bluuebunny/crossref_metadata_2025 huggingface dataset:
Does restructuring hospitals result in greater efficiency - an empirical test using diachronic data
Authors: Braithwaite Jeffrey , Westbrook Mary T , Hindle Donald , Iedema Rick A , Black Deborah A
Published: January 2006

Hospitals are being restructured more frequently. Increased cost efficiency is the usual justification given for such changes. All 20 major teaching hospitals in Australia's two most populous states were investigated by classifying each over a 5-6 year period in terms of their cost efficiency (average cost per case weighted by Australian diagnosis-related group [AN-DRG] data and adjusted for inflation) and structure, categorized as traditional-professional (TP), clinical-divisional (CD), or clinical-institute (CI). In all, 12 hospitals changed structure during the study period. There was slight evidence that CD structures were more efficient than TP structures but this was not supported by other evidence. There were no significant differences in efficiency in the first or second years following changes from either TP to CD or TP to CI structures. All four hospitals changing from CD to CI structure became significantly less efficient. This may be due to frequency rather than type of change as they were the only hospitals that implemented two structural changes. Hospitals that changed or did not change structure were similar in efficiency at the beginning and at the end of the study period, in overall efficiency during the period, and in trends toward efficiency over time. The findings challenge those who advocate restructuring hospitals on the grounds of improving cost efficiency.
Influenza outbreaks and hospital bed occupancy in Rome (Italy): current management does not accommodate for seasonal variations in demand
Authors: Fusco D , Saitto C , Arcà M , Perucci C A
Published: January 2006

Objective: Our goal was to assess how different hospital wards react to influenza epidemics, and whether related specialties cooperate in coping with winter bed crises.

Study design: The Lazio Hospital Information System (HIS) dataset from July 1998 to June 2001 was used for the study. The HIS collects data on all hospital discharges. We considered diagnosis-related groups (DRG) as the reason for hospital stay and used DRG to classify admissions as influenza related or influenza unrelated. Time series analysis of daily bed occupancy in different specialty areas by influenza-related and influenza-unrelated cases was performed. Generalized additive models (GAMs) were used to take the effect of short-term and seasonal bed occupancy into account on influenza-related occupancy.

Results: Influenza-related bed occupancy ranges from 770 patients/day during the influenza season to 525 patients/day during the rest of the year. Daily occupancy by influenza-related cases represents 2.8% of total hospital occupancy and 7% of general medicine occupancy during the influenza season. When comparing the influenza season with the rest of the year, general medicine occupancy by influenza-related cases increases by 51% versus the 25-32% increase in other specialty wards. Little change in daily occupancy by influenza-unrelated cases was observed in all specialties when comparing the influenza season with the rest of the year.

Conclusions: Hospital specialty wards react poorly and single handedly to a minor and predictable burden. Any winter bed crisis in the Lazio region is probably the result of defective management of available beds more than excess in demand.
Hospital admissions: who is admitted through the emergency department?
Authors: Khaliq Amir A , Broyles Robert W
Published: January 2006

This study examines the co-variates that separate patients who presented an emergent condition without a physician referral and were admitted through the hospital emergency department (ED) from their counterparts who were referred by a physician for the treatment of an elective or urgent condition and were admitted through the admissions department. The analysis was based on 295,945 inpatient admissions in 1999 to short-term acute-care hospitals in Oklahoma. Employing hospital admission as the unit of analysis, logistic regression was used to examine the differential likelihood of admission without a physician referral and through the ED of the uninsured, Medicare beneficiaries, Medicaid recipients, African Americans and Native Americans. The results of the logistic regression analysis indicated that Medicaid recipients and the uninsured were more likely than their commercially-insured counterparts to be admitted, without a physician referral, to an acute-care hospital in Oklahoma following an evaluation in the ED. The findings also suggest that African Americans and, to a lesser extent, Native Americans were more likely than their white counterparts to be admitted through the ED without benefit of a physician referral.
Organizational strategies to tackle health-care disparities in the USA
Authors: Exworthy M , Washington A E
Published: January 2006

US health policy is beginning to address health-care disparities, mainly in terms of racial/ethnic groups and access to care for vulnerable groups. Though not widespread, policies are engaging a wide range of organizations, including federal, state and local government, insurers, providers and philanthropic foundations. It initially seems strange that US health-care organizations (HCOs) are seeking to tackle disparities, as the system itself generates huge disparities. This article reviews the reasons underlying growing interest in disparities in the USA, examines the barriers and opportunities facing such initiatives and considers their likely impact. Demographic changes, efforts to widen access to care and to remedy health-care discrimination are the primary factors in driving these initiatives. HCOs (and others) are faced with implementation barriers including structural impediments of the health-care system, the limited extent to which the issue has permeated within HCOs, and data collection. Opportunities for progress can be garnered from the mounting evidence base, the various programmes being implemented, and emerging links with quality improvement initiatives. The USA is faced with ongoing efforts to keep the issue on the (policy and managerial) agenda, to integrate strategies into organizational systems and processes, and to monitor the effects of such strategies.
Comparing hospital staff and patient perceptions of customer service: a pilot study utilizing survey and focus group data
Authors: Fottler Myron D , Dickson Duncan , Ford Robert C , Bradley Kenneth , Johnson Lee
Published: January 2006

