bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction
Authors: Roy Jeffrey
Published: July 2003

The emergence of e-government may not be a natural evolution of existing public sector structures and processes, although the degree to which it is not drives much debate. Meaningful research on this topic could thus be helpful in providing a basis for more clarity, insight, and understanding of this important topic. The aim of this special issue on e-government is, as a result, to generate new and relevant scholarly contributions on the transformation at work in the public sector today, due to the growing online patterns of socioeconomic and political activity shaping individual and organizational behavior around the world.
New Technologies and Institutional Change in Public Administration
Authors: Gascó Mila
Published: July 2003

This article aims to study and analyze, from a multidisciplinary point of view, the organizational and institutional transformations that public administration is experiencing due to a country’s transition to the information and knowledge society. Three specific goals are pursued: (a) studying the use of new technologies in the public administration, (b) studying the impact brought about by the use of new technologies by the public administration, and (c) studying the institutional changes caused by the use of these technologies. To achieve these goals, three guiding lines are considered: first, the term governance; that is, the collection of institutions and rules that set the limits and the incentives needed for the constitution and functioning of interdependent networks of actors (government, private sector and civil society actors); second, the new institutionalism perspective; and finally, the relationship between technology and organizational and institutional change.
Who Participates and Why?
Authors: Weber Lori M. , Loumakis Alysha , Bergman James
Published: July 2003

Scholars continue to find that political participation, especially beyond voting, is in limited supply in the United States. However, the rise of the Internet provides possibilities to mitigate such circumstances. Some scholars suggest that the Internet disconnects citizens from public life, while other studies note that it provides a venue for further participation in public life. The question remains as to whether the Internet mobilizes or demobilizes citizens. The article explores this question using Survey2000, a comprehensive, Internet-based, social scientific survey conducted in 1998 by scholars at Northwestern University in conjunction with the National Geographic Society. A positive relationship is found between engagement on the Internet and civic and political participation. However, the article also finds that the Internet appears to exacerbate the socioeconomic bias already exhibited by civic and political participation prior to the rise of the Internet.
Emerging Electronic Infrastructures
Authors: GrÖNlund ÅKe
Published: July 2003

The concepts of electronic government and electronic democracy have common roots in that electronic government must rest on, and support, democratic principles. This article discusses how the components of a democratic society are treated as they are built into the emerging electronic infrastructures, dealing with services and dialogues pertinent to the functioning of the public sector, and tries to find emerging patterns. This article opens a discussion on the nature of the emerging infrastructures by reviewing four implementations of local e-democracy and putting them into the context of global e-government development, in particular the European Union’s development of “eEurope.” It is found that the cases represent different models of democracy, models that are only partially explicit. The development is governed more by gradual implementation of information and communication technology than a general political agenda. This means local actors have great influence, and hence, e-democracy is not deterministic; it can come in many shapes.
Internet and Society
Authors: Ferrigno-Stack Josephine , Robinson John P. , Kestnbaum Meyer , Neustadtl Alan , Alvarez Anthony
Published: July 2003

In June 2001, more than 50 graduate students and Internet scholars gathered at the University of Maryland, College Park, and the University of California, Berkeley, to meet and discuss the state of Internet and society research at the first annual WebShop. Distinguished speakers presented their research and interacted with the students over a 3-week period. This article is a summary of those presentations and a brief analysis of the features of the 2001 WebShop.
Negotiating Teacher Compensation: Three Views of Comprehensive Reform
Authors: Conley Sharon , Muncey Donna E. , Gould Jewell C.
Published: July 2003

Recently, the question of how best to compensate teachers for the work they do has become newsworthy again. The authors report on work undertaken in three American Federation of Teachers (AFT) sites to develop new and comprehensive compensation plans. All three plans are viewed (locally and nationally) as comprehensive reforms of existing compensation systems, yet each plan is distinctive as well. Each of the compensation plans examined combines aspects of different compensation alternatives. Thus, each site is developing its own model, although the components are drawn from an apparently small set of alternative arrangements. Using union bargainers’descriptions as a starting point, the authors compare the three plans and their implementation (actual and proposed) and discuss several observations that bargainers made about their work. The article concludes with some observations concerning the emerging compensation negotiating process and products and some of the directions that compensation reform is moving in.
Teacher Unions and Gender Equity Policy for Education
Authors: Marshall Catherine
Published: July 2003

