bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting the Performance of Cooperative Simultaneous Localization and Mapping (C-SLAM)
Authors: Mourikis Anastasios I. , Roumeliotis Stergios I.
Published: November 2006

In this paper we study the time evolution of the position estimates’ covariance in Cooperative Simultaneous Localization and Mapping (C-SLAM), and obtain analytical upper bounds for the positioning uncertainty. The derived bounds provide descriptions of the asymptotic positioning performance of a team of robots in a mapping task, as a function of the characteristics of the proprioceptive and exteroceptive sensors of the robots, and of the graph of relative position measurements recorded by the robots. A study of the properties of the Riccati recursion, which describes the propagation of uncertainty through time, yields (i) the guaranteed accuracy for a robot team in a given C-SLAM application, as well as (ii) the maximum expected steady-state uncertainty of the robots and landmarks, when the spatial distribution of features in the environment can be modeled by a known distribution. The theoretical results are validated both in simulation and experimentally.
Square Root SAM: Simultaneous Localization and Mapping via Square Root Information Smoothing
Authors: Dellaert Frank , Kaess Michael
Published: November 2006

Solving the SLAM (simultaneous localization and mapping) problem is one way to enable a robot to explore, map, and navigate in a previously unknown environment. Smoothing approaches have been investigated as a viable alternative to extended Kalman filter (EKF)-based solutions to the problem. In particular, approaches have been looked at that factorize either the associated information matrix or the measurement Jacobian into square root form. Such techniques have several significant advantages over the EKF: they are faster yet exact; they can be used in either batch or incremental mode; are better equipped to deal with non-linear process and measurement models; and yield the entire robot trajectory, at lower cost for a large class of SLAM problems. In addition, in an indirect but dramatic way, column ordering heuristics automatically exploit the locality inherent in the geographic nature of the SLAM problem. This paper presents the theory underlying these methods, along with an interpretation of factorization in terms of the graphical model associated with the SLAM problem. Both simulation results and actual SLAM experiments in large-scale environments are presented that underscore the potential of these methods as an alternative to EKF-based approaches.
A Generative Model of Terrain for Autonomous Navigation in Vegetation
Authors: Wellington Carl , Courville Aaron , Stentz Anthony (Tony)
Published: November 2006

Current approaches to off-road autonomous navigation are often limited by their ability to build a terrain model from sensor data. Available sensors make very indirect measurements of quantities of interest such as the supporting ground height and the location of obstacles, especially in domains where vegetation may hide the ground surface or partially obscure obstacles. A generative, probabilistic terrain model is introduced that exploits natural structure found in off-road environments to constrain the problem and use ambiguous sensor data more effectively. The model includes two Markov random fields that encode the assumptions that ground heights smoothly vary and terrain classes tend to cluster. The model also includes a latent variable that encodes the assumption that vegetation of a single type has a similar height. The model parameters can be trained by simply driving through representative terrain. Results from a number of challenging test scenarios in an agricultural domain reveal that exploiting the 3D structure inherent in outdoor domains significantly improves ground estimates and obstacle detection accuracy, and allows the system to infer the supporting ground surface even when it is hidden under dense vegetation.
Determinants of listeners' enjoyment of a performance
Authors: Thompson Sam
Published: November 2006

A questionnaire survey was conducted to investigate the relationship between 22 variables that could influence a listener's enjoyment of a performance of classical music. A total of 264 musicians and concertgoers participated in the survey, and an exploratory principal components analysis was used to reveal relationships between the variables. This analysis suggested that the data could be described according to a simpler set of six underlying components, which, in turn, might form the basis of an empirically testable model of affective responses. Difficulties with the existing data and directions for future research are discussed.
A survey investigation of the effects of music listening on chronic pain
Authors: Mitchell Laura A. , MacDonald Raymond A.R. , Knussen Christina , Serpell Michael G.
Published: November 2006

Research interest into alternatives to analgesic medication has grown substantially during the past two decades. Moreover, a number of studies have provided empirical evidence that music listening, and in particular listening to our own preferred music, may provide an emotionally engaging distraction capable of reducing both the sensation of pain itself and the accompanying negative affective experience. The current study is a survey of 318 chronic pain sufferers, which aimed to (i) give a detailed description of the music listening behaviour of this group and relate this to experience of pain and quality of life, and (ii) indicate the numbers who consider music listening to be part of their pain management and investigate their perceptions of the benefits. Results indicated distraction and relaxation to be the most frequently perceived benefits of music reported by participants. Both frequent music listening and a perception of music as personally important were further found to relate to higher quality of life. Also, personal importance of music was significantly related to listening to help pain. These findings suggest beneficial effects of music listening to long-term pain.
Lifestyle correlates of musical preference: 1. Relationships, living arrangements, beliefs, and crime
Authors: North Adrian C. , Hargreaves David J.
Published: November 2006

