not as the very condition of literary reading insofar as the latter relies on a sacralization of literature. Finally, doxa appears as a valuable tool for the analysis of reading effects when we consider its modes of enunciation. The essay thus compares the innocent doxa in a text by Edouard Bled with the distanced doxa in a text by Jean Cau and/or the ambivalent doxa in Enfance by Nathalie Sarraute(each of which is presented in the Appendix). However, it concludes on the idea that the perception of these effects primarily depends on the reader's ideological flexibility.
Psychological Processes Underlying Literary Impact
Authors: Gerrig Richard J. , Rapp David N.
Published: December 2005

Most psychological researchers now accept the premise that literary narratives have an effect on people's everyday lives. Contemporary research examines the types of psychological processes that give rise to literary impact. The article describes experiments in two broad areas. First, it supports a position called the willing construction of disbelief and relates that to readers' feelings of having been transported to narrative worlds. The data suggest that readers must expend strategic effort to reject the information they acquire from literary narratives. Second, the article discusses the ways in which the unfolding of causes and consequences in literary narratives affect readers' judgments and understanding of characters and outcomes. These experiments support the claim that readers may derive bodies of evidence from their literary experiences that they apply to their own life experiences.
“Twofold Vibration”: Samuel Beckett's Laws of Form
Authors: Berensmeyer Ingo
Published: December 2005

The formal specifics of Samuel Beckett's writing have so far been redescribed in terms of mysticism, ordinary language philosophy,phenomenology, and deconstruction. Expanding on but also departing from these descriptions, this article tests the capability of a different heuristic vocabulary, derived from systems theory and second-order cybernetics, to reconstruct the formal dynamics of Beckett's writing and to reveal the structural principle that determines the generation of form in Beckett's work. The argument assumes that George Spencer Brown's dynamic (operative) concept of form can be used as a conceptual basis for describing the complex and baffling operation performed by Beckett's writing, and it proposes that this literary technique is best understood as a double recursion that envisages the unpresentable generativity of the literary text. These hypotheses are developed by drawing on a wide range of Beckett's work, including major plays,prose, Film, work for television, and critical writings.
Toward an Ethics of Postvisuality: Some Thoughts on the Recent Work of Zhang Yimou
Authors: Chow Rey
Published: December 2005

Taking as its point of departure the unresolved problematic of ethics in poststructuralist theory, this essay approaches ethics from the perspective of mediated visuality in contemporary cultural politics. Noting how the sensitivity to otherness—be it in the form of mass culture, gender, or race—has often been accompanied by iconophobia, a fundamental distrust and rejection of images, the author offers an analysis of the contemporary Chinese film Happy Times, directed by Zhang Yimou, as an instance of a kind of ethical film practice in which a responsible, noniconophobic thinking about visuality and its implications may be traced. In a culture caught between the forces of globalization and its own attempts at modernization, such as contemporary China's, Zhang's work contributes to an ethics of what may be called postvisuality.
The Poetry of September 11: The Testimonial Imperative
Authors: Alkalay-Gut Karen
Published: December 2005

In October 2001, Lawrence Ferlinghetti declared that from now on, poetry would be classified “as B.S. and A.S.—Before and After September 11.” Despite the exaggeration, it is clear that testimonial and elegiac elements of poetry and spoken or sung text have become more valued. In public places and forums, there began to surface poems in which aesthetics were apparently subordinated to communicative function and “direct”expression. Indeed, poetry has acquired a long lost social purpose—to order, inform, unite, and console a confused and grieving people. The Internet, accordingly, became the primary venue where the narratives and the emotions collected. Its intrinsic democratic character was utilized, and every testimony of emotion or witness was accepted as equally privileged, so a television witness had as much right to feel and express this emotion as an actual witness. As George Lakoff noted, “The people who did this got into my brain, even three thousand miles away. All those symbols were connected to more of my identity than I could have realized.” This study attempts to characterize this distinctive explosion of testimonial and elegiac poetry.
Qui Tam Claims: Threat to Voluntary Compliance Programs in Health Care Organizations
Authors: Ruhnka John C. , Gac Edward J. , Boerstler Heidi
Published: December 2005

