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This study explores the dynamics of how organizations make appeals for legitimacy in unstable fields. Empirically, we investigate the debate surrounding U.S. Department of Agriculture organic food certification from 1990 to 2011, which took place as the field of organic food production was destabilized by the entrance of new market participants, as well as the effort by the federal government to regulate what constituted “organic” food. We argue that organizations alter appeals for legitimacy (legitimating accounts) when organization fields undergo change and existing or expected legitimating accounts are undermined by any number of forces, such as social movements, shifting markets, or new actors. Our results illustrate how actors strategically deploy rhetoric to appeal to different constituencies and audiences in an unstable field, and highlight how organizational actors in the organic certification debate sought to legitimate claims. [ABSTRACT FROM AUTHOR]

This article provides qualitative findings from a community-based, mixed-method study of African American caregivers of elders. Using constant comparative analysis of 21 in-depth interviews, investigators explored the reciprocal, interactive influence between caregiving and religion or spirituality. Findings suggested that participants perceived their approach to care as a personal ministry. Analysis of the core category of Caregiving as Ministry identified four characteristics of the participant's care approach: (a) caregiving is an honor and a blessing, (b) caregiving is my identity, (c) caregiving is sustained by a personal relationship with God, and (d) caregiving is a higher calling from God. The article concludes with three implications for direct and community-based social work practice. [ABSTRACT FROM AUTHOR]

One of the most controversial issues related to the use of spiritually-based social work interventions is the use of prayer by practitioners. The current study explores prayer-related activities and related decision making among a random sample of 204 licensed clinical social workers in a mid-Atlantic state in the United States. A substantial percentage of practitioners report praying for (55%) or praying/meditating with their clients (33%). Furthermore, practitioner responses to four clinical vignettes, reflecting Canda's (1990) suggested ethical guidelines for practitioner behavior, reveal that the majority do not adhere to such guidelines--either in terms of personal comfort with the use of prayer or views about its ethical use. Implications for practitioners, administrators, and educators are presented. [ABSTRACT FROM AUTHOR]

The complaint of fatigue is common in community, primary care, and psychiatric settings. Fatigue is often associated with depression and psychosocial stress. This report investigated the role of alexithymia and depression in fatigue as reported in a sample of 151 psychiatric outpatients (75 men and 76 women) who completed all scales. The mean age of the sample was 45.5 yr. (SD= 12.5), and mean education was 16.2 yr. (SD=2.4). Fatigue was inversely correlated with education (-.16) and positively correlated with depression (.44), anxiety (.30), and alexithymia (.35). However, in a multivariate regression analysis, only depression and alexithymia remained significant (p ≤ .01). [ABSTRACT FROM AUTHOR]

The original Emotional Intelligence Scale of Fukunishi utilized 65 items measuring 3 basic dimensions: intrapersonal, interpersonal, and situational. 170 psychiatric outpatients (84 men and 86 women) completed the inventory. The mean age of the sample was 41.1 yr. (SD = 12.4). Compared with the 65-item scale, factor re-analysis yielded a new 34-item solution with significant correlations for the Intra- psychic (.97) and Interpersonal dimensions (.96) of the larger scale, but not with the Situational dimension (.43). The correlation between the total inventory scores was also significant (.94). [ABSTRACT FROM AUTHOR]