The relationships and networks of teacher unions and the women’s movement helped create the political pressure for the development of policy for gender equity in education. This research, using documents and interviews, shows how, from shared values, the policy discourse and strategies for gender equity opened policy windows for federal and state policies, how the American Federation of Teachers (AFT) and National Education Association (NEA) created their own strategies (e.g., resolutions, training, and curricular materials), and how the unions and women’s movement activists built social capital from their combined strengths. It also shows that the networks, relationships, and shared values helped maintain some gender policy implementation when governmental attention, programs, and budgets were inadequate. The research illustrates teacher unions as agents for social change. It also expands policy studies by focusing on gender as a substantive policy issue in education. Finally, it demonstrates the possibilities for combining frameworks from policy windows with social capital theory.
Managing in the Middle: School Leaders and the Enactment of Accountability Policy
Authors: Spillane James P. , Diamond John B. , Burch Patricia , Hallett Tim , Jita Loyiso , Zoltners Jennifer
Published: July 2003

This article investigates how mid-level managers make sense of and mediate district accountability policy. Arguing that teachers’evolving perceptions and understanding of accountability policies are likely to be mediated by school leaders, the authors explore how school managers enact their policy environments, focusing chiefly on the ways in which they construct district accountability policies. Adopting a cognitive or interpretive frame on implementation, the authors illuminate how school leaders’ sense-making is situated in their professional biographies, building histories, and roles as intermediaries between the district office and classroom teachers.
Overcoming the Paradox of Change without Difference: A Model of Change in the Arena of Fundamental School Reform
Authors: Woodbury Sonia , Gess-Newsome Julie
Published: July 2003

Fundamental shifts in American educational practices have been difficult to accomplish and sustain. Most reform efforts that have sought to significantly alter accepted patterns of schooling have emerged in practice as shadows of their original intent. This article reviews four perspectives on educational reform that provide insights into the historical paradox of change without difference. None of those previous perspectives, however, adequately accounts for the complexity of the reform process. A new model of educational reform, the Teacher-Centered Systemic Reform (TCSR) model, integrates the previous perspectives and highlights teacher thinking as a central factor shaped by the interdependent influences of the general context of reform, a teacher’s personal profile, and the structural and cultural contexts of teachers’work within embedded systems. The authors provide examples that illustrate how the TCSR provides a more comprehensive framework for the design and evaluation of reform initiatives.
Elections, Voting, and Democracy in Local School District Governance
Authors: Feuerstein Abe
Published: July 2003

This article examines the role of school board elections in local school governance. The article argues that the history of school governance including many current reforms such as mayoral takeovers, state intervention, and various market driven models tell a story of decreasing public voice in local educational affairs. The article further argues that the current lack of faith in government in general and school boards in particular is related to an adversarial view of democracy. Deliberative democracy is presented as an alternative to adversarial practices that rely too heavily on elections and voting to create a sense of legitimacy. Some of the benefits associated with increased deliberation over educational policy would be enhanced accountability, improved public spiritedness, and a greater sense of mutual respect.
Minority Voting Issues
Authors: Contreras A. Reynaldo
Published: July 2003

The purpose of this article is to present an analysis of how electoral law has affected minority group efforts to participate in the electoral process. The focus is on those factors that have played a critical role in obstructing minority enfranchisement. The literature reviewed suggest a number of factors that affect political participation, including social networks, education, income, employment status, and region of residence. The existing research suggests that the pursuit of equality in voting participation needs to be undertaken not only from the social and political levels but also from the institutional level. The issue of political equality cannot be addressed before the hurdle of minority enfranchisement is fully understood and resolved. Only then can we comprehend other challenging issues of political representation and coalition building across minority groups or between majority and minority groups in all areas of social policy, including education. Today, the hard-won gains of minorities are in danger of being extinguished.
Seeking the Mantle of "Opportunity": Presidential Politics and the Educational Metaphor, 1964-2000
Authors: Hess Frederick M. , McGuinn Patrick J.
Published: July 2003

Traditionally, scholars have accorded the issue of education only a minor role in understanding presidential elections. The authors suggest that this is a mistake and offer a reassessment of education's symbolic and substantive role in contemporary presidential politics. In particular, education's embodiment of opportunity and personal responsibility made it a crucial metaphor in post-Great Society politics. The new conservatism that emerged in 1964 would enjoy success with its sunny promise of individual opportunity but would eventually be torn between its implicit guarantee of universal opportunity and opposition to activist government. In the early 1990s, centrist Democrats used education to exploit this tension and slip the party's "tax and spend" reputation. Republican nominees, in turn, struggled to demonstrate their commitment to extending opportunity to all Americans. In 2000, Republican candidate George W Bush used an accountability-driven education program to neutralize the Democratic advantage but, in so doing, created a potential party rift with implications for future presidential politics and national education policy.
The Political Economy of Gubernatorial Elections: Implications for Education Policy
Authors: Fusarelli Lance D.
Published: July 2003