The measurement of patient satisfaction is crucial to enhancing customer service and competitive advantage in the health-care industry. While there are numerous approaches to such measurement, this paper provides a case study which compares and contrasts patient and staff perceptions of customer service using both survey and focus group data. Results indicate that there is a high degree of correlation between staff and patient perceptions of customer service based on both survey and focus group data. However, the staff and patient subgroups also provided complementary information regarding patient perceptions of their service experience. Staff members tended to have more negative perceptions of service attributes than did the patients themselves. The focus group results provide complementary information to survey results in terms of greater detail and more managerially relevant information. While these results are derived from a pilot study, they suggest that diversification of data sources beyond patient surveys may enhance the utility of customer service information. If further research can affirm these findings, they create exciting possibilities for gathering valid, reliable and cost-effective customer service information.
User charges in public health facilities in Tanzania: effect on revenues, quality of services and people's health-seeking behaviour for malaria illnesses in Korogwe district
Authors: Mubyazi Godfrey , Massaga Julius , Kamugisha Mathias , Mubyazi J-Nyangoma , Magogo Grace C , Mdira K-Yahya , Gesase Samuel , Sukwa Tom
Published: January 2006

User charges in public health facilities are aimed at improving efficiency and quality of health services. In Africa, evidence about their effect on patient attendance and community health-seeking behaviour are mixed. This paper reports a study of the effect of user charges on revenue collection, quality of services and people's health-seeking behaviour in relation to malaria in Korogwe district, Tanzania. Data were collected through focus-group discussions with community members, interviewing community leaders and health workers, field observations and review of patient registers. Generally, there was no distinct difference in the trends of patient attendances before and after user fee introduction. Public awareness about cost-sharing policy was high, but had low appreciation in the administration of exemptions and waivers. Shortage of drugs, laboratory facilities, and inhospitality of nurses lowered their confidence in the user-fee system. Autonomy to collect and prioritize expenditure of user-fee revenue at the health-facility level was appreciated by community leaders and health workers who, however, had reservations with funds being held at the district level and delays by the DMO's office in approving budgets submitted in request for expenditure of such revenues. Thus, despite the potential of user charges for revenue mobilization, problems with their administration lowers public confidence in the user-fee system improving quality and accessibility of services to the poor.
Use of 3G mobile phone links for teleconsultation between a moving ambulance and a hospital base station
Authors: Banitsas Konstantinos A , Perakis Konstantinos , Tachakra Sapal , Koutsouris Dimitrios
Published: January 2006

We developed a mobile teleconsultation system based on third-generation mobile phone links. The system comprised a laptop computer and a digital camcorder. It was installed inside an ambulance to allow video-conferencing between the moving vehicle and a doctor at a base station. In addition to video and voice, high-quality still images could also be transmitted. A series of 17 trial runs with real ambulance patients was conducted in the city of Athens. In general, the videoconferencing sessions produced relatively clear video. The bandwidth was high enough for a satisfactory video of 10–15 frames/s. During a total testing period of 23 h and in an area of about 180 km2, there were nine instances of signal loss, amounting to a total of 17 min. The general opinion formed by the doctors was that the system produced good results. All initial diagnoses made using the system agreed with the final diagnoses of the patients. The study showed that the mobile system could reduce the time before an ambulance patient is seen by a doctor.
Organizational centralization in radiology
Authors: Aas I H Monrad
Published: January 2006

Traditionally, hospitals have a radiology department, where images are taken and interpretation occurs. Teleradiology makes it possible to capture images in one location and transmit them elsewhere for interpretation. Organizational centralization of radiology interpretations is therefore of interest. Empirical data have been collected in qualitative interviews of 26 resource persons with substantial experience with picture archiving and communication systems and teleradiology, from 12 departments of radiology in Norway. The response rate was 90%. A total of 21 theoretically possible types of centralization of image interpretation were identified, representing combinations of three categories of geographical centralization, and seven categories of centralization according to function. Various advantages and disadvantages of centralization were identified. Organizational changes may be decisive for the future of teleradiology, but it may be wise to plan for change in small steps, since we know little about how broad future organizational changes based on teleradiology will be, or what will decide how far particular organizations will go.
Telemedicine for acute burn treatment: the time has come
Authors: Saffle Jeffrey R
Published: January 2006

This brief paper sets out the arguments for the routine use of telemedicine in the evaluation of burns. Two cases are reported from the author's practice that show the need for it.
Remote support for emergency medicine using a remote-control laser pointer
Authors: Ohta Shoichi , Kuzuoka Hideaki , Noda Mariko , Sasaki Hirokazu , Mishima Shiro , Fujikawa Tadashi , Yukioka Tetsuo
Published: January 2006

