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Notes: Managers constantly struggle with where to allocate their resources and efforts in managing the complex service delivery system called a hospital. In the broadest sense, their decisions and actions focus on two important aspects of health care—clinical or technical medical care that emphasizes “what” the patient receives and process performance that emphasizes “how” health care services are delivered to patients. Here, we investigate the role of leadership, clinical quality, and process quality on patient satisfaction. A causal model is hypothesized and evaluated using structural equation modeling for a sample of 202 U.S. hospitals. Statistical results support the idea that leadership is a good exogenous construct and that clinical and process quality are good intermediate outcomes in determining patient satisfaction. Statistical results also suggest that hospital leadership has more influence on process quality than on clinical quality, which is predominantly the doctors' domain. Other results are discussed, such as that hospital managers must be mindful of the fact that process quality is at least as important as clinical quality in predicting patient satisfaction. The article concludes by proposing areas for future research.

Notes: summary  The literature has documented a controversial discussion on the possible relationship of otogenous symptoms and craniomandibular dysfunction since the 1920s. Therefore, an investigation was conducted which consisted of two parts: a case study with population-based controls and a cross-sectional study. The aim of the first study was to screen a group of patients suffering from acute or chronic tinnitus for temporomandibular disorders (TMD) in comparison with a population-based group of volunteers without tinnitus. To this end, 30 patients (13 females and 17 males, age 18–71 years) suffering from acute hearing loss associated with tinnitus, isolated acute tinnitus, and chronically transient tinnitus were examined for symptoms of craniomandibular dysfunction. The results were compared with those of clinical functional analysis from 1907 subjects selected representatively and according to age distribution from the epidemiological ‘Study of Health in Pomerania’ (SHIP); the occurrence of tinnitus was ruled out in these control subjects. Statistical analysis was performed with Chi-square and Mann–Whitney U-tests. Sixty per cent of the tinnitus patients and 36·5% of the control subjects exhibited more than two symptoms of TMD (P = 0·004). Tinnitus patients had significantly more muscle palpation pain (P 〈 0·001), temporomandibular joint (TMJ) palpation pain (P 〈 0·001), and pain upon mouth opening (P 〈 0·001) than the general population group. No statistical differences were found in TMJ sounds, limitation of mandibular movement, or hypermobility of the TMJ. Furthermore, 4228 subjects of the population group examined in the epidemiological study were screened for co-factors of tinnitus with the help of a multivariate logistic regression model which was adjusted for gender, age, and a variety of anamnestic and examined data. Increased odds ratios (OR) were found for tenderness of the masticatory muscles (OR = 1·6 for one to three painful muscles and OR = 2·53 for four or more painful muscles), TMJ tenderness to dorsal cranial compression (OR = 2·99), listlessness (OR = 2·0) and frequent headache (OR = 1·84) A relationship between tinnitus and TMD was established in both examinations. Tinnitus patients seem to suffer especially from myofascial and TMJ pain. A screening for TMD should be included in the diagnostic survey for tinnitus patients.

Notes: Background  Baseline staging in patients with primary cutaneous malignant melanoma (MM) is routine, but the diagnostic accuracy and the impact on clinical outcome are still unclear.Objectives  To evaluate the sensitivity and specificity of baseline staging in the early detection of regional lymph node metastases or distant metastases in patients with MM.Methods  One hundred consecutive patients with MM of Breslow's tumour thickness over 1·0 mm were enrolled. All patients had an extensive baseline staging including physical examination, ultrasound (US) of the abdomen and regional lymph nodes, chest X-ray, whole-body positron emission tomography (PET) and sentinel lymph node biopsy. The sensitivity and specificity of detection of macroscopic or microscopic metastases in the regional lymph nodes or at distant sites were calculated for each method.Results  Sentinel lymph node biopsy was positive in 26 patients. US detected two of 26 histologically tumour-positive sentinel nodes (sensitivity 8%, specificity 88%) and PET two of 26 (sensitivity 8%; specificity 100%). There were three lymph node metastases with a diameter 〉 4 mm. All of them were found suspect at physical examination. Two of them were detectable with US, two with PET, and all were identified with either US or PET. Nine patients had suspect findings at distant sites, which were all false positive on further investigation (specificity of the combined staging procedures 91%). At 18 (6–37) months' follow-up, five of 26 (19%) patients with a positive sentinel node and four of 74 (5%) of patients with a negative sentinel node had recurrent or progressive disease.Conclusions  The combination of physical examination and lymph node US detects the great majority of patients with macroscopic lymph node metastasis (approximately 3% of patients at baseline). Only 10% of patients who have a histologically tumour-positive sentinel node are macroscopically detectable. Altogether, approximately 25% of patients have a positive sentinel node biopsy, among 90% microscopic. The value of whole body staging at baseline remains limited, since distant metastases can hardly ever be detected. The survival benefit of baseline staging and surveillance in patients with cutaneous MM remains to be established by comparative prospective trials.