This article examines the impact of gubernatorial turnover on education policy initiatives in Florida, New York, and Texas. Within the past decade, each of these states was led by a Democratic governor; followed by a Republican successor: Has partisan turnover in the governorship substantially changed the nature, scope, and direction of education reform initiatives? Does it matter whether the governor is a Democrat or a Republican? After reviewing the political writings, campaigns, and actions of governors in each state, the author identifies several national and state-level forces-the economy, state constitutional constraints, an emerging elite ideological consensus, and the necessity to drive toward the conservative middle-that have created conditions in which partisan gubernatorial control matters less than previous research suggests.
Direct Democracy and Higher Education: The State Ballot as an Instrument of Higher Education Policy Making
Authors: McLendon Michael K. , Eddings Stuart
Published: July 2003

A topic to which students of higher education politics and public policy have paid no attention is the resurgent direct democracy movement in the American states. This article seeks to clarify the nature and scope of the statewide ballot phenomenon as it affects the higher education policy domain. The article embeds the issue of higher education balloting in historical context by examining the conceptual origins and contemporary debate surrounding the direct democracy movement in the United States. The article then defines the boundaries of higher education ballot activity by analyzing ballot trends affecting higher education over the past decade. Results reveal that although voters recently have decided a range of important campus governance questions, the two most significant areas of ballot activity over the past decade involve money and morality. The authors explore a variety of theoretical implications of the research.
A Research Agenda on Elections and Education
Authors: Meier Kenneth J.
Published: July 2003

Politics is a significant factor in determining education policy. Despite efforts to isolate education from the impact of elections, recent research has demonstrated that local, state, and federal elections affect education policy. This article integrates the findings in this volume, posits a set of hypotheses, and traces a research agenda for the study of elections and politics.
Would Privatization of K-12 Schooling Lead to Competition and Thereby Improve Education? An Industrial Organization Analysis
Authors: Sanders Nicholas M.
Published: July 2003

Some scholars have argued that to improve K-12 education, we should eliminate public schools and let private schools compete for students. Missing from such proposals is analysis of K-12 schooling to determine its propensity for competition. In this article, the author develops a working definition of the K-12 education industry, presents characteristics of other industries that industrial organization economists have determined undermine the operation of a competitive marketplace, and considers whether these characteristics apply to K-12 schooling. Some conditions—ease of entry into the market, product differentiation, and availability of resources—support competition. However, large economies of scale in a local market and relative price inelasticity of demand imply monopolies and trusts. Also, inadequate information and probable external costs suggest considerable regulation would be needed. The author tentatively concludes that the industry will not be competitive but emphasizes the potential of industrial organization analysis rather than the author’s conclusion.
Experience Counts: Career Stage and Teachers’ Responses to Mathematics Education Reform
Authors: Drake Corey
Published: July 2003

This article explores the relationships between elementary teachers’ career stages and their interpretation and implementation of mathematics education reform. This is done using (a) secondary analysis of data from a survey of several hundred teachers in California after the passage of statewide mathematics education reforms and (b) in-depth case studies of sixteachers implementing a reform-oriented mathematics curriculum. The author finds that teachers at different career stages differ significantly in their approaches to mathematics education reform. In particular, they differ in their willingness and ability to teach in reform-oriented ways, in their understandings of reform, and in how they integrate reform ideas into their current practices. This study has implications not only for the design of future education reform policies but also for the analysis and understanding of educators’responses to these policies.
A Descriptive Study of Six High School Puente Classrooms
Authors: Cazden Courtney B.
Published: July 2003

This article reports observational research in six High School Puente 9th and 10th grade classrooms in four schools in Northern and Southern California during fall, winter, and spring visits in 2000-2001. After two opening vignettes, observations are summarized in five categories: curriculum and teaching, socialization into habits of mind and habits for life, teacher perceptions of differences between Puente and non-Puente classes, Puente events outside the classroom, and how the four teachers learned to be Puente teachers. Finally, three conceptual frameworks are suggested for these findings.
Linking Instructional Intervention and Professional Development: Usingthe Ideas behind Puente High School English to Inform Educational Policy
Authors: Pradl Gordon M.
Published: July 2003

After a review of theory supporting literacy education that incorporates the existing cultural capital of previously underserved students, this article outlines the discipline rationale behind Puente’s approach to the 9th and 10th grade English curriculum. This English program for Mexican American/ Latino students, which works in tandemwith the counseling and mentoring strands of the High School Puente Project, employs literary works and writing assignments that connect directly to the lived experience of the students. It also attempts to enact a process approach to the teaching of writing and includes portfolio assessments. Crucially, this secondary school intervention begins with a carefully designed plan to train participating teachers and continues supporting themwith teaching materials and strategies. Taken together, the features of Puente English support educational policy initiatives that link staff development with curriculum and teaching methods designed to build on students’cultural background and prior experience.
Counselor, Coordinator, Monitor, Mom: The Roles of Counselors in the Puente Program
Authors: Grubb W. Norton , Lara Claudia M. , Valdez Susan
Published: July 2003

