bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community Perception of Rural Hospital Conversion/Closure: Re‐conceptualising as a Critical Incident
Authors: Petrucka Pammla M. , Wagner P. Susan 
Published: December 2003

ABSTRACTBackground:  In this article, a consideration of the role and meaning of the rural hospital is contextualised within the health reform environment in Saskatchewan (Canada). Individual and community perceptions of the impact of the conversion/closure of a rural hospital are often unheard and more often unheeded. Some researchers suggest hospital conversion/closure is a devastating event in the life of rural communities, yielding long‐lasting medical, economic and psychological consequences. Method:  This article examines the concept of critical incidents with the intent of proposing a working definition of the concept. Lazarus and Folkman's (1984) construct of appraisal provides the framework for discussion and re‐conceptualisation of critical incidents. Results and Conclusions:  The recommendation is to consider the adoption of an alternate definition of critical incident shifting away from professional or external delineation of an event's meaning. The proposed definition states that a critical incident is any external event that alters an individual's or community's life from the perspective of that individual or community. Finally, the conversion/closure of a rural hospital is considered within this re‐conceptualised ‘critical incident’ definition.
Retroperitoneoscopic heminephroureterectomy for children with duplex anomaly: Initial experience
Authors: KAWAUCHI AKIHIRO , FUJITO AKIRA , NAITO YASUYUKI , SOH JINTETSU , UKIMURA OSAMU , YONEDA KIMIHIKO , MIZUTANI YOICHI , MIKI TSUNEHARU 
Published: December 2003

Abstract Objectives:  To evaluate the feasibility of retroperitoneoscopic heminephroureterectomy for children with duplex anomaly.Methods:  Retroperitoneoscopic heminephroureterectomy was performed in five children (four girls and one boy) with complete duplication of the ureter, of whom four (age range 1–5 years; mean age 3.3 years) had upper pole ectopic megaureters and one (3 years old) had an upper pole megaureter with ureterocele. In the patient with ureterocele, distal ureterectomy and ureterocelectomy were performed by Pfannenstiel incision.Results:  The mean operation time was 346 min (range 270–450 min) in the four patients with ectopic megaureter and 420 min (330 min for heminephroureterectomy) in the patient with ureterocele. The mean estimated blood loss was 43 mL (range 5–100 mL) in the four patients with ectopic megaureter and 40 mL in the patient with ureterocele. No postoperative complications were observed. Postoperative intravenous pyelography showed normal pyelogram and renal function of the preserved lower pole in all cases.Conclusions:  Retroperitoneoscopic heminephroureterectomy for children is feasible, safe and has good postoperative results, including cosmetic results. However, the operation time needs to be reduced.
Written Language, Standard Language, Global Language
Authors: Halliday Michael A. K. 
Published: December 2003

AbstractEnglish, along with a small number of other languages in the modern period, has expanded away from local through national to international domains, changing significantly along the way. But the changes are not simply those that take place in the normal course of the history of a language; other changes come about as a language takes on new cultural, economic and political responsibilities. Critical moments occur when a language comes to be written as well as spoken, and then when it comes to function as a standard language for some sort of nation‐state. In that socio‐historical perspective English is now acquiring a new identity as the global language of the late capitalist world. Some of the consequences of this development are beginning to show; but we have yet to find out what the long‐term effects are that arise when a language finds itself globalized.
Globalization, Literacy and Ideology
Authors: Hasan Ruqaiya 
Published: December 2003

AbstractGlobalization has aroused mixed reactions: some regard it as a blessing while others are convinced that it is simply the old game of domination under a new name. There is an urgent need to understand the nature of the semantic processes that support this contradictory reading. It is important to realize that the resolution of this contradiction does not lie in a simplistic choice between truth and falsehood. Rather what we are witnessing is the deployment of language in a struggle to control the very picture of reality. Whatever the outcome, one thing seems certain: to understand how globalization might affect our lives, we will need a form of literacy that goes beyond simple interpretation to reflection on the social significance of acts of meaning: literacy must enable one to decide whose meanings are voiced in which acts of semiosis and for whose benefit.
Towards A Norm in South African Englishes: The Case for Xhosa English
Authors: Klerk Vivian De 
Published: December 2003