To survey parents of children with selective mutism (SM) in regard to (1) the role of the primary care physician in the diagnosis of SM; (2) the social and school consequences of SM; and (3) their opinion of the effectiveness of different treatment modalities, a 39-item written survey was mailed to 27 parents with at least one child diagnosed with SM on the basis of diagnostic and statistical manual TV-text revision (DSM IV-TR) criteria. Twenty-seven parents (100%), with a total of 33 children with SM, completed the survey. There were 24 girls and 9 boys. The mean age when parents had strong concerns about symptoms of SM was 3.8 years, but diagnosis did not occur until nearly a year later. Twenty-three (69.7%) of the children with SM were never diagnosed accurately or referred by their primary care physicians. SM caused important school/social problems for 17 (51.5%) of the children. Speech therapy was provided for 36.4% of children and was thought to have been helpful for 30% of them. Behavior modification was the treatment for 45.5% of children and perceived to be helpful for 66.7% of them. Selective serotonin re-uptake inhibitor pharmacotherapy was prescribed for 17 (51.5%) of the children and believed to be effective for 11 (65%) of them. Primary care physicians in this study rarely diagnosed accurately or referred children with SM in a timely fashion, even though symptoms of the condition were generally very apparent and parents had expressed concern. Behavioral modification, pharmacotherapy with SSRTs, and early intervention are viable treatment options. Early diagnosis is key to preventing long- term effects of this condition. [ABSTRACT FROM AUTHOR]

Recent studies have shown that endovascular abdominal aortic aneurysm repair (EVAR) has decreased costs, as well as decreased intensive care unit and total hospital length of stays when compared to abdominal aortic aneurysm (AAA) repair using a retroperitoneal exposure. The authors hypothesized that the fast-track AAA repair, which combines a retroperitoneal exposure with a patient care pathway that includes a gastric promotility agent and patient-controlled analgesia, would have no differences when compared to EVAR. Records of 58 patients who underwent AAA repair between April 14, 2000, and July 12, 2002, were reviewed retrospectively. Demographic information, length of stay, intraoperative and postoperative complications, mortality, and costs were evaluated. Fifty-eight AAA repairs were performed with the EVAR (n = 28) and fast-track (n = 30) techniques. The EVAR group was slightly older (72 vs 68 years, p = 0.04), had slightly smaller average aneurysm size (5.5 ±0.13 vs 6.1 ±0.17 cm, p = 0.008), and had more patients designated American Society of Anesthesia class 4 (p<0.0001). Both groups were predominantly male. Otherwise there were no statistically significant differences in risk factors. Patients who underwent fast-track repair tended to have a longer operation (216 ±7.4 vs 158 ±6.8 minutes, p<0.0001), with a greater volume of blood (1.8 ±0.29 vs 0.32 ±0.24 units, p = 0.0005), colloid (565 ±89 vs 32 ±22 cc, p<0.0001), and crystalloid transfusions (4,625 ±252 vs 2,627 ±170 cc, p<0.0001). There were no statistically significant differences in the number of intraoperative or postoperative complications between the 2 groups. EVAR patients resumed a regular diet earlier (0.21 ±0.08 vs 1.8 ±0.11 days, p<0.0001). Intensive care unit stay was shorter for EVAR (0.50 ±0.10 vs 0.87 ±0.10 days, p = 0.01), but floor (2.1 ±0.23 vs 2.6 ±0.21 days, p = 0.17), and total hospital lengths of stay (2.8 ±0.32 vs 3.4 ±0.18 days, p = 0.07) were similar between the 2 groups. Total hospital cost was lower in the fast-track ($10,205 ±$736 vs $20,640 ±$1,206, p<0.0001) leading to greater overall hospital earnings ($6,141 ±$1,280 vs $107 ±$1,940, p = 0.01). Fast-track AAA repair is a viable alternative for the treatment of abdominal aortic aneurysms. Compared to endovascular repair, the fast-track method had increased transfusions of blood and intravenous fluids and increased operating room times, but equivalent lengths of floor and total hospital stay and increased total hospital earnings. [ABSTRACT FROM AUTHOR]

Parents and their teenage children were questioned about medical marijuana and whether they believed that passage of medical marijuana laws in their states would increase teenage use of marijuana for non-medical purposes. A 24-question written survey was distributed separately to teenager/parent pairs who visited 1 of 2 suburban general pediatric offices located in Vienna, Virginia or Mason, Ohio. Completed surveys were collected from 393 parent-teen pairs. Only 13% of the teenagers admitted to ever smoking marijuana while 6% admitted smoking it in the past 30 days. There was good agreement between parents and teens (81% of parents and 76% of their teenagers who responded to the survey) that regular use of marijuana causes harm to many or most users, not just "potheads." Although there was close agreement in the range of opinions about medical marijuana (i.e., from liberal use to no use) by parents as a group and the teens as a group, agreement between the answers of parents matched with their own children was poor based on K-coefficient analysis (K=0.20). Twenty-eight percent of the parent group and 55% of the teenagers believed that passage of state laws for medical marijuana would make it easier for teens to smoke marijuana for medical purposes. [ABSTRACT FROM AUTHOR]

