Making the Connections: Gender Quotas, Representation, and Critical Mass in Latin America

Using Argentina, Brazil, Chile, and Mexico as case studies, this paper examines how women’s collaboration influences the effects of gender quotas on women’s representation. The efficacy of gender quotas in increasing the numerical representation of women and improving gender equality outcomes is well-researched, but questions remain about the precise linkages between the numerical representation of women and the substantive representation of women. This thesis analyzes previously identified linkages alongside actions by women’s organizations in national legislatures and civil society to better understand women’s roles as critical actors in making gender quotas successful. The findings suggest that women’s collaboration is crucial in achieving and defining substantive representation, ensuring proper implementation of quotas, and translating higher numerical representation into real gender equality outcomes

Understanding Craving for Cigarettes: A Multidimensional Assessment Approach

Cigarette smoking is a serious health hazard affecting a sizeable proportion of the adult population. The addictive nature of cigarettes has been blamed for the difficulty smokers experience in achieving and maintaining abstinence. Cigarette cravings are frequently cited as a factor contributing to relapse. Addiction theories proposed independently by Wikler, Siegel, and Solomon view cravings as classically conditioned responses to internal or external cues. These responses are presumably multidimensional, having cognitive, emotional, and physiological manifestations. The current study examined cigarette cravings under controlled laboratory conditions. Forty-six male and female undergraduates served as participants. Stimuli commonly associated with smoking relapse were presented to three groups of subjects: current smokers, recent ex-smokers, and nonsmokers. Both imaginal and in vivo cue exposure were employed. The findings clearly demonstrated that these laboratory procedures were effective in producing cigarette cravings among former and current smokers, with in vivo exposure eliciting stronger urges than imaginal cue presentation. As predicted, smokers experienced stronger cravings than ex-smokers, while nonsmokers reported essentially no urges to smoke. The results also supported the multidimensional nature of cravings. Together, state anxiety, skin conductance, and heart rate accounted for 38% of the variance in craving ratings. Individuals with a history of smoking experienced greater anxiety in response to imaginal and in vivo cues than nonsmokers, but the three groups did not differ on physiological reactions to cue exposure. Multiple regression analyses examined factors associated with craving strength. Cognitive avoidance of imaginal stimuli was not predictive of craving, but clarity of imagery was positively related to urge level. Other variables associated with craving strength included extraversion, trait anxiety, use of stimulant drugs, use of depressant drugs, and nicotine dependence. These baseline variables accounted for approximately a third of the variance in craving responses to cue exposure. The results of this study are consistent with theoretical views of cigarette cravings as multidimensional conditioned responses. The implications for assessment of cravings in a laboratory setting are discussed

The Effects of Malpractice Tort Reform on Defensive Medicine

Positive defensive medicine occurs when physicians order additional tests or procedures primarily to avoid malpractice liability. This paper shows the degree of defensive medicine occurring across states is related to the malpractice environment in the states. As the environment changes due to malpractice tort reform, defensive medicine practices also change. This paper shows the existence of positive defensive medicine and how it adds to total health care expenditures for head trauma victims in 23 states in 2000. Moreover, given different malpractice environments across states, we witness variations in defensive medicine practices leading to differences in health care expenditures

The Effects of Malpractice Tort Reform on Defensive Medicine

Medical malpractice crises occur across states to differing degrees, thus the proposed changes in state tort reforms differ accordingly. The primary overt goals of tort reform aim to address: rising medical malpractice insurance rates, increased frequency and severity of awards, and the increased incidence of doctors shuttering offices or fleeing states due to untoward malpractice environments. A secondary goal of tort reform is to reduce health care costs attributed to malpractice costs. Clearly, as malpractice tort reforms are debated in state capitols and reforms take place, the effects of the reforms on the goals above can be examined. However, there is an often ignored implication of reform requiring attention. How do reforms affect doctors\u27 decisions and behaviors in treating patients? Specifically, do doctors change their behavior as the malpractice environment changes, and if so, do these changes affect health care costs? Given the variety of state tort reforms occurring over the last several years, we can examine how each one affects health care costs attributed to changes in physician behavior. Since the early 1970\u27s economists, lawyers, and many within the medical community have debated the existence of defensive medicine. Using the Office of Technology Assessment definitions (OTA, 1994), positive defensive medicine occurs when physicians order additional tests or procedures primarily to avoid malpractice liability. Negative defensive medicine occurs when doctors avoid certain patients or treatments chiefly out of concern for malpractice liability. The thrust of this paper deals with positive defensive medicine. Given different malpractice environments across states, we witness variations in positive defensive medicine practices leading to differences in health care expenditures. The plan of the paper is as follows. First, we note the existence of defensive medicine. Next, we discuss malpractice tort reform across states. Lastly, we show which reforms have demonstrable impacts on defensive medicine and therefore on health care expenditures

Effectiveness of a Metacognitive Shopping Intervention for Adults with Intellectual Disability Secondary to Down Syndrome

