bluuebunny/crossref_metadata_2025 huggingface dataset:
Brown-Séquard: Selected Contributions of a Nineteenth-Century Neuroscientist
Authors: Aminoff Michael J.
Published: March 2007

That eccentric experimentalist, Charles Edouard Brown-Séquard, flitted restlessly between the major cities of the old and new worlds in the nineteenth century, replacing outdated concepts with new ideas of his own concerning the operation of the nervous system in health and disease. He used the experimental approach to generate hypotheses but had no interest in showing by meticulous study that his views were correct, leaving this to others. Extending his work on the integrative action of the nervous system, he came to believe that humoral factors are important in integrating the operation of the intact animal. Such views brought chilling disapproval and his erratic and unfocused approach led to dramatic success but later obscurity. Ironically, many of his views that were originally ridiculed or misunderstood have been vindicated by the later work of others and are now widely accepted. The significance and potential implications of other concepts that he advanced, such as the basis of sensory disturbances after spinal cord lesions, have yet to receive the recognition that they merit. NEUROSCIENTIST 6:60-65, 2000
Review : Mapping Brain Pathophysiology and Higher Cortical Function with Magnetic Resonance Imaging
Authors: Warach Steven
Published: March 2007

Advances in magnetic resonance imaging (MRI) have moved the technology beyond its application solely as a diagnostic test to become a tool for addressing questions of in vivo pathophysiology and higher cortical function in humans. Diffusion-weighted MRI measures the apparent rate of translational movement of water molecules through brain parenchyma. This measurement can be used to determine axonal orientation within white matter, to define regions of tissue edema, and to permit early identification of ischemic neuronal injury related to impairment of Na+-K +-ATPase activity in experimental and human stroke. Changes in various aspects of cerebral perfusion—blood volume, blood flow, and hemoglobin oxygen saturation—can be mea sured with MRI, and altered cerebrovascular circulation and regional brain activation can thereby be inves tigated. Echo planar imaging is a method of ultrafast data acquisition with MRI—individual images are ac quired on the order of 100 msec. Echo planar imaging makes diffusion and perfusion measurements more practicable for diverse applications and allows for the study of temporal characteristics of regional brain responses to stimuli. Diffusion and perfusion MRI, generally termed functional MRI, are tools for studying in vivo brain physiology with MRI and are being applied to a broad range of questions in neuroscience. The Neuroscientist 1:221-235, 1995
Promoting Scientific Literacy: An Opportunity for the Neuroscience Community
Authors: Collins J.G.
Published: March 2007

Scientists represent a logical approach to curiosity, to imagination, to the unknown. Children are born with these traits. It is our job—our duty—to keep alive the quest for the next question. As working adult scientists, you bring to the classroom an adult personification of the quest. You hold the light of those early childhood traits. Your profession is a never-ending adventure into the unknown (Scott Anderson, Title II Teacher Trainer, Orleans Pansh Schools).
REVIEW ■ : Jun, Fos, and CREB/ATF Transcription Factors in the Brain: Control of Gene Expression under Normal and Pathophysiological Conditions
Authors: Herdegen Thomas
Published: March 2007

The expression and activation of transcription factors and the control of gene transcription in the nervous system is a recent and rapidly expanding field in neurosciences. This research area may provide insights concerning the information transfer that arises from postsynaptic potentials or ligand-coupling of membrane receptors and terminates in gene expression. Visualization of both de novo synthesis of inducible transcription factors (ITFs) and phosphorylation of preexisting transcription factors have been used to mark neurons, pathways, and networks excited by various stimuli. This article summarizes basics of the transcription process and the complex functions of Jun, Fos, and CREB/ATF proteins, as well as the use of ITFs as experimental instruments in neurophysiology and neurobiology. The major focus is on the alterations in ITF expression following acute or chronic pathophysiological stimuli as mirrors of alterations in neuronal programs underlying adaptation, dysfunctions, or the development of diseases affecting the nervous system. NEUROSCIENTIST 2:153-161, 1996
Neural Aspects of Fatigue
Authors: Fuglevand Andrew J.
Published: March 2007

Fatigue brought about by intense muscular contraction typically is accompanied by a reduction in motor-unit firing rate. The decrease in motor-unit output with fatigue appears to be caused by two interacting processes: 1) a decline in the net excitatory drive to motoneurons and 2) adaptation in the responsiveness of motoneurons to synaptic input. Whether a reduction in motor-unit firing rate in itself contributes to force loss associated with fatigue, however, is an unresolved question. The neuromuscular wisdom hypothesis suggests that decreases in firing rate help to maintain force by optimizing the input to motor units as their contractile properties change. On the other hand, recent work indicates that mechanical function of some motor units is altered during prolonged activity such that diminished firing rate would augment force loss and, thereby, contribute to fatigue. Neural adaptations, therefore, may serve to limit the extent of muscular activity. NEUROSCIENTIST 2:203-206, 1996
REVIEW ■ : The Suprachiasmatic Nucleus: A Circadian Oscillator
Authors: Ibata Yasuhiko , Tanaka Masaki , Tamada Yoshitaka , Hayashi Seiji , Kawakami Fumio , Takamatsu Teturo , Hisa Yasuo , Okamura Hitoshi
Published: March 2007

