bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring healthcare performance by analytic hierarchy process: a developing‐country perspective
Authors: Ahsan M.K. , Bartlema J. 
Published: June 2004

AbstractThe formulation and solution of multi‐criteria healthcare decision problems is of critical importance to the health and socio‐economic betterment of developing countries. The study shows how the multi‐criteria decision‐making method could facilitate implementation of healthcare performance analysis, especially for the public healthcare system of Bangladesh, which operates mainly through thana health complexes (THCs). We include outreach services and rural facilities together with ongoing THC activities, and analyze their relative performance. The methodology uses a phase of the Delphi method and of the analytic hierarchy process (AHP) approach. The outcome of Delphi is used as input for the hierarchical processing procedure in AHP and determines performance order of the healthcare activities. Results from AHP are discussed for implementation in decision‐making and the managerial policymaking process, towards improvement of overall healthcare performance.
Cosmopolitan Legalism Meets ‘Thin Community’: Problems in the Global Governance of Intellectual Property
Authors: May Christopher 
Published: June 2004

AbstractThe making of knowledge and information into property, through intellectual property rights (IPRs) has commonly been justified using a set of cosmopolitan norms. These norms of justification have been extensively deployed within the structures of global governance for IPRs. However, the political community that underpins such norms in national jurisdictions is lacking at the global level. Many of the political problems now recognized with the globalized protection of IPRs stem from this tension between cosmopolitan legalism and the contemporary ‘thin’ global community.
Examining and Explaining the Northern League's ‘U-Turn’ from Europe
Authors: Chari Raj S. , Iltanen Suvi , Kritzinger Sylvia 
Published: June 2004

AbstractSet in the context of the larger literature on regionalist parties and specifically on the Italian Northern League, this paper examines and explains why the party moved from Euro-positivism to Euroscepticism. Drawing on concepts raised in the larger comparative politics literature, five explanations of this U-turn towards Europe are evaluated. It is argued that, despite the strength of explanations that focus on the desires of party supporters, the role of public opinion, the potential influence of economic investors or the role of EU-level institutions in shaping party preferences, a more cogent explanation focuses on domestic-level developments. The conclusions will underscore the general implications of this research for the study of parties, particularly regionalist ones in the EU, highlighting that a party's changing stance towards supranational integrationist polices can be best understood as a consequence of its experience in a political system's electoral system.
The Politics of Banking in Romania: Soft Loans, Looting and Cardboard Billionaires
Authors: Cernat Lucian 
Published: June 2004

AbstractIn this article attention is focused on the features of the emerging Romanian banking system, its failures, and their determinants. These failures were either politically driven or simply a result of the weak regulatory capacity of the state (as the owner of the banks) and lax monitoring from the central bank, as the central authority entrusted with the responsibility to maintain a well-functioning banking system. The reluctance of various governments, regardless of their political orientation, to apply sanctions against banks that are in trouble until the last possible moment encourage excessive risk-taking when banks first encounter financial difficultics, and asset-stripping when the insiders realize that a bank's continued viability is in jeopardy. Based on a number of case studies, the article argues that, in post-1989 Romania, insider trading, self-loans and blunt theft appeared more as systemic features rather than isolated incidents.
The Tragedy of the Kursk: Crisis Management in Putin's Russia
Authors: Barany Zoltan 
Published: June 2004

AbstractThe objective of this paper is to reconstruct both the Kursk incident and especially the reaction to it by Russian military and political authorities with the aim of gauging the extent of continuity and change of Soviet-era practices in three key areas of contemporary Russia's public institutional life: (1) the organizational behaviour and institutional culture of the Russian military; (2) the behaviour of Russia's executive political leadership, i.e. President Vladimir Putin; and (3) the media of mass communication. Reaction to such crises, the author argues, can shed much light on the actual behavioural patterns and operating assumptions of relevant institutions and leaders. The method employed is essentially a detailed forensic reconstruction of the incident and its aftermath from three angles: the reactions of the military authorities; the reactions of Putin; and the reactions of the mass media (and of the authorities to the mass media).The individual is nonsense, the individual is zero.Vladimir Mayakovsky, 1921Human life still costs nothing here.Leonid Radzikhovskii, 2000
Being Irish
Authors: O'Kelly Ciarán 
Published: June 2004