Cites key survey findings on the antibiotic-prescribing habits of Board-certified pediatric infectious disease specialists (PIDS) for children with upper respiratory tract infections. Examination of judicious antibiotic use for purulent rhinorrhea; Sample cases on the issue; Implications on clinical pediatrics.

Examines the psychometric properties of the illness attitudes scale of psychiatric patients. Utilization of health care for unnecessary tests and medical procedures for hypochondriacs; Methods use in determining the number of meaningful factors; Replication of the study for assessing stability of the factor structure.

Although some researchers have studied backgrounds and needs of persons who are incarcerated, few investigators have examined the multiple occurrence of these life factors within the same sample and even fewer have compared the differences between men and women on these variables. The author examined differences between 81 incarcerated men and women in the history and severity of substance abuse, family-of-origin factors, previous abuse and neglect, and current personal functioning. Results indicated that although the women consistently had more problems in these areas than did their male counterparts, male respondents also displayed a significant need for services. Recommendations for relevant programming for both incarcerated men and women are presented, and the role of social work in effective service delivery is discussed. [ABSTRACT FROM AUTHOR]

There is a growing recognition in the literature that traditional service approaches are not effective with the homeless mentally ill. A specialized practice model rooted firmly in the special characteristics and realities of this diverse population is needed. The authors propose components of such a practice model, including practice principles, worker characteristics, and agency supports. Examples from a three-year federally funded project serving homeless adults with mental illness are presented. [ABSTRACT FROM AUTHOR]

The best curative treatment for esophageal malignancy remains controversial. In 2003, we presented our institution's experience with 124 patients treated from 1990 to 2001. Here we update that experience with an additional 6 years' data. A total of 221 patients underwent surgical resection from 1990 to 2007; 128 had up-front surgery, 88 underwent surgery after neoadjuvant radiation and chemotherapy (NARCS), and five underwent surgery after neoadjuvant, single-agent therapy. Principle outcomes of interest were 30-day and in-hospital mortality as well 3- and 5-year survival rates. Overall 3- and 5-year survival rates were 38 and 33 per cent. NARCS achieved complete pathologic result in 32 per cent of patients with corresponding 3- and 5-year survival rates of 58 and 53 per cent. The 3- and 5-year survival rates for all patients undergoing NARCS were 36 and 31 per cent versus 24 and 18 per cent for patients with up-front surgery for anything over Stage I disease (P = 0.01). The 3- and 5-year survival rates for patients with up-front resection of Stage I disease were 78 and 70 per cent. Overall, 30-day and in-hospital mortalities were 1.8 and 2.3 per cent. Since January 1,2000, hospital mortality has been less than 0.8 per cent. We prefer NARCS for malignancy of the esophagus, except in those patients with high-grade dysplasia (carcinoma in situ), suspected Stage I disease, poor performance status, or urgent/emergent circumstances. [ABSTRACT FROM AUTHOR]