We have developed a laser pointing system, the GestureLaser, which allows a remote operator to control a videocamera and a laser beam via a networked personal computer. The laser spot can be moved by the mouse cursor controlled by the remote instructor. The system was tested by giving remote instruction in thoracentesis to inexperienced operators using a training mannekin. Seven medical students received instructions using the laser pointer and another seven received instruction without the laser pointer. All operators completed the task correctly. The laser pointer group correctly identified the centesis space and performed the task on the first trial. When the laser pointer was not used, four operators (57%) made a mistake in selecting the centesis space at the first trial. The mean times for both stage 1 – verbal versus GestureLaser 59 s (SD 13) versus 44 s (SD 5), p = 0.015 – and stage 2 – verbal versus GestureLaser 98 s (SD 20) versus 64 s (SD 7), P = 0.002 – were significantly shorter when the GestureLaser was used. The study shows that the laser pointing system can be used to remotely instruct a novice operator in performing thoracentesis. It could improve collaboration between geographically separated sites.
Telemedicine for delivery of health care in Parkinson's disease
Authors: Samii Ali , Ryan-Dykes Peggy , Tsukuda Ruth Ann , Zink Claudia , Franks Romay , Nichol W Paul
Published: January 2006

We have used telemedicine at the Seattle Veterans Administration Medical Center to deliver follow-up care to patients with Parkinson's disease (PD). Patients were located at eight facilities which were 67–2400 km from the medical centre. Each facility had videoconferencing equipment (connected by Internet Protocol at 384 kbit/s), and computer terminals that could access the patient's electronic medical record. Over a three-year period, we used telemedicine for 100 follow-up visits on 34 PD patients. Visits lasted 30–60 min. Patients and providers were satisfied with the use of the technology. Savings amounted to approximately 1500 attendant travel hours, 100,000 travel kilometres, and US$37,000 in travel and lodging costs. For the first 82 telemedicine visits, the video quality was inadequate for scoring all components of the motor Unified Parkinson Disease Rating Scale (UPDRS). For the last 18 visits, a different videoconferencing unit produced better video quality, which was satisfactory for motor UPDRS measurements, except for components that required physical contact with the patient (rigidity and retropulsion testing). Our experience shows that telemedicine can be used effectively for follow-up visits with selected PD patients who are unable to travel.
Remote ophthalmology services: cost comparison of telemedicine and alternative service delivery options
Authors: Kumar Sajeesh , Tay-Kearney Mei-Ling , Chaves Francisco , Constable Ian J , Yogesan Kanagasingam
Published: January 2006

We calculated the cost of an established tele-ophthalmology service, from a health-provider's perspective, and compared this with the cost of three other existing eye-care service delivery options. During a 12-month study period, 118 persons took part in the tele-ophthalmology consultations between a rural clinic located approximately 900 km from the Lions Eye Institute in Perth. The variable costs of tele-ophthalmology were $166.89 (Australian dollars) per patient, and the alternatives cost $445.96, $271.48 and $665.44 per patient. Tele-ophthalmology incurred a set-up cost of $13,340. The threshold at which tele-ophthalmology became cheaper than any of the alternative options occurred at a workload of 128 patients. Tele-ophthalmology offers a viable alternative to conventional eye-care service in rural and remote areas.
Effect of telemedicine on patients' diagnosis and treatment
Authors: Bynum Ann B , Cranford Charles O , Irwin Cathy A , Banken Joseph A
Published: January 2006

We conducted a post-consultation survey during 1998–2002 (n=412 consultations) in the Rural Hospital Telehealth Project run by the University of Arkansas for Medical Sciences. Changes in the patient's diagnosis and treatment plan as a result of the telemedicine session were assessed. There were 47 consultants, who conducted 2–82 consultations each. The teleconsultants established a diagnosis in 74 consultations. This was 26% of the 286 respondents. Of the 63 respondents for cases where there was a prior diagnosis and a change was applicable, 17 consultants (27%) reported that there was a change in the patient's diagnosis. The consultants established a patient treatment plan in 139 consultations. This was 52% of the 268 respondents. Of the 123 respondents for cases where there was a prior treatment plan and a change was applicable, 82 (67%) consultants reported a change in the treatment plan. The changes in diagnosis and management imply benefits for the rural population in Arkansas as a result of the use of telemedicine.
Telemedicine systems and telecommunications
Authors: Harnett Brett
Published: January 2006

Successful telemedicine requires appropriate equipment and some kind of telecommunications medium. However, successful telemedicine requires more than just technology. The three essential components are the personnel, the technology and a liberal measure of perseverance. Before the technology can be selected, it is necessary to consider the nature of the information to be transmitted between the sites and the time frame over which it must be sent to achieve the desired clinical goals, because this will determine the choice of equipment and the telecommunications network. Factors to be considered include the types of information to be transmitted, the quantity of information to be transferred, and security and privacy (e.g. in Europe and the USA there has been recent legislation about data security). The choice of transmission method for any telemedicine application is, in practice, a compromise between what one would like and what one can afford. In practice, various trade-offs have to be made, which include cost, availability of the service (i.e. the coverage), bandwidth, reliability and quality of service. Equipment and the telecommunications medium are a necessary, but not sufficient, pre-requisite for a successful telemedicine programme. The right people are also required and they must be properly trained.
Email teleconsultations: well formulated clinical referrals reduce the need for clinic consultation
Authors: Bergus George R , Emerson Myra , Reed David A , Attaluri Ashok
Published: January 2006

