bluuebunny/crossref_metadata_2025 huggingface dataset:
New gasoline homogeneous charge compression ignition combustion system using two-state direct injection and assisted spark ignition
Authors: Wang Z , Wang J-X , Shuai S-J , Ma Q-J
Published: April 2006

Homogeneous charge compression ignition (HCCI) combustion was studied in a four-stroke gasoline engine with a direct injection system. The spark ignition and electronically controlled two-stage gasoline injection system are adopted to control the mixture formation, ignition timing, and combustion rate in the HCCI engine. The engine could be operated in HCCI combustion mode in a range of loads from 1 to 5 bar indicated mean effective pressure (IMEP) and operated in SI combustion mode up to loads of 8 bar IMEP. The HCCI combustion characteristics were investigated under different air—fuel ratios, engine speeds, starts of injection, as well as spark ignition enabled or not. By introducing the second fuel injection in the compression stroke, the stratified concentration is formed and the mixture is cooled, which means that HCCI ignition timing can be controlled and the load range can be extended by tuning the mixture concentration and temperature. At a critical ignition temperature, especially in SI—HCCI combustion mode transition, assisted SI improves the stability of HCCI combustion.

In order to understand better the physicochemical process in the cylinder, an improved three-dimensional computational fluid dynamics code has been utilized to simulate the intake, two-stage spray, compression, and combustion processes of the HCCI engine. The calculated results show that a homogeneous lean charge could be realized by single fuel injection in the intake stroke. With the help of the intake swirl and squish flow in the compression stroke, a rich mixture resulting from the second fuel injection can be formed near the spark. Hydroxyl ions (OH) reach to a maximum at the periphery of the fuel-rich zone; a great number of spots are ignited simultaneously. It works as an initiation to ignite the surrounding lean mixture zone.
A study of an electrorheological fluid-based mount for broadband vibration isolation in a squeeze mode
Authors: Wu Jian-Da , Tseng Wen-Kung , Chen Rong-Jun
Published: April 2006

In this paper, a study for electrorheological (ER) fluid in a squeeze mode for broadband frequency vibration attenuation is presented. Semi-active vibration control has been used more extensively because it offers both the reliability of passive systems and the versatility of active control systems. In particular, ER fluid is one of the favourite actuator materials that can be used in smart materials and structures because they offer a fast, reversible, controllable, and continuous change of rheological properties. In the present study, a vibration control technique for ER fluids in the squeeze mode is proposed for broadband vibration control. The controller is designed based on a single-degree-of-freedom (SDOF) mechanical model with a frequency counting technique, and is implemented on a single-chip microprocessor. Experimental investigations are carried out to evaluate the effectiveness of the proposed controller for reducing the vibration on a squeeze mode test platform. The experimental results indicate that the proposed technique is effective for vibration control of squeeze mode ER fluid systems.
Sequential Search with Multiattribute Options
Authors: Lim Churlzu , Bearden J. Neil , Smith J. Cole
Published: April 2006

We describe a search problem in which a decision maker (DM) must select among sequentially encountered options. Each option is described by multiple attributes, and the value of an option is given by a separable function of its attribute values. However, the attribute values are not known with certainty, and can only be ascertained in a predefined order, at some fixed cost. During the search the DM can choose to select an option, purchase information about an attribute value, reject (permanently) the current option and continue the search, or terminate the search and accept a status quo outcome. We introduce a threshold policy for this search process, and prove the optimality of this policy for separable value functions. We then furnish a dynamic programming procedure for prescribing an optimal policy for this problem. Finally, we derive analytic solutions to some special cases of the problem, and present a case study that demonstrates a possible use of the proposed approach.
Use of Decision Analysis in the Army Base Realignment and Closure (BRAC) 2005 Military Value Analysis
Authors: Ewing Paul L. , Tarantino William , Parnell Gregory S.
Published: April 2006

In 2001, Congress enacted legislation that required a 2005 Base Realignment and Closure (BRAC) round to realign military units, remove excess facility capacity, and support defense transformation. The United States Army used multiple-objective decision analysis to determine the military value of installations and an installation portfolio model to develop the starting point to identify potential unit realignments and base closures, providing the basis for all recommendations. Ninety-five percent of the army’s recommendations were accepted by the BRAC 2005 Commission. The army expects these recommendations to create recurring savings of $1.5 billion annually after completion of BRAC implementation. This paper offers four contributions to decision analysis literature: an instructive application of multiple-objective decision analysis methods to portfolio selection, a useful method for constructing scales for interdependent attributes, a new method for assessing weights that explicitly considers importance and variation (Swing Weight Matrix), and practical advice on how to use multiple-objective decision analysis methods in a complex and controversial political environment.
From the Editors…
Authors: Clemen Robert T. , Kleinmuntz Don N.
Published: April 2006