The suprachiasmatic nucleus (SCN) is considered to be a circadian oscillator that regulates a set of phys iological aspects of behavior, including sleep-wakefulness and hormone release in mammalian species. In this review, we describe recent research that has begun to reveal the functional organization of the SCN. The SCN, which consists of a bilateral pair of tiny nuclei located just above the optic chiasm, contains several kinds of peptidergic neurons, but vasoactive intestinal peptide (VIP), arginine vasopressin (AVP), and somatostatin (SOM) neurons are the main components. VIP neurons and AVP neurons show distinctly different locations in the SCN; the former are found in the ventrolateral portion, whereas the latter are localized in the dorsomedial portion. VIP neurons receive all neuronal inputs from other regions of the CNS, such as those evoked by photic stimulation via the retinal ganglion cells and those relayed by 5HT inner vation from the raphe nuclei. VIP neurons relay their information to other kinds of neurons in the SCN, such as AVP and SOM neurons. VIP neurons, thus, may play a significant role in entrainment of circadian rhythm. VIP, AVP, SOM, and their mRNAs show rhythmic fluctuations that are predicted by this model; VIP and its mRNA show diurnal variation under the influence of photic stimulation, whereas AVP, SOM, and their mRNAs show endogenous rhythms. Immediate early genes (lEGs), such as c-fos mRNA, are also expressed in VIP neurons in the SCN, and IEG expression in the cells appears to be modified by photic stimuli. Together with transplantation studies showing that exogenous SCN tissue tends to restore circadian rhythm in arrhythmic animals, these results are beginning to clarify the function of the SCN in setting, maintaining, and resetting the biological clock. NEUROSCIENTIST 3:215-225, 1997
REVIEW ■ : Glial Derived Extracellular Matrix Components: Important Roles in Axon Growth and Guidance
Authors: Faissner Andreas
Published: March 2007

Axon growth and guidance, and the correct recognition of distant targets by growth cones rank among the most spectacular achievements of the developing nervous system. The establishment and reformation of adequate networks and the plasticity of synaptic connections are vital for the function and the restoration of the nervous system under conditions of health and disease. Therefore, considerable efforts have been devoted to the elucidation of the molecular and cellular bases of the establishment of interneuronal con nections. It is well established that interactions between neurons and astrocytes are of regulatory importance in this context. Thus, astroglia guides migrating neurons and advancing growth cones to their destination. On the other hand, astrocytes design transient boundaries that deflect axons and segregate groups of neurons, and form scars involved in the inhibition of axonal regeneration after lesion. This duplicity of astroglia is presumably mediated by various gene families. Among these, extracellular matrix (ECM) con stituents seem particularly suited to embody and mediate the ambivalence of astrocytes because these compounds appear to exert either conducive or inhibitory/repulsive effects depending on interacting cell types and conditions. Furthermore, ECM constituents are upregulated by astrocytes upon lesion and con tribute to the construction of glial scars. This review focuses on this class of compounds and their possible functions in the wiring of neural networks. NEUROSCIENTIST 3:371-380, 1997
Review : Neural Stem-Like Cells: Developmental Lessons with Therapeutic Potential
Authors: Snyder Evan Y.
Published: March 2007

It is possible, by a variety of means, to isolate, propagate, and characterize engraftable clones of cells from the mammalian CNS that fulfill the operational definition of a "stem cell": self-maintaining, self-renewing, and extremely multipotent in vitro and in vivo. Even as debates flourish over how neural stem cells might best be defined, identified, represented, and manipulated, clonal cells with "stem-like" features have begun to provide valuable models for studying commitment, differentiation, and plasticity in the CNS. Furthermore, by learning in this way the basic biology of neural stem cells, and by then exploiting those inherent properties for therapeutic ends, novel and multifaceted strategies seem poised to emerge for redressing a variety of heretofore untreatable CNS dysfunctions. Stem-like cells have begun to show promise for neural cell re placement and molecular support therapy in various animal models of degenerative, developmental, and acquired CNS insult. NEUROSCIENTIST 4:408-425, 1998
A Multisite Study of Health Professionals’ Perceptions and Practices of Family-Centered Care
Authors: Bruce Beth , Letourneau Nicole , Ritchie Judith , Larocque Sylvie , Dennis Christine , Elliott M. Ruth
Published: March 2007