Several studies indicate that musical preferences provide a means of discriminating between social groups, and suggest indirectly that musical preferences should correlate with a variety of different lifestyle choices. In this study, 2532 participants responded to a questionnaire asking them to state their musical preference and also to provide data on various aspects of their lifestyle (namely interpersonal relationships, living arrangements, moral and political beliefs, and criminal behaviour). Numerous associations existed between musical preference and these aspects of participants' lifestyle. The nature of these associations was generally consistent with previous research concerning a putative liberal–conservative divide between differing groups of fans. It is concluded that participants' musical preferences provided a meaningful way of distinguishing different lifestyle choices.
The role of music in adolescents' mood regulation
Authors: Saarikallio Suvi , Erkkilä Jaakko
Published: November 2006

The aim of this study was the exploration and theoretical clarification of the role of music in adolescents' mood regulation. The phenomenon was approached through an inductive theory construction. The data were gathered from eight adolescents by means of group interviews and follow-up forms, and were then analysed using constructive grounded theory methods. The analysis resulted in a theoretical model, which describes mood regulation by music as a process of satisfying personal mood-related goals through various musical activities. The general nature of the mood regulation is described, the goals and strategies of mood regulation are examined, and finally the specific role of music in mood regulation is discussed.
Beyond valence and activity in the emotional connotations of music
Authors: Collier Geoffrey L.
Published: November 2006

In the scaling of emotions in general, and their application to music in particular, the valence (good/bad) and activity or arousal dimensions are ubiquitous. Naive intuition and critics' writings have assumed a greater profundity in music's ability to express emotions than this would imply. Five experiments were performed to show that music is capable of expressing a greater detail in emotional range than can be captured by these two dimensions. The basic paradigm had participants rank order sets of emotions with respect to how well they applied to brief, unfamiliar instrumental selections. People did so rapidly, with significant reliability, even when the affective compass of the emotions to be ranked was restricted to enforce attention to subtle withindimension distinctions, or expanded to allow attention to subtle distinctions.
Promoting orchestral performance: the interplay between musicians' mood and a conductor's leadership style
Authors: Boerner Sabine , von Streit Christian Freiherr
Published: November 2006

This study investigates the degree to which a conductor's transformational leadership and orchestral musicians' positive group mood have a beneficial effect on orchestral performance. The authors study the assertion that there is an interaction effect of conductor's transformational leadership style and group mood in the orchestra. In this view, neither the conductor's transformational leadership nor the musicians' positive group mood alone foster success; only the interaction between transformational leadership and positive group mood is effective at promoting orchestral performance. An empirical study of 208 musicians from 22 German symphony orchestras reveals the assumed interaction effect of a conductor's leadership style and musicians' group mood on the artistic quality of the orchestra.
A quantitative analysis of Beethoven as self-critic: implications for psychological theories of musical creativity
Authors: Kozbelt Aaron
Published: November 2006

How well can composers judge their own ideas and works? This question remains largely unanswered, in part because qualitative data sources like quotations and anecdotes have not been systematically examined. This archival case study of Ludwig van Beethoven remedies this by comprehensively analyzing his self-critical statements. Explicit self-criticisms of 70 compositions were found in Beethoven's letters or conversations, spanning his whole career and most musical forms. Beethoven's positive or negative assessments are reliably associated with three citation measures of aesthetic success, and the likelihood of correct decisions strongly increased with age. His comments comparing several similar masterpieces are likewise largely consistent with expert ratings and recording counts. Finally, the ranking of works by listener-hours (number of complete recordings multiplied by performance duration) correspond closely to Beethoven's intra-genre preferences. The results suggest considerable self-critical acumen on Beethoven's part. The results support an expertise view of musical creativity in which knowledge and experience are likely to enable both progressively greater creative accomplishments and sounder self-criticism.
EPCglobal Standards in the Pharmaceutical Industry: Toward a Safe and Secure Supply Chain
Authors: Celeste Robert , Cusack Beth Ann
Published: November 2006

This article focuses on the value of standards and the industry's work to date on an ePedigree standard, track-and-trace and electronic product code (EPC)/radio frequency identification (RFID). Parallels are drawn between the development of the bar code standard in the 1970s by EPCglobal's parent company, GS1 US, and the activities seen today in the EPC/RFID marketplace. The article also touches on issues such as patient privacy, item identification, sensor technology. Last, the article identifies areas other than counterfeit that may benefit from the standards that are being developed today.
Prescription Drug Counterfeiting: Distributors Meet the Challenge
Authors: Ducca Anita T.
Published: November 2006