This issue contains two articles on sequential decision making and dynamic programming, and two on military applications. Lim, Bearden, and J. C. Smith extend a typical search model to consider multiattribute options, while Bickel and J. E. Smith develop a novel method for finding the optimal policy in an oil exploration problem. Ewing, Tarantino, and Parnell describe an application of decision analysis that guided part of the U.S. Base Realignment and Closure program, and Klimack and Kloeber apply decision analysis to develop recommendations for improving the U.S. Army’s basic training program.
Book reviews
Authors: Siegal Michael
Published: April 2006

The resilience of language: What gesture creation in deaf children can tell us about how all children learn languages: Edited by Susan Goldin‐Meadow New York and Hove: Psychology Press. 2003. 288 pages, Hardback. £29.95/$49.95. ISBN 1841690260
Development of the Levels of Emotional Awareness Scale for Children (LEAS‐C)
Authors: Bajgar Jane , Ciarrochi Joseph , Lane Richard , Deane Frank P.
Published: April 2006

A performance‐based assessment of the structure and complexity of emotional awareness was developed, the Levels of Emotional Awareness Scale for Children (LEAS‐C). A pilot study (N=6, ages 9–12, Mage=10.2 years) was conducted to construct, trial, and select scenarios suitable for the scale. A larger validity study (N=51, ages 10–11, Mage=10.3 years) examined the relationship between the LEAS‐C and two emotion knowledge tasks: emotion expressions and emotion comprehension; two verbal tasks: vocabulary and verbal productivity; and a cognitive developmental measure: the Parental Descriptions Scale (PDS). Gender differences in LEAS‐C performance were also examined. The LEAS‐C was significantly related to emotion comprehension, and the verbal tasks. Consistent with adult studies, females reported significantly higher LEAS‐C scores compared with males. Gender effects remained when controlling for the two verbal tasks. Preliminary support for the validity of the LEAS‐C as an objective assessment of emotional complexity in children is found in this study. Results also suggest that gender differences in emotional awareness occur at a young age.
The development of afterlife beliefs in religiously and secularly schooled children
Authors: Bering Jesse M. , Blasi Carlos Hernández , Bjorklund David F.
Published: April 2006

Children aged from 4;10 to 12;9 attending either a Catholic school or a public, secular school in an eastern Spanish city observed a puppet show in which a mouse was eaten by an alligator. Children were then asked questions about the dead mouse's biological and psychological functioning. The pattern of results generally replicated that obtained earlier in an American sample, with older children being more apt to state that functions cease after death than younger children (11‐ to 12‐year‐olds > 8‐ to 9‐year‐olds > 5‐ to 6‐year‐olds), and all children being more likely to attribute epistemic, desire, and emotion states to the dead mouse than biological, psychobiological, and perceptual states. Although children attending Catholic school were generally more likely to state that functions continue after death than children attending secular school, the pattern of change with regard to question type did not differ between the Catholic and secular groups. The results were interpreted as reflecting the combined roles of religious instruction/exposure and universal ontogeny of cognitive abilities on the development of children's afterlife beliefs.
Chinese Exclusion, Photography, and the Development of U.S. Immigration Policy
Authors: Pegler-Gordon Anna
Published: April 2006

This article argues that photographic identity documentation was central to the implementation of Chinese exclusion and to the development of U.S. immigration policy in the late-nineteenth and early-twentieth centuries. Starting in 1875, as restrictionists implemented and expanded exclusion policies, they developed an extensive system of photographic identity documentation to attempt to control Chinese immigrants. The Immigration Bureau used this system as a model for the expansion of photographic identity documentation to other racialized immigrant groups and, in 1924, to all immigrants. This aspect of immigration policy has been overlooked by most historians both because of their focus on written records and because of their attention to European immigrants, who remained largely untouched by official photographic practices until they were restricted as part of the racially based National Origins Act of 1924. However, the history of Chinese immigration identity documentation shows both that exclusion was central to the development of U.S. immigration policy and that visual regulation was a key component of immigration restriction.

Chinese immigrants fought against their exclusion, representation, and regulation by the United States through three key strategies. First, elite Chinese community leaders launched diplomatic, legal, and political challenges to the implementation of new photographic documentation policies. When these challenges were unsuccessful, documented Chinese took control over their own photographic images, presenting themselves as respectable individuals in their identity documentation. Finally, excluded Chinese resisted their rejection under the exclusion laws by manipulating photographs and photographic documentation in order to enter the United States. In contrast to legal efforts to resist photographic immigration regulation, these extra-legal strategies successfully undermined the discriminatory exclusion policies, challenged the purposes of documentation, and questioned the photograph's emerging authority as evidence.
Sappho as the Tenth Muse in Hellenistic Epigram
Authors: Gosetti-Murrayjohn Angela
Published: April 2006