AbstractThis article is one of a series commissioned by Government and Opposition exploring identity politics in several national and international contexts. Though ostensibly a civic republic, Ireland has been shaped by a certain conception of Irish culture. Cultural claims are typically political but have the potential to allow community interests to override concern for individual well-being. The construction of the Irish state focused on the maintenance of an idea of being Irish rather than on the welfare of people throughout Ireland, both North and South. As a result, a conservative formulation of Irish identity was locked into the state's structures.
Special Care Facility Compared with Traditional Environments for Dementia Care: A Longitudinal Study of Quality of Life
Authors: Reimer Marlene A. , Slaughter Susan , Donaldson Cam , Currie Gillian , Eliasziw Michael 
Published: June 2004

Objectives: To compare the effect of a specialized care facility (SCF) on quality of life (QoL) for residents with middle‐ to late‐stage dementia over a 1‐year period with residence in traditional institutional facilities.Design: A prospective, matched‐group design with assessments of QoL every 3 months for 1 year.Setting: Twenty‐four long‐term care centers and four designated assisted living environments in an urban center in western Canada.Participants: One hundred eighty‐five residents with Global Deterioration Scores of 5 or greater were enrolled: 62 in the intervention SCF group and 123 in the traditional institutional facilities groups.Intervention: The SCF is a 60‐bed purpose‐built facility with 10 people living in six bungalows. The facility followed an ecologic model of care that is responsive to the unique interplay of each person and the environment. This model encompasses a vision of long‐term care that is more comfortable, more like home, and offers more choice, meaningful activity, and privacy than traditional settings.Measurements: QoL outcomes were assessed using the Brief Cognitive Rating Scale, Functional Assessment Staging, Cohen‐Mansfield Agitation Inventory, Pleasant Events Scale—Alzheimer's disease, Multidimensional Observation Scale of Elderly Subjects, and Apparent Affect Rating Scale.Results: The intervening SCF group demonstrated less decline in activities of daily living, more sustained interest in the environment, and less negative affect than residents in the traditional institutional facilities. There were no differences between groups in concentration, memory, orientation, depression, or social withdrawal.Conclusion: The present study suggests that QoL for adults with middle‐ to late‐stage dementia is the same or better in a purpose‐built and staffed SCF than in traditional institutional settings.
Ethnicity and Time to Institutionalization of Dementia Patients: A Comparison of Latina and Caucasian Female Family Caregivers
Authors: Mausbach Brent T. , Coon David W. , Depp Colin , Rabinowitz Yaron G. , Wilson‐Arias Esther , Kraemer Helena C. , Thompson Larry W. , Lane Geoffrey , Gallagher‐Thompson Dolores 
Published: June 2004

