bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heroic Death
Authors: Seale Clive 
Published: September 2003

This paper shows how individuals in late modern social conditions seek to imbue dying, and caring for the dying, with meaning. Accounts provided in a survey of 250 individuals who knew people who had died in the UK are examined. The analysis counters the view that the denial of death is widespread in conditions where religion no longer offers individuals a meaningful narrative for the dying self. Scripts for proclaiming heroic self-identity in the face of death are promoted by cultural experts and appropriated by many lay individuals. This involves a struggle against external and internal enemies to gain knowledge, the opportunity to demonstrate courage and a beatific state of emotional accompaniment in which `carers' and dying people participate. Unlike more traditional forms of heroism, this script deviates from celebrating solely masculine qualities and includes a female heroics of care, concern and emotional expression. At the same time, some deaths cannot be written into this script, which is particularly well suited to deaths from cancer and AIDs. The deaths of the very old, the mentally confused and sudden unexpected deaths are often difficult to interpret in these heroic terms. Additionally, a rival script exists amongst some lay individuals that stands in opposition to the professional consensus on the desirability of open awareness. This emphasises the benefits of continuing the everyday project of the self oblivious of oncoming death, with others shouldering the burden of awareness in an attempt to protect the dying person against the strain of knowledge. This rival script, however, commands decreasing allegiance in a society where the project of the self is rarely given over to the care of others, and trust is commonly negotiated in confessional moments.
Constraints on Gender: The Family Wage, Social Security and the Labour Market; Reflections on Research in Hartlepool
Authors: Morris Lydia 
Published: September 2003

In this paper, using data gathered from 40 married or cohabiting couples in Hartlepool, I argue that despite challenges to the `family wage' through long-term male unemployment, growing job insecurity, increased economic activity of married women, and the demonstrable importance of their earnings for the household, a wife's role as earner or potential earner continues to be viewed as peripheral. This is largely to be explained by an interaction between Supplementary Benefit rulings and the part-time nature of much of the demand for women's labour, such that a wife is most likely to take on, or continue in, employment where her husband is himself in work or perceived to be only temporarily unemployed. The operation of the informal sector of the economy is examined in this context, and the possible effects of proposed changes in Supplementary Benefit rulings discussed.
The First Historical Act: A Review of the Open University Course
Authors: Mackenzie Gavin 
Published: September 2003

The Open University course Work and Society (DE 325) was introduced for the first time in 1985. It represents a recent, very influential attempt by a group of scholars to provide a curriculum for the study of the area with which this journal is concerned. We have asked two reviewers to consider the materials which comprise the course and give, from their own individual perspectives, a critical review of them. The bibliographical details of the units and other publications which make up the course are given at the end of the reviews.
The Politics of the Black Economy
Authors: Thomas J. J. 
Published: September 2003

On the basis of indirect estimates of the size of the black economy, it has been argued that failure to measure black economic activity in official government statistics has produced a misleading picture of the state of the economy, overestimating both the rate of inflation and the level of unemployment and underestimating the effects of tax rates on the level of tax evasion. These arguments, which suggest that large numbers of those recorded as being wholly unemployed are actually working in the black economy, have strong political implications for tax cuts and attitudes towards welfare and poverty. This paper provides a critique of the indirect measures of the size of the black economy and argues that none of them can be relied upon to produce accurate estimates. An examination of some of the microeconomic evidence collected by economists, sociologists and anthropologists suggests (i) that the more dramatic numbers produced by indirect measures may represent considerable overestimates of the actual size of the black economy in the United Kingdom and (ii) that there may be good reasons why it is easier for moonlighters rather than the unemployed to work in the black economy. If this is so, the policy arguments based on these indirect measures of the black economy do not rest on firm foundations and should therefore be regarded as political special pleading.
Household Strategies: The Individual, The Collectivity and The Labour Market - The Case of Married Couples
Authors: Morris Lydia 
Published: September 2003