Family-centered care (FCC) has been promoted as the optimal philosophy for children and families in their interactions with health professionals. Furthermore, FCC is a health care delivery model that seeks to fully involve families in the care of children through an approach that is respectful and supportive. This multisite survey was undertaken to determine the differences in health professionals’ perceptions and practices of FCC and to examine factors that influence those perceptions and practices. Findings revealed that although advances have been made in recognizing the key elements of FCC, difficulties remain in implementing these elements. The “dilemma of helping,” the potential lack of interprofessional collaboration, the design of the health care delivery system, as well as the potential lack of continuing education and mentoring programs are proposed as explanations for these findings.
Conjoint Research Interviews With Frail, Elderly Couples: Methodological Implications
Authors: Racher Frances E. , Kaufert Joseph M. , Havens Betty
Published: March 2007

In this phenomenological study, frail, rural elderly couples were interviewed as dyads. Couples participated in semistructured interviews and jointly constructed their responses. The elderly couple or dyad was the unit of inquiry, data collection, and analysis. The study sought to maximize the understanding of the couple as a unit as partners negotiated and constructed their responses. The method of data collection provided opportunity to observe the verbal and nonverbal interaction of the couple, the process used to construct the conjoint dialogue, and the content of the discourse. The couple conversation was richer in content and more effective in addressing the research question than were individual interviews. This article focuses on the methodological issues as they relate to the couple as the dyadic unit of research. Dialogue from the study illustrates the richness of the data gathered using this method.
A Most Wonderful, Tragic Experience: The Phenomenon of Mothering in Caregiving an Adult Son with AIDS
Authors: Nelms Tommie P.
Published: March 2007

The purpose of this Heideggerian hermeneutic study was to gain an understanding of the phenomenon of mothering experienced by women who served as primary caregivers for their adult sons who died of AIDS. Fifteen mothers provided in-depth interviews. Data were categorized into the constituents of human being: lived relationship, lived time, lived body, and lived space. The mothers revealed close and (re)connected relationships with their sons, intertwined with issues of homosexuality, stigma, economics, physical care, and death. The essence of the mothering for these women was the biological relationship, the life-threatening illness, their commitment to care for their sons, the overriding engagement of the mothers and sons, and the reconnections to care given their sons as infants and children. A call of conscience, in the Heideggerian sense, compelled the mothers to care for their dying sons.
Longitudinal Change in Conjugal Support and Coping Behaviors of Elderly Marital Partners
Authors: Ducharme Francine
Published: March 2007

The purposes of this longitudinal study were to examine the effect of time and gender on elderly marital partners' perceptions of conjugal support and coping behaviors and to examine the association between these perceptions and the partners'psychological well-being. A sample of 135 couples, 65 or older, drawn from users and nonusers of health and social services in a large metropolitan area, were interviewed at home. Twenty-four months later, 90 of these couples were reinterviewed. The perception of conjugal support was significantly more positive at the time of the second interview than at the time of the first, and husbands' perceptions were significantly more positive than their wives'. Elderly partners made significantly greater use of their informal support system and reframing at the time of the second interview. Women made significantly greater use of their informal support system than did men. A pattern of significant associations between conjugal support and life satisfaction as well as between cognitive coping strategies and life satisfaction wasfound at both time periods. Results provide information on factors associated with psychological well-being and provide direction for the development of nursing strategies aimed at fostering better quality of life.
Persons with AIDS and their Family Caregivers: Negotiating the Journey
Authors: Bunting Sheila McGuire
Published: March 2007

Increased incidence of AIDS in North America and throughout the world has posed a challenge to nursing to provide care for these clients and their families. In this study a theoretical model was derived to explain howfamily members manage the experience of living with AIDS. Interviews with 11 family members and 9 persons with AIDS (PWAs) were submitted to the grounded theory method of constant comparative analysis. Negotiating the Journey was found to be the basic social psychological process that conceptually related and explained the variability in the experiences of participants. Strategies within the negotiating process included Control of Awareness, Gearing Up, Finding a Guide, Gauging the Territory, Living with AIDS, Working the System, Framing Time, and Making Tradeoffs. PWAs and their families learned and gained competencies in the negotiation of their journeys. They then used their wisdom to help others by Becoming Guides.
Oregon's Physician-Assisted Suicide Legislation: Troubling Issues for Families
Authors: Tilden Virginia P. , Lee Melinda A.
Published: March 2007

An individual autonomy framework, rather than a family framework, has prevailed in the national debate about physician-assisted suicide for the terminally ill. However, the separation of individual andfamily is artificial in the context of life-threatening illness. This article describesfamily issues when terminally ill patients consider physician-assisted suicide. Issues includefamily roles, motives, disagreements, and grief; the problems of misuse of a lethal prescriptive; and failed suicide attempts. For multiple reasons described, thefamilyperspectiveis needed in debates about physician-assisted suicide.
An Analysis of Empirical Studies Examining the Impact of the Cancer Diagnosis and Treatment of an Adult on Family Functioning
Authors: Cooley Mary E. , Moriarty Helene J.
Published: March 2007

