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PubMed2006

Competition or collaboration--the tensions within the purchaser provider relationship in nurse education.

AIMS: To explore the nature of the relationship between purchasers and providers from the perspectives of the key individuals involved in healthcare education in the late 1990s. To discuss the lessons that can be learned for nursing from their experiences. BACKGROUND: Although the findings illustrate experiences of individuals at a specific time, the issues that arise have implications for contemporary health care, as contract use is increasing and, with the introduction of foundation trusts, contracts may replace Service Level Agreements. METHOD: The design was qualitative and the methods used were policy analysis and interviews. Interviews were conducted with a national, purposive sample of 70 participants. RESULTS: The key finding was the amount of variation in effectiveness of relationships. Many purchasers and providers formed strong partnerships but a number had fraught relationships--a situation perceived as detrimental to productive working. A significant issue for current healthcare was the reasons why relationships worked well in some institutions and were ineffective in others. CONCLUSIONS: There are a number of key lessons that can be learned about the nature of the relationship between purchasers and providers and applied to contemporary health care. Notably: .the value of clear policy aims; .the importance of context and history in shaping the relationship; .the necessity of ensuring that individuals involved have the ability and commitment to make the relationship work; .the need to view the contracting relationship as a dynamic 'project' that must be worked on; .the value of sharing good practice.

Attitude of Health Personnel↗

PubMed2005

Scaling the structure--function relationship for clinical perimetry.

PURPOSE: The full ranges of glaucomatous visual field defects and retinal ganglion cell losses extend over several orders of magnitude and therefore an interpretation of the structure-function relationship for clinical perimetry requires scaling of both variables. However, the most appropriate scale has not been determined. The present study was undertaken to compare linear and logarithmic transformations, which have been proposed for correlating the perimetric defects and neural losses of glaucoma. METHODS: Perimetry, by behavioural testing, and retinal histology data were obtained from rhesus monkeys with significant visual field defects caused by experimental glaucoma. Ganglion cell densities were measured in histologic sections of retina that corresponded to specific perimetry test locations for the treated and control eyes. The linear (percentage) and logarithmic (decibel) relationships for sensitivity loss as a function of ganglion cell loss were analysed. RESULTS: With decibel scaling, visual sensitivity losses and ganglion cell densities were linearly correlated with high coefficients of determination (r(2)), although the parameters of the functions varied with eccentricity. The structure-function relationships expressed as linear percentage-loss functions were less systematic in two respects. Firstly, the relationship exhibited considerable scatter in the data for small losses in visual sensitivity and, secondly, visual sensitivity losses became saturated with larger losses in ganglion cell density. The parameters of the percentage-loss functions also varied with eccentricity, but the variation was less than for the decibel-loss functions. CONCLUSIONS: Linear scaling of perimetric defects and ganglion cell losses might potentially improve the structure-function relationship for visual defects associated with small amounts of cell loss, but the usefulness of the relationship is limited because of the high variability in that range. With log--log co-ordinates, the structure--function relationship for clinical perimetry is relatively more accurate and precise for cell losses greater than about 3 dB. The comparatively greater accuracy and precision of decibel loss functions are a likely consequence of the logarithmic scale of stimulus intensities for perimetry measurements and because the relationship between visual sensitivity and the number of neural detectors is a form of probability summation.

Animals↗

PubMed1990

Stroke volume and the three phase cardiac output rate relationship with ventricular pacing.

Knowledge of how stroke volume (SV), and hence cardiac output (CO), changes with ventricular pacing rate (R) constitutes a key aspect of sensor driven, variable rate pacemakers. It has been established that the relationship between CO and pacing rate exhibits three phases for rest and constant exercise. At low rates (phase 1), CO increases with increasing R; with additional rate increase (phase 2), CO either remains constant or increases slightly; and above some critical rate, CO decreases (phase 3). However, the nature of the relationship between SV and pacing rate has not been as clearly described. Therefore, the objectives of this study were (1) to describe and document the relationship between SV and R, and (2) to demonstrate the consequence of this relationship in terms of the three phase CO versus R relationship. In six anesthetized dogs, right ventricular SV was determined from pulmonary artery blood flow measured using an electromagnetic flow meter, and the right ventricle was paced over a range of rates. In general, SV decreased with increasing R, although the exact nature of the relationship varied from animal to animal. The results demonstrate that it is the manner in which SV decreases with increasing R that determines the three phase relationship between CO and R. The relationships described in this study have important implications for choosing pacing rates for patients receiving sensor driven, variable rate pacemakers.