Recent treatments of the household effects of economic change have tended to focus on household outcomes with reference to the use of resources of time and labour, paying scant attention to differences of power and interest within the home. It is suggested here that the most fruitful focus for the investigation of such intrahousehold divisions is the management of household finance. The purpose of this paper is to demonstrate, by reference to existing literature on married couples, that: (a) households constitute an amalgam of often conflicting individual interests, and that (b) some of these interests, particularly as expressed through access to and control over household resources, are closely related to experience and/or behaviour in the labour market. In doing so questions are raised about the balance between personal needs and interests, and those of the household as a collectivity, and the relative significance of both these concerns for the motivation to earn. The notion of a household strategy and the emergence of a strategy in practice should therefore take account of these different interests and the way they are acknowledged or suppressed in the organisation of household finance. In pursuing such analysis it becomes necessary to take account of how far spending obligations and orientations towards spending and consumption are fashioned or constrained by gender roles, and the way in which the emergent patterns interact with position and behaviour in the labour market.
Household Work Strategies and Forms of Labour: Conceptual and Empirical Issues
Authors: Warde Alan 
Published: September 2003

This paper explores some theoretical and empirical issues concerning the different forms of work that people engage in in contemporary capitalist societies. The theoretical issues derive from four sources: Harding & Jenkins' argument that distinctions between the formal and the informal economy are unsustainable; Hilary Silver's critique of Gershuny's self-service economy thesis; debates about an adequate definition of `work'; and the debate about the usefulness of the concept of household work strategy. The empirical aspect of the paper emanates from a replication of aspects of Pahl and Wallace's study of the Isle of Sheppey among households in the North West of England. The concept of household work strategy is defended as a way of understanding the ways in which forms of work are combined, endorsing a modified version of the methodological approaches of Gershuny and Pahl. However, exception is taken to certain of the interpretative themes and empirical trends identified by both authors. Evidence against Gershuny's self-service society thesis is provided, pointing to the merits of an Engel's Law interpretation based on the tendency for affluent, dual-earner households to purchase services on the market. The study of North West households, while confirming substantial parts of Pahl's empirical analysis, authorises different lines of interpretation. The argument overall is directed towards an understanding of the social relations governing different forms of work and the value of a theoretical approach to work based on several alternative ways of providing use-values.
Patterns of Working Hours in Large-Scale Grocery Retailing in Britain and France: Convergence after 1992?
Authors: Gregory Abigail 
Published: September 2003

As 1992 approaches, a major question being raised is to what extent the development of the Single European Market will allow the integration of societies and economies with different structures, laws and traditions, and encourage the convergence of organisational and institutional patterns across member states. This article explores this question by examining patterns of working hours in large-scale grocery retailing in two member states - Britain and France. Based on comparative fieldwork carried out in 1986 and 1987 it shows that patterns of working hours currently differ in terms of patterns of part-time hours (levels of use, length of contracts, shift lengths and patterns) and the types of flexibility in working hours, and seeks to explain these differences in terms of the differing social policies and industrial relations frameworks relating to part-time work and to working hours more generally in the two countries. The article speculates on the possible effect of the Single European Market on large-scale grocery retailing as part of a wider assessment of factors likely to influence patterns of working hours in this sector after 1992. It finds that there are indeed pressures towards convergence, particularly affecting Britain, as a result of commercial, technological and European social policy measures with major implications for employers and for women's patterns of employment. It suggests, however, that in the short to medium term past national specificities will continue to maintain the differences found.
Air embolism as a cause of the systemic inflammatory response syndrome: a case report
Authors: Kapoor Tarun , Gutierrez Guillermo 
Published: September 2003

AbstractWe describe a case of systemic inflammatory response syndrome associated with air embolism following the removal of a central line catheter, coupled with a deep inspiratory maneuver. The presence of a patent foramen ovale allowed the passage of a clinically significant amount of air from the venous circulation to the systemic circulation. The interaction of air with the systemic arterial endothelium may have triggered the release of endothelium-derived cytokines, resulting in the physiologic response of systemic inflammatory response syndrome.
Adenosine A1 Antagonism Attenuates Atropine‐resistant Hypoxic Bradycardia in Rats
Authors: Kaplan Justin L. , Gao Erhe , De Garavilla Lawrence , Victain Michelle , Minczak Bohdan , Dalsey William C. 
Published: September 2003

