bluuebunny/crossref_metadata_2025 huggingface dataset:
The autonomy of economics from Judeo‐Christian thought: a critique
Authors: Beed Clive , Beed Cara
Published: September 2003

In the contemporary relation between economics and Judeo‐Christian thought, Smith identifies three positions. These are disciplinary autonomy for economics, disciplinary interdependence between economics and Christian thought, and distinctively Christian economic analysis. Little evaluation has been made of these positions. Two representatives, as Smith classifies them, of the disciplinary autonomy and interdependence positions are evaluated from the distinctively Christian economic analysis viewpoint. Unlike Smith's classification, both J. David Richardson and Anthony Waterman are assessed as belonging to the disciplinary autonomy group, in which mainstream orthodox economic science is allegedly able to proceed independent of religious input. This position is criticized insofar, as Richardson's major and influential paper in the area (1988) is found to disregard any appraisal of the contribution of modern orthodox economic theory to the explanation of real world processes, and to overlook the contribution Christian thought might make to economic explanation. Both Richardson and Waterman assume an understanding of the “science” in economic science that is problematic, while Waterman utilizes arguments from the philosopher Leslek Kolakowski, and the economist Frank Knight, that are contestable from a Christian perspective.
Impact des Politiques de Santé et de Nutrition sur la Production et la Sécurité Alimentaires au Togo
Authors: Koffi‐Tessio Egnonto M. , Tossou Yao H. , Homevor Kpotogbé A.
Published: September 2003

La sécurité alimentaire demeure un objectif primordial à atteindre dans les pays en développement. Selon la théorie du capital humain, l’éducation, la santé et la nutrition jouent un rôle important dans le développement économique et l’amélioration du niveau de vie des individus. Sur le plan de la santé et de la nutrition, certaines études ont montré qu’un mauvais état sanitaire et nutritionnel avait des répercutions négatives sur la productivité des travailleurs. La présente étude, utilisant un modèle log‐linéaire et basée sur les techniques de la cointégration, tente de cerner l’impact des politiques de santé et de nutrition sur la production et la sécurité alimentaire au Togo. Les résultats révèlent l’existence d’une rélation d’équilibre de long terme entre les variables explicatives du modèle et les deux variables que sont la production et la sécurité alimentaire. L’estimation par la méthode des moindres carrés ordinaires des modèles de long terme et de court terme sur la production alimentaire a permis de montrer que, de façon générale, les variables du capital humain et du capital physique ont joué un rôle favorable sur la production alimentaire tel que cela a été suggéré par la théorie. Au niveau de la sécurité alimentaire, les résultats aussi bien à long terme qu’à court terme apparaissent moins satisfaisants qu’au niveau de la production alimentaire. En effet, si les effets du capital physique sont pour la plupart non significatifs, ceux du capital humain se révèlent décevants, avec des impacts significativement négatifs pour l’indicateur d’alphabétisation et non significatifs pour les indicateurs de santé et de nutrition. Au vu des résultats, il convient, d’ores et déjà, d’envisager l’am‐ élioration de la qualité des investissements en matière de santé et de nutrition.
Factors Affecting Technical Efficiency among Coffee Farmers in Côte d’Ivoire: Evidence from the Centre West Region
Authors: Binam Joachim Nyemeck , Sylla Kalilou , Diarra Ibrahim , Nyambi Gwendoline
Published: September 2003

This paper presents measures of technical efficiency for a sample of 81 peasant farmers in the low‐income region of Côte d’Ivoire. DEA techniques were used to compute farm‐level technical efficiency (TE) measures. The analysis reveals average levels of technical efficiency equal to 36 per cent and 47 per cent respectively for the CCR (Charnes et al., 1978) and BCC (Banker et al., 1984) models. These results suggest that substantial gains in output and/or decreases in cost can be attained given existing technology. In a second step analysis, two‐limit Tobit regression techniques were used to examine the relationship between TE and various farm/farmer characteristics. From a policy point of view, an important conclusion stemming from the analysis of our sample is that family size, membership to farmer's club or association and the origin of the farmer are the variables found to be most promising for action. The analysis suggests that policymakers should foster the development of the formal farmers’ club or association by building the capacity of the farmers. Our analysis also supports the argument for public sector involvement in the provision of information on labour force management to peasant farmers as a means to improve efficiency levels, and thus household incomes.
The sourcing of technological knowledge: distributed innovation processes and dynamic change
Authors: Howells Jeremy , James Andrew , Malik Khaleel
Published: August 2003

