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PubMed2005

Influence of neuroticism, ethnicity, familism, and social support on perceived burden in dementia caregivers: pilot test of the transactional stress and social support model.

In this study we assessed the new transactional stress and social support model, postulating the role of neuroticism, ethnicity, familism, and social support in perceived burden in dementia caregivers. We used a convenience sample (N=77) of African American and White dementia caregivers. Results substantiated interrelationships among social support variables, and the influence of perceived positive social support on burden. Neuroticism was related to the perception of positive social support and burden. Results corroborated the model, focusing on neuroticism and quality of social support in modeling perceived burden in family caregivers. Findings call attention to the role of presumably long-standing individual differences in neuroticism that influence caregiver appraisals of stress and social support.

Aged↗
PubMed1985

Online search patterns: NLM CATLINE database.

In this article the authors present their analysis of the online search patterns within user searching sessions of the National Library of Medicine ELHILL system and examine the user search patterns on the CATLINE database. In addition to the CATLINE analysis, a comparison is made using data previously analyzed on the MEDLINE database for the same time period, thus offering an opportunity to compare the performance parameters of different databases within the same information system. Data collection covers eight weeks and includes 441,282 transactions and over 11,067 user sessions, which accounted for 1680 hours of system usage. The descriptive analysis contained in this report can assists system design activities, while the predictive power of the transaction log analysis methodology may assists the development of real-time aids.

Cataloging↗
PubMed1996

An intelligent information systems architecture for clinical decision support on the Internet.

This paper presents a prototype of an agent-based intelligent information systems architecture that can provide clinical decision support in a distributed, heterogeneous environment such as the Internet. After presenting the architecture, a specific transaction sequence is detailed and implemented to test the architecture. A transaction sequence is a detailed analysis of all actions by all entities to accomplish the system goal. In this case, the goal is to give decision support information access to a provider in the context of a computerized patient record. Based on the results of the prototype implementation, we argue that the system is scaleable and discuss other transactions, standards, and needed development.

Computer Communication Networks↗
PubMed1990

Stress is in the eye of the beholder: reconceptualizing the measurement of carer burden.

The development of community care policy and the inadequacies of professional responses to the needs of informal carers were described in an earlier paper. A qualitative analysis of carers' replies to a questionnaire survey demonstrated that the most potent stressors, contrary to what has previously been assumed, were linked more to subjective perceptions of events or circumstances than to the objective features of the events and circumstances themselves. This paper presents a quantitative analysis of data from the same survey which confirm the impressions gained from the analysis of the qualitative data. These findings prompt a reconceptualization of carer burden within a transactional model of stress, which is then considered as a basis for understanding how carers adapt to stress in their lives. Practice implications are assessed.

Activities of Daily Living↗
PubMed2005

"If we didn't use humor, we'd cry": humorous coping communication in health care settings.

Folkman and Lazarus's transactional theory of emotion and coping was used to explain how humor influences job satisfaction among health care providers. One hundred forty-two nurses completed measures of humor orientation (HO), coping efficacy, job satisfaction, and open-ended questions about their use of humor to relieve job tensions. This produced 9 categories of producing humor and 8 types of work situations identified in which humor was used to cope. Nurses (21.4%) reported using humor the most often during "patient care" situations (e.g., providing medicines, moving patients, physical therapy, and so on). More than one third (38.66%) of the nurses reported using "word-play/language" as a humorous coping strategy. Higher HO was associated with higher ratings of humor effectiveness, greater self-perceived coping efficacy, and higher emotional expressivity. Path analysis demonstrated that, as the transactional theory would predict, trait HO influences job satisfaction through its effect on heightened coping efficacy. Study limitations include the use of self-report methods and the limited number of responses to the open-ended items. Subsequent research in this area should attempt to validate the categories identified in this study and determine the most effective means of coping. Researchers also should explore differences in health care providers' coping communication based on gender, years of experience, and profession.

Adaptation, Psychological↗
PubMed1994

Assessment of cognitive appraisal and coping linkages using two forms of canonical correlation.

As a conceptual framework for research on stress and coping, the transactional model of Lazarus and Folkman is process-oriented and requires methodologies that capture the process nature of cognitive appraisal and coping across stages of a transaction. Two forms of canonical correlation were used to analyze strength of association measures between pairs of cognitive appraisal and coping variable sets for 138 student subjects. Analysis indicated that, when an environmental transaction includes more than one time period, the generalized canonical correlation approach may offer some advantages in assessing linkage strength over the pairwise method.

Adaptation, Psychological↗
PubMed1996

Ecological metaphors as scientific boundary work: innovation and authority in interwar sociology and biology.

The development of human ecology during the interwar period was a significant scientific innovation enabled by the sociological use of biological concepts as tropes for social organization. This examination of the connections between biology and sociology illuminates a process whereby new scientific knowledge is generated, new scientific communities are formed, and individuals become scientists. These relationships were arranged around the negotiable boundaries between the social and the natural in 20th-century science. This process is examined through an analysis of scientific texts, metaphor transaction in science, and mentoring practices that reveal the transmission and bounding of knowledge and authority.

