Understanding the role of mediating risk factors and proxy effects in the association between socio-economic status and untreated hypertension

The association between socio-economic status (SES) and untreated hypertension varies according to a country's level of development and racial/ethnic group. We sought to confirm this variation in women from China and the United States (US) as well as to investigate the impact of SES on several mediating risk factors. We also investigate the extent to which SES explains racial/ethnic differences in untreated hypertension in the US. We used cross-sectional data from 1814 non-pregnant women in China (China Health and Nutrition Survey (CHNS), 1997) and 3266 non-pregnant women in the United States (National Health and Nutrition Examination Survey (NHANES III), 1988–1994) respectively. A variety of statistical modelling techniques was used to predict untreated hypertension as a function of several mediating factors and to simulate the impact of changes in SES. The age-adjusted prevalence of untreated hypertension was significantly higher (p<0.01) for low-income White and Black women compared to Mexican American or Chinese women. Untreated hypertension was not significantly associated with income or education in Mexican Americans or women in China. Obesity and light physical activity had the largest mediating effect on the association between SES and untreated hypertension for all racial/ethnic groups. However, this effect was not as strong as the proxy effect of income and education. SES did not completely explain racial/ethnic differences in hypertension in the US. While SES was more strongly associated with hypertension in Blacks than Whites, Blacks were still 1.97 (95% CI 1.47–2.64) times more likely to have untreated hypertension than Whites after adjusting for SES differences. The association between SES and untreated hypertension varied by country and racial/ethnic group. An important explanation for this variation was the differential effect of SES on mediating risk factors. SES disparities between Whites and Blacks in the US partly explain differences in the prevalence of untreated hypertension between these racial/ethnic groups.

Parent-proxy and child self-reported health-related quality of life: using qualitative methods to explain the discordance

Background: Although parent-proxy reports of health-related quality of life (HRQOL) are only moderately correlated with child reported HRQOL, it remains unknown why these scores differ. The aim of this study was to use a qualitative methodology to examine why parents and children report different levels of HRQOL.

Method: The sample consisted of 15 parent–child pairs. A think-aloud technique was used where parents and children were given a generic HRQOL instrument (KIDSCREEN) and instructed to share their thoughts with the interviewer. Qualitative analyses were conducted to assess whether parents and children base their answer on different experiences or reasoning, have different response styles, or interpret the items differently.

Results: There was discordance between parents and children, in terms of rating scale and in terms of the reasoning for their answer. Children tended to have different response styles to parents, where for example, children tended to provide extreme scores (highest or lowest score) and base their response on one single example, more than parents. Parents and children interpreted the meaning of the items very similarly.

Discussion: This study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.

Resisting web proxy-based HTTP attacks by temporal and spatial locality behavior

A novel server-side defense scheme is proposed to resist the Web proxy-based distributed denial of service attack. The approach utilizes the temporal and spatial locality to extract the behavior features of the proxy-to-server traffic, which makes the scheme independent of the traffic intensity and frequently varying Web contents. A nonlinear mapping function is introduced to protect weak signals from the interference of infrequent large values. Then, a new hidden semi-Markov model parameterized by Gaussian-mixture and Gamma distributions is proposed to describe the time-varying traffic behavior of Web proxies. The new method reduces the number of parameters to be estimated, and can characterize the dynamic evolution of the proxy-to-server traffic rather than the static statistics. Two diagnosis approaches at different scales are introduced to meet the requirement of both fine-grained and coarse-grained detection. Soft control is a novel attack response method proposed in this work. It converts a suspicious traffic into a relatively normal one by behavior reshaping rather than rudely discarding. This measure can protect the quality of services of legitimate users. The experiments confirm the effectiveness of the proposed scheme.

Effects of asenapine in bipolar I patients meeting proxy criteria for moderate-to-severe mixed major depressive episodes: a post hoc analysis