This paper outlines the knowledge and technology sourcing practices of a range of key firms and organisations across the UK based on primary research, and analyses the key factors related to managing the technological knowledge boundaries of the firm. In particular, the paper considers the dynamic dimension considerations to such issues. As such it outlines important differences between short and long time horizons, before analysing in more detail some of the implications for firms of technological change over the long term. The paper seeks to highlight the importance of the time dimension in helping to explain why and how firms source technological knowledge externally and how they align their sourcing activities to their strategies associated with developing current and future capabilities.
Can Theories of Meaning and Reference Solve the Problem of Legal Determinacy?
Authors: Bix Brian H.
Published: August 2003

Abstract. A number of important legal theorists have recently argued for metaphysically realist approaches to legal determinacy grounded in particular semantic theories or theories of reference, in particular views of meaning and reference based on the works of Putnam and Kripke. The basic position of these theorists is that questions of legal interpretation and legal determinacy be approached through semantic meaning. However, the role of authority (in the form of lawmaker choice) in law in general and democratic systems in particular require that these realist “solutions” to the problem of legal determinacy be rejected or at least significantly revised.
A Modest Notion of Coherence in Legal Reasoning. A Model for the European Court of Justice
Authors: Soriano Leonor Moral
Published: August 2003

Abstract. The aim of this article is to propose a theoretical theme to explain coherence in legal reasoning. The main argument that this paper wants to put forward is that theories of coherence in the legal system should be differentiated from theories of coherence in legal reasoning. These focus on arguments, and on how the given arguments are connected. In particular, the notion of coherence in legal reasoning proposed here is a modest one. The article applies this theme to the case‐law of the European Court of Justice in environmental matters. This provides an example of how to deal with conflicts between incommensurable goods, and how to promote coherence by justifying decisions.

Simple folk have an advantage over the learned, who often get lost in the search for general laws. They often have the intuition of the individual. But this intuition by itself is insufficient. (Eco, The Name of the Rose)
Friendship, Identity, and Solidarity. An Approach to Rights in Plant Closing Cases
Authors: Chartier Gary
Published: August 2003

Abstract.My focus is on the problem of plant closings, which have become increasingly common as the deindustrialization of America has proceeded since the early 1980s. In a well‐known article, Joseph William Singer proposed that workers who sued to keep a plant open in the face of a planned closure might appropriately be regarded as possessing a reliance‐based interest in the plant that merited some protection. I seek to extend this sort of argument in two ways. In the first half of the paper, I point to the way in which “tacit obligation” emerges in friendship between persons in the absence of explicit commitments. Employers and employees are of course not as such friends. But I argue that the development of tacit obligations binding friends provides a useful analogy for understanding the growth of similar tacit obligations binding plant owners to workers and local communities. In the second half, I draw on Margaret Radin's work on property and identity to ground a related argument. I suggest that the potential contribution of plants—and the traditions and networks of relationships they help to create and sustain—to the identities of workers and communities provides reason for at least some legal protection of employee and community interests.
Why a Charter of Fundamental Human Rights in the EU?
Authors: Eriksen Erik Oddvar
Published: August 2003

Abstract. It has been argued that human rights politics is detrimental to social integration. But human rights are not merely abstract principles which, when positivated, secure negative freedom. When they are constitutionalised and turned into fundamental rights they contain a guarantee for equal freedom to all citizens. A charter of fundamental rights is a means to enhance the legal certainty of the citizens, reduce arbitrariness and moral imperialism and to institutionalise the right to justification. However, as the principle of popular sovereignty points to a particular society, and human rights point to an ideal republic, only with a cosmopolitan order can the problem of human rights politics be resolved.
The Sinews of Peace: Rights to Solidarity in the Charter of Fundamental Rights of the European Union
Authors: Menéndez Agustín José
Published: August 2003

Abstract. This article examines the provisions on social and economic rights contained in the Charter of Fundamental Rights of the European Union. After a conceptual clarification of the terms “fundamental rights” and “rights to solidarity,” three main claims are made. First, not all rights to solidarity are granted the status of fundamental rights in the Charter, in contrast with the treatment of the right to private property. Second, positive law does not justify such an approach. An analysis of the sources of the Charter clearly indicates that the right to private property is not a proper fundamental right as Community law stands. Third, rights to solidarity could be construed as a repository of arguments that Member States and regions could invoke when claiming an exception to the four fundamental freedoms.
Natural Law and the Bhagavad‐Gita: The Vedic Concept of Natural Law
Authors: King Michael S.
Published: August 2003