Abstract Objectives: To test the following hypotheses: Hypoxia induces bradycardia and hemodynamic compromise that are resistant to atropine but responsive to selective antagonism of the adenosine A1 receptor (A1AdoR). The mechanism for such attenuation is independent of the vagus nerve. Methods: Ten minutes after sham or actual bilateral cervical vagotomy, paralyzed ventilated rats were made hypoxic (5% fractional inspired oxygen, continued until death). Five minutes after beginning hypoxia, intravenous treatment with BG‐9719, a selective A1AdoR antagonist (0.1 mg/kg); atropine (0.1 mg/kg); BG‐9719 vehicle; or saline was initiated. These drug doses were based on pilot studies. Of the eight treatment groups (eight possible combinations of vagotomy status and drug/vehicle treatment), n= 8 in all except nonvagotomized, vehicle‐treated rats (where n= 7). Results: Heart rate and left ventricular contractility decreased rapidly with hypoxia. Atropine had minimal effects in prolonging survival (from mean ± SEM of 15.5 ± 2.1 minutes to 20.2 ± 2.5 minutes, p = 0.94) and attenuating posthypoxic decreases in heart rate (p = 0.89) and contractility (p = 0.83) compared with saline. BG‐9719 prolonged survival, however, from 14.4 ± 1.9 minutes (with vehicle treatment) to 37.2 ± 6.8 minutes (p < 0.001). Survival, heart rate, and contractility were preserved with BG‐9719 compared with atropine and vehicle (p < 0.05, all comparisons). Vagotomy prevented the effects of BG‐9719 on survival prolongation (p = 0.003), heart rate (p = 0.01), and contractility (p < 0.001) but did not affect those outcomes in saline‐treated rats. Conclusions: Survival, heart rate, and contractility were better preserved with BG‐9719 than atropine. A1AdoR selective antagonism, possibly because of its multiple mechanisms for attenuating hypoxic cardiac insufficiency, resulted in better hemodynamic and clinical outcomes. That attenuation seems to have a component of vagal mediation.
Randomized Clinical Trial of Propofol versus Methohexital for Procedural Sedation during Fracture and Dislocation Reduction in the Emergency Department
Authors: Miner James R. , Biros Michelle , Krieg Susan , Johnson Christopher , Heegaard William , Plummer David 
Published: September 2003

AbstractAlthough methohexital has been well studied for use in emergency department (ED) procedural sedation (PS), propofol has been evaluated less extensively for ED use. Objective: The authors hypothesized that there is no difference in the depth of sedation and the rate of respiratory depression (RD) between propofol and methohexital in PS during the reduction of fractures and dislocations in the ED. Methods: This was a randomized prospective study of nonintoxicated adult patients undergoing PS for fracture or dislocation reduction in the ED between July 2001 and March 2002. Patients were randomized to receive either propofol or methohexital, 1 mg/kg intravenously, followed by repeat boluses of 0.5 mg/kg every 2 minutes until adequate sedation was achieved. Doses, vital signs, end‐tidal CO 2 (ETCO 2) by nasal cannulae, pulse oximetry, and bispectral electroencephalogram analysis (BIS) scores were recorded. RD was defined as an ETCO 2 greater than 50 torr, an oxygen saturation less than 90% at any time, or an absent ETCO 2 waveform. After returning to baseline mental status, patients completed three 100‐mm visual analog scales (VASs) regarding pain associated with the procedure, recall of the procedure, and satisfaction. RD rates and VAS outcomes were compared with chi‐square tests. Results: There were 109 patients enrolled; six were excluded for study protocol violations. Of the remaining 103 patients, 52 received methohexital (reduction successful in 94%) and 51 received propofol (98% successful). No cardiac rhythm abnormalities or significant decline in systolic blood pressure (>20%) was detected. Six patients required bag‐valve‐mask‐assisted ventilations during the procedure, all for less than 1 minute; four of these patients received methohexital, and two received propofol. By the authors' definition, RD was seen in 25 of 52 (48%) patients receiving methohexital and 25 of 51 (49%) patients receiving propofol (p = 0.88). The mean minimum recorded BIS score was 66.2 (95% confidence interval [CI] = 62 to 70) for methohexital and 66 (95% CI = 60 to 71) for propofol. VAS results showed similar rates of reported pain, recall, and satisfaction for the two agents. Conclusions: The authors were unable to detect a significant difference in the level of subclinical RD or the level of sedation by BIS between the two agents. The use of either agent seems to be safe in the ED.
Development and Validation of a New Index to Measure Emergency Department Crowding
Authors: Bernstein Steven L. , Verghese Vinu , Leung Winifred , Lunney Anne T. , Perez Ivelisse 
Published: September 2003