The Department of Justice (DOJ) reports that after violent crime, health care fraud is the department's top priority. The number of health care fraud investigations pending at the DOJ increased from 270 cases in 1992 to more than 4,000 in 1997. The DOJ's primary weapon in prosecuting health care fraud is the federal False Claims Act (FCA) of 1863 (31 U.S.C. secs. 3729–3733). Almost unique among federal antifraud provisions, the FCA may also be used by “private prosecutors” to file lawsuits on behalf of the federal government charging organizations with submitting false claims to the government. The FCA rewards such whistle-blowers with a share of any resulting recoveries as a bounty and protects them from discharge for filing false claims lawsuits against their employers. It also requires defendants to pay the costs and attorneys fees of successful claimants. Although the private “bounty hunter” features of the FCA date back to the Civil War, these so-called qui tam claims were nearly dormant until 1986, when Congress amended the FCA to revive their use. Following the 1986 amendments, and paralleling the rapid increase in federal reimbursements for health care costs, private qui tam claims have far expanded beyond their traditional purview of defense contracts into the field of health care. By 1997, health care providers were the targets of 54 percent of the 530 private qui tam lawsuits filed that year.
“A Tempest in a Cocktail Glass”: Mothers, Alcohol, and Television, 1977–1996
Authors: Golden Janet
Published: December 2005

This article examines the portrayal of pregnancy and alcohol in thirty-six national network evening news broadcasts (ABC, CBS, NBC). Early coverage focused on white, middle-class women, as scientific authorities and government officials warned against drinking during pregnancy. After 1987, however, women who drank during pregnancy were depicted as members of minority groups and as a danger to society. The thematic transition began before warning labels appeared on alcoholic beverages and gained strength from official government efforts to prevent fetal alcohol syndrome. The greatest impetus for the revised discourse, however, was the eruption of a “moral panic”over crack cocaine use. By linking fetal harm to substance abuse, the panic suggested it was in the public's interest to control the behavior of pregnant women.
Welfare Reform, Substance Use, and Mental Health
Authors: Jayakody Rukmalie , Danziger Sheldon , Pollack Harold
Published: December 2005

Reform has transformed traditional entitlement to cash welfare under Aid to Families with Dependent Children (AFDC) into a transitional program known as Temporary Assistance to Needy Families (TANF). Because of the new work requirements and the time-limited nature of assistance, policy makers are increasingly confronted with what to do when welfare recipients do not effectively make the transition from welfare to work. Increasingly, the language of public health is being used to determine who is“employable” and who is not. Thus renewed attention is being focused on the individual characteristics of participants themselves,particularly specific diagnoses that might reduce employability. This article focuses on substance abuse and mental health problems among single mothers and examines their relationship to welfare receipt. We analyze data from the 1994 and 1995 National House-hold Survey of Drug Abuse (NHSDA) and find that 19 percent of welfare recipients meet the criteria for a DSM-III-R(Diagnostic and Statistical Manual of Mental Disorders, third edition revised) psychiatric diagnosis. About the same percentage have used illicit drugs during the previous year. Logistic regression results indicate that mental and behavioral health problems that are significant barriers to self-sufficiency are increasingly important in this era of time-limited benefits.
The Impact of HMOs on Hospital-Based Uncompensated Care
Authors: Thorpe Kenneth E. , Seiber Eric E. , Florence Curtis S.
Published: December 2005

Managed care in general and HMOs in particular have become the vehicle of choice for controlling health care spending in the private sector. By several accounts, managed care has achieved its cost-containment objectives. At the same time, the percentage of Americans without health insurance coverage continues to rise. For-profit and not-for-profit hospitals have traditionally financed care for the uninsured from profits derived from patients with insurance. Thus the relationship between growth in managed care and HMOs,hospital “profits,” and care for the uninsured represent an important policy question. Using national data over an eight-year period, we find that a ten-percentage point increase in managed care penetration is associated with a two-percentage point reduction in hospital total profit margin and a 0.6 percentage point decrease in uncompensated care.
Health Care Report Cards: Implications for Vulnerable Patient Groups and the Organizations Providing Them Care
Authors: Davies Huw T. O. , Washington A. Eugene , Bindman Andrew B.
Published: December 2005

Standardized public reporting on the quality of health care (report cards)offers an opportunity to empower purchasers and consumers so that they can make choices that can result in better health care for less money. However,not all population subgroups are equally well served by the publication of such data. In particular, vulnerable patient groups such as the poor, the less educated, the chronically sick, and members of ethnic or linguistic minorities may find issues of importance to them largely neglected. In addition, the way that report card data are collected, analyzed, and presented may further marginalize the experiences of these groups who in any case are already underserved by the health system. This observation also has important implications for health care providers who serve primarily large numbers of vulnerable patients. The differential impacts of report card data on vulnerable patient groups (and their providers) need to be addressed by researchers and policy makers if access issues are not to be damaged further by the providers' pursuit of quality and value.
Policing Medicaid and Medicare Managed Care: The Role of Courts and Administrative Agencies
Authors: Mello Michelle M.
Published: December 2005