Abstract. Western natural law theory emphasises the derivation of principles of right action said to be universal and objective from the application of practical reasonableness to the pursuit of basic human goods that are self‐evident or based on human nature. Critics say its methodology is inherently subjective. In contrast, the Vedic approach to natural law of the Bhagavad‐Gita emphasises the full development of a universal aspect of human nature—consciousness—to promote right action. A healthy person with a developed intellect, clear mind, balanced emotions and full perception is best placed to fulfil his or her society's highest ideals of ethical and lawful conduct. The Vedic approach advocates a supportive social environment and the use of meditation techniques to promote such development. Research has found that the Transcendental Meditation (TM) program promotes improvement in mind, body and behaviour. For example, offenders in Australia, the United States and Senegal practising the technique experienced decreased substance abuse and recidivism and improved wellbeing. From a scientific perspective, TM promotes these improvements by producing a unique psychophysiological state of restful alertness that dissolves stress that blocks the unfoldment of full potential in life.
Global networks and local developments: agendas for development geography
Authors: Bebbington Anthony
Published: August 2003

It can be argued that development geography has left few traces either on the broader canvas of development theory or on the thought and practices of social actors engaging with material processes of change typically framed within the language of development. This paper argues that this is because the sub‐field has been somewhat too case study oriented, and because its prac‐titioners have, with some exceptions, kept themselves – or at least their identities – at the margins of debates within and among development actors. Yet development geography has much to con‐tribute to on‐going reflections on the nature of development. The paper explores themes that might be at the centre of an empirically grounded but theoretically oriented development geography that might speak to contemporary processes of globalisation and local change. It suggests that comparative case study work exploring the ways in which the development of capitalism and processes of intervention are both linked and vary across space still offers fruitful terrain for theory.
Technological revolution meets policy and the market: Explaining cross‐national differences in agricultural biotechnology regulation
Authors: Bernauer Thomas , Meins Erika
Published: September 2003

Abstract. The development and marketing of agricultural biotechnology applications has led to controversies over whether and how to regulate this new technology. The European Union (EU) has imposed severe restrictions on agricultural biotechnology, particularly in terms of approval and labeling of genetically modified organisms (GMOs) in food. The United States has adopted a far more permissive approval policy and has not required labeling. This article explains these differences in terms of the collective action capacity of consumer and producer interests, and the institutional environment in which regulation has taken place. We find that the regulatory outcome in the EU can be traced back to nongovernmental organizations’ (NGOs) increased collective action capacity due to public outrage, an institutional environment favorable to anti‐biotechnology NGO interests (multilevel regulatory policy making) and a disintegration of the producer coalition due to NGO campaigns and differences in industrial structure. Biotechnology politics in the United States has been dominated by a strong and cohesive coalition of pro‐biotechnology upstream and downstream producers and farmers. Because of lower public outrage and a less favorable institutional environment (centralized regulatory policy making), anti‐biotechnology NGOs in the United States have been largely excluded from agricultural biotechnology policy making.
The euro, economic interests and multi‐level governance: Examining support for the common currency
Authors: Banducci Susan A. , Karp Effrey A. , Loedel Peter H.
Published: September 2003

Abstract.  Support for a common currency and the European Monetary Union signifies that European citizens are willing to transfer power from the nation‐state to the European Union (EU). Given the symbolic importance of national currencies, this willingness to give up sovereignty over currency has important implications for the further integration and development of the European Union. Drawing on a multi‐level governance perspective and past research into public support for European integration, we examine how economic factors such as the value of the national currency and individual factors such as diffuse support for the EU and education condition support for the euro. We hypothesize that citizens will be less likely to support a common currency when they lack diffuse support for the EU, when their own national currency is strong or when their country's domestic agenda is squeezed by austerity measures. Using pooled Euro Barometer data from 1992 to 2000, we find support for these hypotheses indicating that citizens take into account domestic economic performance when evaluating EU institutions, but we also find that individual attitudes toward the EU play a role in support for the euro.
Parents' Perceptions of Pediatric Primary Care Quality: Effects of Race/Ethnicity, Language, and Access
Authors: Seid Michael , Stevens Gregory D. , Varni James W.
Published: August 2003

Objective.To examine the effects of race/ethnicity, language, and potential access on parents' reports of pediatric primary care experiences.

Data Sources/Study Setting.Primary survey data were collected (67 percent response rate) from 3,406 parents of students in kindergarten through sixth grade in a large urban school district in California during the 1999–2000 school year.

Data Collection.The data were collected by mail, telephone, and in person. Surveys were administered in English, Spanish, Vietnamese, and Tagalog.

Study Design.Data were analyzed using multiple regression models. The dependent variable was parents' reports of primary care quality, assessed via the previously validated Parents' Perceptions of Primary Care measure (P3C). The independent variables were race/ethnicity, language, and potential access to care (insurance status, presence of a regular provider of care), controlling for child age, gender, and chronic health condition status, and mother's education.

Principal Findings.Parents' reports of primary care quality varied according to race/ethnicity, with Asian and Latino parents reporting lower P3C scores than African Americans and whites. In multivariate analyses, both language and potential access exerted strong independent effects on primary care quality, reducing the effect of race/ethnicity such that the coefficient for Latinos was no longer significant, and the coefficient for Asians was much smaller, though still statistically significant.