Objectives: To compare rates of institutionalization of dementia patients cared for by Latina and Caucasian female caregivers and to explore which caregiver and care‐recipient characteristics predicted institutionalization.Design: Longitudinal.Setting: San Francisco Bay area, California.Participants: Two hundred sixty‐four female caregivers of dementia patients (154 Caucasian women, 110 Latinas) who participated in an intervention project designed to reduce caregiver stress and may represent a sample that is more stressed and motivated than a general sample of caregivers.Measurements: Number of days between baseline interview and institutionalization was recorded over an 18‐month period. Kaplan‐Meier survival analysis with the log rank statistic was used to test for ethnic differences in time to institutionalization. Cox regression analyses were conducted to determine whether care‐recipient or caregiver characteristics (e.g., care‐recipient age and memory and behavior problems; caregiver depression, years of education, income, and views of the caregiving role) significantly interacted with ethnicity to explain time to institutionalization.Results: Latinas delayed institutionalization significantly longer than their Caucasian counterparts; care‐recipient characteristics or caregiver demographics did not explain these results, although Latinas who identified greater benefits or more‐positive aspects of the caregiving process at baseline were less likely to institutionalize their loved one than those who reported fewer benefits of caregiving. Less‐acculturated Latinas were significantly more likely to identify positive aspects of caregiving than more‐acculturated Latinas.Conclusion: Latina dementia caregivers delay institutionalization significantly longer than female Caucasian caregivers. In addition, Latino cultural values and positive views of the caregiving role are important factors that may significantly influence their decision to institutionalize loved ones with dementia.
Breast Cancer Treatment in Older Women: Impact of the Patient‐Physician Interaction
Authors: Maly Rose C. , Leake Barbara , Silliman Rebecca A. 
Published: June 2004

Objectives: To assess the impact of the patient‐physician interaction on breast cancer care in older women.Design: Cross‐sectional survey.Setting: Los Angeles County, California.Participants: Two hundred twenty‐two consecutively identified breast cancer patients aged 55 and older who were within 6 months of breast cancer diagnosis and/or 1 month posttreatment.Measurements: Dependent variables were patient breast cancer knowledge, treatment delay, and receipt of breast‐conserving surgery (BCS). Key independent variables were five dimensions of the patient‐physician interaction by patient report, including physician provision of tangible and interactive informational support, physician provision of emotional support, physician participatory decision‐making style, and patient perceived self‐efficacy in the patient‐physician interaction. Age and ethnicity were additional important independent variables.Results: In multiple logistic regression models, only physician interactive informational support had significant relationships with all three dependent variables, controlling for a wide range of patient sociodemographic and case‐mix characteristics, visit length, number of physicians seen, social support, and physician sociodemographic and practice characteristics. Specifically, informational support positively predicted patient breast cancer knowledge (adjusted odds ratio (AOR)=1.18, 95% confidence interval (CI)=1.00–1.38), negatively predicted treatment delays (AOR=0.80, 95% CI=0.67–0.94), and positively predicted receipt of BCS (AOR=1.29, 95% CI=1.07–1.56). Age and ethnicity were not significant predictors in these models.Conclusion: One specific domain of the patient‐physician interaction, interactive informational support, may provide an avenue to ensure adequate breast cancer knowledge for patient treatment decision‐making, decrease treatment delay, and increase rates of BCS for older breast cancer patients, thereby potentially mitigating known healthcare disparities in this vulnerable population of breast cancer patients.
Self‐Reported Alcohol Consumption and Falls in Older Adults: Cross‐Sectional and Longitudinal Analyses of the Cardiovascular Health Study
Authors: Mukamal Kenneth J. , Mittleman Murray A. , Longstreth W. T. , Newman Anne B. , Fried Linda P. , Siscovick David S. 
Published: June 2004

Objectives: To assess the cross‐sectional and longitudinal associations between alcohol consumption and risk of falls in older adults.Design: Cross‐sectional and longitudinal analyses.Setting: Four U.S. communities.Participants: A total of 5,841 older adults enrolled in the Cardiovascular Health Study, an ongoing, population‐based, prospective cohort study, participated.Measurements: Self‐reported alcohol consumption at baseline, self‐reported frequent falls at baseline, and the 4‐year risk of falls of participants who denied frequent falls at baseline.Results: Cross‐sectional analysis indicated an apparent inverse association between alcohol consumption and risk of frequent falls (adjusted odds ratio in consumers of 14 or more drinks per week=0.41; 95% confidence interval (CI)=0.14–1.17; P for trend=.06), but longitudinal analysis indicated a similar 4‐year risk of falls in abstainers and light to moderate drinkers but a 25% higher risk in consumers of 14 or more drinks per week (95% CI=3–52%; P for trend=.07). Similar results were found in analyses stratified by age, sex, race, and physical activity.Conclusion: Consumption of 14 or more drinks per week is associated with an increased risk of subsequent falls in older adults. Cross‐sectional studies may fail to identify this risk of heavier drinking, perhaps because older adults at risk for falls decrease their alcohol use over time or because heavier drinkers at risk for falls tend not to enroll in cohort studies. However, because this study relied upon annual reporting of falls, further prospective studies should be conducted to confirm these findings.
Assessment of Individual Risk of Death Using Self‐Report Data: An Artificial Neural Network Compared with a Frailty Index
Authors: Song Xiaowei , Mitnitski Arnold , MacKnight Chris , Rockwood Kenneth 
Published: June 2004