Animals↗

PubMed1989

Defining a family heritage and a new relationship identity: two central tasks in the making of a marriage.

The roles of origin family environmental characteristics and couple consensus-building process within the development of marital relationships were examined prospectively in 16 premarital couples. Three important findings emerged. First, significant correlations were found between dimensions of origin family environment and the reported level of satisfaction within the couple's current relationship. Second, measures of the couple's ability to reach consensus concerning important interpersonal relationships appeared to be important mediators of the association between origin family environment and current relationship satisfaction. Third, important gender differences emerged that replicate and extend prior findings that portray women in the role of "relationship specialist" within their marriages. As a group, these findings were best explained by a developmental model of early marriage that envisions the young couple as facing two entwined tasks: to define both their family heritage and their new relationship identity. Overall, the importance of examining family-of-origin characteristics and consensus-building process as critical determinants of the fate of intimate relationships received strong support. The gender differences found in the literature reviewed, as well as the results of this study, have largely been overlooked by the theory and practice of family therapy. Efforts on both the research and theory construction fronts are needed to increase our understanding of the mechanisms whereby prior family experience is brought forward into current intimate relationships.

Adult↗

PubMed1997

Parent-adolescent relationships, physical disciplinary history, and adjustment in adolescents.

Physical discipline occurs within the context of the parent-child relationship, yet it is often not examined within this important context. The current study examined whether negative effects of physical discipline on older adolescent adjustment are mediated by the overall parent-child relationship. The sample consisted of 253, mostly Caucasian, middle-class, adolescent participants (mean age = 18.4, 67% female). Physical punishment history, parent-adolescent relationships, and adjustment were assessed with self-report instruments. For females, relationships with parents partially mediated the association between physical punishment and adjustment. Physical punishment was negatively associated with both adjustment and parent-adolescent relationships. For males, physical punishment was not related to adjustment. Parent-adolescent relationships were positively associated with adjustment for both females and males. Physical punishment by fathers was negatively associated with father-son relationships. The results suggest the importance of exploring links between physical punishment and adjustment within the context of parent-child relationship, as well as examining males, females, mothers, and fathers separately.

Adaptation, Psychological↗

PubMed2003

Identification of biological relationships from text documents using efficient computational methods.

The biological literature databases continue to grow rapidly with vital information that is important for conducting sound biomedical research and development. The current practices of manually searching for information and extracting pertinent knowledge are tedious, time-consuming tasks even for motivated biological researchers. Accurate and computationally efficient approaches in discovering relationships between biological objects from text documents are important for biologists to develop biological models. The term "object" refers to any biological entity such as a protein, gene, cell cycle, etc. and relationship refers to any dynamic action one object has on another, e.g. protein inhibiting another protein or one object belonging to another object such as, the cells composing an organ. This paper presents a novel approach to extract relationships between multiple biological objects that are present in a text document. The approach involves object identification, reference resolution, ontology and synonym discovery, and extracting object-object relationships. Hidden Markov Models (HMMs), dictionaries, and N-Gram models are used to set the framework to tackle the complex task of extracting object-object relationships. Experiments were carried out using a corpus of one thousand Medline abstracts. Intermediate results were obtained for the object identification process, synonym discovery, and finally the relationship extraction. For the thousand abstracts, 53 relationships were extracted of which 43 were correct, giving a specificity of 81 percent. These results are promising for multi-object identification and relationship finding from biological documents.

Algorithms↗

PubMed2004

Relationship between blood velocity and conduit artery diameter and the effects of smoking on vascular responsiveness.