The much-publicized 2000 case of Frew v. Gilbert, in which a federal judge castigated the State of Texas for deficiencies in its Medicaid program, brought renewed attention to the issue of regulating the quality of care in Medicaid and Medicare HMOs. Frew and other recent cases highlight both the promise and the pitfalls of relying on courts to correct deficiencies in public managed care programs. This article argues that while litigation over inadequacies in Medicare and Medicaid managed care can serve an important signaling function in alerting agencies and legislatures about the need for reform, the role of the courts in policing public managed care is circumscribed by several constraints. Barriers to class action litigation and differences in the institutional capacities of courts and administrative agencies mean that litigation is best viewed as a supplement, not an alternative, to a renewed commitment to strong quality monitoring on the part of Centers for Medicare and Medicaid Services and state Medicaid agencies.
The Politics of Discretionary Medicaid Spending, 1980–1993
Authors: Kousser Thad
Published: December 2005

Why do some states choose to spend more than four times as much as others to provide health care to the disadvantaged? Political scientists who have traditionally explored this question by analyzing trends in overall Medicaid expenditures lumped states' discretionary spending in with other money that states are mandated to spend. Analyses of total expenditures found that socioeconomic factors drove spending but that party control of state legislatures made no difference in health policy making.

By isolating discretionary state Medicaid expenditues from total spending figures, I reexamine the influences of political as well as economic and demographic factors. The often-doubted importance of party control becomes clear. This study investigates spending patterns in the discretionary portions of state Medicaid programs in forty-six states from 1980 to 1993 and analyzes both incremental program changes and absolute differences in state spending. To discover how greatly the researcher's choice of dependent variables can affect results, optional spending is separated from total spending levels and the variation is modeled in both.

Focusing not on the spending that the federal government requires of state officials but on the policies that state officials actually choose allows a balanced exploration of both political and economic effects on welfare expenditures. This research also provides new insights about which forces will shape policy decisions if more and more control of the public health care system is devolved to the states.
On Values and Democratic Policy Making: The Deceptively Fragile Consensus around Market-Oriented Medical Care
Authors: Schlesinger Mark
Published: December 2005

Market-oriented strategies, embodied in managed competition, have become the primary focus of contemporary U.S. health policy. This dominance reflects the emergence of a bipartisan coalition of support among political elites. This study traces the historical evolution of elite support for the market and suggests that the consensus favoring managed competition is deceptively fragile, with support riven by cleavages in the values used to judge fairness in the allocation of medical care. A unique data set of matched questions asked of both policy elites and the general public is used to document these differences in ethical norms. The implications of these cleavages help to explain three puzzling aspects of contemporary U.S. health policy: (1) the persisting inability to translate the principles of managed competition into politically feasible reforms, (2) the repeated failures to implement demonstration projects intended to test competitive pricing within the Medicare program, and (3) the inability of state regulations to assuage the public's concerns about managed care. Some prescriptions for a more revealing and effective treatment of market reforms in health policy conclude this study.
Responding to the Immunoglobulin Shortage: A Case Study
Authors: Boulis Ann , Goold Susan , Ubel Peter A.
Published: December 2005

In fall 1997, a shortage of intravenous immunoglobulin (IVIG) developed in the United States because of increased demand for the product, reduced supply,and product recalls. This shortage is a useful model for understanding how our health care system responds to scarcity. Although the U.S. government took steps to inform the medical community of the shortage, with few exceptions,the government did not respond to the shortage in a timely or effective manner. Instead, it took a relatively passive role, leaving IVIG manufacturers and distributors, health care institutions, and clinicians to fend for themselves. The shortage likely had an uneven impact on patients, based on the relative market strength of the health care institutions in which they received care and the individual patient's ability to absorb the increasing out-of-pocket costs of scarce IVIG. Market mechanisms have now largely alleviated the shortage and significantly reduced its detrimental impact on patients. However, future shortages of IVIG or other scarce medical products,such as vaccines and antibiotics, would benefit from more immediate and coordinated efforts not only to make sure that scarce health care resources are distributed in a just manner but also to identify and remedy the sources of health product supply problems.
Congress, Health Care, and Congressional Caucuses: An Examination of the Diabetes Caucus
Authors: Burgin Eileen
Published: December 2005

Caucuses have become a critical feature of the congressional landscape, yet are neglected in the literature on health-policy making in Congress. The principal goal of the article is to use the Diabetes Caucus as a case study to highlight this significant yet underappreciated political actor in the health-policy realm in Congress. The exploration, which draws on information gathered from thirty-two interviews with members of the Diabetes Caucus and their staff, will contribute to an increased understanding of both Congress's operations in the health area and the potential impact of caucuses on health-policy making. The article emphasizes particular characteristics relating to the membership and objectives of the Diabetes Caucus. In addition,the study stresses that the group had the requisite political momentum to achieve legislative successes when a policy window opened in the 105th Congress because it served much like, in the terminology of John Kingdon, a“policy entrepreneur.”
The Many Faces of Access: Reasons for Medically Nonurgent Emergency Department Visits
Authors: Guttman Nurit , Zimmerman Deena R. , Nelson Myra Schaub
Published: December 2005

