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PubMed2000

Studying perceptions of juror influence in vivo: a social relations analysis.

Because of legal constraints and statistical limitations there has been little research on social influence in actual juries. We used Kenny's (1994) social relations model to examine jurors' perceptions of social influence in the jury. After rendering a verdict in criminal or civil court cases, jurors rated how influential each member of the jury had been and provided self-reports of their personality traits. Perceptions of influence in the jury were mostly in the eye of the beholder, with jurors high in Conscientiousness and low in Openness being most likely to report that they were personally influenced by other jurors. There were small but statistically significant levels of consensus in the ratings of how influential the jurors were. To the extent that they did agree, jurors rated extraverted, tall men as most influential.

Adult↗
PubMed1998

Influence of Third-Year Clerkships on Medical Student Specialty Preferences.

Purpose - The purpose of this study was to investigate influences on third-year medical students' specialty preferences.Method - A survey questionnaire was mailed to third-year medical students at two medical schools. The questionnaire asked students to rate the degree to which various aspects of the third-year curriculum and perceived specialty characteristics influenced their specialty preferences.Results - A total of 214 (70%) of eligible students responded, of whom 46% were female and 57% preferred primary care (PC) specialties. The most frequently cited influential clerkship was internal medicine. Most clerkships (72%) had a positive influence on students' preferences. PC clerkships had more positive influences than non-primary care (NPC) clerkships, especially among PC-oriented students. The most influential aspects of clerkships were faculty and residents, especially in PC clerkships. For both PC- and NPS-oriented students, the diagnostic and patient-related characteristics of their preferred specialties were highly influential. PC-oriented students were more likely to be attracted to prevention and biopsychosocial aspects of specialties, and NPC-oriented students to the opportunity to do procedures and intervene in illnesses. Student gender appeared to have little influence on response patterns, except as a proxy for specialty preference, which, for women, was more likely to be a primary care specialty.Conclusion - These findings suggest that the third-year clerkships, especially at non-university sites, play an important role in specialty choice, and that factors attracting students to PC differ significantly from those attracting students to NPC.

Journal Article↗
PubMed2001

Adolescent drug use in Mexico and among Mexican American adolescents in the United States: environmental influences and individual characteristics.

The authors compared high school students in Baja California Norte (BCN), Mexico (n = 775), with Mexican American students in Los Angeles (LA), California (n = 516). The students' use of cigarettes, alcohol, marijuana, cocaine, inhalants, and other illicit drugs were compared, because these vary by gender, country, and their age of first drug use and are influenced by demographic variables, individual characteristics, and environmental influences. More BCN students than LA students had used alcohol, but more LA than BCN students had used illicit drugs and initiated drug use earlier. When demographic variables were influential, they were most powerful and increased the risk for drug use more than environmental factors or individual characteristics. Environmental factors were most influential for boys' drug use, whereas environmental and demographic variables were most influential for girls' drug use.

Adolescent↗
PubMed1999

Characteristics of 'low risk' and 'high risk' dives by young adults: risk reduction in spinal cord injury.

STUDY DESIGN: To establish benchmark normative data for dive entries performed by young adults of the age range most likely to sustain a diving spinal cord injury. Data acquired from analysis of the dives performed, along with survey information, were used to determine which factors make the most contribution to the level of risk in diving. OBJECTIVES: To identify influential variables which could contribute to risk of spinal cord injury for each of four types of dives. The types of dives investigated were: dive entries from deck level to tread water (Treadwater); deck level to swim 25 m (Deck); starting block height to swim 25 m (Block); and a running dive entry to swim 25 m (Running). SETTING: Victoria, Australia. METHODS: Ninety-five first year university students (average age 19.9 years) performed three or four dives which were video-recorded for later analysis. Maximum depth reached was used as an indicator of risk, and velocity at maximum depth, distance at maximum depth, angle of entry and flight distance were measured for each dive. Participants also completed a questionnaire designed to elicit information about their swimming and diving background. Unlike previous diving studies, participants were recreational rather than competitive swimmers. They were not aware that the dive was the focal point, assuming that the researchers were investigating their swimming and treadwater ability. RESULTS: A stepwise multiple regression was applied to predict depth for each dive condition, and demonstrated that four variables were able to account for 56% of the variance for Treadwater, 68% for Deck; 73% for Running and 79% for Block. In all conditions involving swimming after the dive (ie Deck, Block and Running), beta weights showed that distance at maximum depth had the greatest influence on the depth of a dive. Flight distance and angle of entry were the next most influential variables. For the Treadwater condition, beta weights showed angle of entry was the most influential variable, followed by velocity at maximum depth, distance at maximum depth and swim rank. CONCLUSION: It is recommended that divers strive to surface in as short a distance as possible by maximising flight distance and aiming for a low entry angle. Implementation of steering-up techniques will assist in minimising dive depth.