The diagnosis of cancer is a family affair. Programs of research that evaluate the impact of the cancer diagnosis and treatment on thefamily system can be used to promote more effective physical and psychosocial adjustment of individual family members and the family as a whole. The purpose of this article is to describe an analysis of published empirical studies examining the impact of the cancer diagnosis and treatment of an adult on family functioning. The theoreticalframework, sample, the unit of analysis, measures, and selectedfindings are identified for each study. Feetham's criteriafor research offamilies are applied to evaluate the studies. Implicationsforfuture theory development and research are also presented.
Understanding Family Legacy in Family Health Concerns
Authors: Plager Karen A.
Published: March 2007

Family legacy stories recover an understanding of family health that has become marginalized in the predominant ways that family health is studied in the family disciplines. This article describes what family legacy means for family and family member health concerns, activities, and practices in their everyday life. Six families with school-age children took part in an interpretive study of health practices and concerns in families. Five to six in-depth family group interviews were conducted with each family using semistructured, open-ended questions. All families had meaningful family legacy stories that set up health concerns and shaped health practices, activities, and habits. A paradigm case exemplifies how a family may extend, flee from, and/or reshape family-of-origin legacies in their family of progeny. Exploring and acknowledging family legacy recognizes a rich part of family life and can enhance the nurse’s and family’s understanding of family health and related practices, activities, and habits.
Prevailing Impressions in Science and Medical News
Authors: LOGAN ROBERT A. , ZENGJUN PENG , WILSON NANCY FRASER
Published: March 2007

In a content analysis, the authors assess the prevailing impressions toward social actors in the coverage of science and biomedical news in the Los Angeles Times and The Washington Post during biennial periods from 1989 to 1995. The social actors and outcome variables studied were favorability toward science and medical professionals, the health care delivery system, science and medicine as social institutions, industry, government, and public interest groups. The study found that prevailing impressions toward industry, government, the health care delivery system, science and medical professionals, science and medicine as social institutions, and public interest groups were within a middle or ascribed equivocal range for both newspapers during all the time periods surveyed. The findings challenge some qualitative, case-study-based scholarship that suggests prevailing impressions are skewed in highly favorable or unfavorable directions toward social actors in science reporting.
The Consequences of Improving Dissemination in Garbage-Can Decision Processes
Authors: Mandell Marvin B.
Published: March 2007

Although overlooked to date, computer simulation represents a potentially fruitful research approach for contributing to our understanding of the effectiveness of strategies for increasing the use of policy analysis. In this article an initial step is taken toward tapping this potential. Specifically, the "garbage-can" model of decision making developed by Cohen, March, and Olsen (1972) is modified so that it reflects a possible contribution of policy analysis to decision making. This model is then used to obtain insights concerning the impacts of one category of strategies for increasing the use of policy analysis, namely, those concerned with dissemination, on organizational decision making. While insights concerning the impacts of dissemination strategies on organizational decision making are certainly important in their own right, a more general purpose of this article is to demonstrate the role that simulation models can play in developing knowledge concerning the effectiveness of strategies for increasing the use of policy analysis .
As Scientists and Citizens
Authors: Sy Karen J.
Published: March 2007

Many academics are reluctant to enter policy-making forums. Those who do so are an important and intriguing minority. This study takes a close look at faculty active in advisory mechanisms to government and reveals them to be individuals whose careers include considerable experience outside academia, whose time commitments on c ampus are highly varied, and whose attitudes are supportive of university service to government. Most of the expert advisers also engage in political activities as citizens, and the relationship of participation in these dual modes poses questions for future research.
Knowledge Utilization
Authors: Backer Thomas E.
Published: March 2007

Knowledge utilization—research, scholarly and programmatic intervention activities aimed at increasing the use of knowledge to solve human problems—is presently in its third wave of actavcty in the United States. Definitions of the field, a historical analysis of each of the three waves (1920-1960, 1960-1980, and the present), and an overview of the knowledge base on knowledge utilization are presented in a brief state-of-the-art review for this field as of 1990. Seven larger societal trends that will affect knowledge utilization in the 1990s are explored, along with four significant challenges that the field will face internally, and some suggested mechanisms for creative response.
Communication-Information Relationship in Self-Representation
Authors: Mokros Hartmut B. , Lievrouw Leah A.
Published: March 2007