Conclusions.To reduce racial/ethnic disparities in primary care, attention should be paid both to policies aimed at improving potential access and to providing linguistically appropriate services.
The Contribution of Nurse Practitioners and Physician Assistants to Generalist Care in Washington State
Authors: Larson Eric H. , Palazzo Lorella , Berkowitz Bobbi , Pirani Michael J. , Hart L. Gary
Published: August 2003

Objective. To quantify the total contribution to generalist care made by nurse practitioners (NPs) and physician assistants (PAs) in Washington State.

Data Sources. State professional licensure renewal survey data from 1998–1999.

Study Design. Cross‐sectional. Data on medical specialty, place of practice, and outpatient visits performed were used to estimate productivity of generalist physicians, NPs, and PAs. Provider head counts were adjusted for missing specialty and productivity data and converted into family physician full‐time equivalents (FTEs) to facilitate estimation of total contribution to generalist care made by each provider type.

Principal Findings. Nurse practitioners and physician assistants make up 23.4 percent of the generalist provider population and provide 21.0 percent of the generalist outpatient visits in Washington State. The NP/PA contribution to generalist care is higher in rural areas (24.7 percent of total visits compared to 20.1 percent in urban areas). The PAs and NPs provide 50.3 percent of generalist visits provided by women in rural areas, 36.5 percent in urban areas. When productivity data were converted into family physician FTEs, the productivity adjustments were large. A total of 4,189 generalist physicians produced only 2,760 family physician FTEs (1 FTE=105 outpatient visits per week). The NP and PA productivity adjustments were also quite large.

Conclusions. Accurate estimates of available generalist care must take into account the contributions of NPs and PAs. Additionally, simple head counts of licensed providers are likely to result in substantial overestimates of available care. Actual productivity data or empirically derived adjustment factors must be used for accurate estimation of provider shortages.
Economic Consequences of Underuse of Generic Drugs: Evidence from Medicaid and Implications for Prescription Drug Benefit Plans
Authors: Fischer Michael A. , Avorn Jerry
Published: August 2003

Objective.To calculate the financial impact of underuse of generic medications in state Medicaid programs.

Data Sources/Study Setting.State‐by‐state data on Medicaid drug spending for 48 states and the District of Columbia in calendar year 2000.

Study Design.We compared the total amount paid by each state Medicaid program for brand name prescriptions with the amount that would have been paid for generic versions of the same agent, to estimate the level of unrealized savings from use of substitutable generic drugs. We also examined whether variation in prices between states represented a potential source of unrealized savings.

Principal Findings.Analysis of state‐by‐state Medicaid prescription drug spending in 2000 identified potential savings of $229 million that could have been realized from greater use of generic drugs. If the best available prices from each state had been used nationally, savings would have increased to $450 million. The majority of the unrealized savings were concentrated in a small group of medications, including clozapine, alprazolam, and levothyroxine.

Conclusions.Federal regulations on prescription drug reimbursement limit the excess spending on brand name drugs in the Medicaid program to a small percentage of total spending, although the absolute dollar amount is large. Further savings could be realized if lowest available prices were used nationwide. Concentrating on specific agents may be a productive way to address the unrealized savings.
Variations in Patterns of Care and Outcomes after Acute Myocardial Infarction for Medicare Beneficiaries in Fee‐for‐Service and HMO Settings
Authors: Luft Harold S.
Published: August 2003

Objective. To assess revascularization and mortality after acute myocardial infarction (AMI) for all Medicare patients in fee‐for‐service (FFS) and health maintenance organization (HMO) settings in California.

Data Sources/Study Setting. Hospital discharge abstract and death certificate data linked with Medicare enrollment files for patients aged 65 and over with Medicare coverage (69,040) discharged from a California‐licensed hospital in 1994–1996.

Study Design. Risk‐adjusted results were assessed for HMOs and FFS, as well as for FFS beneficiaries from areas served by each plan.

Data Collection/Extraction Methods. Risk models were based on all sampled patients. The HMO patients were aggregated into 17 pseudoplans: 5 individual plans, 4 large plans split geographically (10 observations), and 2 “pseudoplans” of small HMOs. Observed versus expected 30‐day mortality rates, lengths‐of‐stay (LOS) during the index hospitalization and any transfers, revascularization (coronary artery bypass graft [CABG] surgery and/or percutaneous transluminal coronary angioplasty [PTCA]) during the index hospitalization or 30 days after admission, were calculated for each pseudoplan.