This essay contributes to the study of the biographical tradition of Sappho in antiquity and to the reception of Sappho in the Hellenistic period by investigating the evolution in Hellenistic epigram of the construction of Sappho as the Tenth Muse. It focuses particularly on the lineage of epigrams with allusive gestures to Sappho, Hesiod, and other epigrams in circulation that contributed to the ossification of Sappho as an iconic figure. In addition, the essay entertains how and why Sappho was treated differently than male lyric poets by the epigrammatists.
Unmarked Space: Odysseus and the Inland Journey
Authors: Purves Alex
Published: April 2006

This paper analyzes the importance of the border between land and sea in Greek thought by asking what it means for Odysseus to walk so far inland that he meets people who have no knowledge of ships or oars. When he leaves the orienting border of the sea behind, Odysseus enters a terrain where he becomes completely lost for the very first time. I argue that the turning of both Odysseus and the Odyssean poet inland looks not only to the end of the poem, but also to the end of epic and the Homeric tradition.
Divorcing Ideology from Marxism and Marxism from Ideology: Some Problems
Authors: Rose Peter W. (Peter Wires)
Published: April 2006

The de Liberis Educandis, emanating from the circle of Plutarch, provides directives for fathers in the education of sons. The argument for the intervention of fathers is expressed and even conceived in rhetorical forms. Excellence in speaking is understood as the result and the proof of free birth, a test of legitimacy. The speech of wives, concubines, nurses, slaves, freedmen, flatterers, and the vile constitute threats to the ideal education and ideal man. The author's prescriptions are more concerned with creating ideal relationships among menÃfather, teacher, and young studentÃthan with particulars of curriculum.
"'Fascination' is absolute of Clime": Reading Dickinson's Correspondence with Higginson as Naturalist
Authors: Asahina Midori
Published: April 2006

Higginson's detailed record of his interview with Dickinson reflects the temperament of a naturalist, as do his notes on "Negro Spirituals" during the Civil War. By sending Higginson the poem "Except the smaller size," which echoes Thoreau's "Wild Apples," Dickinson deliberately situates Higginson as her preceptor for her work on immortality. Dickinson's remarks on Higginson's nature essays, Out-Door Papers, illustrate the importance of Higginson as naturalist.
"The Inner Brand": Emily Dickinson, Portraiture, and the Narrative of Liberal Interiority
Authors: Blackwood Sarah
Published: April 2006

Emily Dickinson was famously suspicious of visual portraiture. This essay contends that this unease productively critiques the promises of liberal selfhood. Contrary to the tenets of liberal individualism, Dickinson's poetics assert that selfhood and interiority do not exist prior to aesthetic representation. The poet's engagement with the portrait confounds liberal ideals of interiority and individual expression.
Emily Dickinson's Unutterable Word
Authors: Fagan Deirdre
Published: April 2006

It may be the dream of every author to discover the one word that says it all. For Dickinson, the dash—invariably ambiguous, often inscrutable—comes close to that all-inclusive unutterable word. Paul Crumbley's study of the manuscripts caused him to devise something of a translator's guide to the dash. While this is an intriguing approach, it seems rather that her bounteous mark of punctuation, her signature mark as a poet, matters because it exists, not because of how it does. It may simply be a twitch of sorts and to suggest that it had the same sort of intentionality as her words is to make meaning where even Dickinson herself can be found speechless.
Exceeding Legal and Linguistic Limits: Dickinson as "Involuntary Bankrupt"
Authors: Guthrie James T
Published: April 2006

In about 1878 Dickinson wrote two drafts of what appears to have been a letter intended for Judge Otis Lord. The language in the drafts may be construed as one extended metaphor in which the poet compares herself to, among other things, an "involuntary bankrupt." That term would have had a particular signification for Judge Lord, who, Dickinson knew, was well versed in the history of American bankruptcy law. In Dickinson's larger extended trope, bankruptcy functions as one of several representations of excess, a topic that may have arisen frequently during the course of Dickinson's correspondence with the Judge.
Surround Sound: Dickinson's Self and the Hearable
Authors: Peterson Katie
Published: April 2006

The essay looks at significant revisions in one Dickinson poem, "Further in Summer than the Birds," and argues for a version of poetic selfhood fueled by humility, and devoted to anonymity, that also tests traditional conceptions of individuality and authorship.
Perspectives from the Front Lines of Tobacco Control
Authors: Burrus Barri , Northridge Mary E , Hund Lisa , Green Molly , Braithwaite Kisha , Sabol Barbara , Healton Cheryl , Treadwell Henrie M
Published: April 2006

This research is designed to share valuable experiences and transferable principles from program staff of the Legacy/Community Voices initiative who have been involved in planning, implementing, evaluating, and sustaining tobacco control activities in underserved communities. Interviews were conducted with 13 front line staff from 9 sites: Alameda County, California; Detroit, Michigan; El Paso, Texas; Ingham County, Michigan; Miami, Florida; New Mexico; North Carolina; Northern Manhattan; and West Virginia. A model emerged from these interviews that places the life cycle of a program in a central position, with many of the identified themes (working with local champions, obtaining support from multiple partners, increasing organizational capacity) repeated throughout, albeit in different forms at different stages. Reflecting upon wisdom gained and identifying best processes for such work may help ensure that tobacco control programs are developed that are culturally safe and effective in meeting the needs of diverse communities throughout the United States.
Bridging the Gap: Providing Health Care to Newly Released Men
Authors: Jarrett Nicole C , Adeyemi Sherry A , Huggins Thomas
Published: April 2006