Biology↗
PubMed2003

Quantitative model of price diffusion and market friction based on trading as a mechanistic random process.

We model trading and price formation in a market under the assumption that order arrival and cancellations are Poisson random processes. This model makes testable predictions for the most basic properties of markets, such as the diffusion rate of prices (which is the standard measure of financial risk) and the spread and price impact functions (which are the main determinants of transaction cost). Guided by dimensional analysis, simulation, and mean-field theory, we find scaling relations in terms of order flow rates. We show that even under completely random order flow the need to store supply and demand to facilitate trading induces anomalous diffusion and temporal structure in prices.

Journal Article↗
PubMed1982

The therapeutic advantage to the family therapist of intervening in the family-clinician system.

Attempting family therapy in the context of a family-clinician system poses extreme difficulties for the therapist. He cannot be effective if he diagnoses only the family system. He must broaden his analysis to include other clinicians' transactions with the family. Once he accomplishes this perceptual leap, he can intervene in the family-clinician system most effectively with paradoxical methods. He may find that a change in his own contribution to the system solves the family's problem.

Family Therapy↗
PubMed1992

Topic control as relational control and its effect on the outcome of therapy.

The concept of relational control was measured using the index of Topic Control to investigate Haley's assertion that successful therapy is characterized by the therapist controlling the definition of the therapeutic relationship and defining it as a complementary relationship in which the therapist is in a "one-up'' position. Following Haley's assertion, it was hypothesized that: (a) across a sample of successful therapeutic dyads, therapists exhibit a greater measure of Topic Control than clients; (b) across a sample of successful and unsuccessful therapists, successful therapists exhibit a greater measure of Topic Control than unsuccessful therapists; (c) across a sample of successful and unsuccessful clients, unsuccessful clients exhibit a greater measure of Topic Control than successful clients; and (d) across a sample of unsuccessful therapeutic dyads, clients exhibit a greater measure of Topic Control than therapists. Analysis of therapist-client transactions for Topic Control was conducted by trained raters across 18 full-case transcripts of actual therapy interviews. The same transcripts were also analyzed by trained raters with respect to clients' change over the course of treatment. The results did not support the notion that across successful dyads therapists exhibit a greater measure of Topic Control than clients; and they did not support the hypothesis that across successful and unsuccessful therapists, successful therapists exhibit a greater measure of Topic Control. Also, there was no support to show that across successful and unsuccessful clients, unsuccessful clients exhibit a greater measure of Topic Control. Finally, the results did not support that across unsuccessful dyads, clients exhibit greater Topic Control than therapists.

Adult↗
PubMed2005

Transaction costs and community-based natural resource management in Nepal.

Transaction costs in community-based resource management are incurred by households attempting to enforce property right rules over common resources similar to those inherent in private property rights. Despite their importance, transaction costs of community-based management of common pool resources (CPRs) are often not incorporated into the economic analysis of participatory resource management. This paper examines the transaction costs incurred by forest users in community forestry (CF) based on a survey of 309 households belonging to eight different forest user groups (FUGs) in the mid hills of Nepal. The analysis reveals that the average 'poor' household incurred Nepalese rupees (NRS) 1265 in transaction costs annually, while wealthier 'rich' households incurred an average of NRS 2312 per year. Although richer households bear higher proportions of such costs, transaction costs for CF management as a percentage of resource appropriation costs are higher for poorer households (26%) than those of middle-wealth (24%) or rich households (14%). There are also village differences in the level of transaction costs. The results show that transaction costs are a major component of resource management costs and vary according to socio-economic status of resource users and characteristics of the community.

Community Participation↗
PubMedDate not supplied

Relational control in difficult physician-patient encounters: negotiating treatment for pain.

Many physicians report feelings of frustration and anger resulting from encounters with patients during which there is disagreement over the use of narcotics to treat pain. In this article, investigators report a relational control analysis of transcripts of three encounters of this type in order to explore the control dimension of these interactions. Similar analyses in the literature have reported that patients in general attempt to gain control of the interaction more often than previously thought. Results of this analysis, however, were remarkable in that nearly half of the transactions were characterized by competition for control. In addition, a descriptive analysis of the control-gaining strategies revealed physician strategies of giving instructions and orders, explicitly rejecting or disagreeing, providing reasons, and attempting to negotiate; patient strategies included explicitly rejecting or disagreeing and providing reasons. Communication skills training may enhance physicians' ability to understand their feelings of discomfort in this type of interaction as well as train them to be more effective communicators during interactions in which there is a struggle for control.

Communication↗
PubMed1988

Computerized accounting for the dental office. Using horizontal applications general ledger software.