Background: The purpose of this study was to examine the effects of a metacognitive strategy-training intervention on the shopping performance of adults with intellectual disability secondary to Down syndrome. Method: A single subject ABA design across six participants was employed and included a 2-week baseline data collection period, followed by an 8-week intervention phase, and a 2-week follow-up data collection period 1 month after intervention end. Time, frequency, and level of assistance required by the participants to demonstrate targeted shopping skills were measured during baseline, intervention, and follow-up probe phases. Results: As a group, the participants experienced statistically significant improvements in time (x2 = 144.25, px2 = 38.00, px2 = 207.08, pZ = -8.50, pd = 0.92), frequency (Z = -4.07, pd = -2.60), and level of assistance (Z = -9.39, pd = -2.44). Results calculated for individual participant performance mirrored group results. Conclusion: The findings of this study suggest that the intervention effectively improved the participants’ shopping performance. Further research is warranted

Lessons Learned in Conducting School Health Research in Massachusetts: A Massachusetts School Nurse Research Network (MASNRN) Project

The Institute of Medicine (2007) and the Robert Wood Johnson Foundation (RWJF) (2010) recognized that the school environment plays a role in shaping children’s health and health behaviors, and school health services are positioned to model these approaches. The majority of school health services are school nurse (SN) managed (RWJF, 2012; Schainker, 2005), but a research gap exists linking school health services with improved student outcomes (Hootman, 2002; Lear, 2007). In Massachusetts, the student health research question ideally has roots in the expertise of the SN. The researcher conducting a school-based student health study interacts with SNs and administrators in school districts that vary by the type and number of health staff , as well as district location and size. These variables confound the research design in terms of structure and process. IRB issues and permission for research conduction in the school district are particularly vexing. Consent of parents and assent of children are required, and SNs participating in the research must complete human subjects training. Massachusetts School Nurse Research Network (MASNRN) was founded in 2004 by a group of SN experts to conduct school based research. The 100 members of MASNRN have conducted studies across the state and within school districts on asthma, availability of epinephrine for anaphylaxis, bullying, immunizations, training modules and mental health. Particular lessons learned from the unique experience of conducting research in schools are presented

Development and Validation of a Food-Frequency Questionnaire for the Determination of Detailed Fatty Acid Intakes

Objective: To validate a fat intake questionnaire (FIQ) developed to assess habitual dietary intake while focusing on the assessment of detailed fatty acid intake including total trans unsaturated fatty acids (TUFA). Design: An 88 food item/food group FIQ was developed using a meal pattern technique. Validation was achieved by comparison with dietary intake assessed by a modified diet history (DH) in a cross-over design. Eighty-four individuals supplied adipose tissue biopsies for linoleic acid and total TUFA analysis as an independent validation of the FIQ and DH. Setting: Medical Centre, Dublin Airport, Republic of Ireland. Subjects: One hundred and five healthy volunteers (43 females and 62 males aged 23–63 years). Results: Significant correlations (P , 0.0005) were achieved for intakes of energy (0.78), total fat (0.77), saturated fat (0.77), monounsaturated fat (0.63), polyunsaturated fat (0.73), TUFA (0.67) and linoleic acid (0.71) assessed by the FIQ compared with the DH. Linoleic acid intake assessed by the FIQ and the DH was significantly correlated with adipose tissue concentrations (r ¼ 0.58 and 0.49, respectively; P , 0.005); however, total TUFA intake was poorly correlated with adipose tissue concentrations (r ¼ 0.17 and 0.10 for FIQ and DH, respectively). Conclusions: The FIQ compared favourably with the DH in assessing habitual diet, in particular fatty acid intake. In addition, the FIQ was successfully validated against the linoleic acid composition of adipose tissue, an independent biomarker of relative fatty acid status. The FIQ could therefore be used as an alternative to the DH as it is a shorter, less labour-intensive method

Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality

OBJECTIVES: The purpose of this study was to investigate the association between obtaining hemodynamic data from early pulmonary artery catheter (PAC) placement and outcomes in cardiogenic shock (CS). BACKGROUND: Although PACs are used to guide CS management decisions, evidence supporting their optimal use in CS is lacking. METHODS: The Cardiogenic Shock Working Group (CSWG) collected retrospective data in CS patients from 8 tertiary care institutions from 2016 to 2019. Patients were divided by Society for Cardiovascular Angiography and Interventions (SCAI) stages and outcomes analyzed by the PAC-use group (no PAC data, incomplete PAC data, complete PAC data) prior to initiating mechanical circulatory support (MCS). RESULTS: Of 1,414 patients with CS analyzed, 1,025 (72.5%) were male, and 494 (34.9%) presented with myocardial infarction; 758 (53.6%) were in SCAI Stage D shock, and 263 (18.6%) were in Stage C shock. Temporary MCS devices were used in 1,190 (84%) of those in advanced CS stages. PAC data were not obtained in 216 patients (18%) prior to MCS, whereas 598 patients (42%) had complete hemodynamic data. Mortality differed significantly between PAC-use groups within the overall cohort (p \u3c 0.001), and each SCAI Stage subcohort (Stage C: p = 0.03; Stage D: p = 0.05; Stage E: p = 0.02). The complete PAC assessment group had the lowest in-hospital mortality than the other groups across all SCAI stages. Having no PAC assessment was associated with higher in-hospital mortality than complete PAC assessment in the overall cohort (adjusted odds ratio: 1.57; 95% confidence interval: 1.06 to 2.33). CONCLUSIONS: The CSWG is a large multicenter registry representing real-world patients with CS in the contemporary MCS era. Use of complete PAC-derived hemodynamic data prior to MCS initiation is associated with improved survival from CS