Principal Findings. Risk‐adjusted death rate was slightly higher in FFS than in HMO settings (p<.01 with one risk adjustment model, n.s. with another). Three pseudoplans had significantly (p<.01) better than expected mortality rates. One pseudoplan was significantly worse (p<.05) with one risk adjustment model but not the other. The LOS and revascularization rates varied widely, but were not associated with outcomes. Plans with among the best results had the lowest LOS and revascularization rates. These pseudoplans were less likely to have their patients initially admitted to a hospital with revascularization capability, but the hospitals they used had higher CABG volumes. Even if CABG facilities were available during the index admission, in these plans with better than expected mortality rates, revascularization was often postponed or carried out elsewhere.

Conclusions. For Medicare patients having an AMI in the mid‐1990s in California, risk‐adjusted outcomes were no different, or slightly better on average, for those in HMOs than in FFS. Not all plans performed equally well, so understanding what leads to differences in quality is more important than simple comparisons of HMOs versus FFS.
Identifying Physician‐Recognized Depression from Administrative Data: Consequences for Quality Measurement
Authors: Spettell Claire M. , Wall Terry C. , Allison Jeroan , Calhoun Jaimee , Kobylinski Richard , Fargason Rachel , Kiefe Catarina I.
Published: August 2003

Background. Multiple factors limit identification of patients with depression from administrative data. However, administrative data drives many quality measurement systems, including the Health Plan Employer Data and Information Set (HEDIS®).

Methods. We investigated two algorithms for identification of physician‐recognized depression. The study sample was drawn from primary care physician member panels of a large managed care organization. All members were continuously enrolled between January 1 and December 31, 1997. Algorithm 1 required at least two criteria in any combination: (1) an outpatient diagnosis of depression or (2) a pharmacy claim for an antidepressant. Algorithm 2 included the same criteria as algorithm 1, but required a diagnosis of depression for all patients. With algorithm 1, we identified the medical records of a stratified, random subset of patients with and without depression (n=465). We also identified patients of primary care physicians with a minimum of 10 depressed members by algorithm 1 (n=32,819) and algorithm 2 (n=6,837).

Results. The sensitivity, specificity, and positive predictive values were: Algorithm 1: 95 percent, 65 percent, 49 percent; Algorithm 2: 52 percent, 88 percent, 60 percent. Compared to algorithm 1, profiles from algorithm 2 revealed higher rates of follow‐up visits (43 percent, 55 percent) and appropriate antidepressant dosage acutely (82 percent, 90 percent) and chronically (83 percent, 91 percent) (p<0.05 for all).

Conclusions. Both algorithms had high false positive rates. Denominator construction (algorithm 1 versus 2) contributed significantly to variability in measured quality. Our findings raise concern about interpreting depression quality reports based upon administrative data.
Improved Comorbidity Adjustment for Predicting Mortality in Medicare Populations
Authors: Schneeweiss Sebastian , Wang Philip S. , Avorn Jerry , Glynn Robert J.
Published: August 2003

Objective. To define and improve the performance of existing comorbidity scores in predicting mortality in Medicare enrollees.

Data Sources. Study participants were two Medicare populations who had complete drug coverage either through Medicaid or a statewide pharmacy assistance program: New Jersey Medicare enrollees (NNJ=235,881) and Pennsylvania Medicare enrollees (NPA=230,913).

Study Design. Frequently used comorbidity scores were computed for all subjects during the baseline year (January 1, 1994, to December 31, 1994, and one year later in Pennsylvania). The study outcome was one‐year mortality during the following year. Performance of scores was measured with the c‐statistic derived from multivariate logistic regression models. Empirical weights were derived in the New Jersey population and the performance of scores with new weights was validated in the Pennsylvania population.

Principal Findings. A score based on ICD‐9‐diagnoses (Romano) performed 60 percent better than one based on patterns of medication use (Chronic Disease Score, or CDS‐1) (c=0.771 vs. c=0.703). The performance of the Romano score was further improved slightly by inclusion of the number of different prescription drugs used during the past year. Modeling the 17 conditions included in the Romano score as separate binary indicators increased its performance by 8 percent (c=0.781). We derived elderly‐specific weights for these scores in the New Jersey sample, including negative weights for the use of some drugs, for example, lipid lowering drugs. Applying these weights, the performance of Romano and CDS‐1 scores improved in an independent validation sample of Pennsylvania Medicare enrollees by 8.3 percent and 43 percent compared to the scores with the original weights. When we added an indicator of nursing home residency, age, and gender, the Romano score reached a performance of c=0.80.

Conclusions. We conclude that in epidemiologic studies of the elderly, a modified diagnosis‐based score using empirically derived weights provides improved adjustment for comorbidity and enhances the validity of findings.
Do Commercial Managed Care Members Rate Their Health Plans Differently than Medicaid Managed Care Members?
Authors: Roohan Patrick J. , Franko Scott J. , Anarella Joseph P. , Dellehunt Laura K. , Gesten Foster C.
Published: August 2003

Objective. To determine if members of commercial managed care and Medicaid managed care rate the experience with their health plans differently.