The Healthcare Distribution Management Association (HDMA) and its primary full-service health care distributor members, other members of the health care supply chain, and government officials have made considerable progress in the ongoing effort to further secure the nation's prescription drug supply chain. However, all stakeholders must continue to seek additional deterrents. Based on past experiences, effective anticounterfeiting techniques involve 3 crucial components: (1) the approaches must be innovative, (2) every supply chain partner must share the commitment to fight counterfeit drugs, and (3) they include interim measures, particularly those emphasizing preventing criminal counterfeiters from getting into the system. These components are met by the recommendations of the HDMA and its distributor members including the adoption of supply chain technologies, such as radio frequency identification; stricter, uniform distributor licensing standards across the 50 states; and tougher regulation, stronger enforcement, and harsher penalties for the crime of counterfeiting medicine. Also strongly supported are continuous improvements in business practices. The US health care supply chain has evolved, and there have been important changes since the enactment of the Prescription Drug Marketing Act. This article recommends strategies for meeting the challenge of counterfeit drugs.
The Food and Drug Administration's Counterfeit Drug Initiative
Authors: Bernstein Ilisa B. G. , Shuren Jeffrey
Published: November 2006

There have been significant efforts by the public and private sector to further secure our nation's drug supply from counterfeit drugs. In 2004, FDA released a framework as guidance for these efforts and has been facilitating the implementation of this framework. Technology-based solutions, such as using radio-frequency identification (RFID) as a means to create an electronic pedigree that documents the movement of a drug product through the drug supply chain, is an important element of the framework. In 2005, two years after the release of the framework, FDA issued an update reporting the progress on reaching the goals of the framework, including RFID implementation, use of electronic pedigree, the pedigree requirements under the Prescription Drug Marketing Act. This article summarizes the findings of FDA's Counterfeit Drug Task Force 2006 Update. A full copy of the report can be accessed at http://www.fda.gov/oc/initiatives/counterfeit/report6_06. pdf.1
Potential Liability for Counterfeit Medications
Authors: deKieffer Donald E.
Published: November 2006

Counterfeit drug cases have increased over the past 5 years. More people have been taking counterfeit drugs, and surprisingly, there have been relatively few lawsuits. Because of this, there still exists a question as to who will be liable. Counterfeit drugs usually enter the market through diversion. Once the drugs have entered the market, they are still difficult to detect because they appear like the real drug, and they are often destroyed through ingestion. Also, if a patient does not recover, that does not mean the drugs were counterfeit. This makes it difficult to prove liability because there needs to be causation. Proving that a counterfeit drug actually caused the injury can be very difficult. After causation is shown, there is the question of whom to sue. Often the wholesaler is the most vulnerable. The Fagan case illustrates the potential liability faced by wholesalers and others in the pharmaceutical industry. That litigation has raised the awareness of wholesalers and others about the potential liability of buying drugs in the secondary market.
Prescription Drug Wholesalers: Drug Distribution and the Inspection Process (A Florida Perspective)
Authors: Laven David L.
Published: November 2006

Counterfeit and diverted drugs are a growing problem not only in the US drug distribution supply chain but also in similar drug distribution supply chains the world over. These systems are being infiltrated by a growing trend in the illegal trade of pharmaceuticals, the result of activities of unscrupulous drug wholesalers, rogue Internet sites, foreign pharmacies, and organized criminal elements, all of which are motivated by huge profits. Efforts must be taken and new paradigms implemented on many fronts that will ultimately lead to maintaining the integrity of drug products and their packaging, securing the movement and safety of drug products as they travel through the US drug distribution supply chain. In addition, enhancing regulatory oversight and enforcement, increasing penalties for counterfeiters and drug diverters, advocating and pursuing heightened vigilance and awareness of counterfeit and diverted drugs, and increasing international collaboration are avenues that will aid in combating drug diversion and counterfeiting. This article will address several topics pertaining to drug wholesale distribution practices and how avenues for counterfeit and diverted drugs can permeate this process, notably through the secondary or shadow or gray drug market. Discussion will also highlight the emergence of Florida's drug pedigree laws and what were the goals to be obtained through enhanced legislative and enforcement action since 2003, coupled with the current state of these pedigree laws today as a result of action emanating from the 2006 Florida legislature (notably House bills HB371 and HB1540). Trends and developments in these major areas will be reviewed, with some analysis rendered noting strengths and areas of remaining weakness that require additional attention in the ongoing battle to stem the tide of drug diversion and counterfeiting, both nationally and within the state of Florida.
How to Catch a Pirate 101: A Guide for the Investigation of Bad Wholesaling Practices
Authors: Ling Louis A.
Published: November 2006