Adult↗
PubMed1993

Clarification of the pH-dependent kinetic behaviour of papain by using reactivity probes and analysis of alkylation and catalysed acylation reactions in terms of multihydronic state models: implications for electrostatics calculations and interpretation of the consequences of site-specific mutations such as Asp-158-Asn and Asp-158-Glu.

1. The complex behaviour of papain (EC 3.4.22.2) in acidic media has been investigated by (a) stopped-flow reactivity probe kinetics using 4,4'-dipyrimidyl disulphide (I) and 2,2'-dipyridyl disulphide (II) as thiol-specific time-dependent inhibitors with markedly different susceptibilities to activation by hydronation (protonation) and (b) using the multitasking application program SKETCHER for the rapid evaluation of pH-dependent kinetic data by means of interactive manipulation of calculated curves. 2. The substantially lower basicity of (I) (pKa 0.91) than that of (II) (pKa 2.45) combined with retention of high reactivity permitted the pKa for the formation of the (Cys-25)-S-/(His-159)-Im+H ion-pair state of papain to be determined kinetically as 3.4, a value close to that (3.3) deduced by potentiometric difference titration [Lewis, Johnson and Shafer (1976) Biochemistry 15, 5009-5017] and lower than the value (approx. 4) often reported from pH-dependent kinetic studies. The higher values are now known to arise from inadequate data analysis that does not take account of other overlapping kinetically influential ionizations. 3. Re-evaluation of the extensive sets of pH-kcat/Km data for the hydrolysis of nine substrates by papain reported by Polgár and Halász (1978) (Eur. J. Biochem. 88, 513-521) by making use of SKETCHER, the known pKa value (3.4) from the reaction with compound (I) and two additional kinetically influential pKa values deduced from the reaction with compound (II) now permits the identification of the pH-dependent events in reactions of papain with inhibitors and substrates. 4. A major conclusion is that, whereas in reactions of simple alkylating agents and compound (I) full nucleophilic character of (Cys-25)-S-/(His-159)-Im+H is provided by hydronic dissociation with pKa 3.3-3.4, in catalysis relatively little catalytic competence is produced consequent upon ion-pair formation. Substantial catalytic competence requires further hydronic dissociation with pKa approx. 4, and for cationic substrates further enhancement is produced by hydronic dissociation with pKa approx. 5. 5. The present work, together with the kinetic analysis of reactions of papain in alkaline media reported by Mellor, Thomas, Topham and Brocklehurst [Biochem. J. (1993) 290, 289-296], defines the kinetically influential ionizations of papain as 3.4, 4.0, 5.0, 8.3 and 10.0 of which 3.4 and 8.3 relate to the formation and subsequent dehydronation of the ion-pair state.(ABSTRACT TRUNCATED AT 400 WORDS)

Acylation↗
PubMed2001

Theories of drug craving, ancient and modern.

This paper reviews the principal theoretical models of drug craving and provides some directions for future research. The main models are classified broadly into three categories: (1) phenomenological models; based on clinical observation and description; these have been influential in classification systems of addictive disorders and in the development of pharmacological therapies; (2) conditioning models: based on conditioning theory; these have been influential in the development of cue exposure treatments; (3) cognitive theories; based on cognitive social learning theory: these have been influential in the development of cognitive therapies of addiction. It is concluded that no one specific theory provides a complete explanation of the phenomenon of craving. However, theories of craving grounded in general theories of human behaviour offer greatest promise, and generate more specific and testable research hypotheses. Theories that do not require craving to be present for relapse to occur have more empirical support than those that provide simplistic causal explanations. The cue-reactivity model shows promise in the exploration of the relationship between craving and relapse. However, further attention to the phenomenology of craving could help to advise the future measurement and study of drug craving, particularly in the context of research in which drugs are available to human subjects, with adequate ethical safeguards. There is a need for further study of the temporal dynamics of craving and consensus in the field on the most appropriate methods of measurement. Finally, new psychotherapies such as cue exposure and pharmacotherapies that aim to attenuate drinking behaviour, such as naltrexone and acamprosate, provide opportunities to improve understanding of the nature and significance of craving. However, the relatively uncritical assumption that craving is the underlying basis of addiction and represents the most appropriate target for treatment is challenged.

Behavior, Addictive↗
PubMed2002

Indicators of early research productivity among primary care fellows.