Investigating why people use the hospital emergency department (ED) for visits considered medically nonurgent can enhance our understanding of people's expectations of health care services, of their conceptions of prudent lay judgment, and of difficulties in negotiating the logistics of primary care services. This study identified reasons for such ED use from users'perspectives in both pediatric and adult visits. Respondents were asked to explain what brought them to the ED and to define an emergency. The study was conducted in two northeastern U.S. hospital EDs. The analysis drew on a convenience sample of 408 (331 pediatric, 77 adult users) face-to-face interviews that employed both open- and closed-ended questions. Findings indicate most patients had medical insurance and a regular place of care and most arrived by car or taxi. Twelve main themes emerged under three main categories: conceptions of needs, appropriateness, and preference for the ED. The findings indicate that various reasons for ED use may be construed as access issues. These include beliefs regarding limited availability of after-hour consultation services and of timely appointments at one's primary care site. Drawing on the findings, a typology that distinguishes between groups of users according to their preference for the ED, a level of congruence between their own reason and their definition of an emergency was developed. The typology suggests that people's concerns that influence their decision to come tothe ED cannot be solved simply by expanding primary care services or by educational interventions. Its application yields recommendations for services and interventions.
Attitudes of People with Disabilities toward Physician-Assisted Suicide Legislation: Broadening the Dialogue
Authors: Fadem Pamela , Minkler Meredith , Perry Martha , Blum Klaus , Moore Leroy F. , Rogers Judi , Williams Lee
Published: December 2005

This article presents the methods, findings, and implications of a participatory action research project that attempted to shed additional light on the debate over death with dignity (DWD) or physician-assisted suicide(PAS) legislation. In-depth, qualitative interviews with forty-five physically disabled residents of the San Francisco Bay Area, conducted by others with disabilities, revealed a wide breadth of opinions about and attitudes toward such legislation. For close to half of the participants, the desire for autonomy in making end-of-life decisions was a primary concern, yet fear that PAS legislation could violate this autonomy in various ways was a deep concern as well. Also reported were widespread accounts of disability-based discrimination and frequent expressions of fear about openly discussing positions that diverge from the official, publicly held opinions of disability leaders who oppose such legislation. The findings support those of a recent Harris poll demonstrating considerable diversity of opinion about PAS legislation among people with disabilities. The findings further suggest the need for additional research on the apparent disjunction between the diversity of attitudes held by those interviewed and the more unified position taken by many disability activists. Use of the study findings to promote greater dialogue within the community and to better position people with disabilities to take their place at the policy table also is discussed. In addition, the findings are seen as reinforcing the need for the public health community to become more engaged in this central ethical debate.
How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations
Authors: Tuohy Carolyn Hughes , Flood Colleen M. , Stabile Mark
Published: December 2005

The impact of private finance on publicly funded health care systems depends on how the relationship between public and private finance is structured. This essay first reviews the experience in five nations that exemplify different ways of drawing the public/private boundary to address the particular questions raised by each model. This review is then used to interpret aggregate empirical analyses of the dynamic effects between public and private finance in OECD nations over time. Our findings suggest that while increases in the private share of health spending substitute in part for public finance (and vice versa), this is the result of a complex mix of factors having as much to do with cross-sectoral shifts as with deliberate policy decisions within sectors and that these effects are mediated by the different dynamics of distinctive national models. On balance, we argue that a resort to private finance is more likely to harm than to help publicly financed systems, although the effects will vary depending on the form of private finance.
Plus ça Change: Health Sector Reforms in Greece
Authors: Davaki Konstantina , Mossialos Elias
Published: December 2005

Changes in the health care sector in Greece since the pathbreaking introduction of the National Health System (NHS) in 1983 have been sluggish. Twenty years after its inception and a series of attempts to reform it, the NHS remains centralized, fragmented in terms of coverage, and quite far removed from its principles of equity and effi ciency. Being part of an idiosyncratic welfare state, the health care system is bound to refl ect the particularities of Greek society and economy, namely, clientelism, a weak formal—and a thriving informal—economy, the lack of a strong administrative class, a weak labor movement, and strong organized interests. As a result, several ambitious reform plans have failed repeatedly owing to an array of interrelated economic, political, and social factors that channel potential changes toward the trodden path. This constellation creates unfavorable conditions for the introduction and implementation of major reforms.