Open Access. Powered by Scholars. Published by Universities.®
- Keyword
-
- Public health services and systems research (115)
- Practice-Based Research Networks (101)
- Public health economics (91)
- Health Services Research (43)
- Book Reviews (19)
-
- Practice-based research networks (13)
- Psychology and Psychiatry (10)
- Health Law and Policy (9)
- Human Rights Law (9)
- Juveniles (8)
- Health Economics (7)
- Leadership (7)
- Public health (7)
- Social cognition (7)
- Decision making (6)
- Domestic Relations (6)
- Health (6)
- Law and Society (6)
- Mental Health (6)
- Popular Press (6)
- Adolescents (5)
- Books (5)
- Children (5)
- Health Policy (5)
- Intercountry Adoption (5)
- International Law (5)
- Pakistan (5)
- Psychiatry (5)
- Wellness (5)
- Women (5)
- Publication Year
- Publication
-
- Glen Mays (132)
- Tazeen S Ali Dr (30)
- William C. McPeck (24)
- Confluence Journal Environmental Studies (CJES), Kogi State University, Nigeria (14)
- Dr. Stephanie Rossit (13)
-
- Joseph Lucke (12)
- Lynn Shaw (10)
- Seth M. Holmes PhD, MD (9)
- Leah C. Neubauer (8)
- Emmanuel Mario B Santos aka Marc Guerrero (7)
- Lisa A Forrest (7)
- Maxine G Schmidt (7)
- Neil Greenberg (7)
- Reid G. Fontaine (7)
- David San Filippo Ph.D. (6)
- Kimberly D. Acquaviva, PhD, MSW (6)
- Ardis Hanson (5)
- David M. Smolin (5)
- Elián P. Cabrera-Nguyen (5)
- Raymond Quirolgico (5)
- Joyce K Kutin RN, MSN, MOL (4)
- Kip Klingman (4)
- Michael S. Givel (4)
- Tomi Gomory (4)
- Yuhui Zheng (4)
- Brooks B. Gump (3)
- Francisco Soto Mas (3)
- Marc Jones (3)
- Michael J Roy (3)
- Richard N Bradley (3)
- File Type
Articles 421 - 450 of 457
Full-Text Articles in Medicine and Health Sciences
Book Review 1 The New Science Of Selling And Persuasion: How Smart Companies And Great Salespeople Sell By William T. Brooks, William C. Mcpeck
Book Review 1 The New Science Of Selling And Persuasion: How Smart Companies And Great Salespeople Sell By William T. Brooks, William C. Mcpeck
William C. McPeck
This is my personal review of The New Science of Selling and Persuasion: How Smart Companies and Great Salespeople Sell by William T. Brooks and published by Wiley in 2004.
Life Goes On: Living With Hiv And Aids In Singapore, Francis Khek Gee Lim
Life Goes On: Living With Hiv And Aids In Singapore, Francis Khek Gee Lim
Francis Khek Gee Lim
No abstract provided.
Empowering Seniors To Promote Health And Safety In The Home., A. Sorcinelli, K. Cooper, Lynn Shaw Dr.
Empowering Seniors To Promote Health And Safety In The Home., A. Sorcinelli, K. Cooper, Lynn Shaw Dr.
Lynn Shaw
No abstract provided.
Between The Black And Red Light, Savad Rahman
Between The Black And Red Light, Savad Rahman
savad rahman
Between the Black & the Red Light http://www.boloji.com/society/074.htm Original in Malayalam: Chillumedayilirunn Kalleriyoo by Savad Rahman Translated in English by Sony V. Mathew
Mumbai is truly one of a kind. You might have been residing here for a decade or more but still you can�t be absolutely certain of your way. Andheri, Dadar, Navi Mumbai� the longer you travel the more you get confused. Such is the traffic and human convergence associated with this great city that, it could take hours to move from one point to another. But Kamathipura has always been an exception, in more ways than one. …
Peer Rejection And Social Information-Processing Factors In The Development Of Aggressive Behavior Problems In Children, Reid G. Fontaine, Kenneth A. Dodge, Jennifer E. Lansford, Virginia Salzer Burks, John E. Bates, Gregory S. Pettit, Joseph M. Price
Peer Rejection And Social Information-Processing Factors In The Development Of Aggressive Behavior Problems In Children, Reid G. Fontaine, Kenneth A. Dodge, Jennifer E. Lansford, Virginia Salzer Burks, John E. Bates, Gregory S. Pettit, Joseph M. Price
Reid G. Fontaine
The relation between social rejection and growth in antisocial behavior was investigated. In Study 1,259 boys and girls (34% African American) were followed from Grades 1 to 3 (ages 6-8 years) to Grades 5 to 7 (ages 10-12 years). Early peer rejection predicted growth in aggression. In Study 2,585 boys and girls (16% African American) were followed from kindergarten to Grade 3 (ages 5-8 years), and findings were replicated. Furthermore, early aggression moderated the effect of rejection, such that rejection exacerbated antisocial development only among children initially disposed toward aggression. In Study 3, social information-processing patterns measured in Study 1 …
Practical Skills For Family Caregivers, Mary A. Corcoran
Practical Skills For Family Caregivers, Mary A. Corcoran
Mary A Corcoran
No abstract provided.