Transient changes in arterial diameter in response to transient ischemia-induced changes in arterial blood velocity have been used as an index of vascular health. The purpose of this study was to determine the relationship between blood velocity and diameter in the brachial artery by different methods of increasing blood velocity. Acute cigarette smoking was used with otherwise healthy young occasional smokers to determine the influence of endothelial-nitric oxide pathways on the arterial diameter-blood velocity relationship. Nine nonsmokers and 12 occasional smokers (<1 pack/wk) were tested. Blood flow to the forearm was manipulated to indirectly investigate the relationship between blood velocity and diameter in the brachial artery. Blood flow to forearm was manipulated through the use of 1) 5-min ischemia; 2) handgrip exercise; 3) indirect local heating; and 4) 5-min ischemia plus indirect local heating. A strong relationship was observed between blood velocity and diameter independent of the method used to increase blood velocity (R(2) = 0.89). The mean slope of the velocity-diameter relationship was not different between nonsmokers and occasional smokers who abstained from smoking at least 2 days. Acute smoking did not alter the slope of the velocity-diameter relationship although the mean intercept was decreased as a result of consistent vasoconstriction (7-10%). The mechanisms by which smoking impairs vascular health are largely unknown. These findings differ from previous smoking studies that used chronic and/or heavier smokers. The velocity-diameter relationship appears independent of the method for increasing velocity. Acute smoking in occasional smokers results in vasoconstriction without altering vascular responsiveness. The velocity-diameter relationship may be a useful measure of the progression of vascular disease.

Adult↗

PubMedDate not supplied

Stereotypical relationship patterns and psychopathology.

BACKGROUND: We explored the relationship between the consistency of relationship patterns and the severity of psychopathology. METHOD: Relationship patterns were assessed by means of Relationship Anecdote Paradigm interviews rated according to the Core Conflictual Relationship Theme (CCRT) method. The repetition of the same type of CCRT components across relationship narratives indicated stereotypical patterns. RESULTS: Subjects treated in an inpatient setting (n = 25) told narratives with more consistent patterns than subjects in an outpatient setting (n = 32). Relationship episodes of normal adults (n = 23) were more flexible compared with the two clinical groups. Especially repetitions of the wish component were closely associated with the severity of psychopathology assessed by SCL-90R. CONCLUSIONS: The consistency of relationship patterns seems to be connected with the severity of psychopathology.

Adaptation, Psychological↗

PubMedDate not supplied

Explaining variation in affiliative relationships among male white-faced capuchins (Cebus capucinus).

Relationships among coresident male white-faced capuchins are highly variable, ranging from affiliative to aggressive. In this paper I examine the affiliative relationships of all adult and subadult males residing in four social groups in Santa Rosa National Park, Costa Rica. Relationships among males in two study groups were neutral and tolerant, while in the remaining two groups males were highly affiliative. Male-male dyadic affiliative interactions were examined to determine which variables (group size, sex ratio, age relationship, relationship duration, and rank distance) influence the quality of male relationships within the study groups. Group size explained much of the variation, with males in small groups being more affiliative. However, the duration and history of the relationship among coresident males appears to be the most important variable in understanding male-male relationships within social groups.

Aging↗

PubMed2003

Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease.

BACKGROUND AND PURPOSE: Blood pressure lowering in patients with a previous transient ischemic attack (TIA) or stroke reduces the risk of recurrent stroke and coronary vascular events. However, there is uncertainty about the risks and benefits in patients with severe carotid occlusive disease, particularly those with a carotid occlusion or bilateral > or =70% carotid stenosis in whom cerebral perfusion is often impaired and may depend directly on systemic blood pressure. Therefore, we studied the effect of carotid artery disease on the relationship between blood pressure and stroke risk in patients with recent TIA or stroke. METHODS: We compared the relationship between blood pressure (systolic and diastolic blood pressures, pulse pressure) and stroke risk in TIA and stroke patients with documented stenosis of at least 1 carotid artery [European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET)] with that in TIA and stroke patients with a low prevalence of carotid disease [United Kingdom Transient Ischaemic Attack (UK-TIA) Aspirin Trial]. In ECST and NASCET, we also determined the relationship between blood pressure and stroke risk in patients with unilateral carotid occlusion and patients with bilateral > or =70% carotid stenosis. RESULTS: Stroke risk on medical treatment increased with blood pressure in ECST and NASCET, but the relationships were less steep than in the UK-TIA trial. The relationship between blood pressure and stroke risk was not affected by the presence of a unilateral carotid occlusion but was significantly affected by the presence of bilateral carotid stenosis > or =70% (interaction: systolic blood pressure, P=0.002; diastolic blood pressure, P=0.03; pulse pressure, P=0.003). In this group, the relationship was inverted because of the high stroke risks at lower blood pressures. This interaction was not present after carotid endarterectomy and was not present for the risk of myocardial infarction. CONCLUSIONS: The risk of stroke increases with blood pressure in the great majority of patients with symptomatic carotid artery disease, but the relationship is less steep than in other patients with TIA or stroke. The relationship is unaffected by unilateral carotid occlusion alone but is inverted in patients with bilateral > or =70% carotid stenosis, suggesting that aggressive blood pressure lowering may not be advisable in this group. These patients represent only a few percent of all patients with TIA or stroke but have a high risk of recurrent stroke.

