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PubMed1978

Meeting the special needs of Appalachian alcoholics.

The Appalachian Regional Comprehensive Alcoholism Program in Beckley, West Virginia, was established in 1972 to meet the needs of a four-county catchment area. In designing the program, planners took into account the special cultural and economic characteristics of the population to be served--individualism, isolation, religiosity, conservatism, distrust of newcomers, and economic deprivation--and set up a program they believe respects local norms. For instance, the program has been staffed mainly by local professionals. Individual therapy, family therapy, and crisis intervention are used much more frequently than group psychotherapy, and clients have a strong voice in treatment decisions. Local ministerial associations are involved whenever possible, and outreach efforts include home visits as well as the use of the media to disseminate information.

Adult↗
PubMedDate not supplied

Blindness and LeFort III fractures.

Injuries to the nasal frontal complex involve a moderately high degree of optic nerve trauma. This paper reviews opinions from notable experts in the field of maxillofacial trauma on appropriate management for acute facial fractures involving injury to the optic nerve and causing blindness in one eye. The opinions are mixed, but the overall attitude is one of conservatism. It is concluded that the weight of opinion supports a conservative approach consisting of external fixation without mobilization of the fractures, and a delayed cosmetic repair.

Blindness↗
PubMed2006

Essentialist beliefs about homosexuality: structure and implications for prejudice.

The structure of beliefs about the nature of homosexuality, and their association with antigay attitudes, were examined in three studies (Ns = 309, 487, and 216). Contrary to previous research, three dimensions were obtained: the belief that homosexuality is biologically based, immutable, and fixed early in life; the belief that it is cross-culturally and historically universal; and the belief that it constitutes a discrete, entitative type with defining features. Study 1 supported a three-factor structure for essentialist beliefs about male homosexuality. Study 2 replicated this structure with confirmatory factor analysis, extended it to beliefs about lesbianism, showed that all three dimensions predicted antigay attitudes, and demonstrated that essentialist beliefs mediate associations between prejudice and gender, ethnicity, and religiosity. Study 3 replicated the belief structure and mediation effects in a community sample and showed that essentialist beliefs predict antigay prejudice independently of right-wing authoritarianism, social dominance orientation, and political conservatism.

Adolescent↗
PubMed1988

Biomaterials entrepreneurship.

Entrepreneurial companies in biomaterials serve a valuable function in lowering the risk of developing new products and devices. In many cases liability considerations and a pragmatic conservatism make it difficult for established health-care products suppliers to develop new products directly. Biomaterials entrepreneurs encounter more difficulties in achieving commercial success than do entrepreneurs in other fields. For any reasonable profit to be made, the entrepreneur must be able to convert the biomaterial into a useful device. Safety and toxicity test data collection take a minimum of three years to collect, and it is often five or more years before a positive cash flow can be obtained. Start-up funding can be obtained from government agencies, charitable foundations, and private investment capital. A major health-care company can often be attracted once initial successes have been achieved. Biomaterials usage and device design is specific for each function or need. Specific devices that are currently needed are small (c. 4 mm) diameter artificial blood vessels, synthetic skin, and internal prosthetic devices which have better tissue compatibility, abrasion, corrosion, and wear resistance especially for flexing devices such as artificial joints, ligaments and tendons.

Biocompatible Materials↗
PubMed2000

Policy implications of the biological model of mental disorder.

The current dominant paradigm of mental disorder is that psychopathology is a deviation from normal physiological functioning of the brain. This paradigm is closely allied to the identity theory of mind in philosophy, which holds that mental phenomena are identical with the physical state of the brain. The assumptions of the biological model have policy implications, regardless of the utility or 'truth' of the paradigm, which should be made explicit for the assessment of ethics in mental health policy formulation. The nature of mental phenomena has been debated throughout history, without consensus. Several critiques of the biological model are offered to encourage enquiring scepticism. The policy implications discussed are political conservatism, broadened rationales for forced treatment, utility in managed care, and the use of medical necessity criteria to allocate treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed2002

Anatomy of the spinal accessory nerve plexus: relevance to head and neck cancer and atherosclerosis.