Controlling Emotions In Sport, Marc Jones
Controlling Emotions In Sport, Marc Jones
Marc Jones
Emotions play a central role in sport performance. Accordingly, it is important that athletes are able to draw on a range of strategies to enhance emotional control. The present paper outlines a number of strategies based on Lazarus’ cognitive-motivational-relational theory of emotion. Strategies are outlined that aim to change cognitions, resulting in either a more appropriate emotional response or a suppression of the expression of emotion and any maladaptive behavioral consequences. These techniques comprise self-statement modification, imagery, socratic dialogue, corrective experiences, self-analysis, didactic approach, storytelling metaphors and poetry, reframing, cognitive paradox, and use of problem-solving skills. Furthermore, given the changes …
The Press For Help Project Concept, Program And Working Paper Of Emmanuel Mario B Santos And His Marc Guerrero Communications Inc., Emmanuel Mario B. Santos Aka Marc Guerrero
The Press For Help Project Concept, Program And Working Paper Of Emmanuel Mario B Santos And His Marc Guerrero Communications Inc., Emmanuel Mario B. Santos Aka Marc Guerrero
Emmanuel Mario B Santos aka Marc Guerrero
FORETHOUGHT. DECLARATION OF IDEAOLOGY AND PRINCIPLES. VISION. MISSION. VALUES. GOALS. BASIC HELP project. EDUCATIONAL HELP project. MEDICAL HELP project. LEGAL HELP project. EMERGENCY HELP project. LIVELIHOOD HELP project. SPIRITUAL and CULTURAL HELP project. ENVIRONMENTAL HELP project. REENGINEERING HELP project. INTERNATIONAL HELP project. QUADRO CREDO Matthew 5.1-12, the Jerusalem Bible. The Universal Filipino Beatitudes. SALIN SA FILIPINO. DESIDERATA. AFTERTHOUGHT.
Language Plasticity Revealed By Electroencephalogram Mapping, Armando F. Rocha, Flávia B. Foz
Language Plasticity Revealed By Electroencephalogram Mapping, Armando F. Rocha, Flávia B. Foz
Armando F Rocha
Reasoning is the result of the computations made by intelligent systems, for instance those in the brain. It is not an abstract concept because calculations performed by computations are very concrete transactions among the different central processing unit components. Entropy measurements are proposed here to disclose the plasticity of the cerebral processing associated with language comprehension in video game playing. It is also assumed that entropy may be evaluated from the correlation coefficients obtained for the game event-related activity calculated for the different electroencephalogram derivations in the 10/20 system. The brain mapping derived from these entropy measurements clearly demonstrates the …
Response Decision Processes And Externalizing Behavior Problems In Adolescents, Reid Griffith Fontaine, Virginia Salzer Burks, Kenneth A. Dodge
Response Decision Processes And Externalizing Behavior Problems In Adolescents, Reid Griffith Fontaine, Virginia Salzer Burks, Kenneth A. Dodge
Reid G. Fontaine
Externalizing behavior problems of 124 adolescents were assessed across Grades 7–11. In Grade 9, participants were also assessed across social-cognitive domains after imagining themselves as the object of provocations portrayed in six videotaped vignettes. Participants responded to vignette-based questions representing multiple processes of the response decision step of social information processing. Phase 1 of our investigation supported a two-factor model of the response evaluation process of response decision (response valuation and outcome expectancy). Phase 2 showed significant relations between the set of these response decision processes, as well as response selection, measured in Grade 9 and (a) externalizing behavior in …
Strategies Used By Families To Simplify Tasks For Individuals With Alzheimer's Disease And Related Disorders: Psychometric Analysis Of The Task Management Strategy Index, Laura Gitlin, Lorraine Winter, Sandy Schinfeld, Marie Dennis, Mary A. Corcoran, Walter Hauck
Strategies Used By Families To Simplify Tasks For Individuals With Alzheimer's Disease And Related Disorders: Psychometric Analysis Of The Task Management Strategy Index, Laura Gitlin, Lorraine Winter, Sandy Schinfeld, Marie Dennis, Mary A. Corcoran, Walter Hauck
Mary A Corcoran
No abstract provided.