OBJECTIVE: Little is known about the impact of fellowship training in primary care on subsequent research productivity. Our goal was to identify characteristics of research fellows and their training associated with subsequent publications and research funding. DESIGN: Mail survey in 1998. SETTING AND PARTICIPANTS: 1988-1997 graduates of 25 National Research Service Award primary care research fellowships in the United States. OUTCOME MEASURES: 1) Publishing 1 or more papers per year since the beginning of fellowship, or 2) serving as principal investigator (PI) on a federal or non-federal grant. RESULTS: One hundred forty-six of two hundred fifteen program graduates (68%) completed the survey. The median age was 38 years, and 51% were male. Thirty-two percent had published 1 or more papers per year, and 44% were PIs. Male gender (odds ratio [OR], 3.6; 95% confidence interval [95% CI], 1.4 to 9.2), self-reported allocation of 40% or more of fellowship time to research (OR, 4.4; 95% CI, 1.8 to 11.2), and having an influential mentor during fellowship (OR, 5.0; 95% CI, 1.5 to 17.2) were independently associated with publishing 1 or more papers per year. Fellows with funding as a PI were also more likely to have an influential mentor (OR, 3.0; 95% CI, 1.3 to 7.2). CONCLUSION: Primary care fellows who had influential mentors were more productive in research early after fellowship. Awareness of the indicators of early research success can inform the policies of agencies that fund research training and the curricula of training programs themselves.

Family Practice↗
PubMed1995

Critical characteristics of technique in throwing the discus.

The purpose of this study was to identify those characteristics of the techniques used by elite discus throwers that are most closely related to the distances they record. The subjects were the competitors in the discus throw events at two major meetings. Two S-VHS video cameras were used to record the performances of the subjects; the direct linear transformation (DLT) procedure was used to obtain three-dimensional data from these records. For the males, the change in speed of the discus during the second double support phase was more influential than the change in speed during any other phase in accounting for differences in the distances of the throws recorded. For the females, the changes in speed during the flight phase and during the second double support phase were about equally influential in accounting for differences in the distance thrown. The findings suggest that emphasis placed on achieving a large change in the speed of the discus during the second double support phase is well founded; that the speed of release is the most influential determinant of the distance of the throw; and that, in most cases, the aerodynamic forces exerted on the discus during the flight increase the distance of the throw.

Acceleration↗
PubMed1998

Cardiac rehabilitation: gender differences in factors influencing participation.

This study investigates gender differences in the barriers and incentives that are most influential in the coronary patient's decision to participate in cardiac rehabilitation programs (CRPs) and suggests strategies to counter these barriers. Patient surveys were administered to consecutive English-speaking attenders and referred nonattenders to a cardiac rehabilitation center at a university healthcare system in Toronto, Canada. A survey questionnaire, constructed from a literature review and advice from key informants, examined potential factors affecting decisions to engage in CRPs. One hundred twenty-nine attenders at a CRP and 61 referred nonattenders completed the questionnaire. Physician recommendation was reported to be the most important factor influencing both women's and men's decisions to participate in CRPs, followed by encouragement from family members. For women who had attended CRP, encouragement from their adult children was significantly more influential than it was for men. Attention to health promotion was also a significantly more powerful motivator for women than it was for men. For CRP nonattenders, concomitant illness, transportation problems, and inconvenient timing of the program were stated to be the three most important barriers to CRP participation in both sexes, although women rated concomitant illness as a significantly more powerful barrier than did men. The decision to participate in CRPs involves several factors, some of which are different or more important for women. As physician recommendations continue to be the single most important factor in motivating both men and women to attend, strengthened and increased physician endorsement will likely encourage higher levels of participation in CRPs. For women, permission should be sought to discuss the advantages of CRPs with adult children who are apparently influential in the decision. As women nonattenders are more concerned than men about the effects of concomitant illnesses, reassurance should be provided about customized programs and exercise targets that consider the needs and limitations of individuals with other health conditions.

Aged↗
PubMed1986

The development of migration expectations: changes throughout the lifecourse.

This research examines how the relative influence of factors that determine an individual's expectations of moving varies throughout the lifecourse. Factors representing personal characteristics, ties to origin, and ties to potential destinations were used to discriminate between expected migrants and nonmigrants in three population subgroups representing different stages of life. These subgroups included a general adult population, a preretirement population, and an elderly population. The results indicate that personal characteristics are most influential among preretirement persons, ties to origin are most influential among the general and elderly populations, and ties to potential destinations are influential among all population subgroups.

Adult↗
PubMed2003

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care.