This article provides background information regarding the secondary source pharmaceutical wholesaling market, how it operates, and how some of its operators introduce counterfeit, adulterated, mislabeled, stolen, or other undesirable drugs into the nation's drug supply. After this discussion, the article details investigative techniques that can be used to detect bad wholesaling practices. Finally, the article ends with a series of recommendations specifically targeted to regulators and industry actors intended to curb the activities of bad wholesalers.
Complete Resolution of Olanzapine-Induced Diabetic Ketoacidosis
Authors: Fulbright April R. , Breedlove Keith T.
Published: November 2006

We report the case of a nondiabetic man who developed diabetic ketoacidosis associated with high-dose olanzapine. Olanzapine has been associated with diabetic ketoacidosis and also with weight gain, lipid abnormalities, and the development of type 2 diabetes. This case is of interest both because of the sudden onset and because the patient's blood glucose stabilized 1 month after discontinuation of olanzapine, thus allowing insulin therapy to be discontinued. The patient has now been stabilized on ziprasidone with no further abnormalities in blood glucose.
Network Composition and Health Behaviors Among Older Samoan Women
Authors: Levy-Storms Lené , Lubben James E.
Published: November 2006

Purpose: The purpose of this article is to explore how kin and nonkin social support networks influence health behaviors among older Samoan women.

Method: Using a cross-sectional survey design, 290 Samoan women who were age 50 years and older were interviewed. Using separate logistic regressions, each health behavior was regressed on age and kin and nonkin social support networks after controlling for background characteristics and health status.

Results: In multivariate analyses, higher scores on kin increased the likelihood of never salting food, getting screened for diabetes in the past year, and having had a mammogram in the past 2 years, whereas higher scores on nonkin increased the likelihood of exercising at all and ever trying to lose weight.

Discussion: Kin networks positively affect mostly chronic disease-related health behaviors, whereas nonkin networks positively affect mostly lifestyle-related health behaviors.
Variation in Long-Term Care Needs Assessors’ Willingness to Support Clients’ Requests for Admission to a Residential Home
Authors: Jörg Frederike , Borgers Natacha , Schrijvers Augustinus J. P. , Hox Joop J.
Published: November 2006

Objectives: The purpose of this study is to determine what client, needs assessor, and agency factors explain variation in decision making by long-term care needs assessors concerning clients requesting admission to a residential home.

Method: Hypothetical case vignettes were sent to needs assessors allocating services for the elderly. Multilevel logistic regression analysis provided random and fixed effects.

Results: The authors found random effects of the level of needs assessors are negligible, of the level of agencies small though statistically significant, clients receiving largest relative share of the variance. The amount of care already present appeared most important in the decision. Needs assessors were willing to support their clients’ wishes only when they were clearly motivated. Policy implications considering the tension between clients’ preferences and equity are discussed.
Care at the End of Life
Authors: Zapka Jane G. , Carter Rickey , Carter Cindy L. , Hennessy Winnie , Kurent Jerome E. , DesHarnais Susan
Published: November 2006

Objective: To profile communication and recommendations reported by adults with terminal illness and explore differences by patient and physician characteristics.

Method: This pilot was a cross-sectional study sample of 90 patients (39 Caucasian, 51 African American) with advanced heart failure or cancer. Participants completed an in-person, race-matched interview.

Results: Participation was high (94%). Discussion about end-of-life topics was low. For example, only 30% reported discussion of advance directives, and 22% reported their physician inquired about spiritual support. Participants with cancer were significantly more likely to be receiving pain and/or symptom management at home, aware of prognosis, and participating in hospice. African American participants who were under the care of African American physicians were less likely to report pain and/or symptom management than other racial matches.

Discussion: Although additional research on factors related to communication is important, initiation of patient-centered counseling by all physicians with seriously ill patients is essential.
Derivation and Confirmation of Scales Measuring Medical Directors’ Attitudes About the Hospitalization of Nursing Home Residents
Authors: Marcantonio Edward R. , O’Malley A. James , Murkofsky Rachel L. , Caudry Daryl J. , Buchanan Joan L.
Published: November 2006

Objectives: To derive and confirm scales measuring medical director’s attitudes about hospitalization of nursing home residents.

Method: The authors surveyed nursing facility medical directors about the necessity of hospitalizing residents for eight clinical conditions and compared the ratings to those obtained from an expert panel to derive a relative hospitalization score. They also asked about factors that might influence hospitalization decisions. They performed a factor analysis to derive scales that measure attitudinal determinants of hospitalization and used the relative hospitalization score to confirm the scales.