Ethological Aspects Of Stress In A Model Lizard, Anolis Carolinensis, Neil Greenberg
Ethological Aspects Of Stress In A Model Lizard, Anolis Carolinensis, Neil Greenberg
Neil Greenberg
Research on the stress response in reptiles can provide a useful comparative perspective for understanding how the constituent elements of the response can be put into service of diverse behavioral adaptations. A summary of the neural and endocrine causes and consequences of specific behavioral patterns seen in the small diurnal lizard, Anolis carolinensis, has provided a model for the exploration of the dynamics of autonomic and neurohormonal contributions to adaptive behavior. In this species, changes in body color provide indices of the flux of circulating stress relevant hormones, and are seen in situations from spontaneous exploration through agonistic behavior. Furthermore, …
Adaptive Functions Of The Corpus Striatum: The Past And Future Of The R-Complex, Neil Greenberg
Adaptive Functions Of The Corpus Striatum: The Past And Future Of The R-Complex, Neil Greenberg
Neil Greenberg
The basal ganglia is emerging from the shadow cast by the most conspicuous clinical expression of its dysfunction: motor disorders.What is revealed is the nexus of a widely distributed system which functions in integrating action with cognition, motivation, and affect. Prominent among non-motor functions are striatal involvement in building up of sequences of behavior into meaningful, goal-directed patterns and repertoires and the selection of appropriate learned or innate sequences in concert with their possible predictive control. Further, striatum seems involved in declarative and strategic memory (involving intentional recollection and the management of retrieved memories, respectively). Findings from reptile experiments indicate …
Mental Health Parity: National And State Perspectives 2001: A Report To The Florida Legislature, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe
Mental Health Parity: National And State Perspectives 2001: A Report To The Florida Legislature, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe
Ardis Hanson
The federal Mental Health Parity Act of 1996 requires insurers to offer the same benefits for mental disorders and substance abuse as they would for physical disorders, including any annual or lifetime limitations and restrictions placed upon such coverage. This report examines actuarial studies, the current state of parity legislation across the nation, cost of treatment issues, and the impact on Florida should parity legislation be passed.
Rights Of Inequality: Rawlsian Justice, Equal Opportunity, And The Status Of The Family, Justin Schwartz
Rights Of Inequality: Rawlsian Justice, Equal Opportunity, And The Status Of The Family, Justin Schwartz
Justin Schwartz
Is the family subject to principles of justice? In A Theory of Justice, John Rawls includes the (monogamous) family along with the market and the government as among the "basic institutions of society" to which principles of justice apply. Justice, he famously insists, is primary in politics as truth is in science: the only excuse for tolerating injustice is that no lesser injustice is possible. The point of the present paper is that Rawls doesn't actually mean this. When it comes to the family, and in particular its impact on fair equal opportunity (the first part of the the Difference …
Benchmarking Patient Outcomes, Ellen B. Rudy, Joseph F. Lucke, Gayle R. Whitman, Lynda J. Davidson
Benchmarking Patient Outcomes, Ellen B. Rudy, Joseph F. Lucke, Gayle R. Whitman, Lynda J. Davidson
Joseph Lucke
Purpose: To examine the usefulness of three types of benchmarking for interpreting patient outcome data.
Design: This study was part of a multiyear, multihospital longitudinal survey of 10 patient outcomes. The patient outcome used for this methodologic presentation was central line infections (CLI). The sample included eight hospitals in an integrated healthcare system, with a range in size from 144 to 861 beds. The unit of analysis for CLI was the number of line days, with the CLI rate defined as the number of infections per 1,000 patient-line days per month.