OBJECTIVES: To examine patient satisfaction with and recommendation of a hospital, with a special focus on the correlation of these measures to patient ratings of interpersonal and technical performance of the hospital. DESIGN: Telephone survey of patients with four specific conditions after their discharge from hospitals. SETTING: Accredited district teaching hospitals and above, nationwide in Taiwan. PARTICIPANTS: A total of 4945 patients from 126 hospitals diagnosed with or undergoing procedures related to stroke, diabetes mellitus, Caesarean section, or appendectomy were interviewed by telephone. MAIN OUTCOME MEASURES: Overall patient satisfaction and recommendation were measured by single-item questions. Interpersonal skills were measured by three items: doctors' explanation, attitude, and caring. Technical skills were measured by another three items: hospital equipment, clinical competence, and outcome of treatment. RESULTS: Interpersonal skills were as influential or more influential than clinical competence on patient satisfaction for three of the four disease categories. In contrast, technical competence was a more influential predictor for recommendation for patients in all four disease categories. CONCLUSION: The preliminary results imply that a hospital with high percentage of patient satisfaction does not necessarily receive a high level of recommendation. This finding provides new insights for researchers and for hospital managers who devote resources exclusively for achieving the highest possible levels of patient satisfaction.

Adolescent↗
PubMed1996

Determinants of specialty choice of physician assistants.

PURPOSE: Although physician assistants (PAs) became part of the U.S. health scene in 1967 and have made important contributions to primary care, available information about the factors that may influence the career choices of this rapidly-growing group of health care providers is sparse. The intent of this analysis was to identify the main factors underlying the specialty-choice decisions of PAs in the first practice year after completing PA training and the reasons for their selections. METHOD: Data were collected from a 1994 survey of 4,416 PAs who had graduated in 1991-1993. Usable responses were obtained from 1,472 PAs (33%). Each PA was asked to state the specialty he or she had entered in the first practice year and also to rate each of 33 possible reasons for this decision. Primary care specialties were defined as family medicine, general internal medicine, and general pediatrics. The ratings were subjected to a factor analysis. RESULTS: The 33 original variables were reduced to nine basic factors influencing the specialty-choice decisions of the PAs, accounting for 47.3% of the variance. The two most important factors were intellectual content of the specialty and a technical orientation. Then factor scores were computed for each PA and subjected to further examination, in which the PAs were divided into two groups: 776 who had entered primary care specialties, and 646 who had entered non-primary-care specialties (50 did not specify their specialties). For the PAs in non-primary-care specialties, the most influential factors were technical orientation and income/employment. For the PAs in primary care, the most influential factors were prevention, academic environment, debt/scholarship, intellectual content, and peer influence. CONCLUSION: For this recently graduated group of PAs, factors representing the kinds of activities they would be engaged in as health care providers were among the most influential, but the relative importances of the factors varied according to whether the PAs were in primary care or non-primary-care specialties, with the latter group being more strongly influenced by marker forces such as income and employment opportunities.

Career Choice↗
PubMedDate not supplied

Regional and institutional variation in burn care.

In reviewing the literature on burn therapy and observing clinical burn care, we noted differences among institutions and individual experts in several areas. To study variation in burn care, we surveyed the 140 burn centers listed by the American Burn Association to determine how burn care is currently administered in the United States and Canada. Responses were obtained from 83 hospitals (60%). The survey addressed resuscitation, operative and nonoperative wound care, medications, antimicrobial agents, and pain control. The major influence on care appeared to be the experience of the director (considered "very influential" in 85%) compared with the literature ("very influential" in 12%) and habit/what works for us ("very influential" in 48%). The Parkland formula was used "always" or "often" by 78%, and the Brooke formula "never" by 81% of respondents. Lactated Ringer's solution was the most popular initial fluid, and most (78%) respondents changed fluids after 24 hours. However, the fluids used in the second 24 hours varied equally among several choices. The use of colloids also varied without a set pattern. Furosemide (Lasix) and nonsteroidal antiinflammatory drugs were used "rarely" or "never" by 67% of centers in the acute stage. H2 blockers were used for gastritis prophylaxis "always" or "often" in 60% (vs 53% for antacids and 20% for sucralfate [Carafate]). Tube feedings were started on day 1 after burn injury "always" by less than 30% of centers. Total parenteral nutrition was not commonly used. Most centers use of silver sulfadiazine on the body and hands, but facial topical antimicrobial therapy varied.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1996

Wild-type p53 negatively regulates the expression of a microtubule-associated protein.