This article compares two examples of how information is privileged and then used by individuals to build representations of themselves and their lives. The aim is to explore the utility of an analytic vocabulary to describe this privileging process. In the first example, an adolescent's construction of a suicide note shows how individuals, in the hours before they take their own lives, may choose certain types of information and thereby construct self-representations for significant others. The other example focuses on a scientist's research narrative showing how researchers consciously construct descriptions to communicate the value and necessity of their work to peers or to larger audiences.
Environmentalism and Science
Authors: Rycroft Robert W.
Published: March 2007

How has American environmentalism affected the U.S. scientific enterprise? After two decades of intense and often rancorous debate about environmental protection, has the environmental movement changed the pursuit of scientific knowledge in significant ways? This article examines the relationship between environmentalists and scientists on four dimensions: (a) the degree to which scientific research has become more applied; (b) the relative success or failure of efforts to integrate and coordinate research projects and programs; (c) the amount of synthesis of scientific information for policy purposes that has taken place; and (d) the level of professionalizing that has occurred in environmental science, economics, policy, and management. Results indicate that environmentalism has had little impact on science.
New Definitions of Misconduct: Priorities for the 1990s
Authors: Zwolenik James J.
Published: March 2007

In 1992, two new definitions of scientific misconduct were proposed that differ significantly from those previously adopted by the U.S. National Science Foundation and the U.S. Public Health Service, and many universities. This commentary considers insights underlying the proposals, asks whether the proposals cover the full range of likely serious deviations from accepted practice, and attaches priority to viewing definitions of misconduct in science within the investigative and adjudicative contexts where they operate.
Constructing and Reconstructing Scientific Ignorance
Authors: Stocking S. Holly , Holstein Lisa W.
Published: March 2007

In Ignorance and Uncertainty: Emerging Paradigms, Australian sociologist Michael Smithson observes that Western intellectuals, who once preoccupied themselves with knowledge, are increasingly pondering ignorance. Those who are not, he adds, should consider doing so. It is an arresting suggestion, not unlike the one art instructors often make to students of drawing: do not look at the figure; look at the space around the figure. Once attention is focused on ignorance rather than on knowledge, one begins to see that ignorance is not the simple absence of knowledge. Instead, like the space around objects, ignorance has its own configurations. It varies in amount, form, and substance, depending on the perspective. And just as artists make use of the representational power of space, scientists and nonscientists alike often manipulate ignorance, maximizing or minimizing it in ways that affect the credibility of what we know. In developing this argument, the article draws on the insights of historians, philosophers, mass communications and legal scholars, discourse analysts, and sociologists of science to examine scientists' use of ignorance claims in the construction of science and in science for public policy. It also looks at how nonscientists sometimes appropriate and attempt to manipulate such claims, often through the news media. Such uses, the article argues, reflect and serve claimants' interests. The news media, in turn, appropriate and emphasize those ignorance claims that advance and protect their own particular concerns.
Internet Connectivity of State Health Departments
Authors: BARINAS-MITCHELL EMMA J.M. , DAVIS NORRIS L. , McGUIRE MAUREEN T. , AARON DEBORAH J. , LaPORTE RONALD E.
Published: March 2007

A new era of public health is emerging, with the use of the Internet at the forefront. Improving the efficiency of information transfer through the use of new telecommunications tools, such as the Internet, will lead to advances in health worldwide. To describe the current status of Internet connectivity within the U.S. public health system, state health departments were surveyed by telephone. A total of 47 state health departments participated in the survey. The results indicate that 92 percent were connected to the Internet in some way; however, 74 percent of those connected had personnel restrictions on usage and/or limited access to the Internet. Only 6.4 percent of the states indicated that all of their local health departments were connected. The results of this survey reveal that despite the widespread use of the Internet, the public health system in the United States has limited connectivity with respect to the number of personnel who can access the Internet and the Internet services they are able to use. It is important for the future of public health to establish a network linking the public health departments in the United States.
Selective Contracting in Managed Care: The Case of Substance Abuse Treatment
Authors: Lemak Christy Harris , Alexander Jeffrey A. , D’Aunno Thomas A.
Published: March 2007

The authors address two critical questions concerning managed care and outpatient substance abuse treatment organizations. Specifically, they consider (1) to what extent selective contracting occurs between managed care firms and treatment providers and (2) what attributes of treatment providers and their operating environments are associated with selective contracting. Using data from a nationally representative sample of outpatient treatment organizations, the authors find evidence of systematic selection. Several indicators of providers’ quality and costs, including accreditation status, private ownership, size, and prior experience with managed care, are positively associated with managed care contracting. By contrast, units providing methadone treatment are less likely to be involved in managed care. To a lesser extent, characteristics of treatment providers’ operating environment, including extent of competition based on costs and attributes of the Medicaid managed care program, are also positively associated with managed care contracting.
Medical Practice Profiling: Concepts and Caveats
Authors: Brand Donald A. , Quam Lois , Leatherman Sheila
Published: March 2007