This article analyzes the roles of counselors in Puente, a reform to address weak high school counseling. Compared to most schools with one-on-one advising, Puente counselors arrange group meetings about college, cooperate with English teachers, set up meetings with parents to enhance participation in their children’s academic lives, arrange field trips to colleges, and carry out many other activities beyond conventional roles. Their perspectives about students and parents reveal the complexity of Puente and of moving students toward college. Several problems continue to plague Puente—many common to other school reformefforts—including inadequate staff development, insufficient funding, and varying support from schools. However, Puente still provides a compelling model of how counseling roles could be revised, especially in small learning communities, to enhance the progress of all students.
The Long-Term Outcomes of Puente
Authors: Moreno José F.
Published: July 2003

This exploratory study focuses on the long-termeducational outcomes of a precollege outreach program: Puente. Based on interviews with 31 matched pairs of Puente and non-Puente students, I explore whether Puente students had greater levels of college participation, persistence in college, and overall preparedness in relation to their counterparts. Albeit a limited sample, Puente does make a difference in students’ college participation, persistence in college, and preparedness. Students generally attributed their success to the knowledge and information gained through the program with the Puente counselor serving as an important “institutional agent.” This exploratory study affirms the need for greater research on the long-term influences of precollege outreach programs and concludes with a call to understanding increased college participation through the lens of access and success where stronger linkages are encouraged between precollege outreach programs and college-based support programs.
Parents and Families in Precollege Preparation: The Lack of Connection between Research and Practice
Authors: Tierney William G.
Published: July 2003

A discrepancy exists between (a) research supporting the hypothesis that parent and family involvement increases the chances of low-income students’ gaining entrance into college and (b) the practice of family participation in college outreach programs. This article explores the role of cultural capital, structural barriers, cultural integrity in programformation, and identity construction in encouraging or deterring parent and family involvement. A review of the literature and an analysis of various college outreach programs suggest a greater emphasis is needed on incorporating family involvement into the central organization of outreach programs. Given agreement among researchers and practitioners that family involvement is paramount to students’academic success, the author suggests ways to implement familial participation through a prioritization of resource allocation, the creation of evaluative frameworks for assessment of program effectiveness, and continued support in the formof further research, policy making, and funding.
Five Bridges along Students’ Pathways to College: A Developmental Blueprint of Families, Teachers, Counselors, Mentors, and Peers in the Puente Project
Authors: Cooper Catherine R.
Published: July 2003

What program components might enhance our effectiveness in promoting college access for all students? This article considers five bridges along students’ pathways to college: family involvement, culturally enriched teaching, counseling, mentoring, and peers. Longitudinal case studies of Puente students highlight how these bridges function along Latino students’pathways to their college and career aspirations. Bridges often extended beyond high school to support students’college enrollment, transfer, and retention. A developmental model and prototype database are proposed for both qualitative case studies and variable-based analyses of bridges across students’worlds, family demographics, college and career aspirations, math and English pathways, and college admission and enrollment. Developmental models and longitudinal research can help outreach programs such as Puente strengthen bridges along multiple pathways to college and careers. As these tools advance science, policy, and practices, they can also transformacademic pipelines.
Cruzando El Puente: Building Bridges to Funds of Knowledge
Authors: González Norma , Moll Luis C.
Published: July 2003

What can be learned fromthe Puente experience about identifying and incor porating local funds of knowledge of Latino communities into precollege preparation? This article focuses on how Puente teachers and students can enhance their practice and mutual learning through ethnographic fieldwork in the students’home community. Through investigating the many local funds of knowledge that can be utilized to validate students’ identities as knowledgeable individuals who can use such knowledge as a foundation for future learning, both teachers and students can engage in a critical pedagogy predicated on resources and not deficits.
Organizational Innovation in Victorian Social Housing
Authors: Morris Susannah
Published: July 2003

Different organizational forms may be developed at different points in time to meet societies’social welfare goals. This article considers how we can understand and explain change in the range of institutions chosen to address the problem of the London slums between 1840and1914.A number of theories, which posit some periodization or sequencing in the evolution of nonprofit, public, and for-profit provision, are examined and compared with this historical example. Theories that are implicitly periodized yet not properly historicized cannot account adequately for the process of change in the choice of organizational types to meet society’s social welfare goals. For the nonprofit field to learn from history, we must first understand the causal processes that lie behind that history and the factors that explain change as a process of continuity in particular contexts rather than as an abrupt transfer from one unspecified time period to the next.
Beyond Charitable Choice: The Diverse Service Delivery Approaches of Local Faith-Related Organizations
Authors: Campbell David
Published: July 2003