We examined how well primary-care physicians formulated their clinical referrals when asking for help with patient-related clinical problems using an email-based teleconsultation service. Over 100 family physicians made use of the service. The specialists were medical school faculty members. The service was initiated in May 1996 with 19 specialists and expanded to 34 specialties over the next five years. A total of 1618 patient-related clinical questions were analysed, the outcome for the analysis being whether specialists recommended a clinic consultation. Specialists recommended a clinic consultation in response to 10% of their clinical questions about patients. There was a strong association between how family physicians formulated their clinical questions and whether the specialist recommended a clinic consultation. When the family physicians specified a clinical task (P<0.001), intervention (P=0.004) and outcome (P<0.001) in their questions, specialists were less likely to recommend a clinic consultation. This influence was independent of the amount of clinical information included with the question (P>0.05). About 5% of the questions that included all three question components resulted in the recommendation for a clinic consultation, compared with nearly 30% of the questions containing none of these components. How family physicians formulate their clinical questions influences whether specialists request a clinic consultation.
A Cultural Tourist in Romantic Germany: Henry Crabb Robinson as Nineteenth-Century Life Writer
Authors: Stelzig Eugene L
Published: January 2006

Henry Crabb Robinson is mostly remembered for having cultivated the acquaintance of many of the leading writers of his time in Germany and England, and for his value as a source of historical information about his better known peers. This article argues that despite the fact that Robinson never completed his Reminiscences, his letters, diaries, journals, and other writing indicate that he deserves to be considered an important nineteenth-century autobiographer.
Bawdy Bodies or Moral Agency? The Struggle for Identity in Working-Class Autobiographies of Imperial Germany
Authors: Jensen Birgit A
Published: January 2006

Master narratives in Imperial Germany typically equated "the laborer" with immoral bodies. Proletarian autobiographers insisted that wretched existential conditions caused working-class bawdiness, and devised counterstories to the ideological theft of moral agency. Class-conscious male authors outlined a proletarian morality, while female authors in general claimed either a private or bourgeois respectability for themselves.
Maxims in Kant's Practical Philosophy
Authors: McCarty Richard R.
Published: January 2006

A standard interpretation of Kantian "maxims" sees them as expressing reasons for action, implying that we cannot act without a maxim. But recent challenges to this interpretation claim that Kant viewed acting on maxims as optional. Kant's understanding of maxims derives from Christian Wolff, who regarded maxims as major premises of the practical syllogism. This supports the standard interpretation. Yet Kant also viewed commitments to maxims as essential for virtue and character development, which supports challenges to the standard interpretation, and raises questions about the coherence of Kant's overall conception of the role of maxims in practical philosophy.
Smith's Humean Criticism of Hume's Account of the Origin of Justice
Authors: Pack Spencer J , Schliesser Eric
Published: January 2006

It is argued that Adam Smith criticizes David Hume's account of the origin of and continuing adherence to the rule of law for being not sufficiently Humean. Hume explained that adherence to the rule of law originated in the self-interest to restrain self-interest. According to Smith, Hume does not pay enough attention to the passions of resentment and admiration, which have their source in the imagination. Smith's offers a more naturalistic and evolutionary account of the psychological pre-conditions of the establishment and morality of justice than Hume had. Yet, Smith's account also makes room for a thin conception of Lockean natural right to property, while rejecting the contractualist and rationalistic elements in Locke. It emerges that Smith severs the intimate connection that Hobbes and Hume made between justice and property.
Plotinus's Ethics of Disinterested Interest
Authors: Remes Pauliina
Published: January 2006

Plotinus' recognises the possibility of conflict between self-referential aims and the good of the kosmos. His solution resembles closely one attributed sometimes to the Stoics. The inner reformation Plotinus proposes will yield a detached understanding of the whole universe. This view is accompanied by a realisation that one's happiness lies in functioning as a part of the whole and in contributing to the perfection of the universe. Other-regard cannot, therefore, be seen as altogether missing from neoplatonic ethics. What gives Plotinus' ethics an agent-centred spin is its emphasis on how this state can be attained. Promoting the self's true well-being by an inward turn is the only means to an understanding of what is good simpliciter.
Hume on Promises and the Peculiar Act of the Mind
Authors: Cohon Rachel
Published: January 2006