Medical practice profiling has gained prominence in recent years as insurance companies, managed care organizations, and government agencies have used and promoted this method of analyzing medical practices. Surprisingly, however, a conceptual basis for profiling-even a clear definition-has been lacking. The present article supplies the missing conceptual foundation and offers an in-depth discussion of the strengths and limitations of the profiling method. The article explains and critiques various measures of medical practice, discusses alternative data sources, provides a framework for evaluating data quality, and addresses key analytical issues concerning the proper use of data for profiling. The objective is to help administrators, researchers, policymakers, patients, physicians, and others interested in profiling understand this genre of analysis so that they will be better equipped to evaluate its results.
Is the Target Income Hypothesis an Economic Heresy?
Authors: Rizzo John A. , Blumenthal David
Published: March 2007

This study is the first to relate physician-specific measures of target and actual income to pricing decisions. We find that a higher ratio of target to actual income leads to a significant price increase among self-employed, fee-for-service primary care physicians, with an elasticity of approximately 0.3, but not among self-employed primary care physicians who are not paid on a fee-for-service basis. Thus we find evidence of target income pricing when, as in the case of fee-for-service practices, physicians stand to gain financially from their pricing decisions. Although the target income hypothesis (TIH) has been criticized for lacking firm grounding in economic theory, this article argues that the notion of targets has a long history in economic theory and pricing to achieve a target is not new. Moreover, a variety of economic explanations render such behavior consistent with profit maximizing objectives.
Dissatisfaction and Disenrollment in a Subsidized Managed Care Program
Authors: Patrick Donald L. , Martin Diane P. , Madden Carolyn W. , Diehr Paula , Cheadle Allen , Skillman Susan M.
Published: March 2007

We studied members of the subsidized Basic Health Plan (BHP)from four managed health care organizations (MHCO). We compared low-income enrollees' and disenrollees' satisfaction with benefits, membership, and care from their MHCOs. Enrollees disenrolled primarily because they became insured through an employer, their income increased, or they moved out of the area. These disenrollees were less satisfied overall and with the amount of premiums and the total amount of medical costs covered. Disenrollees were also less satisfied with the ease and convenience of obtaining care, availability of phone advice, and quality of care. Disenrollees were more likely to be employed or to have a family member in fair or poor health. Satisfaction was high with MHCOs, although it varied considerably by site, particularly with ability to select doctors. Respondents reported affordability the most desired feature and lack of prescription coverage the least desired feature. Overall, disenrollment was not associated highly with dissatisfaction.
Use of Health Care for the Treatment of Mental Problems among Racial/Ethnic Subpopulations
Authors: Freiman Marc P. , Cunningham Peter J.
Published: March 2007

This article analyzes the degree to which interactions between race/ethnicity and other characteristics of a person and their local area are important in determining the probability of any mental health care use. Separate equations are estimated for "Blacks and Hispanics" and "Whites and other groups." Simulations are then performed where the probabilities of use are estimated for individuals in one racial/ethnic group, using coefficients estimated for another racial/ethnic group. These simulations show that the probability of use for Blacks and Hispanics would be similar to Whites if they were subject to the same behavioral patterns (regression coefficients) as Whites, and vice versa. The results indicate the limitations of simply using dummy variables to represent race/ethnicity and the value of learning more about how the health care system interacts with persons of different racial/ethnic backgrounds. Policies that directly affect the location, characteristics, and behavior of health care providers, as well as the behavior of consumers, may be as relevant to achieving equality of use or access as incremental changes in health coverage.
Growing Diversification in HMOs, 1988-1994
Authors: Gabel Jon , Whitmore Heidi , Bergsten Chris , Grimm Lily Pan
Published: March 2007

Based on data from annual surveys conducted by the American Association of Health Plans, this article shows growing product diversification among the nation's HMOs. Between 1988 and 1994 the percentage of HMOs offering point-of-service (POS) plans increased from roughly 20 percent to 74 percent, and the percentage offering PPO plans rose from about 25 percent to 58 percent. Today, most HMOs view themselvesas managed care organizations (MCOs) offering an array of health plans and products, not as traditional, close-ended HMOs. Future analysis of the health care industry should regard the MCO rather than the HMO as the unit of analysis. One potential developing problem is the growth of self-insured HMO plans. If current trends continue, self-insured HMO plans could erode the insurance function in the HMO market, as occurred in the indemnity market in the 1980s.
Managed Care and Physician Referral
Authors: Grembowski David E. , Cook Karen , Patrick Donald L. , Roussel Amy Elizabeth
Published: March 2007