The term spinal accessory nerve plexus may be defined as the spinal accessory nerve with all its intra- and extracranial connections to other nerves, principally cranial, cervical, and sympathetic. The term is not new. This review examines its applied anatomy in head and neck cancer and atherosclerosis. Over the centuries, general studies of neural and vascular anatomy and embryology formed a basis for the understanding upon which the plexus is described. During the past century, its anatomy and blood supply have come to be better understood. The importance of almost all of the plexus to head, neck, and upper extremity motor and sensory functions has come to be realized. Because of this understanding, surgical neck dissection has become progressively more conservative. This historical progression is traced. Even the most recent anatomic studies of the spinal accessory nerve plexus reveal configurations, new to many of us. They were probably known to classical anatomists, and not recorded in readily available literature, or not recorded at all. Human and comparative anatomic studies indicate that the composition of this plexus and its blood supply vary widely, even though within the same species their overall function is very nearly the same. Loss of any of these structures, then, may have very different consequences in different individuals. As a corollary to this statement, data are presented that the spinal accessory nerve itself need not be cut during surgical neck dissections for severe impairment to occur. In addition, data are presented supporting the theory that atherosclerosis by obstructing vessels to this plexus and its closely connected brachial plexus will very likely result in their ischemic dysfunction, often painful. Finally evidence, as well as theory, is stated concerning anatomic issues, methodology, outcome, and possible improvements in surgical procedures emphasizing conservatism.

Accessory Nerve↗
PubMed2006

An examination of the Environmental Protection Agency risk assessment principles and practices: a brief commentary on section 4.1.3 of the EPA March 2004 Staff Paper.

The US Environmental Protection Agency (EPA) recently issued a Staff Paper that articulates current risk assessment practices. In section 4.1.3, EPA states, "... effects that appear to be adaptive, non-adverse, or beneficial may not be mentioned." This statement may be perceived as precluding risk assessments based on non-default risk models, including the hormetic--or biphasic--dose-response model. This commentary examines several potential interpretations of this statement and the anticipated impact of ignoring hormesis, if present, in light of necessary conservatism for protecting human and environmental health, and the potential for employing alternative risk assessment approaches.

Dose-Response Relationship, Drug↗
PubMed2003

Dealing with discreteness: making 'exact' confidence intervals for proportions, differences of proportions, and odds ratios more exact.

'Exact' methods for categorical data are exact in terms of using probability distributions that do not depend on unknown parameters. However, they are conservative inferentially. The actual error probabilities for tests and confidence intervals are bounded above by the nominal level. This article examines the conservatism for interval estimation and describes ways of reducing it. We illustrate for confidence intervals for several basic parameters, including the binomial parameter, the difference between two binomial parameters for independent samples, and the odds ratio and relative risk. Less conservative behavior results from devices such as (1) inverting tests using statistics that are 'less discrete', (2) inverting a single two-sided test rather than two separate one-sided tests each having size at least half the nominal level, (3) using unconditional rather than conditional methods (where appropriate) and (4) inverting tests using alternative p-values. The article concludes with recommendations for selecting an interval in three situations-when one needs to guarantee a lower bound on a coverage probability, when it is sufficient to have actual coverage probability near the nominal level, and when teaching in a classroom or consulting environment.

Biomedical Research↗
PubMed1990

The value of the Claybury Selection Battery in predicting benefit from group psychotherapy.

Before receiving psychodynamic group psychotherapy at the Uffculme Clinic four groups of out-patients were assessed on the Claybury Selection Battery and the SCL 90, and therapists were asked to predict their progress. Outcome was assessed at about three months and one year by patients' self-reports of symptom change on the SCL 90 and therapists' ratings of progress. Only one of the three Claybury questionnaires, the TEQ, which measures attitudes to treatment, was significantly correlated with outcome, along with therapists' predictions. This result is different to that of a previous study which also found that outcome correlated with direction of interest (DIQ) and conservatism (C). The C and DIQ scales may provide useful predictive information only in a small proportion of cases.

Adaptation, Psychological↗
PubMed2002

Correlates of self-perceptions of spirituality in American adults.

To advance knowledge in the study of spirituality and physical health, we examined sociodemographic, behavioral, and attitudinal correlates of self-perceptions of spirituality. Participants were a nationally representative sample of 1,422 adult respondents to the 1998 General Social Survey. They were asked, among other things, to rate themselves on the depth of their spirituality and the depth of their religiousness. Results indicated that, after adjustment for religiousness, self-perceptions of spirituality were positively correlated with being female (r = .07, p < .01), having a higher education (r = .12, p < .001), and having no religion (r = .10, p < .001) and inversely correlated with age (r = -.06, p < .05) and being Catholic (r = -.08, p < .01). After adjustment for these sociodemographic factors, self-perceptions of spirituality were associated with high levels of religious or spiritual activities (range in correlations = .12-.38, all p < .001), low cynical mistrust, and low political conservatism (both r = -.08, p < .01). The population was divided into 4 groups based on their self-perceptions of degree of spirituality and degree of religiousness. The spiritual and religious group had a higherfrequency of attending services, praying, meditating, reading the Bible, and daily spiritual experience than any of the other 3 groups (all differences p < .05) and had less distress and less mistrust than the religious-only group (p < .05 for both). However, they were also more intolerant than either of the nonreligious groups (p < .05 for both) and similar on intolerance to the religious-only group. We conclude that sociodemographicfactors could confound any observed association between spirituality and health and should be controlled. Moreover, individuals who perceive themselves to be both spiritual and religious may be at particularly low risk for morbidity and mortality based on their good psychological status and ongoing restorative activities.