Aged↗

PubMed1996

Acid aspiration results in ileal injury without altering ileal V(O2)-D(O2) relationships.

Systemic organ endothelial injury and V(O2)-D(O2) relationship alterations occur frequently in the setting of acute lung injury, and they are believed to play an important role in the pathogenesis of the multiple organ dysfunction syndrome (MODS). However, the relationship, if any, between systemic organ endothelial injury and V(O2)-D(O2) relationship alterations remains unknown. We hypothesized that microvascular endothelial injury and attendant interstitial edema would result in increased diffusion distances for oxygen and altered systemic organ V(O2)-D(O2) relationships. To test this hypothesis, we utilized the in situ autoperfused feline ileal preparation to evaluate ileal V(O2)-D(O2) relationships in control animals (n = 5) and in animals with HCl-induced acute lung and systemic organ injury (n = 5). As expected, ileal endothelial protein permeability (CL/CP) was increased in HCl-injured animals compared to control animals (0.187 +/- 0.024 versus 0.097 +/- 0.009; p < 0.01). However, contrary to our original hypothesis and despite marked morphologic and endothelial protein permeability alterations, ileal V(O2)-D(O2) relationships were not altered in the HCl-injured animals. Moreover, V(O2)-D(O2) relationships in the ileum remained unchanged even when ileal venous pressures were increased to 15 mm Hg. Taken together, these findings do not support an important role for oxygen diffusion limitation in the pathogenesis of altered systemic organ V(O2)-D(O2) relationships.

Animals↗

PubMed2004

Relationship between visual field sensitivity and retinal nerve fiber layer thickness as measured by scanning laser polarimetry.

PURPOSE: To evaluate the strength and pattern of the relationship between visual field (VF) sensitivity and retinal nerve fiber layer (RNFL) thickness measurements by scanning laser polarimetry (SLP). METHODS: Fifty-four eyes of 54 normal subjects (age, 42 +/- 15 years; VF mean deviation [MD], -0.69 +/- 1.01 dB) and 51 eyes of 51 glaucoma patients (age, 66 +/- 14 years; VF MD, -6.92 +/- 5.43 dB) were imaged with an SLP using fixed corneal compensation (FCC) and variable corneal compensation (VCC). VF sensitivity was recorded in the dB and the 1/L scales. Linear and logarithmic relationships were sought globally and in six VF sectors. Relationships of VF and RNFL thickness with age were sought in normal subjects. RESULTS: Both VF sensitivity and RNFL thickness declined with age (as determined by the regression slope): -0.13% (P = 0.0005) and -0.64% (P = 0.0001) per year for dB and 1/L VF sensitivity, respectively, and -0.25% (P = 0.003) per year for VCC RNFL thickness. FCC RNFL thickness was not statistically significantly related to age. The relationship of VF sensitivity to VCC global (R(2) = 0.49) and sectoral (R(2) = 0.00-0.47) RNFL thickness was greater than for FCC global (R(2) = 0.12) and sectoral (R(2) = 0.00-0.21) RNFL thickness. Relationships were curvilinear with the dB scale, with logarithmic regression of dB VF sensitivity against RNFL thickness being significantly better than linear regression. Logarithmic regression of 1/L VF sensitivity against RNFL thickness was no better than linear regression for all sectors. There was no relationship between VF sensitivity and RNFL thickness in the temporal peripapillary RNFL sector. CONCLUSIONS: The strength of the structure/function relationships compare well with previous reports in the literature. The relationships were curvilinear with the dB scale and linear with the 1/L scale, and were much stronger with VCC than with FCC RNFL thickness measurements.