Results: The survey had a 79% response rate. The relative hospitalization score demonstrated that medical directors were slightly less likely to recommend hospitalization than expert panel physicians. Factor analyses yielded 10 scales focusing on nursing home functioning, economics, resident specific considerations, and physician attitudes. Eight of the 10 scales had significant bivariable associations with the relative hospitalization score, and 6 had significant multivariable associations.

Discussion: Medical directors identify multiple determinants of hospitalization for nursing facility residents across several domains. Hospitalization decisions for nursing facility residents are complex and involve clinical and nonclinical factors.
The blood of the insane
Authors: Noll Richard
Published: November 2006

The history of serological investigations of the blood of the insane is traced from the initial such study in 1854 by a solitary Scottish asylum physician, who counted the blood cells of his lunatic patients under a weak microscope, to the January 2005 announcement by an international team of geneticists of the development of a genomic blood test that can differentially diagnose schizophrenia and bipolar disorder. The story of the first claim of the development of a blood test for madness in 1912 -the Abderhalden defensive ferments reaction test -is related in detail. Studies of the blood of the insane have followed four general methodological paradigms: the corpuscular richness paradigm (1854); the metabolic paradigm (c. 1895); the immunoserodiagnostic paradigm (1906); and the medical genomics paradigm (2005).
Psychopathology and the essence of language: the interpretation of aphasia by Kurt Goldstein and Roman Jakobson
Authors: Friedrich Janette
Published: November 2006

This paper presents a comparative analysis of the research on aphasia carried out by the linguist Roman Jakobson and the neuropsychiatrist Kurt Goldstein. The linguistic theory of aphasia advocated by Jakobson in the 1950s and 1960s is based on clinical case studies reported by Goldstein at the beginning of the 1930s. However, Jakobson used Goldstein’s clinical observations without taking into account his theoretical work on language pathology. In particular, Jakobson fed the symptoms described by Goldstein into a structuralist model, allowing him to predict different types of aphasia deductively. Goldstein, however, saw the clinical manifestations of aphasia as a particular way of being in the world. By studying the changes associated with the patient’s reaction to the disease, Goldstein wanted to reach an understanding of language functioning in the normal subject. He distinguished between an instrumental use and a symbolic use of language, the latter mainly characteristic of language use in the normal subject. Only a symbolic use reveals the essence of language by showing its intimate nature, the psychic link tying the subject to the world.
Behaviorally-based disorders: the historical social construction of youths’ most prevalent psychiatric diagnoses
Authors: Mallett Christopher A.
Published: November 2006

Psychiatry in the USA controls the definitions of mental health disorders and diagnosis through required practice utilization of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and fiscal reimbursement using it. The present sociohistorical research paper presents and critically examines the Manual’s systemic and diagnostic development of today’s most prevalent youth mental health diagnoses ( conduct and oppositional defiant disorders). Through a social construction theoretical paradigm, this research identified diagnostic classification systems, nosology changes, critical time periods, conducive social and cultural conditions, and key individuals involved in the development of these youth behaviorally-based disorders within two distinct historical time frames: 1880 to 1968 and 1969 to 2000. It also identified patterns of nosology system and diagnostic category changes based upon very limited empiricism, inordinately influenced by a limited number of individuals, and understood through a socially constructed framework.
Hysteria and catatonia as motor disorders in historical context
Authors: Shorter Edward
Published: November 2006

It is difficult to imagine motor symptoms in psychiatry as different as hysteria and catatonia. The mechanism of hysteria is presumed to be psychogenic, while catatonia has always been considered to be among the most organic syndromes in psychiatry. Yet hysteria and catatonia have historically been regarded as allied conditions, an observation borne out by recent developments in neuroscience as well as by a growing awareness that the presentation of both conditions has changed over the years. In hysteria, the main shift has been from motor symptoms to sensory complaints such as chronic fatigue; in catatonia, the major change has been the virtual disappearance of negativistic or oppositional behaviour. It is possible that catatonia as well as hysteria may be responsive to changing cultural norms.
Validation of Physician Survey Estimates of Surgical Time Using Operating Room Logs
Authors: McCall Nancy , Cromwell Jerry , Braun Peter
Published: November 2006

The Medicare Physician Fee Schedule (MFS) is based on relative value units that represent the costliness of a particular service compared to all other services. Comparison of current surgical time estimates show systematically longer times than those obtained in the original Harvard study more than a decade ago. Any bias in surgical time estimates is likely to distort MFS payments across specialties. This study is the first to use objectively collected intraservice surgical time to validate estimates of time collected from small-group physician surveys. Median intraservice time estimates are significantly longer than intraservice times from operative logs. The average difference across 60 procedures is 31 minutes; the range is from a few minutes to almost 2 hours. Given that half of the studied surgical procedures is a subset of services that anchors the MFS, surgical times for other related services are likely to be overstated as well.
Do Content and Format Affect Older Consumers’ Use of Comparative Information in a Medicare Health Plan Choice? Results from a Controlled Experiment
Authors: Uhrig Jennifer D. , Harris-Kojetin Lauren , Bann Carla , Kuo Tzy-Mey
Published: November 2006