Charitable choice has focused policy attention on the oft-neglected universe of faithrelated organizations but not necessarily on the corners of that universe that ought to matter most or the questions that are most important. We compare local welfare reform initiatives of eight faith-related organizations to suggest how the debate might be constructively reframed. The evidence (a) argues for putting less focus on congregations as contractors and more attention to their role as sites and resources for church-based coalitions and organizing networks; (b) contradicts a simplified understanding of faithrelated organizations as agents for “instilling virtues and character in the poor,” recognizing that many give equal or greater weight to convincing congregations to fulfill their social obligations; and (c) counters the view that the key challenges are legal or regulatory, instead drawing attention to the difficult local work of integrating the resources of faith-related organizations with other public, private, and voluntary organizations.
Holding Ourselves Accountable: Managing by Outcomes in Girls Incorporated
Authors: Houchin Susan , Nicholson Heather Johnston
Published: July 2003

In partial fulfillment of its mission and vision, Girls Incorporated has created an organizational “culture of analysis.” In partnership with its affiliates and increasingly with outside consultants and evaluators, Girls Incorporated develops, pilots, and evaluates research-based programs. Program staff training and program dissemination emphasize ongoing evaluation and program improvement. The principles of evaluation guide management and governance practices as well. Training for program directors and affiliate trustees include needs assessment, plans for organizational change to serve more girls in ways that better reflect the Girls Incorporated mission, and ongoing evaluation of these efforts.
Use and Effectiveness of Performance-Enhancing Substances
Authors: Boyce Eric G.
Published: July 2003

The use and effects of selected performance-enhancing drugs and nutritional supplements are reviewed. Recent sports medicine studies are mostly double blind and placebo controlled but contain relatively small sample sizes. Their data appear reliable and are reported in reputable journals. Definitions and methods used in sports medicine are provided to enhance the understanding of this literature. The use of performance-enhancing substances is probably under-reported. Anabolic-androgenic steroids are reportedly used in 0% to 1% of women, 0.5% to 3% of high school girls, 1% to 5% of men, 1% to 12% of high school boys, and up to 67% of some groups of elite athletes. The use of combinations of performance-enhancing substances is common. Carbohydrate loading, adequate protein intake, creatine, blood doping, and erythropoietin (epoetin alfa) appear to enhance performance. Anabolic-androgenic steroids enhance performance, but health risks limit their use. Growth hormones and β2 -selective adrenergic agonists may enhance performance, but additional studies are needed. Androstenedione, caffeine, amphetamines, and nonprescription sympathomimetics do not appear to enhance performance. Performance-enhancing drugs have shown some benefit in diseased patients with malnutrition and/or decreases in physical ability. Pharmacists and other health care providers have opportunities to improve the understanding, use, and monitoring of performance-enhancing substances.
Health Risks of Selected Performance-Enhancing Drugs
Authors: Chyka Peter A.
Published: July 2003

This article reviews adverse effects of and the difficulty of attributing toxic effects to selected drugs and dietary supplements that purportedly enhance athletic performance. On surveys estimating the extent of performance-enhancing drug use, 5% of high school students indicated anabolic-adrenergic steroid use, and approximately 28% of collegiate athletes and 5.6% of middle and high school athletes admitted creatine use. Many adverse health effects from the abuse of androgenic-anabolic steroids and androstenedione (a prodrug) are exaggerations of excessive testosterone on hepatic, cardiovascular, reproductive, and behavioral functions that can produce permanent changes. With creatine use, nausea, vomiting, diarrhea, elevated serum transaminase concentrations, hypertension, fluid retention, muscle cramping, and muscle strains have been reported. Ephedra stimulates adrenergic receptors, leading to tachycardia and hypertension, with central nervous system effects of anxiety, tremor, and hyperactivity. From 1997 to 1999, 10 people died and 13 suffered permanent disabilities due to ephedra. γ -Hydroxybutyrate and several prodrugs (γ -butyrolactone and 1,4-butanediol) can produce alternating agitation and coma, amnesia, hypotonia, ataxia, nystagmus, tremors, bradycardia, respiratory depression, and apnea. Although γ -hydroxybutyrate abuse began as a bodybuilding aid, most serious adverse effects are from acute overdoses. Adverse effects from performance-enhancing drugs do occur, but their extent and frequency are unknown.
Drug Testing in Athletes at the 2002 Olympic Winter Games
Authors: Rollins Douglas E.
Published: July 2003