Hume's account of the virtue of fidelity to promises contains two surprising claims: 1) Any analysis of fidelity that treats it as a natural (nonconventional) virtue is incorrect because it entails that in promising we perform a "peculiar act of the mind," an act of creating obligation by willing oneself to be obligated. No such act is possible. 2) Though the obligation of promises depends upon social convention, not on such a mental act, we nonetheless "feign" that whenever someone promises he performs such an act. This paper explains both in light of the philosophical questions about promising that lie behind Hume's investigation, his virtue theory, and the general difficulties he believes we face trying to understand virtues that are in fact artificial in terms of our common-sense, natural conception of virtue. It extracts a lesson for contemporary virtue ethics about the motive of duty.
Narrative, Imagination, and the Religion of Humanity in Mill's Ethics
Authors: Heydt Colin
Published: January 2006

This paper shows how the ethical benefits of Mill's Religion of HumanityÑa life imbued with purpose, an improved regard for others, and greater happiness for oneself from the pleasures of fellow-feelingÑare to be actualized through the imagination's creation of compelling narratives about humanity. Understanding the ethical importance of the Religion of Humanity therefore implies understanding the central role of imagination in Millian ethical life. This investigation serves to articulate a feature of Mill's utilitarianism that differentiates it from Bentham's, namely his commitment to the importance of a religious sensibility in the moral agent. It also raises the broader philosophical issue of what narratives a psychologically tenable humanist world-view requires.
'Despair' in Kierkegaard's Either/Or
Authors: Kosch Michelle
Published: January 2006

The category of despair plays a central role in Kierkegaard's pseudonymous corpus, but its meaning is controversial. This paper offers an interpretation of its use in Either/Or (in particular, in the claim the aesthetic life is despair and the ethical life freedom from despair). After examining and rejecting two recent alternatives, I argue that despair is the conscious or unconscious assumption of a passive or fatalistic attitude toward one's existence, which attitude is informed by a misconstrual of the nature of human agency.
Unwanted Guests in Troubled Times: German Prisoners of War in the Union of South Africa, 1942-1943
Authors: Moore Bob
Published: January 2006

This study examines the role of the Union of South Africa in acting as a detaining power for German prisoners of war taken during the North African campaigns of 1942–43. It highlights the specific problems caused by the sixty-eight hundred German prisoners as potential threats to domestic security in South Africa at a time of internal dissension, contrasting these with the relatively straightforward absorption of one hundred thousand Italian prisoners in the same period. It also looks at the more general problems faced by the British imperial authorities in dealing with German prisoners in this critical period of the war.
Dying with Honour: Literary Propaganda and the Second English Civil War
Authors: Brady Andrea
Published: January 2006

This article discusses contemporary responses to the executions under martial law of Sir Charles Lucas and Sir George Lisle in 1648, following General Thomas Fairfax's siege of Colchester. It compares the royalist propaganda, which established these two royalist partisans as martyred heroes, to the Parliamentary and Army propaganda, which lamented the assassination of the well-known New Model Army colonel Thomas Rainsborough two months later. Analysing newsbooks, accounts by participants and observers, and literary responses (especially the elegy), it finds that popular writers used these deaths to impugn the honour of their opponents, and consequently to argue against reconciliation or compromise.
Apt Pupil: Dwight Eisenhower and the 1930 Industrial Mobilization Plan
Authors: Irish Kerry E.
Published: January 2006

This article takes the view that Dwight D. Eisenhower's work as a staff officer in the War Department in the early 1930s was significant not only for his own career, but also for the United States. In these years, Eisenhower wrote the first detailed industrial mobilization plan, the blueprint the nation would follow if it entered a major war. Though not formally implemented in 1941, much of Eisenhower's plan provided the basis for a more efficient transition to war production than had occurred during World War I. Moreover, his work enhanced his reputation in the Army.
The Costs of Artillery: Eliminating Harassment and Interdiction Fire During the Vietnam War
Authors: Hawkins John M
Published: January 2006

In Vietnam during 1966 and 1967, the United States Army expended nearly half of its artillery ammunition in unobserved Harassment and Interdiction (H&I) strikes. By June 1970, the army had nearly eliminated H&I. The reasons for this shift inform the ongoing debate over American strategy during the Vietnam War. Although both General William C. Westmoreland and his successor, General Creighton W. Abrams, emphasized that poorly applied firepower could cause collateral damage, neither leader viewed H&I as inherently counterproductive. Indeed, both leaders responded to budgetary pressures, rather than concern over civilian casualties, when reducing H&I. Neither reduced H&I fire as part of a radical shift in strategy.
Comments on "W(h)ither the Deaf Community?"
Authors: Carty Breda
Published: January 2006

This article discusses Johnston's estimate of the number of signing Deaf people in Australia and queries whether it adequately accounts for nonnative signers or reflects the numbers who make use of services in Auslan. It concurs with Johnston's projection of a decline in the size of this population, and discusses the ways in which the Deaf community and allied professionals might respond to this scenario.
American Sign Language Teacher Preparation Programs in the United States
Authors: Jacobowitz E. Lynn
Published: January 2006