Adult↗
PubMed1982

Sex-role factor identification and sexual preference of men.

This extension of Bernard and Epstein (1978) compared 117 homosexual and 83 heterosexual men matched on age, education, job category, and race on 43 variables including personality items, age and education, plus additional interest and behavioral items not in the prior study. Five varimax factors were extracted: (a) domestic activities, (b) practical and recreational activities and "masculine" interests, (c) conservatism, (d) boldness, and (e) openness. Composite factor scores were estimated and group means compared. Homosexual men appeared to be more open than heterosexual men, though equally bold. Homosexual men also appeared to engage in more domestic activities, whereas heterosexual men appeared to engage in more practical and recreational activities, have more traditional "masculine" interests, and be more conservative. It was concluded that interest and behavioral factors, in conjunction with personality factors, provide a more comprehensive understanding of the sex-role identification of men.

Adult↗
PubMed1987

An Authority Behavior Inventory.

This article describes the development and validation of an Authority Behavior Inventory (ABI) to assess acceptance of authority. Each of the 24 items on the self-report ABI correlated significantly with corresponding peer ratings. In two studies (n = 200 and n = 150), the ABI was shown to have high internal consistency and high degrees of concurrent validity. Validity was assessed by means of correlations with the General Attitude Towards Institutional Authority Scale (Rigby, 1982, 1984a) using a student and a nonstudent sample; and, among nonstudents, with ratings of attitude to authority provided independently by both the subjects and their raters. In addition, the ABI discriminated significantly between matched subjects judged by peers as differing in attitude to authority, and between supporters of two Australian political parties differing in conservatism.

Journal Article↗
PubMed1989

The political and economic context of mental health care in the United States.

Since the mid-1970s, the mental health treatment system in the U.S. has faced budgetary famine. This is in stark contrast to the growing cornucopia of fiscal resources enjoyed by the overall health care system. This paper explores the complex reasons for this disproportionate allocation in health spending. On the one hand, mental health may suffer from the perception that its diagnoses are largely "subjective" and its treatments do not fit the traditional "medical model" that can be defined precisely and paid for by third-party insurers. But more importantly, the death of mental health resources can be attributed to the peculiar nature and characteristics inherent in American politics. This paper describes the American political environment, from both a historical and a contemporary perspective, to give some insight into the development of policies affecting the mental health system in the U.S. Given the current climate of fiscal conservatism in this country toward any increases in social spending, it is likely that the profound mismatch in need and spending for mental health programs will continue indefinitely.

Civil Rights↗
PubMed2001

Paying for Medicare: benefits, budgets, and Wilbur Mills's policy legacy.

Medicare features an unusually complex financing design. The Hospital Insurance Trust Fund pays for Part A of Medicare (hospital stays), while the Supplementary Medical Insurance Trust Fund finances Part B (doctor visits, outpatient care, and certain home health services). At a time when Medicare policy is generating debate, this article takes a new analytical look at the origins and consequences of the program's peculiar bifurcated structure. Addressing historians of the U.S. welfare state as well as contemporary health policy reformers, the article focuses on the crucial role of legendary Ways and Means Committee chair Wilbur Mills in Medicare's enactment in 1965. The central theme of the article is that fiscal conservatism and a commitment to budgetary restraint constitute important elements of Medicare's original political understanding. Contrary to analysts who argue that Medicare's financing design has produced "perverse" effects, we argue that it has served a valuable social function by encouraging policy makers to confront periodically the costs of one of the largest and fastest-growing federal programs. An argument can be made that Medicare's original division requires modification in order to integrate health care delivery changes of the past few decades. It is crucial, however, for reformers not to lose sight of the policy goals, including fiscal rectitude, that motivated the adoption of Medicare's bifurcated structure in the first place.

Aged↗
PubMed1995

The kinematics and mechanism of prey capture in the African pig-nosed frog (Hemisus marmoratum): description of a radically divergent anuran tongue.