During the 2002 Olympic Winter Games at Salt Lake City, Utah, more athletes tested positive for doping than in all previous Olympic Winter Games combined. Approximately 4% (96) of all registered athletes were tested in the out-of-competition testing phase. There were no positive urine specimens. During the in-competition urine doping control program, 559 urine specimens were tested. There were 2 specimens positive for nandrolone and 1 specimen positive for methamphetamine. During the testing of endurance athletes for erythropoietin and related substances, there were 3 specimens positive for darbepoetin, a substance related to erythropoietin. These results signal an increased awareness of new scientific technologies and a resolve to use these procedures for antidoping efforts. The World Anti-Doping Agency is positioned to take a leadership role in harmonizing the antidoping efforts of the international sport federations, the national Olympic committees, the International Olympic Committee, the national sport governing bodies, and national antidoping agencies.
Maintaining Fluid and Electrolyte Balance During Exercise
Authors: Wittbrodt Eric T.
Published: July 2003

The well-documented benefits and popularity of sports and fitness have led to an increased demand for products that not only replace sweat losses but also provide fuel for continued high-intensity metabolic demands. The twin risks of hypohydration and hyponatremia can lead to morbid and even fatal outcomes if rational replacement regimens are not followed, especially in endurance athletes and during hot or humid conditions. The avoidance of these complications of physical activity with oral replacement products has been documented primarily in high-impact, prolonged-duration events. Replacement fluid should contain water, sodium, and perhaps potassium to avoid overhydration-induced hyponatremia. Carbohydrates are added if muscle exertion is to continue for prolonged periods (>60 minutes in duration). The overuse of oral replacement products may yield the dilution of serum and intracellular electrolytes, hyperglycemia, and gastrointestinal distress. Baseline hydration and glucose status should be optimized before activity, and alterations in the amount and type of fluid ingested may be required for special populations such as children and individuals with chronic disease.
Management of Acute Soft Tissue Injuries
Authors: McGriff-Lee Nayahmka
Published: July 2003

Participation in sports-related activities increases the risk for acute injury to soft tissues. In adults, the sites most often affected include the ankle, knee, and wrist joint structures, along with the muscles of the back and extremities. The subsequent inflammatory response to tissue damage results in pain and swelling, which limits mobility. A thorough patient assessment is required for accurate diagnosis and provides a guide for appropriate treatment. Initial management is based on the principles of basic first aid: rest, ice, compression, and elevation. Pharmacological therapy can also be used to achieve pain relief and improve mobility. There are few well-controlled studies addressing the pharmacotherapy of acute soft tissue injury, but clinical experience with nonsteroidal anti-inflammatory drugs is extensive. Both traditional and nontraditional therapeutic approaches are discussed.
Pharmacotherapy for Altitude-Related Illness
Authors: Ellsworth Allan
Published: July 2003

Altitude-related illness is a frequent cause of morbidity and occasional mortality among recreational sports travelers in the United States and throughout the world. High-altitude illness describes the cerebral and pulmonary syndromes (acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema) that can occur in unacclimatized persons ascending too rapidly to high altitude. The pathogenesis of these syndromes is primarily hypobaric hypoxia that causes compensatory changes in the brain and lungs, resulting in hyperperfusion of microvascular beds, increased capillary pressure, and a microvascular leak with resulting edema and a characteristic constellation of symptoms. Prevention and treatment involve education about rate of ascent; diet; alcohol intake; physical activity; oxygen; hyperbaric chambers; and pharmacotherapy, including acetazolamide, dexamethasone, nifedipine, and salmeterol in selected circumstances.
Improved Strategies for the Treatment of Renal Osteodystrophy
Authors: Hudson Joanna Q.
Published: July 2003

Renal osteodystrophy (ROD) encompasses several distinct skeletal complications resulting from the metabolic abnormalities associated with chronic kidney disease (CKD). Other manifestations of altered calcium and phosphorus homeostasis include an increased risk of cardiovascular mortality and morbidity. Hyperphosphatemia and secondary hyperparathyroidism (HPT) are associated with these adverse events, and ultimately can lead to ROD. Dietary restriction of phosphorus, use of phosphate binding agents, and vitamin D therapy have been the mainstay of therapy for HPT. Recently, several new therapeutic agents have become available for the management of HPT. The nonelemental phosphate binder, sevelamer hydrochloride (Renagel® ) has provided an alternative to calcium-containing binders for the management of hyperphosphatemia. This agent also decreases calcium load and minimizes the risk of hypercalcemia and skin and soft tissue calcifications. Research in the area of vitamin D receptors has lead to the development of vitamin D analogs including paricalcitol (Zemplar® ) and doxercalciferol (Hectorol® ) as alternative agents for HPT. Potential benefits of these analogs include a lower risk of hypercalcemia and hyperphosphatemia compared with calcitriol, although further evaluation is warranted as these agents are used more in clinical practice. Calcimimetics are also in the pipeline as potential agents for management of HPT by inhibition of parathyroid hormone secretion. These new developments in the management of metabolic disorders of CKD provide pharmacotherapeutic alternatives to improve patient outcomes and prevent/manage ROD. The challenge is to determine appropriate guidelines for use of these agents at all stages of CKD.
Renal Drug Transport and Drug-Drug Interactions
Authors: Ronaldson Patrick T. , Bendayan Reina
Published: July 2003