Remember that computer software is designed for accrual accounting, whereas your business operates and reports income on a cash basis. The rules of tax law stipulate that professional practices may use the cash method of accounting, but if accrual accounting is ever used to report taxable income the government may not permit a switch back to cash accounting. Therefore, always consider the computer as a bookkeeper, not a substitute for a qualified accountant. (Your accountant will have readily accessible payroll and general ledger data available for analysis and tax reports, thanks to the magic of computer processing.) Accounts Payable reports are interfaced with the general ledger and are of interest for transaction detail, open invoice and cash flow analysis, and for a record of payments by vendor. Payroll reports, including check register and withholding detail are provided and interfaced with the general ledger. The use of accounting software expands the use of in-office computers to areas beyond professional billing and insurance form generation. It simplifies payroll recordkeeping; maintains payables details; integrates payables, receivables, and payroll with general ledger files; provides instantaneous information on all aspects of the business office; and creates a continuous "audit-trail" following the entering of data. The availability of packaged accounting software allows the professional business office an array of choices. The person(s) responsible for bookkeeping and accounting should choose carefully, ensuring that any system is easy to use, has been thoroughly tested, and provides at least as much control over office records as has been outlined in this article.

Accounting↗
PubMed2000

Institutional considerations in priority setting: transactions cost perspective on PBMA.

Programme budgeting and marginal analysis (PBMA) is increasingly being used as a method of priority setting in the health care sector. Despite this, PBMA has, on occasions, been subject to problems in its application which can be seen as being 'institutional' in nature. This paper examines the extent to which the institutional setting of PBMA affects the way in which it can be conducted. In particular, a transactions costs perspective is taken to analyse the extent to which variation in such costs can alter the incentives of the individual participants. A number of recommendations for improving the sustainability of such projects is then provided. Following this, the implications which this 'institutional' approach has for the evaluation of PBMA are set out.

Budgets↗
PubMed1995

Conducting financial due diligence of medical practices.

Many healthcare organizations are acquiring medical practices in an effort to build more integrated systems of healthcare products and services. This acquisition activity must be approached cautiously to ensure that medical practices being acquired do not have deficiencies that would jeopardize integration efforts. Conducting a thorough due diligence analysis of medical practices before finalizing the transaction can limit the acquiring organizations' legal and financial exposure and is a necessary component to the acquisition process. The author discusses the components of a successful financial due diligence analysis and addresses some of the risk factors in a practice acquisition.

Communication↗
PubMed1994

Description of a stressful encounter: appraisal, threat, and challenge.

The purpose of this study was to examine a potentially stressful event for students, the midterm examination, using the Lazarus transactional stress model. At two time periods during an academic term, 50 students responded to questionnaires focused on the midterm examination and its outcome. Responses were used to identify changes in appraisals, personal stakes, perceptions of threat and challenge; to determine these variables' relations to each other and to the examination grade; and to determine the best predictors of threat, challenge, and grade. Results indicated that threat and challenge perceptions were the only variables that changed as the situation evolved; they were negatively correlated. The best predictor of threat and challenge was control, while the only variable that correlated with grade was harm.

Adult↗
PubMed2000

Coping style following acute stress in competitive sport.

The purpose of this study was to ascertain coping styles among competitive athletes in response to various acute stressors. Specifically, the authors used a 134-item survey to measure approach and avoidance coping styles, with task-focused and emotion-focused coping tendencies nested hierarchically as subdimensions under each. Australian and U.S. college-aged participants indicated the extent to which they used approach, avoidance, task-focused, and emotion-focused coping strategies (a 4-factor model) in response to selected acute stressors experienced during sport competition. The authors computed confirmatory factor analysis to test the theoretically driven model. The criterion loading of .30 and above for each of the factors reduced the survey to 65 items. Findings indicated stronger links between the 2 approach constructs of task- and emotion-focused coping than between the 2 avoidance constructs of those subdimensions. The goodness-of-fit indices for the 4-factor model were 0.58 and 0.57 for Australian and U.S. samples, respectively, and .71 overall. Concomitant low correlations between the 2 approach (0.18) and the 2 avoidance dimensions (0.43) reflected relatively high residuals between stressors. In general, psychometric analyses suggest that coping style may be more prevalent in some situations than others, lending partial support for the transactional model of coping.

Acute Disease↗
PubMed2002

A HIPAA strategy for dental schools.

Certain health care organizations, including dental schools, should be readying themselves to comply with the numerous requirements described within the administrative simplification section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The intent of administrative simplification is to streamline the management of health care transactions while protecting the privacy of certain written, oral, and electronic patient information. There are no field-tested plans for implementing the law because only recently has the health care industry begun to respond to the multitude of requirements. It is essential that each organization create a customized compliance plan that best fits its structure and needs. The purpose of this paper is to propose a five-stage theoretical strategy that could assist a dental school in achieving HIPAA compliance. The first stage involves the selection of a HIPAA task force. The second stage selects the applicable HIPAA requirements, determines the current states of confidentiality and security, manages the electronic transactions standards, and composes a gap analysis. The third stage examines risk analysis and management. The fourth stage encompasses technical modifications, policies and procedures, legal input, and training. The fifth stage addresses the maintenance of the implementation.

Advisory Committees↗