Notes: To cope with iron deficiency fluorescent pseu-domonads produce pyoverdines which are complex peptidic siderophores that very efficiently scavenge iron. In addition to pyoverdine some species also produce other siderophores. Recently, it was shown that Pseudomonas fluorescens ATCC 17400 pro-duces the siderophore quinolobactin, an 8-hydroxy-4-methoxy-2-quinoline carboxylic acid (Mossialos, D., Meyer, J.M., Budzikiewicz, H., Wolff, U., Koedam, N., Baysse, C., Anjaiah, V., and Cornelis, P. (2000) Appl Environ Microbiol 66: 487–492). The entire quinolobactin biosynthetic, transport and uptake gene cluster, consisting out of two operons comprising 12 open reading frames, was cloned and sequenced. Based on the genes present and physiological complementation assays a biosynthetic pathway for quinolobactin is proposed. Surprisingly, this pathway turned out to combine genes derived from the eukaryotic tryptophan-xanthurenic acid branch of the kynurenine pathway and from the pathway for the biosynthesis of pyridine-2,6-bis(thiocarboxylic acid) from P. stutzeri, PDTC. These results clearly show the involvement of the tryptophan-kynurenine-xanthurenic acid pathway in the synthesis of an authentic quinoline siderophore.

Notes: Taking as a point of departure Fernandez's survey (1978), this review seeks to show how research on African Independent Churches (AICs) has been reconfigured by new approaches to the anthropology of Christianity in Africa, in general, and the recent salient popularity of Pentecostal-Charismatic Churches (PCCs) in particular. If the adjectives "African" and "Independent" were once employed as markers of authentic, indigenous interpretations of Christianity, these terms proved to be increasingly problematic to capture the rise, spread, and phenomenal appeal of PCCs in Africa. Identifying three discursive framesChristianity and "traditional religion," Africa and "the wider world," religion and politicswhich organize(d) research on AICs and PCCs in the course of the past 25 years, this chapter critically reviews discussions about "Africanization," globalization and modernity, and the role of religion in the public sphere in postcolonial African societies.

Notes: I review the development of the political opportunity or political process perspective, which has animated a great deal of research on social movements. The essential insight-that the context in which a movement emerges influences its development and potential impact-provides a fruitful analytic orientation for addressing numerous questions about social movements. Reviewing the development of the literature, however, I note that conceptualizations of political opportunity vary greatly, and scholars disagree on basic theories of how political opportunities affect movements. The relatively small number of studies testing political opportunity hypotheses against other explanations have generated mixed results, owing in part to the articulation of the theory and the specifications of variables employed. I examine conflicting specifications of the theory by considering the range of outcomes scholars address. By disaggregating outcomes and actors, I argue, we can reconcile some of the apparent contradictions and build a more comprehensive and robust theory of opportunities and social movements.

Notes: There are two main sources of theoretical doubt regarding the validity of claims for reparation: the questions arising from the non-identity problem and those arising from the supersession thesis. Neither of them significantly undermines the Palestinian refugees' claims to reparations and a right of return.

Notes: Summary.  A unique commercial lead weight from the western Black Sea region is examined in its metrological and historical context. The style and combination of relief symbols on the object (Athenian owl and Kyzikene tunny) suggest a quarter mina in a market weight system used equivalently at Athens and Kyzikos by the last quarter of the fifth century BC, and developed within a long-term process of broad commercial integration of the Aegean and Black Seas in Classical times. The authors consider such a process to have been caused by the economic motivations of individual city-states, not the direct Athenian imperialism expressed in the so-called Standards Decree.

Notes: Alpha-designs have become popular in cultivar trials. Analysis is based on a mixed model. As a result of imbalance, inference tests require approximate methods. This paper investigates the Type I error control of different Satterthwaite approximations for the denominator degrees of freedom of Wald-type F-tests and t-tests in a two-factorial alpha-design with cultivars as the subplot factor and management intensities (fertilization, plant protection) as the main plot factor. Simulation results demonstrate good error control for cultivar comparison at the same intensity, with the need for an approximation which diminishes as the number of cultivars increases. By contrast, a comparison of intensities entails a more substantial departure from the nominal significance level, and this is not entirely offset by any of the approximations. The methods are demonstrated using two real data sets.