In the era of managed care, fundamental changes are occurring in the American health care system that are altering physician referral patterns. Faced with higher premiums that erode profits and competitiveness, employers, government, and nonprofit agencies are contracting with managed care organizations, which control costs partly by imposing constraints and incentives on physician referral behavior. As more and more Americans are covered by managed care plans, it becomes more important to understand how managed care organizations control access to specialists and how these controls affect health outcomes. The authors present a model defining the expected influence of managed care on physician referral based on social exchange theory and the empirical literature. They conclude with a discussion of the future research implications of the model.
Hospital Conversions from for-Profit to Nonprofit Status: The other Side of the Story
Authors: Desai Kamal R. , Young Gary J. , Lukas Carol VanDeusen
Published: March 2007

The authors examined, on a case-by-case basis, the community impact of 15 for-profit hospitals that converted to nonprofit status. These for-profit conversions have been occurring in numbers comparable with those of nonprofit conversions (i.e., nonprofit hospitals that convert to for-profit status), but have attracted far less attention. For each for-profit conversion, the authors compared the change in uncompensated care with the loss to the local community in property tax revenue. In 11 of the 15 cases, the conversion was followed by some level of increase in uncompensated care. However, only three of these conversions produced enough additional uncompensated care to offset the loss in property tax revenue to the community. This analysis, while only a starting point for addressing the community impact of for-profit conversions, suggests that for-profit conversions do not uniformly promote the welfare of the communities where they occur.
Childhood Sexual Abuse and Dating Experiences of Undergraduate Women
Authors: Banyard Victoria L. , Arnold Shanyn , Smith Jennifer
Published: March 2007

Child sexual abuse is a prevalent social problem with a variety of negative consequences for adult survivors. Whereas most studies have focused on intrapersonal effects including depressive symptomatology and post-traumatic stress disorder, recent work has begun to call attention to interpersonal results as well. The current study examined the relationship between the experience of childhood sexual abuse and being a victim of psychological aggression, physical violence, or sexual coercion in a dating relationship in the past year. Participants were 219 female college undergraduates. Child sexual abuse was significantly related to having experienced both physical and psychological dating aggression even after controlling for the presence of conflict in the family of origin. Child sexual abuse was not significantly related to sexual coercion or reports of silencing oneself in relationships.
Fifteen Years of Dissociation in Maltreated Children: Where do We Go from Here?
Authors: Silberg Joyanna L.
Published: March 2007

Controversies have centered on the prevalence of dissociative symptoms and disorders in children and adolescents, recommended treatment approaches, and the potential effects of suggestive interpersonal influences. Convergence among diverse practitioners describing dissociative children and adolescents with similar symptoms and maltreatment histories supports the occurrence of these symptom patterns. Although prevalence information has not been well studied, dissociative symptoms may be found in children from a variety of settings across a continuum of severity. There is not yet agreement on exact treatment protocols, but successful treatment outcomes have been reported. A challenge for future research is to develop assessment protocols that are derived from multiple sources of data, and to incorporate the latest developmental research findings into theory development that addresses psychobiological, family, and cultural factors. The study of dissociation in children and adolescents has the potential to clarify some puzzling child and adolescent presentations and to identify a process by which some children respond and adapt to traumatic environments.
A Misunderstanding Regarding the Duty to Report Suspected Abuse
Authors: Foreman Tonya , Bernet William
Published: March 2007

Confusion exists among professionals as to the circumstances under which a mandatory child abuse reporter must file a report. A review of the literature reveals that professionals sometimes feel obligated to make reports, even though they harbor no suspicion that abuse actually occurred. For example, some individuals believe that they must report abuse allegations made by other individuals, even if the mandatory reporter does not suspect abuse. The authors found that the mandatory reporting statutes of 49 states and the District of Columbia do not require reports unless the reporter has a suspicion of abuse. New York may be an exception. The authors conclude that mandatory reporters generally are not required to report abuse allegations if they themselves do not suspect that abuse occurred. This article encourages mandatory reporters to report abuse as required by the law, but not make unnecessary reports out of confusion or misinformation.
Prediction of Sexual, Emotional, and Physical Maltreatment and Mental Health Outcomes in a Longitudinal Cohort of 290 Adolescent Women
Authors: Bagley Christopher , Mallick Kanka
Published: March 2007

A longitudinal study of 290 Canadian females measured factors at ages 3, 6, 9, and 13 that predicted emotional, physical, and sexual maltreatment occurring up to the age of 16. Significant factors predicting maltreatment were early neurological status and difficult temperament, cognitive status, maternal stress, chronic poverty, negative family climate, weak bonding, and family disruption. There was complex interplay between these factors in predicting both maltreatment status and poor mental health at age 17. Sexual abuse retained a significant link with emotional (but not conduct) problems when effects of physical and emotional abuse were controlled for. Adolescents with a combination of prolonged rather than brief sexual abuse combined with other types of abuse, with a background of family disruption and poverty, and child's impaired coping skills (reflecting poorer cognitive capacity and central nervous system problems) were most likely to have markedly impaired emotional functioning at age 17.
The Impact of DNA Evidence in a Child Sexual Assault Trial
Authors: Golding Jonathan M. , Stewart Terri L. , Yozwiak John A. , Djadali Yas , Sanchez Rebecca Polley
Published: March 2007