Abstract Objectives: To develop a quantitative measure of emergency department (ED) crowding and busyness. Methods: A five‐week study in spring 2002 in an urban teaching ED compared a new index (the Emergency Department Work Index [EDWIN]) with attending physician and nurse ratings of crowding. EDWIN is defined as ∑n it i/N a(B T−B A), where n i = number of patients in the ED in triage category i, t i = triage category, N a = number of attending physicians on duty, B T = number of treatment bays, and B A = number of admitted patients in the ED. The triage system used is the Emergency Severity Index (ESI), which was modified by reversing the ranking of triage categories; that is, an ESI score of 1 represented the least acute patient and 5 the sickest. EDWIN was calculated every two hours in a convenience sample of 60 eight‐hour shifts. With each measurement, the charge attending physician and nurse estimated how busy/crowded the ED was, using a Likert scale. Nurse and physician assessments were averaged and compared with EDWIN scores. Data were analyzed with SPSS 10.0 (SPSS Inc., Chicago, IL). Results: A total of 2,647 patients aged 18 years and older were assessed at 225 time points over 35 consecutive days. Nurses and physicians showed good interrater agreement of crowding assessment (weighted κ 0.61, 95% confidence interval = 0.53 to 0.69). Median EDWIN scores and interquartile ranges (IQRs) when the ED was rated as not busy, average, and very busy were 1.07 (IQR = 0.80 to 1.55), 1.55 (IQR = 1.16 to 1.93), and 1.83 (IQR = 1.42 to 2.45) (p < 0.001). The ED was on diversion for 17 time blocks (6.5% of all blocks), with a median EDWIN of 2.77 (IQR = 1.83 to 3.63), compared with an EDWIN of 1.45 (IQR = 1.05 to 2.00) when not on diversion (p < 0.001). EDWIN scores correlated weakly with various process‐of‐care measures chosen as secondary end points. Conclusions: EDWIN correlated well with staff assessment of ED crowding and diversion. The index can be programmed into tracking software for use as a “dashboard” to alert staff when the ED is approaching crisis. If validated across other sites, EDWIN may provide a tool to compare crowding levels among different EDs.
Incomplete Data Reporting in Studies of Emergency Department Patients with Potential Acute Coronary Syndromes Using Troponins
Authors: Glavan Bradford , Shewakramani Sanjay , Hollander Judd E. 
Published: September 2003