Even though ASL isn�t as easy to learn as it may seem at first, more and more students are enrolling in ASL courses at both the secondary and university levels and choosing ASL as a primary area of study. For this reason the demand for ASL teachers is increasing, and the need for ASL teacher-preparation programs (ASL TPPs) has increased. Therefore, to assess present and future standards, an examination of the current ASL TPPs in the United States was called for. This article compares three ASL TPPs and examines them for compliance with national teaching standards. The analysis of each site highlights four areas: (a) the program, (b) curriculum development, (c) admission and enrollment requirements, and (d) the courses. Following the curricular narratives of these schools is a comparison of their programs with the trends in national standards. The article ends with some recommendations for upgrading the existing and new ASL TPPs.
Comments on "W(h)ither the Deaf Community?"
Authors: Hyde Merv , Power Desmond J. (Desmond John) , Lloyd Karen
Published: January 2006

From the evidence Johnston has presented, it is clear that the number of children being born deaf in Australia has fallen off and that this decline is likely to continue as a result of the technological and social factors he outlines. It also seems that this reduction in numbers is reflected in other countries for which data are available. It is not so clear whether this drop will be as rapid as Johnston fears and whether it will have the effects he predicts on the lives of Deaf people and on the viability of a lively community of users of sign languages—in the Australian case, Auslan.
Variation in ASL: The Role of Grammatical Function
Authors: Lucas Ceil , Bayley Robert
Published: January 2006

Variation in the parts of ASL signs (i.e., phonological variation) has been explained largely by reference to the influence of the preceding and the following segments. This article examines three linguistic variables in ASL: the sign deaf; the location of a class of signs represented by the verb know; and signs produced with a 1 handshape. For all three of these variables, a multivariate analysis of more than nine thousand tokens extracted from videotaped conversations among 207 signers in seven sites across the United States shows that the grammatical function of a sign, rather than the features of the preceding or following signs, is the most important influence on a signer�s choice among the variants. In addition to providing evidence for the role of this previously unexamined influence on variation in ASL, the results of this study highlight the importance of basing claims about the likely causes of variation on empirical studies of broadly representative samples of data collected in the language community.
W(h)ither the Deaf Community? Population, Genetics, and the Future of Australian Sign Language
Authors: Johnston Trevor A
Published: January 2006

According to enrollments in schools for the deaf and data from the national census and neonatal hearing screening programs, the incidence of severe and profound childhood deafness in Australia is, and has been, less than commonly assumed. Factors implicated include improved medical care, mainstreaming, cochlear implants, and genetic science. Data for the United States, Britain, and other developed countries seem consistent with those for Australia. Declining prevalence and incidence rates have immediate implications for sign- based education, teacher-of-the-deaf training programs, and educational interpreting. There are also serious consequences for research, documentation, and teaching regarding Australian Sign Language (Auslan), and for the future viability of Auslan. Prompt action is essential if a credible corpus of Auslan is to be collected as the basis for a valid and verifiable description of one of the few native sign languages in the world with significant attested historical depth.
Response to Comments
Authors: Johnston Trevor A
Published: January 2006

In my response to the commentaries made about my article, I observe that the commentators find no obvious errors with my estimates of the size of the signing deaf community. However, most of them are not as pessimistic as I am partly because of the position they take on a number of issues. Namely, the supposed uniqueness of Australia in its treatment of deaf people and deafness; the relevancy of different types of signers to the fate of signed languages; the inevitability or reversibility of declining numbers; the ethics of reproductive technology; and, finally, the responsibilities of linguists vis-à-vis the communities they work with. In my response, I show how we differently interpret these issues and argue for my perspective on them.
The Political Uses of Sign Language: The Case of the French Revolution
Authors: Rosenfeld Sophia A
Published: January 2006

The story of the Abb� de l�Ep�e�s �methodical signs� is best known as a key moment in Deaf history. However, at the time of the French Revolution this story served a larger political function. The example of de l�Ep�e�s deaf students, and their seemingly miraculous command of ideas learned through gestural signs, helped the French revolutionaries to imagine an ideal state of communication in the midst of a perceived crisis in language and politics. This essay both explains the political effects of this late eighteenth-century fascination with sign language and makes a case for the integration of Deaf history into the history of politics and social life more generally.
Comments on "W(h)ither the Deaf Community?": A Normalization Juggernaut?
Authors: Mitchell Ross E
Published: January 2006

My response to Johnston's (2004) "W(h)ither the Deaf Community?" is theoretical in nature and sociological in perspective. I comment on how Johnston's particular concern for the possible demise of Australian Sign Language (Auslan) in Australia's currently transforming social and medical context surrounding childhood deafness is legitimate but perhaps a bit premature.
Comments on "W(h)ither the Deaf Community?"
Authors: Moores Donald F
Published: January 2006