The kidney plays a vital role in the elimination of xenobiotics including drugs, toxins, and endogenous metabolites. Renal drug elimination involves 3 major processes: glomerular filtration, tubular secretion, and tubular reabsorption. Although glomerular filtration is a simple unidirectional diffusion process, renal tubular secretion and/or reabsorption can involve saturable processes mediated by multiple highly specialized membrane transport systems. Current research has identified that these transport proteins play a significant role in the efficient removal and/or reabsorption of pharmacological agents. Since the majority of membrane transporters have broad substrate specificity, there is a significant risk for drug-drug interactions through competition for similar transport pathways. This article will focus on the cellular expression, localization, and transport properties of various renal drug transport systems (ie, organic anion, organic cation, nucleoside, and adenosine triphosphate [ATP]-dependent efflux transporters). Specific examples of drugs that are transported by each of these mechanisms will be provided. Clinically relevant drug-drug interactions involving renal drug transporters will be discussed to guide the clinician in understanding and preventing these interactions.
A Review on Specialization in Pharmacy—Part II: A Commentary on Postgraduate Training and Pharmaceutical Care
Authors: Laven David L.
Published: July 2003

Many opportunities exist for pharmacists who desire to expand their role in providing comprehensive pharmaceutical care services to patients and other health care providers, who they serve and collaborate with on a daily basis. Consequently, there is a strong trend within pharmacy to specialize in areas of professional interest. In many respects, pharmacy has turned toward the medical model in addressing its needs and providing a framework for specialization in practice. With respect to generalist and specialized practitioners and varying initiatives relative to the medical model, the concept of specialization in pharmacy has recently developed some interesting tangents when issues of certification, credentialing, disease-state management, and added qualifications enter the discussion. The previous installment in this 2-part article focused on specialization in pharmacy and offered a review of the current initiatives by which a pharmacist can achieve specialty status. In this concluding installment, discussion is offered that addresses pharmaceutical care and postgraduate training in pharmacy relative to future professional and societal expectations for pharmacy.
Prayer after Stroke
Authors: Robinson-Smith Gale
Published: July 2003

Research has documented that recovery from a stroke is stressful, often necessitating significant coping efforts. Difficult life events such as stroke may encourage patients to reexamine spiritual aspects of life, and the challenges associated with stroke can promote spiritual growth and development. Because of the life-changing experience of stroke, spiritual practices may assist patients in finding meaning and wholeness through the confidence they offer. The purpose of this article is to report how 8 patients used prayer after stroke as a coping strategy to improve self-efficacy and quality of life after stroke. A qualitative approach using the long interview method was employed to expand on spiritual practices expressed through prayer as a way of coping after stroke. Potential strategies are suggested for nurses that address patients’ spiritual needs.
Effects of Integrating Therapeutic Touch into a Cognitive Behavioral Pain Treatment Program
Authors: Smith Dorothy Woods , Arnstein Paul , Rosa Katherine Cowen , Wells-Federman Carol
Published: July 2003

The purpose of this study was to investigate the effects of offering Therapeutic Touch (TT) as an adjunct to cognitive behavioral therapy (CBT) for people with chronic pain. Patients were randomized to relaxation training (control group) or TT plus relaxation (experimental). Subsequently, all participants attended a CBT program. Preprogram and postprogram data were examined to identify patterns of change in pain intensity, self-efficacy, unitary power, disability, and perceived distress. In addition, patterns of attrition were examined. Patients in this study who were randomized to receive TT fared better in terms of enhanced self-efficacy and unitary power, as well as having lower attrition rates. Trends associated TT with less distress and disability. This pilot study suggests that offering TT as an adjunct to CBT may help to improve clinical outcomes, reduce program attrition, and promote unitary power in those who suffer with chronic pain.
Exploring the Meaning of Spirituality with Aging Adults in Appalachia
Authors: Lowry Lois W.
Published: July 2003