AbstractBlack South African English (BSAE) is generally regarded today as the variety of English commonly used by mother‐tongue speakers of South Africa's indigenous African languages in areas where English is not the language of the majority. Its roots lie in the history of the teaching of English to the black people of this country, where the role models who teach English are second language learners themselves. To date, BSAE has mainly been studied within an applied linguistic framework with emphasis on its character as a second language which is deviant from standard English. An alternative view is to see it as a variety in its own right, a new or world English (Coetsee Van Rooy and Verhoef, 2000; van der Walt and van Rooy, 2002). As a consequence, a new look at norms is becoming increasingly necessary, so that decisions about learners' language competence can be made in terms of this variety. This paper reports on preliminary analyses of a recently collected corpus of Xhosa English (XE) (a sub‐category of BSAE) which consists of naturalistic spoken data, and comprises some 540,000 words of Xhosa English. This large database enables empirical analysis of actual patterns of use in language, making it possible to test earlier speculations which have been based on intuition, and to explore the possibility of systematic differences in the patterns of structure and use in this particular variety. The paper focuses on 20 separate linguistic characteristics, most of which have been previously identified in the literature as being features of BSAE, and analyses each of them in turn, in order to ascertain their usage patterns and frequency of occurrence in the corpus.
The Ownership of English in Japanese Secondary Schools
Authors: Matsuda Aya 
Published: December 2003

AbstractSociolinguistic studies of English in various parts of the world suggest the increasing role of so‐called nonnative speakers in defining the forms and functions of the English language. Their role is crucial especially in English as an international language (EIL) contexts, where the interactions do not necessarily involve native speakers of English. This view, however, does not seem to be as widespread among the users of EIL in the expanding circle as it is among scholars. A qualitative case study of Japanese secondary school students suggests that, although they perceive English as an international language in a sense that it is being used internationally, they do not believe it belongs internationally. The author questions the appropriateness of this view vis‐à‐vis the current status and function of EIL and suggests ways to raise awareness of English varieties and better prepare students for the use of English as an international language.
Word Formative Processes in Camfranglais
Authors: Kouega Jean‐Paul 
Published: December 2003

AbstractThis paper discusses word formation processes in Camfranglais, a composite language developed by Cameroon secondary pupils to communicate among themselves to the exclusion of non‐members. To render their language mysterious and reinforce incomprehensibility, they use various techniques of word formation such as borrowing from various languages, coinage, shortening, affixation, inversion, idiomatic formation and reduplication, to name only these few.
Whose Norms? International Proficiency Tests in English
Authors: Davies Alan , Hamp‐Lyons Liz , Kemp Charlotte 
Published: December 2003

AbstractThe paper reports on research into the claim that widely used English language proficiency tests are unfair (unfair in the sense that a test favouring boys could be said to be unfair to girls). The global spread of English opens a major debate on the acceptability of competing norms, whether they should be exonormative or endonormative (Davies, 1999; Gill, 1999). An International English (IE) view insists that the only acceptable norms are those of native English speakers (NES). A strong World Englishes (WES) view maintains that to impose IE on users of WEs may be discriminatory against non‐native English speakers (NNES). The theoretical and practical aspects of the issue come together in institutionalized English language proficiency testing. The paper reports on comparative definitions by expert local judges of the norms used in international (IELTS and TOEFL) and national (Hong Kong, Singapore, Malaysia, India, China) English language proficiency tests and considers in what ways the differing definitions have in practice influenced language test construction. It further reports on the findings so far with regard to three basic questions:1. How possible is it to distinguish between an error and a token of a new type?2. If we could establish bias, how much would it really matter?3. Does an international English test privilege those with a metropolitan anglophone education?
The Impact of the Prospective Payment System for Skilled Nursing Facilities on Therapy Service Provision: A Transaction Cost Approach
Authors: Zinn Jacqueline S. , Mor Vincent , Intrator Orna , Feng Zhanlian , Angelelli Joseph , Davis Jullet A. 
Published: December 2003

Objective.To examine skilled nursing facilities (SNFs) “make‐or‐buy” decisions with respect to rehabilitation therapy service provision in the 1990s, both before and after implementation of Medicare's Prospective Payment System (PPS) for SNFs.Data Sources.Longitudinal On‐line Survey Certification and Reporting (OSCAR) data (1992–2001) on a sample of 10,241 freestanding urban SNFs.Study Design.We estimated a longitudinal multinomial logistic regression model derived from transaction cost economic theory to predict the probability of the outcome in each of four service provision categories (all employed staff, all contract, mixed, and no services provided).Principal Findings.Transaction frequency, uncertainty, and complexity result in greater control over therapy services through employment as opposed to outside contracting. For‐profit status and chain affiliation were associated with greater control over therapy services. Following PPS, nursing homes acted to limit transaction costs by either exiting the rehabilitation market or exerting greater control over therapy services by managing rehabilitation services in‐house.Conclusions.The financial incentives associated with changes in reimbursement methodology have implications that extend beyond the boundaries of the health care industry segment directly affected. Unintended quality and access consequences need to be carefully monitored by the Medicare program.
Measuring Hospital Quality: Can Medicare Data Substitute for All‐Payer Data?
Authors: Needleman Jack , Buerhaus Peter I. , Mattke Soeren , Stewart Maureen , Zelevinsky Katya 
Published: December 2003