OBJECTIVE: Depression is the predominant psychosocial and suicide burden in bipolar disorder, yet there is a paucity of evidence-based treatments for bipolar depression. METHODS: This post hoc subgroup analysis of data pooled from two 3-week, randomized, placebo- and olanzapine-controlled trials (December 2004-April 2006, N = 489 and November 2004-April 2006, N = 488) examined a subgroup of patients meeting criteria for moderate-to-severe mixed major depressive episodes, defined using DSM-IV-TR criteria for mixed episodes (mania and major depression simultaneously) with a baseline Montgomery-Asberg Depression Rating Scale (MADRS) total score ≥ 20. RESULTS: Decreases in MADRS scores (least squares mean [SE]), the a priori primary outcome, were significantly greater in the asenapine group than in the placebo group from baseline to day 7 (-11.02 [1.82] vs -4.78 [1.89]; P = .0195), day 21 (-14.03 [2.01] vs -7.43 [2.09]; P = .0264), and endpoint (-10.71 [1.76] vs -5.19 [1.98]; P = .039). Decreases in MADRS scores with asenapine were significantly greater than with olanzapine from baseline to day 7 (-6.26 [1.47]; P = .0436). Decreases in Young Mania Rating Scale mean total score were greater with asenapine than with placebo or olanzapine at all time points assessed. A significantly greater reduction from baseline to day 21 in the Short Form-36 mental component summary score was observed with asenapine, but not olanzapine, compared with placebo (16.57 vs 5.97; P = .0093). Asenapine was generally well tolerated. CONCLUSIONS: These data provide support for the potential efficacy of asenapine in mixed major depressive episodes; however, these data cannot be linearly extrapolated to nonmixed major depression.

Mid- to late Holocene landscape change and anthropogenic transformations on Mo‘orea, Society Islands: a multi-proxy approach

Archaeology’s ability to generate long-term datasets of natural and human landscape change positions the discipline as an inter-disciplinary bridge between the social and natural sciences. Using a multi-proxy approach combining archaeological data with palaeoenvironmental indicators embedded in coastal sediments, we outline millennial timescales of lowland landscape evolution in the Society Islands. Geomorphic and cultural histories for four coastal zones on Mo‘orea are reconstructed based on stratigraphic records, sedimentology, pollen analysis, and radiocarbon determinations from mid- to late Holocene contexts. Prehuman records of the island’s flora and fauna are described utilizing landsnail, insect, and botanical data, providing a palaeo-backdrop for later anthropogenic change. Several environmental processes, including sea level change, island subsidence, and anthropogenic alterations, leading to changes in sedimentary budget have operated on Mo‘orea coastlines from c. 4600 to 200 BP. We document significant transformation of littoral and lowland zones which obscured earlier human activities and created significant changes in vegetation and other biota. Beginning as early as 440 BP (1416–1490 cal. ad), a major phase of sedimentary deposition commenced which can only be attributed to anthropogenic effects. At several sites, between 1.8 and 3.0 m of terrigenous sediments accumulated within a span of two to three centuries due to active slope erosion and deposition on the coastal flats. This phase correlates with the period of major inland expansion of Polynesian occupation and intensive agriculture on the island, indicated by the presence of charcoal throughout the sediments, including wood charcoal from several economically important tree species.

The association between the investment opportunity set and corporate financing and dividend decisions: some Australian evidence

Summarizes previous research on the investment opportunity set (IOS) using price-based and investment-based proxies and variance measures; and develops hypotheses on the relationship between IOS, debt/equity ratios and dividend policies. Tests them on 1990-1998 data from listed Australian companies and explains the methodology, which builds on Gover and Gover (1993) by including more recent proxy variables. Finds no significant results from low growth firms, although some high growth firms show lower debt/equity ratios and dividends. Questions the robustness of existing IOS proxies in the Australian context and calls for further research.

Decision making in health care: limitations of the substituted judgement principle

The substituted judgement principle is often recommended as a means of promoting the self-determination of an incompetent individual when proxy decision makers are faced with having to make decisions about health care. This article represents a critical ethical analysis of this decision-making principle and describes practical impediments that serve to undermine its fundamental purpose. These impediments predominantly stem from the informality associated with the application of the substituted judgement principle. It is recommended that the principles upon which decisions are made about health care for another person should be transparent to all those involved in the process. Furthermore, the substituted judgement principle requires greater rigour in its practical application than currently tends to be the case. It may be that this principle should be subsumed as a component of advance directives in order that it fulfils its aim of serving to respect the self-determination of incompetent individuals.