Objectives: To evaluate the potential of an artificial neural network (ANN) in predicting survival in elderly Canadians, using self‐report data.Design: Cohort study with up to 72 months follow‐up.Setting: Forty self‐reported characteristics were obtained from the community sample of the Canadian Study of Health and Aging. An individual frailty index score was calculated as the proportion of deficits experienced. For the ANN, randomly selected participants formed the training sample to derive relationships between the variables and survival and the validation sample to control overfitting. An ANN output was generated for each subject. A separate testing sample was used to evaluate the accuracy of prediction.Participants: A total of 8,547 Canadians aged 65 to 99, of whom 1,865 died during 72 months of follow‐up.Measurements: The output of an ANN model was compared with an unweighted frailty index in predicting survival patterns using receiver operating characteristic (ROC) curves.Results: The area under the ROC curve was 86% for the ANN and 62% for the frailty index. At the optimal ROC value, the accuracy of the frailty index was 70.0%. The ANN accuracy rate over 10 simulations in predicting the probability of individual survival mean±standard deviation was 79.2±0.8%.Conclusion: An ANN provided more accurate survival classification than an unweighted frailty index. The data suggest that the concept of biological redundancy might be operationalized from health survey data.
Iatrogenic magnesium overdose: 2 case reports
Authors: Jackson C. Bisque , Drobatz Kenneth J. 
Published: June 2004

AbstractObjective: To describe the clinical manifestations and treatment of hypermagnesemia and the potential drug errors that can lead to iatrogenic electrolyte toxicities.Summary: We report 2 cases of iatrogenic intravenous (IV) magnesium (Mg) overdose. Both cases developed extreme cardiovascular and neurologic symptoms consisting of vomiting, hypotension, bradycardia, flaccid paralysis, and severe mental depression. Diagnosis was made based upon serum ionized Mg levels (3.47 mmol/L; reference range: 0.43–0.58 mmol/L for Case #1; and 4.64 mmol/L; reference range: 0.42–0.55 mmol/L for Case #2). Each animal was treated with 0.9% NaCl for diuresis and IV calcium gluconate. Within 24 hours, the cardiovascular and neurologic status of both animals, as well as the serum Mg concentration, had normalized. Each animal was discharged with no complications. Both animals had been hospitalized for critical illness and had developed hypomagnesemia that was being treated with Mg sulfate infusions. The cause for the hypermagnesemia was due to miscalculations in treatment orders that led to erroneously administered Mg‐containing solutions. Confusing drug labels and varying units of measurement can lead to erroneous miscalculations, especially in critically ill patients that receive multiple IV infusions.New information provided: This is the first case report of iatrogenic Mg overdose in veterinary medicine. These 2 cases had a good clinical outcome with prompt recognition and supportive care.
Critical role of the vascular endothelial cell in health and disease: a review article
Authors: Duffy Todd C. , Kirby Rebecca , Rudloff Elke 
Published: June 2004