Data Sources. Data from both commercial and Medicaid Consumer Assessment of Health Plan Surveys (CAHPS) in New York State.

Study Design. Regression models were used to determine the effect of population (commercial or Medicaid) on a member's rating of their health plan, controlling for health status, age, gender, education, race/ethnicity, number of office visits, and place of residence.

Data Collection. Managed care plans are required to submit to the New York State Department of Health (NYSDOH) results of the annual commercial CAHPS survey. The NYSDOH conducted a survey of Medicaid enrollees using Medicaid CAHPS.

Principal Findings. Medicaid managed care members in excellent or very good health rate their health plan higher than commercial members in excellent or very good health. There is no difference in health plan rating for commercial and Medicaid members in good, fair, or poor health. Older, less educated, black, and Hispanic members who live outside New York City are more likely to rate their managed care plan higher.

Conclusions. Medicaid members rating of their health care equals or exceeds ratings by commercial members.
Practice Characteristics and HMO Enrollee Satisfaction with Specialty Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy
Authors: Escarce José J. , Kapur Kanika , Solomon Matthew D. , Mangione Carol M. , Lee Paul P. , Adams John L. , Wickstrom Steven L. , Quiter Elaine S.
Published: August 2003

Background. The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential.

Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open‐angle glaucoma (OAG) or diabetic retinopathy (DR).

Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices.

Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18‐item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction.

Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction.

Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction.
Measuring Continuity of Care for Clients of Public Mental Health Systems
Authors: Fortney John , Sullivan Greer , Williams Keith , Jackson Catherine , Morton Sally C. , Koegel Paul
Published: August 2003

Objectives. The aims of this research were to generate a set of time‐variant measures of continuity of outpatient care using administrative data, and to evaluate the validity of these measures for persons in the community with serious mental illness (SMI) who use public mental health services.

Data Sources. Individuals with SMI were identified using multistage random sampling from shelters, streets, and public mental health clinics in Houston, Texas.

Study Design. The study design was observational, cross‐sectional, and retrospective. Based on a review of the literature, five distinct conceptual dimensions of continuity of care were defined: timeliness, intensity, comprehensiveness, stability, and coordination. Repeated measures of continuity were generated for each day of the year. Construct validity was assessed by comparing continuity for housed persons and homeless persons based on the assumption that homelessness is a risk factor for low continuity of outpatient care.

Data Collection. Subjects were interviewed to collect sociodemographic and clinical information. Service use was retrospectively tracked through the administrative records of multiple public sector agencies.

Principal Findings. All five continuity measures demonstrated good construct validity by the fact that homelessness was significantly (p<0.001) and substantially associated with lower continuity of care.

Discussion. The five continuity‐of‐care measures are relatively easy and inexpensive to generate using administrative data. The five continuity‐of‐care measures may be useful for identifying individuals at risk for poor outcomes and for evaluating the ability of public service systems to keep clients engaged in care over time.
Variations in Hospitalization Rates among Nursing Home Residents: The Role of Discretionary Hospitalizations
Authors: Carter Mary W.
Published: August 2003

Objective. To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices.

Data Sources. Quarterly Medicaid case‐mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility‐level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market‐level attributes. Data spans three years (1991–1993) to produce a longitudinal analytical file containing 72,319 person‐quarter‐level observations.

Study Design. Two‐step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion.

Principal Findings. Findings indicate that facility case‐mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions.

Conclusions. Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.
False Positive Mammograms and Detection Controlled Estimation
Authors: Kleit Andrew N. , Ruiz James F.
Published: August 2003

Objective. To investigate the causes of false positive in mammograms.

Data Sources. Secondary data collected from extracts from computerized medical records from 1999 from five thousand patients at a single hospital in a medium‐sized Southern city.

Study Design. Retrospective analysis of electronic medical data on screening and diagnostic mammograms. Detection‐controlled estimation (DCE) was used to compare the efficacy of alternative readers of mammogram films. Analysis was also conducted on follow‐up exams of women who tested positive in the first stage of investigation. Key variables included whether the patient had had a prior mammogram, age of the patient, and identifiers for the individual physicians.

Data Collection/Extraction Methods. Hospital maintains electronic medical records (EMR) on all patients. Extracts were performed on this EMR system under the guidance of clinical expertise. Data were collected for all women who had mammograms in 1999. Random samples were employed for screening mammograms, and all data was used for diagnostic mammograms.