Responding to Johnston's projections for the future of Australian Sign Language (Auslan), I analyzed school enrollments in American educational programs and found similar trends. There are fewer deaf and hard of hearing children in school now than twenty years ago, with the largest decline, approximately 50 percent, among children with profound hearing losses. Consistent with the Australian data, although to a smaller degree, increasing numbers of children are educated through oral-only means, have cochlear implants, and are placed in integrated settings. Despite these trends, Johnston's concerns for Auslan do not appear to apply to ASL, primarily because the American population, and, by extension, the American Deaf population, is fifteen times greater than that of Australia. Even with reductions in numbers a critical mass will remain. Secondly, the American Deaf community is heavily involved in education, more so than in any other country. The future of ASL and the American Deaf community is strong.
Comments on "W(h)ither the Deaf Community?": A Timely Warning
Authors: Vonen Arnfinn Muruvik
Published: January 2006

Inspired by Johnston's thought-provoking article, this article reports from the current Norwegian scene to make two main points. First, Norwegian Sign Language paradoxically appears to be better protected as well as more threatened than ever. Second, success in bilingual deaf education is not logically incompatible with a placement primarily in the local school.
Comments on "W(h)ither the Deaf Community?"
Authors: Burke Teresa Blankmeyer
Published: January 2006

Johnston argues that the impact of science and technology on the Australian Deaf community threatens the viability of the community; this entails that the scientists have a moral duty to record and preserve Auslan for posterity. This response analyzes Johnston's moral imperative through the application of intrinsic and extrinsic values, suggesting that an extrinsic argument may be more persuasive. Technology aims to alleviate human suffering; in this case, it also contributes to human suffering by failing to assess the assumptions resulting from conflating human suffering with "deafness as disability." Adopting a social model of disability changes the locus of human suffering; consequently, other uses of technology, such as genetic selection for Deafness, may be justifiable.
Localization of Tactile Stimuli Depends on Conscious Detection
Authors: Harris Justin A. , Karlov Lisa , Clifford Colin W. G.
Published: January 2006

Neurological reports of “tactile blindsight” suggest that the human somatosensory system can extract behaviorally useful information about the location of a tactile stimulus in the absence of conscious awareness that the stimulus occurred (Paillard et al., 1983; Rossetti et al., 1995). However, in a series of psychophysical experiments with neurologically intact subjects, we found no evidence for such a dissociation. Our subjects' ability to name the finger on which a tactile stimulus had been presented was dependent on their ability to consciously detect that stimulus (Harris et al., 2004). The present experiments followed up on this study and specifically sought evidence for a dissociation when subjects were required to indicate the location of the stimulus either by pointing at or moving the stimulated finger, the same response made by the neurological patients. Once again, localization accuracy was correlated with detection, and, crucially, when both detection and localization were measured using equivalent forced-choice tasks, the subjects were completely unable to identify the location of stimuli that they had not detected. These findings are inconsistent with the dissociation implied by the cases of tactile blindsight, but are consistent with other neurological evidence that detection of a tactile stimulus does not depend on localization (Head and Holmes, 1911; Halligan et al., 1995; Rapp et al., 2002).
Genetic Diversity in Steelhead before and after Conservation Hatchery Operation in a Coastal, Boreal River
Authors: Heggenes Jan , Beere Mark , Tamkee Patrick , Taylor Eric B.
Published: January 2006

Allelic variation at 10 DNA microsatellite loci was assayed in scale samples of steelhead Oncorhynchus mykiss (n = 333) collected between 1976 and 2003 from the lower main stem of the Kitimat River, British Columbia. Our objectives were to (1) investigate the genetic diversity of wild steelhead populations in the river before hatchery stocking began in 1984 (baseline samples: 1976–1977, 1983–1984; n = 145) and (2) assess the potential genetic impacts of interbreeding of returning hatchery adult fish with wild spawners over almost 20 years of large‐scale hatchery operation (1987–2003; n = 188). The annual target number of wild broodstock adults used for hatchery production was 40 (20 of each sex) but varied from 9 to 39 among years. The level of population subdivision (ϑ) among Kitimat River samples was low (0.004) and not significantly different from 0. Tests of ϑ between prehatchery and posthatchery operation indicated no significant changes. Similar results were obtained using other measures of genetic differentiation (principal components analysis of microsatellite allele frequencies and Cavalli‐Sforza genetic distance). Our data, however, did indicate a slight but significant reduction in allelic richness after hatchery stocking. Pairwise tests for genetic differentiation among samples from different year‐classes were nonsignificant. We conclude that for the current management regime there is little apparent impact of hatchery practices on either the genetic structure or variation within the lower main‐stem Kitimat River steelhead, but there may be a reduction in rare alleles. The practice of using substantial numbers of wild fish and multiple year‐classes in the hatchery may have minimized genetic changes via genetic drift.
História da saúde pública no Estado de São Paulo
Authors: Mascarenhas Rodolfo dos Santos
Published: January 2006