Objectives. To assess whether adverse outcomes in Medicare patients can be used as a surrogate for measures from all patients in quality‐of‐care research using administrative datasets.Data Sources. Patient discharge abstracts from state data systems for 799 hospitals in 11 states. National MedPAR discharge data for Medicare patients from 3,357 hospitals. State hospital staffing surveys or financial reports. American Hospital Association Annual Survey.Study Design. We calculate rates for 10 adverse patient outcomes, examine the correlation between all‐patient and Medicare rates, and conduct negative binomial regressions of counts of adverse outcomes on expected counts, hospital nurse staffing, and other variables to compare results using all‐patient and Medicare patient data.Data Collection/Extraction. Coding rules were established for eight adverse outcomes applicable to medical and surgical patients plus two outcomes applicable only to surgical patients. The presence of these outcomes was coded for 3 samples: all patients in the 11‐state sample, Medicare patients in the 11‐state sample, and Medicare patients in the national Medicare MedPAR sample. Logistic regression models were used to construct estimates of expected counts of the outcomes for each hospital. Variables for teaching, metropolitan status, and bed size were obtained from the AHA Annual Survey.Principal Findings. For medical patients, Medicare rates were consistently higher than all‐patient rates, but the two were highly correlated. Results from regression analysis were consistent across the 11‐state all‐patient, 11‐state Medicare, and national Medicare samples. For surgery patients, Medicare rates were generally higher than all‐patient rates, but correlations of Medicare and all‐patient rates were lower, and regression results less consistent.Conclusions. Analyses of quality of care for medical patients using Medicare‐only and all‐patient data are likely to have similar findings. Measures applied to surgery patients must be used with more caution, as those tested only in Medicare patients may not provide results comparable to those from all‐patient samples or across different samples of Medicare patients.
Measuring the Quality of Diabetes Care Using Administrative Data: Is There Bias?
Authors: Keating Nancy L. , Landrum Mary Beth , Landon Bruce E. , Ayanian John Z. , Borbas Catherine , Guadagnoli Edward 
Published: December 2003

Objectives. Health care organizations often measure processes of care using only administrative data. We assessed whether measuring processes of diabetes care using administrative data without medical record data is likely to underdetect compliance with accepted standards for certain groups of patients.Data Sources/Study Setting. Assessment of quality indicators during 1998 using administrative and medical records data for a cohort of 1,335 diabetic patients enrolled in three Minnesota health plans.Study Design. Cross‐sectional retrospective study assessing hemoglobin A1c testing, LDL cholesterol testing, and retinopathy screening from the two data sources. Analyses examined whether patient or clinic characteristics were associated with underdetection of quality indicators when administrative data were not supplemented with medical record data.Data Collection/Extraction Methods. The health plans provided administrative data, and trained abstractors collected medical records data.Principal Findings. Quality indicators that would be identified if administrative data were supplemented with medical records data are often not identified using administrative data alone. In adjusted analyses, older patients were more likely to have hemoglobin A1c testing underdetected in administrative data (compared to patients <45 years, OR 2.95, 95 percent CI 1.09 to 7.96 for patients 65 to 74 years, and OR 4.20, 95 percent CI 1.81 to 9.77 for patients 75 years and older). Black patients were more likely than white patients to have retinopathy screening underdetected using administrative data (2.57, 95 percent CI 1.16 to 5.70). Patients in different health plans also differed in the likelihood of having quality indicators underdetected.Conclusions. Diabetes quality indicators may be underdetected more frequently for elderly and black patients and the physicians, clinics, and plans who care for such patients when quality measurement is based on administrative data alone. This suggests that providers who care for such patients may be disproportionately affected by public release of such data or by its use in determining the magnitude of financial incentives.
How Robust Are Health Plan Quality Indicators to Data Loss? A Monte Carlo Simulation Study of Pediatric Asthma Treatment
Authors: Stuart Bruce , Singhal Puneet K. , Magder Laurence S. , Zuckerman Ilene H. 
Published: December 2003