Men who are incarcerated have higher morbidity rates than the general U.S. population and upon release most rely on the public sector to get their medical needs met. However, little is known about the health care needs, service utilization patterns, and costs of providing primary care to released inmates in an ambulatory setting. Using data from a primary care health center for uninsured men, health profiles and service use over a 12-month period is described for men newly released from prison (n=221). Health care needs and utilization were measured by medical diagnosis and primary care consultation rates. The results show that the newly released men studied had different service use patterns from that of the general population. The average cost of providing care was slightly higher than the center's average cost per individual for a man newly released from prison. The findings demonstrate the need for future research to support program planning of organizations seeking to meet the needs of people newly released from prison.
People Improving the Community's Health: Communith Health Workers as Agents of Change
Authors: Mack Melany , Uken Ron , Powers Jane VanDeMark
Published: April 2006

People Improving the Community's Health (PITCH) uses teams of community health workers to provide targeted outreach, to enroll those eligible in health coverage plans, to provide information and linkages to health and social support services, and to engage community members in community improvement activities. The initiative is based on the assumption that communities must work on the determinants of health and effectively mobilize all their assets to improve not only individual health, but also community health. Developed with support from the Kellogg Foundation's Community Voices Initiative, PITCH addresses intertwined public health concerns about access to health care and community health improvement. Outcomes of PITCH include increased enrollment in health coverage plans as well as increased participation in community improvement activities. The PITCH initiative helps community members work together to unleash the enormous power for change that emerges when people connect to one another, thereby tapping the knowledge, skills, and resources of community members and institutions alike.
Reducing Frequent Flyer Emergency Department Visits
Authors: Michelen Walid , Martinez Jacqueline , Lee Anita , Wheeler Darrell P
Published: April 2006

Accessing comprehensive and timely health care services in the U.S. continues to be a significant problem, particularly for low-income and socially marginalized groups in urban environments. To begin to address these problems, the Northern Manhattan Community Voices partners have turned to health priority specialists (HPSs) and community health workers (CHWs) to help reduce emergency department visits for care that would better be delivered in clinics or provider offices. This paper examines data collected from an emergency department (ED) diversion program between January 2003 and December 2004 and examines the effects of interventions by HPSs and CHWs in relationship to ED usage among 711 patients. At 6-month assessment, 3 interventions were significantly correlated with decreased ED usage: providing health education (pearson correlation = .299; p = .000; N = 177; mean = .02), teaching patients how to use the health care system (pearson correlation = .259; p = .001; N = 177; mean = .01), and providing counseling on social/emotional issues (pearson correlation = .408; p = .000; N = 177; mean = .01). This paper presents data that reflect the operations in a real-life clinical setting working with economically, socially, and linguistically marginalized populations.
Mothers' effectiveness as HIV risk reduction educators for adolescent daughters
Authors: Dancy Barbara L , Crittenden Kathleen S , Talashek Marie L
Published: April 2006

Low-income African American inner city adolescent females continue to be at disproportionately high risk for contracting HIV. Though it has been speculated that mothers' involvement in HIV risk reduction may be helpful in the fight against HIV, very few interventions involve mothers. The Mother/Daughter HIV Risk Reduction intervention (MDRR), an innovative community-based intervention, trains mothers to be their daughters' primary HIV educators. A split-plot repeated measures design was used to test the effectiveness of the MDRR in decreasing daughters' sexual activity over a 2-month period. The mediating variables were daughters' HIV transmission knowledge, self-efficacy and intention to refuse sex. The sample consisted of 262 daughters with a mean age of 12.4 years. The results revealed that mothers were effective in increasing the mediating variables and in reducing their daughters' level of sexual activity. Active involvement of mothers is cost-effective and should be integrated into HIV intervention programs.
Measuring return on investment of outreach by Community Health Workers
Authors: Whitley Elizabeth M , Everhart Rachel M , Wright Richard A.
Published: April 2006

Community health workers (CHWs) are effective in improving access to health care, promoting client knowledge and behavior change, and contributing to improved health status of individuals. However, few outreach programs have evaluated the financial impact of CHWs on health care systems and policies. A longitudinal repeated measures design was used to assess the return on investment (ROI) of outreach by CHWs employed by Denver Health Community Voices. Service utilization, charges and reimbursements for 590 underserved men were analyzed 9 months before and after interaction with a CHW. Primary and specialty care visits increased and urgent care, inpatient, and outpatient behavioral health care utilization decreased, resulting in a reduction of monthly uncompensated costs by $14,244. Program costs were $6,229 per month and the ROI was 2.28:1.00, a savings of $95,941 annually. These data provide evidence of economic contributions that CHWs make to a public safety net system and inform policy making regarding program sustainability.
A Customer Service Approach to Implementing a Best Practice at Community Health Centers
Authors: Zahn Deborah , Ruland Jodie , Thomas Scott (Scott M.)
Published: April 2006