AbstractObjective:To review the human and veterinary literature on the role of the vascular endothelial cell in health, as well as during hypoxic and inflammatory disease states.Data sources:Data from human and veterinary literature were reviewed through a Pubmed search and a manual search of the references listed in articles covering some aspect of vascular endothelial cell function.Human data synthesis:The development of techniques that allow the maintenance and growth of endothelial cells in culture has produced an explosion of new research in the area of endothelial cell physiology. This plethora of data has revealed the critical role that vascular endothelial cells play in both health and disease states. Interspecies variations can occur with respect to the vascular endothelial cell physiology and its response to pathologic conditions.Veterinary data synthesis:There is a paucity of information regarding the role of the vascular endothelial cell in health or disease of small animals. Many human studies use species cared for by veterinarians, providing information that may be applied to small animals and that may be used to construct future studies.Conclusion:An organ system itself, the vascular endothelium is an essential component of all organs in the body. The endothelial cell lining functions to maintain selective permeability between the blood and the tissue it supplies, regulate vascular tone, sustain blood fluidity through regulation of coagulation, and modulate interaction of leukocytes with the interstitium and inflammatory reactions. During disease states, the endothelial cell functions locally to limit the boundaries of the disease process. If these functions are not controlled, they can become a part of the pathogenic process, contributing to blood stasis and thrombosis, potentiation of local inflammation and interstitial edema formation, subsequent tissue hypoxia, and multiple organ dysfunction. Pharmacological investigations targeting the modulation of endothelial function during disease states have not yet advanced treatment protocols. Since all critically ill animals are at risk for some degree of endothelial cell dysfunction, treatment regimens should focus on promoting capillary blood flow and tissue oxygen delivery.
Determination of plasma lysosomal enzyme activity and its relationship to severity of injury following blunt vehicular trauma in dogs
Authors: Chow Rosalind S. , Syring Rebecca S. , Otto Cynthia M. 
Published: June 2004

AbstractObjective: To determine plasma β‐d‐glucuronidase (βG) activity in the first 4 hours following injury in dogs struck by a motor vehicle, and to evaluate whether the degree of enzyme activity is correlated with the severity of injury.Design: A prospective clinical study.Setting: Veterinary Medical Teaching Hospital.Animals: Thirteen client‐owned dogs that were presented to the Veterinary Hospital of the University of Pennsylvania between June and August 1999 for blunt vehicular trauma. Ten healthy student and staff‐owned dogs served as controls.Interventions: None.Measurements: Plasma was analyzed for βG enzyme activity at the time of presentation (n=13), and 1 and 4 hours (n=7) following presentation to the Emergency Service for blunt vehicular trauma. The results were compared with enzyme activity from healthy controls evaluated serially over 4 hours. Fluorometric analysis using 96‐well microtiter plates was used to perform the enzyme assays. The relationships between presentation (n=13) and 4 hours (n=7) of enzyme activity and 3 indices of metabolic and physical disturbance (serum pH, serum lactate and Animal Trauma Triage (ATT) score) at the time of presentation were also investigated.Main results: Of the 13 dogs, 7 fulfilled the inclusion criteria for comparison of enzyme activity of the trauma over time. A statistically significant difference in βG activity was found in the trauma group (mean 75.6±10.4 U) at 4 hours following presentation compared with controls (mean 48.0±6.4 U). This difference was suggested by 1 hour following presentation (trauma group, mean 70.4±10.9 U; control group, mean 49.8±5.5 U), although it did not reach statistical significance. Thirteen dogs fulfilled the inclusion criteria for comparison of only presentation enzyme activity with trauma severity score, serum lactate, and serum pH. No statistically significant relationship was found between the βd‐glucuronidase activity and the presenting ATT score, serum lactate concentration, or serum pH at either presentation or 4 hours, although the power of these analyses was low.Conclusions: These results demonstrate that the activity of βG, a lysosomal enzyme, increases significantly in the systemic circulation in dogs 4 hours following blunt trauma. Additional research to include more severely injured dogs, a larger number of dogs, and to follow the course of injury for a longer period of time would be beneficial to further characterize βG activity following blunt trauma.