Adult↗

PubMed1986

Copatient relationships on a short-term psychiatric unit.

Emotional and physical relationships among copatients on a short-term psychiatric unit were assessed in a two-year prospective study. Sixty-four relationships involving 102 patients were reported; the incidence rate was estimated at 10.7 percent. Thirty-three percent of the relationships were characterized as emotional, 9 percent as physical, and 58 percent as both. Patients involved in the relationships tended to be young and unmarried and to have a diagnosis of eating disorder, personality disorder, or bipolar disorder. Although most of the relationships were reciprocal, half were judged to be destructive and to create management problems. Staff discussed the relationship with the patients when it was considered destructive or exploitative but ignored relationships felt to be positive and healthy. The authors urge further studies of such relationships to help clarify patient management issues.

Adolescent↗

PubMed2006

Social and sexual relationships of adolescents and young adults with cerebral palsy: a review.

OBJECTIVE: To investigate possible barriers to successful social and sexual relationships in adolescents and young adults of normal intelligence with cerebral palsy. DESIGN: A literature review based on a PubMed and PsycINFO search for the period 1990-2003. Included were studies focusing on one or more of the outcome parameters (i.e. social, intimate and sexual relationships) or on associated factors that described relationships with the outcome parameters. RESULTS: Fourteen papers were selected. Two studies investigated exclusively people with cerebral palsy whereas 12 concerned people with a congenital disability and/or physical disabilities, including people with cerebral palsy. All studies addressed adolescents or adults of normal intelligence. A. Social and sexual relationships: In social relationships adolescents and young adults with cerebral palsy were less active than their age mates, and dating was often delayed and less frequent. Adolescents with congenital disabilities indicated that sexuality is an important aspect of their lives, but they experienced difficulties developing a sexual relationship. B. Associated factors: Psychological maladjustment, insufficient self-efficacy and low sexual self-esteem may impair the development of social and sexual relationships. Overprotection in raising children with cerebral palsy and the negative attitudes of other people may have a negative influence on the self-efficacy of people with cerebral palsy. CONCLUSION: The reviewed studies suggest many factors that may influence the development of social and sexual relationships in adolescents and young adults with cerebral palsy. However, evidence was found only for the personal factors self-efficacy and sexual self-esteem and their interrelationships with the parents' way of raising their children and successful experiences in social situations.

Adolescent↗

PubMed2005

Negative density-distribution relationship in butterflies.

BACKGROUND: Because "laws of nature" do not exist in ecology, much of the foundations of community ecology rely on broad statistical generalisations. One of the strongest generalisations is the positive relationship between density and distribution within a given taxonomic assemblage; that is, locally abundant species are more widespread than locally sparse species. Several mechanisms have been proposed to create this positive relationship, and the testing of these mechanisms is attracting increasing attention. RESULTS: We report a strong, but counterintuitive, negative relationship between density and distribution in the butterfly fauna of Finland. With an exceptionally comprehensive data set (data includes all 95 resident species in Finland and over 1.5 million individuals), we have been able to submit several of the mechanisms to powerful direct empirical testing. Without exception, we failed to find evidence for the proposed mechanisms creating a positive density-distribution relationship. On the contrary, we found that many of the mechanisms are equally able to generate a negative relationship. CONCLUSION: We suggest that one important determinant of density-distribution relationships is the geographical location of the study: on the edge of a distribution range, suitable habitat patches are likely to be more isolated than in the core of the range. In such a situation, only the largest and best quality patches are likely to be occupied, and these by definition can support a relatively dense population leading to a negative density-distribution relationship. Finally, we conclude that generalizations about the positive density-distribution relationship should be made more cautiously.

Animals↗

PubMed2002

The heart rate/oxygen consumption relationship during cold exposure of the king penguin: a comparison with that during exercise.