We assessed the efficacy of materials that integrated comparative information on cost, benefits, and quality for employer-based retiree health plans and Medicare Advantage plans in a randomized experiment to test the impact of content and format. Results indicate that older consumers who received the intervention materials found the materials easier to use, gained greater knowledge about Medicare from them, were more likely to value comparative quality information, were more likely to select higher quality plans, and were more likely to choose a plan that reflected the dimensions they found most important compared to older consumers receiving the control materials.
Disparities in Access to Essential New Prescription Drugs between Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanic Whites
Authors: Wang Junling , Noel Jason M. , Zuckerman Ilene H. , Miller Nancy A. , Shaya Fadia T. , Mullins C. Daniel
Published: November 2006

Prior studies do not address racial and ethnic disparities in essential new drug use and whether disparities decrease through time. Using the Medical Expenditure Panel Survey (1996-2001), racial and ethnic disparities were examined separately by comparing non-Hispanic whites to non-Hispanic blacks and Hispanic whites, respectively. New drugs were defined as approved within the past 5 years, and an expert panel identified essential drugs. Negative binomial models adjusted for socioeconomic and health characteristics. The mean annual number of times essential new drugs were obtained among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites were 1.02, 0.94, and 0.70, respectively. After adjusting for confounders, ethnic disparities generally were not significant, but racial disparities became significant. This study did not identify declining disparities during early years of drugs’ life cycles. Disparities exist in new, essential drug acquisition between non-Hispanic whites and non-Hispanic blacks. Socioeconomic and health characteristics explain many of the observed disparities.
Competition in Health Insurance Markets: Limitations of Current Measures for Policy Analysis
Authors: Scanlon Dennis P. , Chernew Michael , Swaminathan Shailender , Lee Woolton
Published: November 2006

Health care reform proposals often rely on increased competition in health insurance markets to drive improved performance in health care costs, access, and quality. We examine a range of data issues related to the measures of health insurance competition used in empirical studies published from 1994-2004. The literature relies exclusively on market structure and penetration variables to measure competition. While these measures are correlated, the degree of correlation is modest, suggesting that choice of measure could influence empirical results. Moreover, certain measurement issues such as the lack of data on PPO enrollment, the treatment of small firms, and omitted market characteristics also could affect the conclusions in empirical studies. Importantly, other types of measures related to competition (e.g., the availability of information on price and outcomes, degree of entry barriers, etc.) are important from both a theoretical and policy perspective, but their impact on market outcomes has not been widely studied.
Market and Plan Characteristics Related to HMO Quality and Improvement
Authors: Scanlon Dennis P. , Swaminathan Shailender , Chernew Michael , Lee Woolton
Published: November 2006

Existing research on health plan performance examines whether variation in plans’ scores is related to enrollee and health plan traits, primarily using cross-sectional research designs. This study extends that literature by incorporating data on market characteristics using a longitudinal framework. We estimate multivariate growth models that relate plan performance on standard measures to market and HMO characteristics using an unbalanced panel of data for 1998 to 2002. We find that HMO competition is not associated with better performance or greater rates of improvement in performance on the HEDIS chronic care measures. HMO penetration, on the other hand, is positively associated with HEDIS performance in several of the chronic care process-and-outcomes measures but not with a greater rate of improvement through time. Our analysis indicates that a significant percentage of the unexplained variation in quality improvement is because of permanent, unobserved plan-level characteristics that future research should strive to identify.
Measuring Managed Care and Its Environment Using National Surveys: A Review and Assessment
Authors: Liang Su-Ying , Phillips Kathryn A. , Haas Jennifer S.
Published: November 2006

Measuring the characteristics of managed care plans and of the health care markets in which the plans operate is a complex undertaking. Based on a previously developed framework of health plan factors, we review measures of managed care plans and the characteristics of the area in which an individual resides using two national surveys, the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS), and other data sources such as the Area Resources File and the United States census. We provide empirical applications of these measures and also discuss common analytical issues that should be considered. Despite the many analytical challenges presented by these complex surveys, the MEPS and NHIS are rich sources of data for examining the impact of health plans and the characteristics of markets or areas on health care expenditures and outcomes.
Hospital Competition, Managed Care, and Mortality after Hospitalization for Medical Conditions: Evidence from Three States
Authors: Escarce José J. , Jain Arvind K. , Rogowski Jeannette
Published: November 2006