It is important that strategies for implementing evidence-based best practices into clinical care are developed and tested. This is particularly true for community health centers (CHCs), which are a primary source of care for low-income patients. This article focuses on a customer service approach to implementing best practices in CHCs. The approach was designed to be responsive to the tremendous demands on and limited resources of CHC staff. The CHC staff were the customers of the project while the project team played a supportive role, acting as a full-service vendor to identify and meet staff needs. Although a tobacco system was the focus of this project, it is applicable to implementing in clinical settings generally, regardless of the particular health topic.
Making a case for the examination of ethnicity of Blacks in United States Health Research
Authors: Arthur Carlotta M , Katkin Edward S
Published: April 2006

Important differences between Blacks of different ethnicities in the U.S. in chronic disease morbidity and mortality have been reported. Blacks in the U.S. constitute a heterogeneous group, including immigrants from Africa, Caribbean nations, Central and South America, as well as people now known as African Americans. Ethnicity among Blacks is seldom examined in health research, although in-depth examination of the ethnicity and culture-related pathways through which psychosocial factors may act to influence health have the potential to improve our understanding of health disparities. This improved understanding could in turn lead to the development of new, innovative, culturally based interventions that may reduce health disparities in the U.S. We briefly review the literature that examines Black ethnicity and birthplace, health outcomes, health-related knowledge and behaviors, and health-related psychological and social factors. We present a conceptual framework to aid in understanding the links between these factors and health. Suggestions are offered for conducting research in the future.
Providers' Assessment of Barriers to Effective Management of Hypertension and Hyperlipidemia in Community Health Centers
Authors: Cook Sandy , Drum Melinda L , Kirchhoff Anne C , Jin Lei , Levie Jessica , Harrison James F , Lippold Susan A , Schaefer Cynthia T , Chin Marshall H
Published: April 2006

We explored 251 providers' (47% licensed practical nurses, 27% registered nurses, 10% physicians, 10% physician assistants, 6% other) perceptions of barriers to effective management of hypertension and hyperlipidemia from 72 Midwest community health centers (CHCs). Optimal care for these diseases is difficult in any setting; little is known about the specific barriers CHCs face. Community health centers often have a multidisciplinary team that participates in patient care. Current models of quality improvement and chronic care management require virtually all CHC providers to know clinical guidelines. Providers in this study generally chose hypertension and hyperlipidemia target levels that met or were more stringent than national guidelines, but lacked confidence to address behavioral change and reported obstacles to modifying patient lifestyle. Community health centers should strengthen providers' skills in facilitating lifestyle change. Improving quality of care requires supporting providers' efforts to take patients' psychosocial and financial challenges into account, and revised policies to eliminate financial and cultural barriers to care.
Perception of Racial Barriers to Health Care in the Rural South
Authors: Fowler-Brown Angela , Ashkin Evan , Corbie-Smith Giselle , Thaker Samruddhi , Pathman Donald E
Published: April 2006

We assessed how commonly people in the rural South perceive racial barriers to care, the characteristics of the people among whom this perception is most common and whether this perception is associated with satisfaction with and use of health services. We analyzed telephone survey data collected in 2002–3, using weighted statistical techniques and multivariate logistic regression in analyses stratified by race. Fifty-four percent of African Americans and 23% of Whites reported that they perceive racial barriers to care in their communities. African Americans who were middle-aged or older, male, or who report being in good-to-excellent health were more likely to perceive racial barriers. Whites who were younger, less educated, and uninsured were more likely than other Whites to perceive racial barriers. For African Americans, perceptions of racial barriers were associated with lower likelihood of being satisfied with care, but not with use of preventive services. The perception of racial barriers to health care is prevalent in the rural South, especially among African Americans. The consequences of this perception may include mistrust and dissatisfaction with medical care.
A Novel Training Model to Address Health Problems in Poor and Underserved Populations
Authors: Furin Jennifer Joan , Farmer Paul , Wolf Marshall , Levy Bruce , Judd Amy , Paternek Margaret , Hurtado Rocio , Katz Joel
Published: April 2006