This study investigated whether exposure to low ambient temperature could be used as an alternative to exercise for calibrating heart rate (fH) against rate of oxygen consumption ((O(2))) for subsequent use of fH to estimate (O(2)) in free-ranging animals. Using the relationship between the oxygen pulse (OP, the amount of oxygen used per heart beat) and an index of body condition (or nutritional index, NI), a relationship between fH and (O(2)) was established for resting king penguins exposed to a variety of environmental temperatures. Although there was a small but significant increase in the OP above and below the lower critical temperature (-4.9 degrees C), there was no difference in the relationship obtained between the OP and body condition (NI) obtained above or below the lower critical temperature. These results were then compared with those obtained in a previous study in which the relationship between fH and (O(2)) had been established for king penguins during steady-state exercise. The relationship between OP and NI in the present study was not significantly different from the relationship between resting OP and NI in the previous study. However, the relationship was different from that between active OP and NI. We conclude that, at least for king penguins, although thermoregulation does not affect the relationship between resting OP and NI, temperature cannot be used as an alternative to exercise for calibrating fH against (O(2)) for subsequent use of fH to estimate (O(2)) in free-ranging animals.

Animals↗

PubMed2002

Physically abused pregnant women's perceptions about the quality of their relationships with their male partners.

OBJECTIVES: Most studies of pregnant victims of intimate partner violence have focused on the violent behaviors, without examining other potentially important dimensions of the relationships. This research studies pregnant abuse victims to examine the frequency of violent behaviors occurring during pregnancy, how women characterize the quality of their relationships, and the association between violence frequency and women's perceptions concerning the overall quality of their relationships. METHODS: Eighty-one women who were physically abused by intimate partners during pregnancy were interviewed. Information was collected concerning the women's: experiences of partner violence during pregnancy; perceptions of other aspects of the quality of their relationships; and sociodemographic characteristics. RESULTS: The most frequent type of violent behavior occurring during pregnancy was verbal aggression, followed by minor violence, and then severe violence. Men perpetrated each type of violent behavior at significantly higher rates than did their female partners. In general, the women were quite negative in their characterizations of many dimensions of their relationships, as well as in their perceptions concerning the overall quality of their relationships, with women who had been victims of more frequent violence being significantly more likely to characterize their relationships as being of lower overall quality (OR = 3.5, 95% CI = 1.4-8.7). CONCLUSIONS: Prenatal care providers are encouraged to screen their patients for intimate partner violence, and to work with others in their community to assure that women in abusive situations are offered appropriate services/interventions including safe and feasible alternatives to staying in unsatisfactory relationships with abusive partners.

Adolescent↗

PubMed1998

Assessing physician/patient relationships in the presence of HIV/AIDS: an exploratory study.

The following study investigates the nature of the relationship between physicians and HIV/AIDS patients within the context of the rapidly evolving services/relationship marketing literatures. The emerging evidence suggests that service providers generally play a critical role in the development of positive consumer attitudes and behaviors, and that relationship marketing practices can contribute to the delivery of health services. However, to date, there appears little evidence supporting the efficacy of employing relationship marketing practices in relation to a target market of HIV/AIDS patients. This exploratory study contributes to the body of knowledge by more closely investigating the nature of the patient-physician relationship relative to HIV/AIDS patients' attitudes, marketing-related behaviors, and overall quality-of-life/life satisfaction judgments. The results of this study first suggest that HIV/AIDS patients use the expectancy disconfirmation model when evaluating the performance of their physician. A reliance on expectancy disconfirmation suggests the likely prevalent role of service quality perceptions and satisfaction judgments in evaluating their relationship with their physician. Second, the results appear to support the conclusion that the patient's evaluation of their physician relationship and subsequent behaviors (e.g., word-of-mouth) are directly related to the patient's general perception of received health services. Thus, the patient/physician relationship may play a particularly powerful role in determining patient (marketing related) outcomes relative to other health service settings. Third, a direct influence is supported between negative affective reactions by patients and subsequent outcome behaviors. This finding lends support for the potential efficacy of service recovery efforts when rendering treatment to HIV/AIDS patients. Finally, evidence is presented demonstrating the effect of positive perceptions of the patient/provider relationship on these patients' overall evaluation of their quality-of-life/life satisfaction. The managerial and research implications of this study are presented and discussed.

Attitude to Health↗