The product of the p53 tumor suppressor gene has a well-documented activity as a transcriptional activator, and several studies indicate that this function is at least in part essential for the ability of p53 to suppress cellular proliferation. However, there is growing evidence that some activities of wild-type p53 may be independent of its trans-activation function; in fact, recent investigations have indicated that the transcriptional repression function of p53, rather than its trans-activation function, may be influential in p53-mediated apoptosis. The focus of this study has been on the identification of genes that exhibit decreased expression during p53-dependent apoptosis, and therefore represent potential p53-repressed genes influential in programmed cell death. This report identifies the gene encoding the microtubule-associated protein MAP4 as one whose mRNA and protein expression decrease in cells following induction of wild-type p53. Importantly, decreased MAP4 expression following p53 induction can be inhibited by molecules that prevent p53-mediated transcriptional repression and apoptosis, such as the adenovirus E1B-19K protein and the Wilms tumor gene product WT1. Additionally, overexpression of MAP4 in cells induced to undergo p53-dependent apoptosis significantly delays this process, indicating that the negative regulation of this gene by p53 may be influential in the rapid progression of apoptosis.

Adenovirus E1B Proteins↗
PubMed1999

Robust regression for clustered data with application to binary responses.

Generalized estimating equations (GEE) can be highly influenced by the presence of unusual data points. A generalization of the GEE procedure, which yields parameter estimates and fitted values that are resistant to influential data, is introduced. Resistant generalized estimating equations (REGEE) include weights in the estimating equations to downweight influential observations or clusters. Influential observations are downweighted according to their leverage or residual in an example of correlated binary regression applied to 137 urinary incontinent elderly patients from 38 medical practices.

Aged↗
PubMed2005

Factors that influence prescribing within a therapeutic drug class.

RATIONALE, AIMS AND OBJECTIVES: The decision to prescribe one drug instead of another within the same therapeutic class may be influenced by a variety of drug-related, direct, or indirect factors; but little is known about which considerations are most important in such choices. The low-molecular-weight heparins (LMWHs) represent a class of drugs that are commonly used and for which therapeutic equivalence has been debated in the literature. The purpose of this study was to identify and compare factors perceived by doctors and clinical pharmacists to be influential in prescribing decisions among LMWHs. METHODS: Doctors and clinical pharmacists were interviewed to elicit information and to rank factors that influence the prescribing and use of LMWHs in community hospitals in the United States. For each factor, the mean and median of the rating were determined along with the frequency distribution across ratings. The non-parametric Mann-Whitney U-test was used to examine differences between doctors and clinical pharmacists. RESULTS: Both groups considered efficacy, formulary status, and policies restricting drug use to be highly influential in the decision to use one LMWH instead of another. Compared to clinical pharmacists, doctors rated personal experience as more influential, whereas they rated drug cost and prescribing guidelines lower. CONCLUSIONS: These findings suggest that doctors and clinical pharmacists differentiate between LMWHs based on differences between products and because of hospital administrative programs (such as drug formularies). This information may be of value in designing programs to alter medication use.

Choice Behavior↗
PubMed2003

Self-management decision influences in heart failure: a preliminary investigation.

Self-management decision making places significant cognitive demands on individuals with heart failure (HF). Before theoretically valid decision supports can be developed, a better understanding of underlying decision characteristics is needed. The purpose of this preliminary study was to describe sources of self-management decision influences for individuals (N = 38) with varying levels of HF (New York Heart Association (NYHA) classifications). Therapeutic value was the most influential source of self-management decision making for these patients, followed by personal beliefs and values, information sources, symptom influence, and task difficulty across all NYHA classes. Symptom influence was least influential for persons in Class II, whereas task difficulty was least influential for those in Classes III and IV. Moderate and significant associations were noted between information sources and personal beliefs and values and between information sources and symptom influence. As the disease progressed, a trend toward fewer decision influences, especially in the task difficulty scale, was noted.

Decision Making↗
PubMed2005

Creation of an online collection of emergency medicine literature.

Residents and medical students are challenged to incorporate the latest medical literature into their clinical practice. However, retrieving influential articles in a timely manner can be difficult. To address this, the authors created a collection of influential primary research literature relevant to the practice of emergency medicine. The authors surveyed local experts as to the most influential articles in their area of expertise and then linked articles in the literature collection to full-text versions available through the medical school's digital library. A total of 154 articles were included in the literature collection. These were organized into 23 subject headings and 23 subheadings. Fifty-two residents were surveyed one month after the collection became available; 18 residents (35%) had used the literature collection at that time. An online collection has several advantages: it makes the most relevant literature immediately available during clinical care and allows residents to elaborate on their own knowledge when clinical problems arise. It also can be easily updated and password protected. Similar collections may be developed for use in other educational settings.

Bibliometrics↗