Objectives. (1) To test the robustness of a health plan quality indicator (QI) for persistent asthma to various forms of data loss and (2) to assess the implications of the findings for other health plan quality measures.Data Sources/Study Settings. Maryland Medicaid fee‐for‐service (FFS) claims. Children with asthma (n=5,804) were selected from Medicaid enrollment records and medical and pharmacy FFS claims filed between June 1996 and December 1997.Study Design. A variant of a HEDIS measure for treatment of persistent asthma (the percent of asthma patients filling two or more rescue medications who also filled a controller medication) was selected to test the robustness of proportion‐based QIs to loss of data. Data loss was simulated through a series of Monte Carlo experiments.Data Collection/Extraction Methods. Merged FFS medical and prescription claims.Principal Findings. The asthma QI measure was highly robust to systematic and random data loss. The measure declined by less than 2 percent in the presence of up to a 35 percent data loss. Redundancy in the numerator of the QI significantly increased the robustness of the measure to data loss.Conclusions. A HEDIS‐related QI measure for persistent asthma is robust to data loss. The findings suggest that other proportion‐based quality indicators, particularly those in which plan members have multiple opportunities to meet the numerator criterion, are likely to reflect true levels of health plan quality in the face of incomplete data capture.
Variability in Asthma Care and Services for Low‐Income Populations among Practice Sites in Managed Medicaid Systems
Authors: Lozano Paula , Grothaus Lou C. , Finkelstein Jonathan A. , Hecht Julia , Farber Harold J. , Lieu Tracy A. 
Published: December 2003

Objective. To characterize and describe variability in processes of asthma care and services tailored for low–income populations in practice sites participating in Medicaid managed care (MMC).Study Setting. Eighty‐five practice sites affiliated with five not‐for‐profit organizations participating in managed Medicaid (three group‐model health maintenance organizations [HMOs] and two Medicaid managed care organizations [MCOs]).Study Design/Data Collection. We conducted a mail survey of managed care practice site informants using a conceptual model that included chronic illness care and services targeting low‐income populations. The survey asked how frequently a number of processes related to asthma care occurred at the practice sites (on a scale from “never” to “always”). We report mean and standard deviations of item scores and rankings relative to other items. We used within‐MCO intraclass correlations to assess how consistent responses were among practice sites in the same MCO.Principal Findings. Processes of care related to asthma varied greatly in how often practice sites reported doing them, with information systems and self‐management support services ranking lowest. There was also significant variation in the availability of services targeting low‐income populations, specifically relating to cultural diversity, communication, and enrollee empowerment. Very little of the site‐to‐site variation was attributable to the MCO.Conclusions. Our conceptual framework provides a means of assessing the provision of chronic illness care for vulnerable populations. There is room for improvement in provision of chronic asthma care for children in managed Medicaid, particularly in the areas of self‐management support and information systems. The lack of consistency within MCOs on many processes of care suggests that care may be driven more at the practice site level than the MCO level, which has implications for quality improvement efforts.
Managed Care Organizational Characteristics and Health Care Use among Children with Special Health Care Needs
Authors: Shenkman Elizabeth , Wu Samuel S. , Nackashi John , Sherman James 
Published: December 2003

Objective. To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children.Data Sources. Telephone survey data from 2,223 parents of children with special health care needs, MCO‐administrator interview data, and health care claims data.Study Design. Cross‐sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee‐for‐Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.Data Collection/Extraction Methods. The telephone and MCO‐administrator survey data were linked to the enrollment and claims files.Principal Findings. The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.Conclusion. After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns.
Measuring Contextual Characteristics for Community Health
Authors: Hillemeier Marianne M. , Lynch John , Harper Sam , Casper Michele 
Published: December 2003

Objective.To conceptualize and measure community contextual influences on population health and health disparities.Data Sources.We use traditional and nontraditional secondary sources of data comprising a comprehensive array of community characteristics.Study Design.Using a consultative process, we identify 12 overarching dimensions of contextual characteristics that may affect community health, as well as specific subcomponents relating to each dimension.Data Collection.An extensive geocoded library of data indicators relating to each dimension and subcomponent for metropolitan areas in the United States is assembled.Principal Findings.We describe the development of community contextual health profiles, present the rationale supporting each of the profile dimensions, and provide examples of relevant data sources.Conclusions.Our conceptual framework for community contextual characteristics, including a specified set of dimensions and components, can provide practical ways to monitor health‐related aspects of the economic, social, and physical environments in which people live. We suggest several guiding principles useful for understanding how aspects of contextual characteristics can affect health and health disparities.