Abstract Objectives: A multidisciplinary panel of experts is developing standardized reporting criteria for risk stratification studies of emergency department (ED) patients with potential acute coronary syndromes (ACS). The authors assessed the need for such criteria by reviewing published studies to determine whether these core criteria currently are being reported. Methods: Studies published during 2000–2001 in eight journals representing emergency medicine, cardiology, and general medicine that evaluated the cardiac troponins for risk stratification of ED patients with chest pain were identified by a systematic MEDLINE review. Two raters independently analyzed each study with a structured tool. The presence or absence of 47 core criteria in eight major reporting categories, which were determined by expert consensus, was abstracted from the articles. When the two raters disagreed, discrepancies were resolved by consensus. Data are presented as percent frequency of occurrence with 95% confidence intervals. Results: Twenty‐two articles met inclusion criteria. The two reviewers had a median of 7.5 initial discrepancies per article (interquartile range = 6 to 10) but achieved consensus on all.Conclusions: Many of the 47 items considered core criteria by the expert committee writing standardized reporting guidelines for risk stratification studies of potential ACS patients were not reported often in major cardiology and emergency medicine journals. There seems to be a need for standardized reporting guidelines because important information is not currently being reported.
Is Total Out‐of‐hospital Time a Significant Predictor of Trauma Patient Mortality?
Authors: Lerner E. Brooke , Billittier Anthony J. , Dorn Joan M. , Wu Yow‐Wu B. 
Published: September 2003

Abstract Objective: To determine if there is an association between total out‐of‐hospital time and trauma patient mortality. Methods: A retrospective review was performed of a convenience sample of consecutive medical records for all admitted patients transported by helicopter or ambulance from the scene of injury to the regional trauma center. Descriptive and univariate analyses were conducted to determine which variables were associated with patient mortality and total out‐of‐hospital time. Multiple predictors logistic regression was used to determine if total out‐of‐hospital time was associated with trauma patient outcome, while controlling for the variables associated with trauma patient mortality. Results: Of the 2,925 patients who were transported from the scene, 1,877 met the inclusion criteria. Six percent (116) did not survive. The multiple predictors model included CUPS (critical, unstable, potentially unstable, stable) status, patient age, Injury Severity Score, Revised Trauma Score, and total out‐of‐hospital time as predictors of mortality. Total out‐of‐hospital time (odds ratio 0.987; p = 0.092) was the only variable not found to be a significant predictor of mortality. Conclusions: Provider‐assigned CUPS status, patient age, Injury Severity Score, and Revised Trauma Score all were significant predictors of trauma patient mortality. Total out‐of‐hospital time was not associated with mortality.
Unrecognized Misplacement of Endotracheal Tubes in a Mixed Urban to Rural Emergency Medical Services Setting
Authors: Jemmett Michael E. , Kendal Kevin M. , Fourre Mark W. , Burton John H. 
Published: September 2003

Abstract Objective: To determine the rate of unrecognized endotracheal tube misplacement when performed by emergency medical services (EMS) personnel in a mixed urban and rural setting. Methods: The authors conducted a prospective, observational analysis of out‐of‐hospital endotracheal intubations (EIs) performed by EMS personnel serving a mixed urban, suburban, and rural population. From July 1, 1998, to August 30, 1999, emergency physicians assessed and recorded the position of out‐of‐hospital EIs using auscultation, direct laryngoscopy, infrared CO 2 detectors, esophageal detector devices, and chest x‐ray. The state EMS database also was reviewed to determine the number of EIs involving patients transported to the authors' medical center and paramedic assessment of success for these encounters. Results: A total of 167 out‐of‐hospital EIs were recorded, of which 136 (81%) were deemed successful by EMS personnel. Observational forms were completed for 109 of the 136 patients who arrived intubated to the emergency department. Of the studied patients, 12% (13 of 109) were found to have misplaced endotracheal tubes. For the patients with unrecognized improperly placed tubes, 9% (10 of 109) were in the esophagus, 2% (2 of 109) were in the right main stem, and 1% (1 of 109) were above the cords. Paramedics serving urban and suburban areas did not perform significantly better (p < 0.05) than intermediate‐level providers serving areas that are more rural. Conclusions: The incidence of unrecognized misplacement of endotracheal tubes by EMS personnel may be higher than most previous studies, making regular EMS evaluation and the out‐of‐hospital use of devices to confirm placement imperative. The authors were unable to show a difference in misplacement rates based on provider experience or level of training.