Two experiments investigated the impact of DNA evidence in a child sexual assault (CSA) case involving a 6-year-old alleged victim. In Experiment 1, participants read criminal trial summaries of CSA cases in which only DNA evidence was presented, only the alleged child victim's testimony was presented, or both forms of evidence were presented. When DNA evidence was presented, there were more guilty verdicts and greater belief of the alleged victim than when only the alleged victim testified. In Experiment 2, DNA evidence was countered by an alibi witness testifying as to the defendant's whereabouts at the time of the alleged assault. The alibi witness reduced the influence of DNA evidence compared with when DNA evidence was presented without this witness. These results are discussed in terms of the comparative strengths of DNA evidence versus the testimony of the alleged victim.
The Importance of Culture in Treating Abused and Neglected Children: An Empirical Review
Authors: Cohen Judith A. , Deblinger Esther , Mannarino Anthony P. , de Arellano Michael A.
Published: March 2007

There is growing evidence that cultural factors may influence symptom development and treatment referral patterns among abused and neglected children. To date, few treatment outcome studies have specifically examined the impact of race, culture, or ethnicity on treatment response among maltreated children. Those that have attempted to include these factors have typically suffered from lack of clarity of the meaning of these terms. This article reviews the available empirical evidence that addresses the influence of culture on symptom formation, treatment-seeking behaviors, treatment preference, and response following child maltreatment. Hypotheses regarding these findings are addressed, and implications for practice, research, and public policy are discussed.
A Model for Conducting Forensic Interviews with Child Victims of Abuse
Authors: Davies Deborah , Cole Judy , Albertella Gigi , McCulloch Lisa , Allen Kelly , Kekevian Harriet
Published: March 2007

The Center for Ċhild Protection has been conducting forensic interviews with suspected child victims of abuse since 1978, with videotaping in place since 1983. The forensic interview protocol is described here, including interview phases, use of anatomically detailed dolls, use of open-ended versus direct questioning, and use of strategies to cope with avoidant children. Supervision, quality assurance, and peer review procedures are described and discussed.
Limitations of the Current Child Sexual Abuse Medical Literature from a Bayesian Perspective
Authors: Fargason Crayton A. , Zorn Kristin , Ashworth Carolyn , Fountain Kathy
Published: March 2007

This article explores whether the current child sexual abuse literature supports the use of Bayes's Theorem as a means of incorporating medical examination findings into child protection decisions. The purpose of the article is to determine whether likelihood ratios for specific physical findings are available from the current medical literature and to describe deficiencies in the quality of the quantitative medical information available to child abuse decision makers. The article reviews the structure of the current literature from a medical decision-making framework. Of the articles providing quantitative estimates of the value of different physical findings for decision making, only one article allows for the calculation of likelihood ratios for physical examination findings in prepubertal females in a form that facilitates decision making. This article fails to address the interaction between different medical findings. In addition, the examiners in this study were not blinded to whether patients examined had been sexually abused. Although the current child abuse literature can provide estimates of the strength of different physical examination findings, decision makers should be aware of the limitations of these estimates.
Current Trends in Children's Legal Representation
Authors: Haralambie Ann
Published: March 2007

Over the past quarter of a century, the legal representation of children has matured into a recognized subspecialty, complete with its own professional organizations, literature, continuing education, jurisprudence, and emerging ethical consensus. The trend has been away from a subjectively based, paternalistic, guardian ad litem model to a more traditional, client-directed, advocacy model. There continues to be recognition of the special duties owed to child clients, with the resulting need for multidisciplinary education and consultation and a more informed, objective method for determining the legal position of children who cannot or will not provide appropriate direction to their lawyers. This article discusses the historical development of child advocacy and the current standards and recommendations applicable to children's lawyers.
Advocacy's Role in Identifying Dysfunctions in Agencies Serving Abused and Neglected Children
Authors: Weinberg Lois A. , Weinberg Carl , Shea Nancy M.
Published: March 2007

This qualitative study addresses how the various agencies (e.g., child welfare, juvenile court, mental health, education) that are responsible for providing services to abused or neglected children or children with disabilities fulfill their responsibilities to a population of foster children with disabilities. The study focuses on the interventions undertaken by legal advocates on behalf of 12 children who were removed from the homes of their parents because of abuse or neglect. It reveals the specific failings, inadequacies, and abuses within and between the multiple agencies responsible for providing services to the children.