Treatment of esophageal cancer has traditionally included surgery as the initial modality. Neoadjuvant chemoradiation therapy has been introduced with the goal of downstaging tumors before surgical resection; however, its role in esophageal cancer remains controversial. We report 116 patients who underwent esophagogastrectomy with reconstruction for carcinoma of the esophagus or esophagogastric junction over a 10-year period (January 1,1990 to June 1, 2001). Forty patients underwent neoadjuvant radiation and chemotherapy followed by surgery. Hospital mortality in this group was 7.5 per cent, complete pathologic response (CPR) was 37.5 per cent, and overall 3- and 5-year survival rates were 47 and 38 per cent. Five-year survival in the 15 patients with CPR was 85 per cent. Five patients underwent neoadjuvant single-agent therapy (four chemotherapy and one radiation) followed by surgery, and none survived to 3 years. Seventy-one patients underwent surgery without neoadjuvant therapy. Hospital mortality in this group was 1.4 per cent, with 3- and 5-year survival of 21 and 17 per cent--a decreased long-term survival compared with the neoadjuvant therapy group despite the observation that patients who underwent neoadjuvant therapy had a larger tumor size on presentation (5.5 ± 0.4 cm vs 3.8 ± 0.2 cm; P = 0.002). Squamous cell carcinomas seemed to be more responsive to neoadjuvant radiation and chemotherapy followed by surgery than were adenocarcinomas, with a CPR of 44.4 versus 35.5 per cent; however, 5-year survival rates in these complete responders were not significantly different (100% and 78%, respectively; P = 0.97). We report that esophagogastrectomy in... [ABSTRACT FROM AUTHOR]

With an increasing proportion of U.S. individuals 80 years of age or older, the authors examined their surgical experience with octogenarians undergoing major, curative-intent thoracic surgery. Between January 1, 1990, and September 1, 2009, 102 octogenarians underwent curative-intent resection for nonsmall cell carcinoma of the lung (NSCCL), esophageal carcinoma (EC), or related surgery for thoracic esophageal perforation (EP). Analysis and reporting followed the guidelines of the Nationwide Inpatient Sample database study (1994 to 2003). Eighty-six patients underwent curative-intent resection for NSCCL, 12 for EC, and four for surgery for EP. Hospital and 30-day mortalities were 0 per cent. Overall 1-, 2-, and 5-year survival rates were: 78, 58, and 32 per cent. Within the NSCCL cohort, minimally invasive exposures (video-assisted thoracic surgery [VATS] and video thoracoscopy [VT]) were associated with fewer and shorter duration of air leaks, leading to shorter length of stay. Since we began using minimally invasive exposure for NSCCL in 2007, the percentage of octogenarians discharged within 5 days of surgery has increased from 35.5 to 66.7 per cent (P = 0.01), and the percentage of patients discharged within 3 days of surgery has increased from 8.1 to 33.3 per cent (P = 0.006). Of 24 patients undergoing surgery for NSCCL since 2007, 18 (75%) underwent minimally invasive (VATS or VT) exposures, of which 15 patients (83.3%) were discharged home within 5 days and eight (44.4%) within 3 days of their procedure. Excellent, short- and longer-term results can be achieved in elderly patients if risks, exposures, and resections are appropriately matched to patient performance. [ABSTRACT FROM AUTHOR]

The authors review their experience with thoracic esophageal perforation at Inova Fairfax Hospital, June 1,1988, to March 1, 2009. With the exception of 6 patients with occult perforation, all of whom survived with nonoperative therapy, aggressive surgical intervention was the standard approach. Among patients treated aggressively with surgery within 24 hours of perforation, hospital survival was 97 per cent versus 89 per cent for patients treated aggressively surgically after 24 hours. In the absence of phlegmon, implacable obstruction, or delay, primary repair resulted in 100 per cent survival. Where phlegmon or resolute obstruction existed, resection and reconstruction resulted in 96 per cent survival. Even when patients were deemed too ill to undergo surgery, cervical diversion was 100 per cent effective in eradicating continuing leak and achieved 89 per cent survival. Endoesophageal stenting was applied as primary treatment or secondarily such as where leak complicated primary repair. When stenting was used as the initial and primary treatment modality, survival was 88 per cent. Targeted drainage was helpful on occasion as an adjunct to initial therapies. Comfort measures alone were appropriate when clinical circumstances merited no effort at resuscitation. Finally, survivors were asked to self-categorize their ability to swallow; 95 per cent responded good to excellent. [ABSTRACT FROM AUTHOR]