This study assessed the effect of hospital competition and HMO penetration on mortality after hospitalization for six medical conditions in California, New York, and Wisconsin. We used linked hospital-discharge and vital-statistics data to study adults hospitalized for myocardial infarction, hip fracture, stroke, gastrointestinal hemorrhage, congestive heart failure, or diabetes. We estimated logistic regression models with death within 30 days of admission as the dependent variable and hospital competition, HMO penetration, and hospital and patient characteristics as explanatory variables. Higher hospital competition was associated with lower mortality in California and New York but not Wisconsin. Higher HMO penetration was associated with lower mortality in California but higher mortality in New York. These findings suggest that hospitals in highly competitive markets compete on quality even in the absence of mature managed-care markets. The findings also underscore the need to consider geographic effects in studies of market structure and hospital quality.
It's Not Too Late: Insomnia Research and Palliative Care
Authors: Hultman Todd
Published: November 2006

The purpose of palliative care is to alleviate noxious symptoms and promote quality of life in patients and families facing life-threatening illness. Although research in palliative care has made advances in evidenced-based practice, research into sleep disturbances in the context of advanced disease has remained very limited. This research deficit is critical given that sleep disturbance can have a significant impact on quality of life. The purpose of this article is to explore relationships between sleep disturbance and palliative care as reflected in the literature. From this perspective, the author concludes with issues of relevance to nursing care of patients with advanced disease.
Effects of Depression on Sleep Quality, Fatigue, and Sleepiness in Persons With Restless Legs Syndrome
Authors: Cuellar Norma G. , Ratcliffe Sarah J. , Chien Darleen
Published: November 2006

BACKGROUND: Restless legs syndrome is a sleep disorder that is associated with depression and poor sleep quality; it possibly affects sleepiness and fatigue, thereby affecting quality of life. OBJECTIVE: To determine the effect of depression on sleep quality, sleepiness, and fatigue in persons with restless legs syndrome. STUDY DESIGN: Descriptive, comparative study. Data was collected on demographics, depression, sleep quality, sleepiness, and fatigue. Participants were grouped based on depression scores. RESULTS: 40% of the sample reported depressive symptomology. Depressed participants had significantly worse sleep quality (t=4.12, df=40, p<.001) and fatigue (t=3.69, df=46, p=.001). Depression did not affect sleepiness (p=.733). CONCLUSIONS: Persons with restless legs syndrome who are depressed have poorer sleep quality and higher fatigue than nondepressed persons with restless legs syndrome. Few participants are being treated for depression. Health care providers must recognize the impact that depression has on persons with restless legs syndrome and develop innovative nonpharmacological strategies to help with depression.
The Experience of Being Sleepy While Managing Type 2 Diabetes
Authors: Chasens Eileen R. , Olshansky Ellen
Published: November 2006

BACKGROUND Although it is known that excessive daytime sleepiness negatively affects mood and motivation, it is unknown how sleepiness affects diabetic management. OBJECTIVE The purpose of this study was to understand the experience of sleepiness in managing type 2 diabetes. STUDY DESIGN This grounded theory study employed three focus groups led by a facilitator knowledgeable of qualitative research. Sessions were tape recorded and then transcribed verbatim. Participants were adults with type 2 diabetes older than 21 years with subjective sleepiness. Transcripts of the sessions were reviewed for themes. RESULTS Seventeen persons participated (35% men, 65% Whites, aged 55.5 ± 7.8 years). Major themes extracted from the data were (a) sleepiness was a daily burden, (b) only the minimum was done, (c) lack of structure exacerbating the difficulty, and (d) persons felt negative personal emotions. CONCLUSIONS Health care providers need to appreciate and understand that sleepiness negatively affects the daily lives of persons with diabetes, making diabetic management more difficult.
Medications and Sleep in Nursing Home Residents With Dementia
Authors: Simpson Katherine M. , Richards Kathy Culpepper , Enderlin Carol A. , O'Sullivan Patricia S. , Koehn Melissa
Published: November 2006

BACKGROUND: Nursing home residents with dementia have characteristic sleep disturbances that correlate with behavioral symptoms, risk for falls, and increased caregiver burden. Interventions to improve sleep in this population consist primarily of pharmacologic agents, which may have negative side effects. OBJECTIVES: This study examined prescribing practices for common classes of medications affecting sleep and compared users and nonusers of these medications for daytime sleep, nighttime sleep, and the percentage of 24-hr sleep that occurred at night. STUDY DESIGN: In this secondary data analysis, actigraphy measured selected sleep variables. RESULTS: 195 nursing home residents participated in the study (mean age = 80.3 years, SD 8.12 years). Of the participants, 70.8% were prescribed two or more psychotropic medications. Novel antipsychotics were the most commonly prescribed class of medication (26%). The percentage of nighttime sleep for users of selective serotonin reuptake inhibitors was 8% lower than that of nonusers (p = .005). CONCLUSION: Medications for the management of dementia, depression, and psychosis may worsen nighttime sleep of nursing home residents with dementia.
Polyamory and its ‘Others’: Contesting the Terms of Non-Monogamy
Authors: Klesse Christian
Published: November 2006