Health disparities are increasingly common and many U.S. practitioners have informal experience working in resource-poor settings. There are, however, few graduate medical education programs that focus on health equity. A graduate medical education program in health equity was developed at Brigham and Women's Hospital based on a review of existing literature and on a survey of junior faculty who have had informal health disparities experience. The Howard Hiatt Residency in Global Health Equity and Internal Medicine was developed as a four-year program to provide intensive training in internal medicine and health disparities. Participating residents are matched with a mentor who has clinical and research experience in the field of global health. In addition to a series of didactic teaching sessions and longitudinal seminars that focus on issues of global health equity, residents take graduate level courses in epidemiology, health policy, ethics, and medical anthropology. Residents also carry out an independent research project in a geographic area that suffers from health disparities. Two residents are selected for training per year. Participating faculty are multidisciplinary and come from diverse Harvard-affiliated institutions. Graduate medical education in the United States with a focus on health equity is lacking. It is hoped that the novel training program in health equity for internal medical residents developed at Brigham and Women's Hospital can serve as a model for other teaching hospitals based in the United States.
Breast Cancer Screening and Health Behaviors among African American and Caribbean Women in New York City
Authors: Garbers Samantha , Chiasson Mary Ann
Published: April 2006

A telephone-based survey regarding breast cancer screening practices among 300 African American and Caribbean women age 40 and over in New York City revealed that while U.S.-born women had significantly different sociodemographic profiles (in terms of insurance status, marital status, educational attainment), they were no more likely to have had a mammogram than the foreign-born women. Adjusting for insurance status and source of care, women with a provider recommendation were 8 times more likely ever to have had a mammogram (AOR 8.01, 95%CI: 3.74–17.14). Among foreign-born Caribbean women in the U.S. for less than half their lives, only 52% ever had a provider recommend a mammogram, compared with 77% of U.S.-born women. The findings confirm previous reports of the importance of physician recommendation in increasing mammography screening among urban Black women, and suggest that efforts to reach Caribbean-born women with breast cancer screening messages should emphasize the important role of providers.
The Pre-Pregnancy Insurance Status of Public Aid Recipients in the Aftermath of Welfare Reform: Women in the Medicaid Gap
Authors: Handler Arden , Rosenberg Deborah Meg , Rankin Kristin M , Zimbeck Meagan , Adams E. Kathleen
Published: April 2006

The passage of welfare reform in 1996 led to sweeping changes in both welfare and Medicaid policy. This study examines the pre-pregnancy Medicaid coverage of women on public aid who had Medicaid payment for delivery in the time periods before and after welfare reform. Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to examine changes in the prevalence of being in the Medicaid Gap (i.e.,having no pre-pregnancy Medicaid coverage despite having Medicaid payment for delivery) in eight states between 1996 (n=302) and 1998–2000 (n=364). Of this population, 16.1% of women were in the Medicaid Gap in 1996, compared with 36.5% in 1998–2000. The overall adjusted relationship between time period and being in the Medicaid Gap was 4.5 (95% CI 2.1–9.6). This analysis suggests that in the period after welfare reform, there was an increase in the prevalence of very low-income women who, despite having their delivery paid for by Medicaid, did not have pre-pregnancy Medicaid coverage. Lack of Medicaid coverage regardless of pregnancy, particularly among women who historically have had such coverage and who are at higher risk of adverse pregnancy outcomes, has important implications for progress toward Healthy People 2010 objectives in prenatal care initiation and utilization, low birth weight, and other pregnancy outcomes.
Racial and Ethnic Disparities in Health: A View from the South Bronx
Authors: Kaplan Sue A , Calman Neil S , Golub Maxine , Davis Joyce H , Ruddock Charmaine , Billings John
Published: April 2006

This study seeks to understand the perspective of Black and Hispanic/Latino residents of the South Bronx, New York, on the causes of persistent racial and ethnic disparities in health outcomes. In particular, it focuses on how people who live in this community perceive and interact with the health care system. Findings from 9 focus groups with 110 participants revealed a deep and pervasive distrust of the health care system and a sense of being disrespected, exacerbated by difficulties that patients experience in communicating with their providers. The paper suggests how health care institutions might respond to these perceptions.
Primary Care and Health Insurance among Women Released from New York City Jails
Authors: Lee Joshua , Vlahov David , Freudenberg Nicholas
Published: April 2006

Factors associated with primary care utilization and health insurance coverage were examined among 511 women leaving jail in New York City from 1997–2001. One year after release, roughly half of the sample reported primary care utilization (47%) and health insurance coverage (56%). Neither outcome was more likely among those reporting diabetes, asthma, or depression. Primary care utilization was more likely among those reporting receipt of public benefits, health insurance coverage, moderate social support, avoidance of illegal activity, and HIV seropositivity. Health insurance coverage was associated with receipt of public benefits, hospitalization, primary care, and avoiding re-arrest. This study demonstrated that a majority of women leaving jail, including those with chronic diseases, lack primary care. These data highlight the need to plan for continuity of care from corrections to the community and suggest further that this can be facilitated with provision of health benefits and social support.
Missing Race/Ethnicity Data in Veterans Health Administration Based Disparities Research: A Systematic Review
Authors: Long Judith A , Bamba Melissa I , Ling Bruce , Shea Judy A
Published: April 2006