High-speed videography and muscle denervation experiments were used to quantify the feeding kinematics of Hemisus marmoratum and to test hypotheses of muscle function. The feeding behavior of H. marmoratum, which feeds on ants and termites, differs radically from that of other frogs that have been studied. During feeding in H. marmoratum, the tongue 'telescopes' straight out of the mouth, as opposed to the 'flipping' tongue trajectory observed in most other frogs. At the time of prey contact, two lateral lobes of tissue at the tongue tip envelop the prey. These lateral lobes are capable of applying significant pulling forces to the prey and the tongue is, therefore, described as prehensile. The trajectory of the tongue can be adjusted throughout protraction so that the frog can 'aim' its tongue in all three dimensions; distance, azimuth and elevation. Bilateral denervation of the genioglossus muscles results in a complete lack of tongue protraction, indicating that the genioglossus muscle is the main tongue protractor in H. marmoratum, as in other frogs. Thus, H. marmoratum provides strong evidence of functional conservatism of the genioglossus muscle within anurans. Bilateral denervation of the hyoglossus muscle indicates that although the hyoglossus is involved in several aspects of normal tongue retraction, including the prehensile capability of the tongue tip, it is not necessary for tongue retraction. Unilateral denervation of the genioglossus muscle causes significant deviation of the tongue towards the denervated side, providing evidence for a mechanism of lateral tongue aiming. On the basis of the kinematics of prey capture, the anatomy of the tongue and the results of the denervation experiments, we propose that H. marmoratum uses a hydraulic mechanism to protract its tongue.

Animals↗
PubMed2004

Detection of genome-scale ordered RNA structure (GORS) in genomes of positive-stranded RNA viruses: Implications for virus evolution and host persistence.

Discrete RNA secondary and higher-order structures, typically local in extent, play a fundamental role in RNA virus replication. Using new bioinformatics analysis methods, we have identified genome-scale ordered RNA structure (GORS) in many genera and families of positive-strand animal and plant RNA viruses. There was remarkably variability between genera that possess this characteristic; for example, hepaciviruses in the family Flaviviridae show evidence for extensive internal base-pairing throughout their coding sequences that was absent in both the related pestivirus and flavivirus genera. Similar genus-associated variability was observed in the Picornaviridae, the Caliciviridae, and many plant virus families. The similarity in replication strategies between genera in each of these families rules out a role for GORS in a fundamentally conserved aspect of this aspect of the virus life cycle. However, in the Picornaviridae, Flaviviridae, and Caliciviridae, the existence of GORS correlated strongly with the ability of each genus to persist in their natural hosts. This raises the intriguing possibility of a role for GORS in the modulation of innate intracellular defense mechanisms (and secondarily, the acquired immune system) triggered by double-stranded RNA, analogous in function to the expression of structured RNA transcripts by large DNA viruses. Irrespective of function, the observed evolutionary conservation of GORS in many viruses imposes a considerable constraint on genome plasticity and the consequent narrowing of sequence space in which neutral drift can occur. These findings potentially reconcile the rapid evolution of RNA viruses over short periods with the documented examples of extreme conservatism evident from their intimate coevolution with their hosts.

Animals↗
PubMed1995

Surgical management of the head and neck cancer patient following concomitant multimodality therapy.

The simultaneous use of chemotherapy and radiotherapy (concomitant therapy) has exceptional promise in the treatment of head and neck cancer. In this limited review, seven head and neck cancer patients who underwent prior concomitant therapy and subsequent surgery developed wound-healing complications that were delayed (22-day average) in onset. Paranasal sinus and base of skull operations had less significant wound morbidity than those cases requiring simultaneous transgression of the neck and upper aerodigestive tract. The use of arterialized flaps did not in itself prevent wound breakdown. The formation of controlled fistulae, delay of reconstruction, and avoidance of simultaneous neck and upper aerodigestive tract entry are important considerations in avoiding wound-healing complications after concomitant therapy. In this select group of patients, surgery should be approached with extreme caution and conservatism.

Adult↗
PubMed1996

Government spending on health care: a cross-national study of public attitudes.

The economic constraints of the last decade have led western industrialized nations to consider, if not actually adopt, more stringent controls over costly social policies such as health care. Using recent, nationally representative data from the United States, Great Britain, West Germany, Italy and Australia, this paper provides an international comparison of attitudes towards government spending on health care. Attitudes are found to differ by country, with Great Britain being most supportive of increased spending and West Germany and the United States most opposed. Multiple regression techniques are used to determine significant socio-demographic and political ideological factors in relation to predicting attitudes towards government spending. In many countries, those who often bear the heavier tax burden, for example, the middle classes and those with higher status jobs, were consistently more likely to oppose an increase in government spending on health; compared with them, women were found to be more supportive of such action. Measures of political ideology were found to be quite consistent and strong predictors of attitudes--political conservatism and more negative attitudes towards government generally were inversely related to support for government increases in health spending. The policy implications of these findings are discussed in the conclusion.

Attitude to Health↗