Normative life satisfaction: measurement issues and a homeostatic model

Previous studies have established that, when life satisfaction is measured over a range from 0 to 100 the mean scores of Western populations average 75 ± 2.5. The consistency of these data has given rise to the idea that life satisfaction may be held under homeostatic control. This paper further investigates this hypothesis by examining the distribution of data within populations. It also examines these data with a view to elucidating various methodological issues regarding life satisfaction measurement. In terms of the methodological issues it is concluded that measurement is best achieved using bi-directional Likert scales with at least 11 choice points. It is also determined that the life satisfaction of Western populations did not change over the decade 1980–1990, and that data derived from college students cannot be validly employed as proxy general population data. In terms of data distribution, it is calculated that the normal range of life satisfaction within Western populations lies within the range 40 to 100. The consistency of this non-normal distribution is argued to be further evidence that life satisfaction is held under homestatic control, and a descriptive model is proposed.

Ambiguities and inconsistencies in relation to the obligations of proxies under corporations law: a model for reform

This article reconsiders the important question which came to light as a result of the controversial 2002 Coles Myer annual general meeting: do directors that are appointed as proxy have an obligation to vote as directed (and indeed should they)? A recent decision of the New South Wales Supreme Court, which was subsequently approved on appeal, stands for the proposition that proxy holders are agents of the shareholders that appointed them. However, currently the Corporations Act only requires a Chairman appointed as proxy to vote as directed — not an ordinary director. This article briefly explains the present state of the law in Australia on this issue, and then explores some interesting recent judicial remarks which may suggest that ordinary directors appointed as proxy must vote as directed in order to satisfy their director’s duties (both common law and statutory) to the company. We finally outline a proposed statutory reform initiative which seeks to remove the present uncertainty in the law by introducing a blanket requirement that all proxy holders must vote as directed.

A mechanism to end conflict in Aceh

On 15 August 2005, the Government of Indonesia and the Free Aceh Movement (GAM) signed an agreement to end almost 30 years of conflict between them over claims to independence. After a series of failed ceasefires, this was the first comprehensive peace agreement, and contained within it the potential to settle the political and economic claims that fuelled a desire for separation in Aceh. The talks that led to the peace agreement followed the devastating tsunami of 26 December 2004, which killed over 100,000 people in Aceh, and an escalated military campaign by the Indonesian military against GAM forces. The talks were brokered by an international mediation organisation and supported by the European Union (EU). Despite some opposition within Jakarta, the talks were ultimately successful, producing an agreement that addressed many of the fundamental concerns of the Acehnese, especially around economic redistribution and local political representation. The EU agreed to monitor the agreement by sending a 200 strong Aceh Monitoring Mission (AAM), supported by monitors from ASEAN states. The main purpose of the AMM was to oversee the decommissioning of GAM weapons and the withdrawal of most Indonesian troops and police. It was thereafter expected to retain a smaller presence in order to monitor the implementation of other aspects of the agreement. The Aceh peace agreement faced a number of hurdles, including whether or not the Indonesian military would work to undermine the peace agreement, and over the continuing presence in Aceh of the military’s proxy militias. There were also concerns that the legislation required to secure aspects of the peace agreement might not be passed by the Indonesian legislature or would be diluted to the point that they would no longer be acceptable to GAM. However, as a politically negotiated agreement to end the conflict, the peace agreement was seen as establishing the model for peace in the region, and was touted by some observers as providing the basis for a model for peace in other parts of Indonesia’s sometimes troubled archipelago.

Social innovators or lagging behind: factors that influence managers' time use

Purpose – The broad aim of this paper is to investigate whether managers in Australia allocate their time differently than other occupational groups, and the impact gender and life situation (using marital status and presence or absence of dependent children as a proxy) has on time allocation.
Design/methodology/approach – To address these broad aims, data are drawn from the 1997 Australian Time Use Survey. This is a nationally representative survey that examines how people in different circumstances allocate time to different activities. Findings – The results of this study highlight three important issues. The first is that male and female managers display different patterns of time use. Male managers' time is dominated by paid employment activities, whereas female managers' time is spent predominantly on employment and domestic activities. The second is that life situation impacts on the time use of female managers, but not male managers. The third important find of this study is that managers' time use is different to other occupational groups. Practical implications – These findings have policy implications relating to work-life balance, career progression and changes in patterns of work. In terms of work-life issues, it reveals that male and female managers face a “time squeeze”, with some evidence of a “second-shift” for female managers. In addition, the findings provide insight into the work-life issues faced by male and female managers. Originality/value – The results of this inquiry provide insight into how different individuals spend their time – insight into “lifestyles”. However, in-depth qualitative studies are required to reveal why individuals allocate their time in this way and to understand the opportunities and constraints individuals face in time allocation.