Many studies evaluating racial disparities in health come from the Veterans Health Administration (VHA) and are based on secondary and administrative data. Often race/ethnicity data are missing in these sources. Knowing how investigators treat missing data is critical in evaluating potential biases. The objectives of this systematic review were to quantify: (1) the data sources for VHA racial/ethnic disparity studies; (2) how missing race/ethnicity data were handled; and (3) the extent of missing race/ethnicity data. Two trained reviewers independently abstracted 114 articles. The Patient Treatment File was the most common source of race/ethnicity data (n=49). For just over half of the articles we were unable to determine if there were missing race/ethnicity data (n=58). When missing race/ethnicity data were quantified, the proportion of instances for which the data were missing ranged from 0% to 48%. Missing race/ethnicity data are frequently present in VHA secondary and administrative data sources, but, the proportion of instances for which such data are missing is explicitly discussed or quantified in only about 50% of all articles using these sources.
Community Health Center Integration: Experience in the State of Ohio
Authors: McAlearney John S , McAlearney Ann Scheck
Published: April 2006

In the face of severe financial challenges and demands to improve quality and service to patients, many community health centers (CHCs) have aligned or integrated with other CHCs, physician groups, or hospitals. Yet the nature of and rationale for these organizational decisions are not well understood. Our research applied an organizational theoretical framework to test whether strategic adaptation theory or institutional theory best describes the integration activity of CHCs in Ohio. We collected primary data from case studies of seven CHCs selected for geographic representation and studied December 2000–January 2001. Semi-structured interviews and a case study database supported our chain of evidence. We found that CHC integration activity was substantial (five of seven CHCs integrated) and extremely varied. Consistent with strategic adaptation theory, we determined that CHC integration actions were predominantly center-specific, rational responses to environmental challenges and were initiated to improve operations or financial performance. Rarely did CHCs initiate major organizational change merely to mimic other CHC actions, as might have been expected of highly institutionalized organizations. Understanding the basis for CHCs' strategic decisions while monitoring financial health will remain critical as lawmakers and administrators work to develop policies that both maintain progress made and improve primary care access for the poor, the uninsured, and those with special health care needs served by these important safety net providers.
Diabetes and Depression Care among Medicaid Beneficiaries
Authors: Sambamoorthi. Usha , Olfson Mark , Wei Wenhui , Crystal Stephen
Published: April 2006

This study evaluates the relationship between diabetes mellitus and depression care among non-elderly Medicaid beneficiaries, using claims data from the 1995 State Medicaid Research Files for Alabama, Georgia, New Jersey, and Wisconsin. Presence of comorbid diabetes was found to be significantly associated with a higher rate of depression diagnosis. Among those who were diagnosed as depressed, treatment of comorbid diabetes was associated with a higher rate of antidepressant treatment than among depression-diagnosed patients who did not also have diabetes. However, among patients with diabetes and depression, a quarter received only tricyclic antidepressants. Controlling for other characteristics, African Americans diagnosed with depression were less likely to receive antidepressant treatment and, if they did receive such treatment, more likely to receive the older tricyclic drugs. These findings raise concern for glycemic control among patients with diabetes and depression treated with tricyclic antidepressants in a low-income Medicaid population. Among depressed Medicaid beneficiaries with diabetes, there are racial differences with regard to quality of mental health care in the presence of diabetes.
Workshop on Global Health Trends for Health Professional Education
Authors: Walker Bailus , Evans Caswell A , Mouton Charles
Published: April 2006

Global finance, trade, communication, media, politics, and the cultivation of overseas relationships to advance U.S. interests are among the forces that have engendered what we now know as globalization, a historical development towards worldwide interconnectedness. While manifest in diverse realms, globalization powerfully influences human health and health services and poses challenges for physicians and other health care professionals. To review these challenges and their ramifications, a workshop was convened at Howard University to consider the implications of global health trends for medical education. Highlights of the discussion are summarized here.
Colorectal Cancer Screening among the Medically Underserved
Authors: Wolf Michael S , Satterlee Melissa , Calhoun Elizabeth , Skripkauskas Silvia , Fulwiler Daniel , Diamond-Shapiro Linda , Alvarez Hugo , Eder Mickey , Mukundan Padmanabhan
Published: April 2006

Prevalence of physician recommendation and patient completion of colorectal cancer screening was investigated among Federally Qualified Health Centers (FQHC) serving low-income neighborhoods in Chicago. Medical records of 3,416 patients receiving primary care services at 1 of 31 FQHCs were randomly chosen for review. In all, 642 patients were identified by age and family history as eligible for colorectal cancer screening and included in this study. Patient demographic information and colorectal cancer screening history were collected. The physician screening recommendation rate was 9.2% (n=59); 7.0% (n=45) of patients were determined to have been appropriately screened for colorectal cancer, primarily by Fecal Occult Blood Test (94.1%, n=43). Among patients who received a recommendation from their physician, 76.2% had completed a screening test. Older patients were more likely than their younger counterparts to have received a recommendation from their physician (p
Measuring Public Integrity
Authors: Camerer Marianne Irene
Published: April 2006