Principal Findings. Study results imply that access to a previous mammogram greatly reduces the incidence of false positives readings. This has important consequences for benefit‐cost, and cost‐effectiveness analysis of mammography. Were previous mammograms always available, the results imply the number of false positives would decrease by at least half. The results here also indicate that there is no reason to believe this decrease in false positive would be accompanied by an increase in the number of false negatives. Other attributes also affected the number of false positives. Mondays and Wednesdays appear to be more prone to false positives than the other days in the week. There is also some disparity in false positive outcomes among the five physicians studied. With respect to detection‐controlled estimation, the results are mixed. With follow‐up data, the DCE estimator appears to generate reasonable, robust results. Without follow‐up data, however, the DCE estimator is far less precise.

Conclusions. Study results imply that access to a previous mammogram reduces by at least half the incidence of false positives readings. This has important consequences for benefit‐cost, and cost‐effectiveness analysis of mammography.
Optimal exit: Solar escape as a restricted three-body problem
Authors: Harmon Nicholas Johann , Leidel Christine , Lindner John F.
Published: August 2003

We analyze solar escape as a special case of the restricted three-body problem. We systematically vary the parameters of our model solar system to show how the optimal launch angle and minimum escape speed depend on the mass and size of the earth. In some cases, it is best to launch near the direction of the earth’s motion, but slightly outward; in other cases, it is best to launch near the perpendicular to the earth’s motion, but inward toward the sun (so as to obtain a solar gravity assist). Between direct escapes for high launch speeds and trapped trajectories for low launch speeds is an irregular band of chaotic orbits that reveals some of the complexity of solar escape and the three-body problem.
Coupled-channel integral equations for quasi-one-dimensional systems
Authors: Cattapan G. , Maglione E.
Published: August 2003

An integral equation approach is developed for the propagation of electrons in two-dimensional quantum waveguides. The original two-dimensional problem is transformed into a set of one-dimensional coupled equations by expanding the full wave function in terms of simple transverse basis functions. The equivalence of the Schrödinger equation with suitable boundary conditions in configuration space to an integral equation approach in momentum space can thus be illustrated in a coupled channel situation with a minimum of geometrical complications. The application to scattering from a point defect embedded in a waveguide is considered. In this case the scattering integral equations reduce to a set of algebraic equations, and typical coupled channel phenomena can be discussed through straightforward mathematical techniques. The convergence problems due to a singular perturbation are briefly considered, and the differences between genuine one-dimensional problems and the present two-dimensional case are discussed.
Physical Push-ups
Authors: Arjmandi Saffar , Brinkman Joseph G. , Toepker Terrence P.
Published: August 2003

“Saffar, how many push-ups can you do in 10 seconds?” “I'll show you, T2.” With that exchange, Saffar proceeded to do 15 push-ups as T2 (Terrence Toepker) did the timing. “I think that the upper limit is set by physical principles and not by your strength.” Assuming that you cannot pull yourself down by grabbing the floor, the shortest time down is caused by gravity acting alone. A simple physics model for this situation could be a straight, uniform plank pivoted at one end that oscillates up and down due to an elastic reflecting impulse that occurs instantaneously at the down position, shown in Fig. 1(a).
Passive Immunization with Neutralizing Antibodies Interrupts the Mouse Mammary Tumor Virus Life Cycle
Authors: Mpandi M. , Otten L. A. , Lavanchy C. , Acha-Orbea H. , Finke D.
Published: August 2003

Mouse mammary tumor virus (MMTV) infects the host via mucosal surfaces and exploits the host immune system for systemic spread and chronic infection. We have tested a neutralizing rat monoclonal antibody specific for the retroviral envelope glycoprotein gp52 for its efficiency in preventing acute and chronic mucosal and systemic infection. The antibody completely inhibits the superantigen response and chronic viral infection following systemic or nasal infection. Surprisingly however, the antibody only partially inhibits the early infection of antigen-presenting cells in the draining lymph node. Despite this initially inefficient protection from infection, superantigen-specific B- and T-cell responses and systemic viral spread are abolished, leading to complete clearance of the retroviral infection and hence interruption of the viral life cycle. In conclusion, systemic neutralizing monoclonal antibodies can provide an efficient protection against chronic retroviral amplification and persistence.
Silent Point Mutation in an Avian Retrovirus RNA Processing Element Promotes c-
myb
-Associated Short-Latency Lymphomas
Authors: Polony Tatjana S. , Bowers Sandra J. , Neiman Paul E. , Beemon Karen L.
Published: August 2003