Estuda-se a história, através da evolução dos serviços estaduais de saúde pública em São Paulo, desde 1891 até o presente. Dois vultos se destacam: Emílio Ribas e Geraldo de Paula Souza. Emílio Ribas conseguiu debelar no fim do século passado surtos epidêmicos de febre amarela, febre tifóide, varíola e cólera e, na Capital, malária. Prova, em um grupo de voluntários, no qual foi o primeiro, a transmissão, por vector, de febre amarela, repetindo, um ano depois, a experiência norte-americana em Cuba. Funda o Instituto Butantã, entregando-o a outro cientista, Vital Brasil. Paula Souza reorganiza, em 1925, o Serviço Sanitário do Estado, introduzindo o centro de saúde, a educação sanitária, a visitação domiciliaria. Lidera, posteriormente, no SESI, a assistência médica, odontológica, alimentar e social do operário. Em junho de 1947 foi criada a Secretaria da Saúde Pública e da Assistência Social cujo primeiro titular foi o Dr. José Q. Guimarães. Deu-se ênfase à implantação de campanhas de erradicação ou controle de doenças transmissíveis (malária, chagas, poliomielite, variola, etc.) e à reforma total da Secretaria da Saúde iniciada em 1970.
Situação da rêde pública de assistência médico-sanitária na área metropolitana da Grande São Paulo
Authors: Yunes João , Bromberg Rosa
Published: January 2006

A situação da rêde pública de Assistência Médico-Sanitária é analisada para a área metropolitana da Grande São Paulo, constituída por 37 municípios, com uma população de 8 milhões de habitantes. Existe para a área uma unidade sanitária do tipo Centro ou Sub-Centro de Saúde para cada 101.025 habitantes. Não há uma proporção homogênea entre o tamanho da população e o número de unidades sanitárias, pois existem sub-regiões que apresentam desde 22.000 até 136.142 habitantes por Pôsto de Saúde. O número de postos de assistência materno-infantil é de 232, havendo uma unidade para cada 34.400 habitantes, variando esta proporção por sub-região desde 2.444 até 73.500 habitantes por Pôsto. Há um dispensário de tuberculose para cada 380.048 habitantes. A sub-região Norte, com 67.000 habitantes, não conta com nenhum dispensário de tuberculose. Quanto ao Dispensário de Dermatologia Sanitária a proporção de habitantes por unidade é de 570.071. As sub-regiões Norte e Sudoeste, com 155.000 habitantes, não possuem nenhum dispensário de dermatologia sanitária. Observa-se a inexistência de critérios locacionais para as Unidades Sanitárias, a par do déficit quantitativo e qualitativo do atendimento. Foram apontados, entre os principais objetivos da reforma administrativa da Secretaria de Saúde do Estado, descongestionamento da cúpula, centralização normativa, descentralização executiva e integração em nível local das unidades sanitárias. Observou-se que se encontram integrados, física e funcionalmente, somente 25,6% dos Centros de Saúde, 40% dos Sub-Centros, 42,8% dos Dispensários de Tuberculose e 42,8% dos Dispensários de Dermatologia Sanitária. De acôrdo com estudo realizado pela Secretaria da Saúde, em 1970, somente 4,7% dos atendimentos foi considerado ótimo; 62,7% das unidade sanitárias não possuíam material suficiente e 52,3% não contavam com recursos humanos de acôrdo com a lotação prevista de pessoal. A par dêste quadro carencial, observou-se falta de coordenação entre os podêres públicos responsáveis pelas unidades sanitárias, levando a supercobertura de algumas áreas e o total abandono de outras.
Prevalência da depressão pós-parto e fatores associados
Authors: Moraes Inácia Gomes da Silva , Pinheiro Ricardo Tavares , Silva Ricardo Azevedo da , Horta Bernardo Lessa , Sousa Paulo Luis Rosa , Faria Augusto Duarte
Published: January 2006

OBJETIVO: Avaliar a prevalência e os fatores associados à depressão pós-parto. MÉTODOS: O estudo foi realizado na cidade de Pelotas, entre outubro e novembro de 2000. As mães (n=410) foram entrevistadas no hospital, utilizando dois questionários sobre informações obstétricas e psicossociais. Posteriormente, as puérperas foram visitadas em casa, entre 30 a 45 dias depois do parto, quando foi aplicada a Escala de Hamilton com o objetivo de medir e caracterizar a presença de sintomas depressivos. O teste do qui-quadrado foi utilizado na comparação entre proporções e a regressão logística não condicional, na análise multivariada. Os dados foram analisados hierarquicamente: no primeiro nível as variáveis socioeconômicas, no segundo, as variáveis demográficas, no terceiro, estavam as variáveis obstétricas e no último nível, as variáveis psicossociais. RESULTADOS: A prevalência de depressão pós-parto encontrada foi de 19,1%. As variáveis renda familiar (OR=5,24; IC 95%: 2,00-13,69), preferência pelo sexo da criança (meninos: OR=3,49; IC 95%: 1,76-6,93) e pensar em interromper a gestação (OR=2,52; IC 95%: 1,33-4,76), apresentaram associação com a ocorrência de depressão. CONCLUSÕES: Os achados sugerem que baixas condições socioeconômicas de vida da puérpera e a não aceitação da gravidez são elementos-chave no desenvolvimento da depressão pós-parto.