This article critically considers measurement tools that have emerged to quantify the quality of governance, in particular, those measuring corruption. It argues that the inherent limitations of these measures, and the emerging phase of the corruption debate towards action, require a new approach. The Public Integrity Index—an independent, in-country expert assessment using investigative journalists and expert social scientist to quantify the capacity of a state's national governance framework to prevent corruption—is critically considered against a checklist of key factors that underpin sound measurement tools.
Ballots, Bribes, and State Building in Bulgaria
Authors: Ganev Venelin I
Published: April 2006

On 25 June 2005, voters cast their ballots in Bulgaria's sixth general elections since the collapse of the communist regime in 1989. The successful completion of another cycle should dispel any residual doubts about the democratic character of the Bulgarian political system. In the aftermath, however, it quickly became clear that the country now faces a new set of challenges. What is the institutional basis of economic growth? Under what conditions might ethnic passions be reignited in an otherwise pacified yet heterogeneous society? And, as Bulgaria moves toward full EU membership, what are the sources and manifestations of the "feckless pluralism" that systematically diminishes the quality of democratic governance?
The Surprising Significance of African Elections
Authors: Lindberg Staffan I.
Published: April 2006

In a time when a greater part of the world hails elections as the hallmark of democracy, skepticism of their true value has severely increased in the academic community. Building on an analysis of 232 elections in Africa, this article argues that an uninterrupted series of elections tends to cause any society to become imbued with democratic qualities since the mere repetition of multiparty elections—regardless of whether they are free and fair—leads to increases in human freedom and the spread of democracy.
Burundiâs Transition: A Beacon For Central Africa
Authors: Peterson Dave
Published: April 2006

Abstract: On 19 August 2005, more than nine-tenths of the members of both houses of Burundiâs legislature capped a free electoral process by choosing Pierre Nkurunziza to serve as the countryâs next president. The implications of this event in this small, conflict-ridden state on the northeastern shore of Lake Tanganyika could reverberate positively throughout the Great Lakes region of central Africa and beyond. While Burundiâs democratic reconstruction is far from complete, the election suggests that even the most violent and sorely divided societies can be restored, given sufficient political will and generous resources to support the process of negotiation and change.
Progress in the Middle East
Authors: Puddington Arch , Piano Aili
Published: April 2006

A modest but potentially significant increase in human rights and democratic freedoms in the countries of the Arab Middle East was the most notable development in the state of world freedom during 2005. This is the principal finding of Freedom in the World 2006, the index of global political rights and civil liberties issued annually by Freedom House. Globally, the state of freedom worldwide showed a slight net improvement from 2004 to 2005. An analysis of regional patterns indicates that the Middle East and North Africa continue to lag behind other world regions when overall levels of freedom are measured.
Getting to Arab Democracy: Lebanon Springs Forward
Authors: Safa Oussama
Published: April 2006

Abstract: The article describes the turbulent months in Lebanon starting with the violent assassination of its prime minister in February 2005 that led to the pullout of the Syrian troops from the country to the landmark legislative electionsâfree of foreign interference for the first time in 29 yearsâthat took place in early summer. The essay sheds light on the complexity of the Lebanese confessional system and traces the evolution of its polity since the making of the country in 1926. Finally, it concludes with recommendations for the future of the country.
Russia: Authoritarianism Without Authority
Authors: Stoner-Weiss Kathryn
Published: April 2006

Do autocracies tend to govern better than democracies? Will a plainly authoritarian recasting of Russia's political system necessarily lead to a more capable state? Russia's president, Vladimir Putin would have us believe so, but recent events—not to mention the long arc of Russian and Soviet history—suggest a different answer. Putin's claims about what ails Russia are wrong. The culprit behind Russia's ungovernability is not the country's halting democracy but rather its weak, poorly institutionalized state. The best cure, moreover, is not authoritarianism— hard or soft —but rather an enhanced democracy, more deeply institutionalized than it ever was under Putin or his predecessor Boris Yeltsin.
Burundiâs Transition: Training Leaders for Peace
Authors: Wolpe Howard , McDonald Steve
Published: April 2006

Abstract: One of the most distinctive elements of Burundiâs transition is the extent to which national leaders have embraced the importance of leadership training as a key to reconciliation and good governance. Indeed, Burundi may be the first case of a country just emerging from conflict in which key leaders have integrated into their peace process a national training program explicitly designed to rebuild their capacity to work effectively together in advancing their countryâs postwar reconstruction. This essay examines the goals and methods of the Burundi Leadership Training Program (BLTP).
More Bang for the Buck: Increasing the Effectiveness of Library Expenditures Through Cooperation
Authors: Kohl David F. , Sanville Tom
Published: April 2006

The long-term strategy of the academic library community needs to focus on improved cost effectiveness rather than becoming preoccupied with the short-term effects of budget reductions. Fortunately, the rise of consortia and the maturing of the automation environment provide a conducive environment for substantial gains in the cost-benefit ratio over a wide range of library services. Examples of such gains in four key library service areas are described.