The avian leukosis virus ΔLR-9 causes a high frequency of B-cell lymphomas within weeks after injection into 10-day-old chicken embryos. These lymphomas result from proviral integrations into the oncogene c-
myb
. In contrast, LR-9, which lacks the 42-nucleotide
gag
gene deletion of ΔLR-9, does not cause a high frequency of c-
myb
-associated short-latency lymphomas. Although viral replication rates and spliced
env
mRNA levels were found to be similar for both viruses, ΔLR-9 exhibited an increase in readthrough transcription compared to LR-9. The ΔLR-9 deletion is located in the region of the
gag
gene corresponding to the matrix (MA) protein as well as in the negative regulator of splicing (NRS) element. To test whether disruption of the NRS or of the MA protein was responsible for inducing short-latency lymphomas, we generated viruses with NRS point mutations that maintained the wild-type Gag amino acid sequence. One of the mutant viruses induced an even higher incidence than ΔLR-9 of short-latency lymphomas with viral integrations into c-
myb
. Thus, we propose that disruption of the NRS sequence promotes readthrough transcription and splicing to the downstream
myb
gene, causing overexpression of a slightly truncated Myb protein, which induces short-latency tumors.
Kaposi's Sarcoma-Associated Herpesvirus/Human Herpesvirus 8 Transcriptional Activator Rta Is an Oligomeric DNA-Binding Protein That Interacts with Tandem Arrays of Phased A/T-Trinucleotide Motifs
Authors: Liao Wei , Tang Yong , Kuo Yu-liang , Liu Bao-Ying , Xu Chi-Jie , Giam Chou-Zen
Published: August 2003

Kaposi's sarcoma associated herpesvirus (KSHV)/human herpesvirus 8 (HHV-8) encodes an immediate early transcriptional activator, Rta, which mediates viral reactivation from latency and lytic viral replication. Here we report the purification and characterizations of HHV-8 Rta and its interaction with Rta-responsive DNA elements. The Rta response element (RtaRE) in the promoter of the KSHV/HHV-8 K8 open reading frame was mapped to a 47-bp sequence (RtaRE1) and a 60-bp sequence (RtaRE2) upstream of the TATA motif. A comparison of the K8 RtaREs with other viral RtaREs revealed a pattern of multiple A/T triplets spaced with a periodicity of 10 or 20 bp. Substitutions of the in-phase A/T trinucleotides of the RtaRE1 with G/C bases greatly diminished Rta responsiveness and Rta binding. By contrast, base substitutions in an out-of-phase A/T-trinucleotide sequence had no effect. Importantly, multimers of (A/T)
3
N
7
and N
5
(A/T)
5
N
6
(A/T)
4
motifs supported a strong Rta response in a copy number-dependent manner. No specific sequence motifs in the spacer regions could be discerned. Potent Rta response, however, was obtained with phased A/T trinucleotides with 7-bp spacers of arbitrary sequences with high G/C content. Lengthening of the phased A/T motifs or lowering of the G/C content of the spacers resulted in a reduction in Rta response. Finally,
Escherichia coli
-derived Rta is an oligomer of 440 kDa in molecular size and binds RtaRE as an oligomer. These results support a model of Rta transactivation wherein the subunits of the Rta oligomer make multiple contacts with a tandem array of phased A/T triplets in the configuration of (A/T)
3
(G/C)
7
repeats.
Involvement of the Matrix and Nucleocapsid Domains of the Bovine Leukemia Virus Gag Polyprotein Precursor in Viral RNA Packaging
Authors: Wang Huating , Norris Kendra M. , Mansky Louis M.
Published: August 2003

The RNA packaging process for retroviruses involves a recognition event of the genome-length viral RNA by the viral Gag polyprotein precursor (PrGag), an important step in particle morphogenesis. The mechanism underlying this genome recognition event for most retroviruses is thought to involve an interaction between the nucleocapsid (NC) domain of PrGag and stable RNA secondary structures that form the RNA packaging signal. Presently, there is limited information regarding PrGag-RNA interactions involved in RNA packaging for the deltaretroviruses, which include bovine leukemia virus (BLV) and human T-cell leukemia virus types 1 and 2 (HTLV-1 and -2, respectively). To address this, alanine-scanning mutagenesis of BLV PrGag was done with a virus-like particle (VLP) system. As predicted, mutagenesis of conserved basic residues as well as residues of the zinc finger domains in the BLV NC domain of PrGag revealed residues that led to a reduction in viral RNA packaging. Interestingly, when conserved basic residues in the BLV MA domain of PrGag were mutated to alanine or glycine, but not when mutated to another basic residue, reductions in viral RNA packaging were also observed. The ability of PrGag to be targeted to the cell membrane was not affected by these mutations in MA, indicating that PrGag membrane targeting was not associated with the reduction in RNA packaging. These observations indicate that these basic residues in the MA domain of PrGag influence RNA packaging, without influencing Gag membrane localization. It was further observed that (i) a MA/NC double mutant had a more severe RNA packaging defect than either mutant alone, and (ii) RNA packaging was not found to be associated with transient localization of Gag in the nucleus. In summary, this report provides the first direct evidence for the involvement of both the BLV MA and NC domains of PrGag in viral RNA packaging.