This phenomenological study explored the meaning of spirituality in the lives of aging adults in Appalachia. Forty adult volunteers in varying states of health ranging in age from 59 to 94 years participated in focus groups. Through open-ended questions, respondents described their perceptions of spirituality, spirituality and health, and the role of spirituality in helping them cope. Themes that emerged from the data were a conviction that God exists and acts in the lives of persons, calls them to action, and is a source of connection in times of loss. Spirituality positively affects attitude, particularly as health declines. Respondents expected respectful and empathic health care providers who would meet their physical needs and be concerned about their spiritual needs. Spirituality was of paramount importance in the lives of these elders; thus, health care providers must consciously include spirituality in assessments and interventions. Nursing curricula must prepare students to provide spiritual care.
Inadequate Nursing Care in an Emergency Care Unit in Sweden
Authors: Nyström Maria
Published: July 2003

The aim of this case study has been to analyze factors that hinder the provision of adequate nursing care in one emergency care unit (ECU). The research question was, What are the conditions that explain the provision of inadequate nursing care in an ECU with reported problems concerning caring attitudes? The design of the study was exploratory and interpretive within a hermeneutic tradition. Nurses were interviewed, and field notes were made from participant observations of routine work and staff meetings. An interpreted whole revealed a lack of a holistic perspective. The difficulty of these nurses in accomplishing a holistic perspective seemed to be due to overvaluation of measurable tasks, such as medical interventions, and undervaluation of nonmeasurable tasks, such as caring. As a consequence, caring interventions failed to strengthen the nurses’ self-esteem in the same high degree as medical tasks.
Applied Concepts of Holistic Nursing
Authors: Lottes Christine R. , Engstrom Del , Engstrom Lorri F.
Published: July 2003

There is a need for spiritual health seminars at the work site and through hospital and other community venues. This article describes how the authors prepared for and conducted seminars in their community. The research demonstrates that religious commitment may play a beneficial role in an individual’s health. Once the authors were armed with this research and a fundamentally sound and practical program, they were able to assist individuals in their community in designing and initiating their own individual spiritual health workouts, which may then influence their physical and mental health. In this way, the authors were able to apply holistic principles of spirit, mind, and body.
Funding Long-Term Care
Authors: Chen Yung-Ping
Published: July 2003

The uncertain need for long-term care services is a risk best protected by insurance. However, the current funding relies heavily on personal payment and public welfare, and only lightly on social and private insurances. This method, akin to sitting on a two-legged stool, is unlikely to be sustainable. To incorporate insurance as a key component of funding and to mobilize public and private resources more effectively, we propose a three-legged-stool funding model under which social insurance would provide a basic protection, to be supplemented by private insurance and personal payment. When these sources do not provide sufficient protection for some individuals, Medicaid as public welfare would serve as a safety net. This article (a) discusses how to implement this funding model by using the trade-off principle in both the public and private sectors when resources for long-term care are scarce, and (b) analyzes several objections to this model from cognitive psychology∕behavioral economics.
Policy Implications of an Annuity Approach to Integrating Long-Term Care Financing and Retirement Income
Authors: Spillman Brenda C. , Murtaugh Christopher M. , Warshawsky Mark J.
Published: July 2003

The authors consider an integrated income and disability annuity as an alternative framework for long-term care financing, show that pooling disability and mortality risks can reduce the need for medical underwriting, and discuss private and public implications. Data from the National Mortality Followback Survey of 1986 were used to simulate current underwriting and minimal underwriting, excluding only those already eligible for benefits. Remaining disability, life expectancy, and premiums are compared under both underwriting assumptions. Under minimal underwriting, 98% of persons age 65 would be eligible to purchase disability protection through an integrated annuity, versus 77% under current underwriting. Premiums for both the income and disability components were lower with minimal underwriting. Combining income and disability protection may be able to expand private markets for long-term care financing beyond what appears possible in the long-term care insurance market. Public policy should avoid the distortion of choices created by focusing exclusively on an insurance model.
Private Long-Term Care Insurance
Authors: Cohen Marc A.
Published: July 2003

The author’s objective is to summarize and synthesize what is known about the private long-term care insurance market and its impact on public expenditures, policy holders, their families, and providers. Primary data were compiled from national studies and published and nonpublished information from the long-term care insurance industry. The study design was the review and analysis of empirical data. Data were collected from in-person, mail, and telephone interviews, as well as from a review of the literature. The market is growing rapidly in part due to the vast improvements in product design and to federal and state public policies. Growth in the market should result in modest reductions in public long-term care expenditures. Most claimants are satisfied with their policy, but many still do not feel that their needs are being met. Service delivery and provider issues are critical to making money work for disabled persons and insurers will be increasingly called on to help address this issue. The market for long-term care insurance will continue to grow. Over time, this insurance will likely play a more meaningful role in meeting the needs of disabled elders and their families.