Drawing on qualitative in-depth interviews with bisexual-identified practitioners of polyamory in the UK, this article shows that love, intimacy and friendship are salient themes in polyamory discourses. An exploration of the question of how respondents define polyamory with regard to different ‘styles of non-monogamy’ reveals that the boundaries of polyamory are contested within the movement that has formed around this concept. The prevalent definition of polyamory as ‘responsible non-monogamy’ usually goes hand in hand with a rejection of more sex- or pleasure-centred forms of non-monogamy, such as ‘casual sex’, ‘swinging’, or ‘promiscuity’. The author argues that the salience of the relational ideologies of love and intimacy hampers the potential of polyamory to ground a truly pluralistic sexual ethics.
‘There Aren’t Words for What We Do or How We Feel So We Have To Make Them Up’: Constructing Polyamorous Languages in a Culture of Compulsory Monogamy
Authors: Ritchie Ani , Barker Meg
Published: November 2006

Polyamory is an emerging sexual story that troubles mononormativity: the dominant discourse of monogamy which is reproduced and perpetuated in everyday conversation and saturates mainstream media depictions. Through an analysis of online discussions, websites and self-help books, this article explores the ways in which members of polyamorous communities construct their identities through language. We argue that the potentials of polyamory are, to some extent, constrained by the conventional mononormative language of partnerships, infidelities and jealousy. However, alternative languages are emerging which offer new discursive possibilities for the development of polyamorous identities, relationships and emotions.
Progressive Polyamory: Considering Issues of Diversity
Authors: Noël Melita J.
Published: November 2006

Polyamory has the potential to revolutionize how people in the USA engage in and think about relationships and families at the beginning of the 21st century. However, as indicated through content analysis of 12 texts published between 1992 and 2004, polyamorists fail to meaningfully acknowledge or collaborate with others with shared interests to advocate common goals. In particular, these texts, written by and geared toward an assumed audience of white, middle-class, able-bodied, educated, American people fail to address how nationality, race, class, age and (dis)ability intersect with gender and sexuality in the theory and practice of polyamory. In order to successfully challenge systemic, intersecting oppressions, polyamorists must move beyond the limits of identity politics to build coalitions and norms of inclusivity around shared issues, such as expanding definitions of relationships, families and communities.
Poly-Hegemonic Masculinities
Authors: Sheff Elisabeth
Published: November 2006

This article explores polyamorous men’s potential to both enlarge and reinforce the concept of hegemonic masculinity through their emotional expressions and management, as well as their sexual expressions and relationships. Polyamorous people openly engage in romantic, sexual, and/or affective relationships with multiple people simultaneously. Polyamory differs from swinging with its emphasis on long-term, emotionally intimate relationships; and from adultery with its focus on honesty and (ideally) full disclosure of the network of sexual relationships to all who participate in or are affected by them. Both men and women have access to additional partners in polyamorous relationships, distinguishing them from polygynous ones. My ethnographic analysis expands sociological understandings of hegemonic masculinity by investigating this previously unexamined area of men’s sexual and romantic interactions. Employing R.W. Connell’s framework of hegemonic masculinity, I analyze some of the ways in which the polyamorous men in my sample are complicit with, marginalized by, subordinate to, and resistant of hegemonic codes of masculinity. I thus expand Connell’s configuration of hegemonic masculinity to include active defiance to its requirements and conclude that, to varied degrees, these poly men attempt to redefine their masculinities and resist the strictures of hegemonic masculinity.
Challenging the paradigm: notes on developing an indigenized teacher education curriculum
Authors: Gopinathan S.
Published: November 2006

While considerable attention is being paid to reforming education systems to prepare students for the challenges of globalization and a knowledge-based economy, teacher education models in the Asia Pacific remain insufficiently critiqued. There is an urgent need to rethink teacher education as, in spite of decades of investment and development, major problems of inequality, attrition, incomplete and inadequate learning continue to blight our education systems. It is proposed that teacher education needs to become more culturally authentic as teaching and learning are best viewed as culturally scripted activities. The utilization of indigenous knowledge will be central to this task. The article concludes with some suggestions for how the task may be started.