Methods: Data on each outcome were collected at the …
Social Work Practice In The Real World: An Argument For Evidence Tested Practice, Tomi Gomory
Social Work Practice In The Real World: An Argument For Evidence Tested Practice, Tomi Gomory
Tomi Gomory
This chapter explores the relevance of practice guidelines for the advancement of clinical social work by attempting to explicate the current epistemology of empirical social work practice, Justificationism, and contrasting it with an alternate epistemology, Fallibilism (Karl Popper’s Critical Rationalism). The chapter asserts the superiority of fallibilism for the advancement of knowledge and recommends its implementation. It is further argued that whether or not clinical practice guidelines are essential to practice depends on whether guidelines can be more explanatory (helpful) than some other alternative such as Falibilitic Critical Thinking (Fa.C.T.) when critically assessed against it. Examples and arguments are offered …
Mental Health Parity: National And State Perspectives 2000: A Report To The Florida Legislature, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe, Sara A. Kuppin
Mental Health Parity: National And State Perspectives 2000: A Report To The Florida Legislature, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe, Sara A. Kuppin
Ardis Hanson
By failing to appropriately treat adults and children with severe mental illness, we incur enormous social costs through payments for disability benefits (Medicaid, SSI, SSDI), increased medical expenses, accidents and suicides, avoidable criminal justice proceedings, lost productivity, and increased need for homeless shelters and services. People who are underinsured are forced by arbitrary caps and limits to increasingly rely on the public sector. By providing parity for mental health, Florida will bring mental health into the mainstream of health care and become a leader in dispelling the prejudice that surrounds treatment of persons with severe mental illness.
Mental Health Parity: National And State Perspectives 1999, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe
Mental Health Parity: National And State Perspectives 1999, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe
Ardis Hanson
Mental health parity legislation could substantially reduce the degree to which financial responsibility for the treatment of mental illness is shifted to government, especially state and local government. There is substantial evidence that both mental health and addictions treatment is effective in reducing the utilization and costs of medical services. There appears to be a lack of substantial evidence to discourage Florida from pursuing mental health and substance abuse parity legislation.
Social Work Assessment Of Adaptive Functioning Using The Vineland Adaptive Behavior Scales: Issues Of Reliability And Validity, Peter Cabrera, Lucienne Grimes-Gaa, Bruce A. Thyer
Social Work Assessment Of Adaptive Functioning Using The Vineland Adaptive Behavior Scales: Issues Of Reliability And Validity, Peter Cabrera, Lucienne Grimes-Gaa, Bruce A. Thyer
Elián P. Cabrera-Nguyen
The assessment of client adaptive functioning is often an important component of a comprehensive social work evaluation. The Vineland Adaptive Behavior Scales (VABS) are the most commonly used quantitative measures of adaptive functioning for clients meeting the criteria for a wide range of disorders. We review the development of the VABS and current knowledge pertaining to the instrument's reliability and validity. We conclude that the ability to administer and interpret the VABS is an important skill for clinical social workers to acquire.
Programs Of Assertive Community Treatment (Pact): A Critical Review, Tomi Gomory
Programs Of Assertive Community Treatment (Pact): A Critical Review, Tomi Gomory
Tomi Gomory
Advocates of Programs of Assertive Community Treatment (PACT) make numerous claims for this intensive intervention program, including reduced hospitalization, overall cost, and clinical symptomatology, and increased client satisfaction, and vocational and social functioning. However, a reanalysis of the controlled experimental research finds no empirical support for any of these claims. Instead, there is evidence that the program is both coercive and potentially harmful. The current promotion of PACT appears to be based more on professional enthusiasm for the medical model than upon any benefit to the clients.
Mental Health Parity: 1998 National And State Perspectives, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe, Ann C. Taylor
Mental Health Parity: 1998 National And State Perspectives, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe, Ann C. Taylor
Ardis Hanson
The federal Mental Health Parity Act of 1996 requires insurers to offer the same benefits for mental disorders and substance abuse as they would for physical disorders, including any annual or lifetime limitations and restrictions placed upon such coverage. To date, twenty states across the nation have enacted parity laws for mental health and/or substance abuse benefits. This report summarizes the essential issues facing the state of Florida in the development of state mental health parity legislation, including an examination of the experiences of other states, a look at potential benefits, and a discussion of the impact of managed care …
Coercion Justified?-Evaluating The Training In Community Living Model (The Original Assertive Community Treatment Model) A Dissertation, Tomi Gomory
Tomi Gomory
This dissertation examines the research and theory offered for Programs of Assertive Community Treatment, the model that is supported by Institutional Psychiatry as the most well validated and best model of intervention applicable to the psychiatric population labeled the Severely and Persistently Mentally Ill. Although this program has been researched for over 25 yrs. and the extensive literature on this model claims to have established it’s efficacy on both the systems and patient level, the findings of my critical review dispute these claims based on the examination of the empirical evidence of all available randomized controlled trials of this intervention …
Intracellular Coexpression Of Epidermal Growth Factor Receptor, Her-2/Neu, And P21ras In Human Breast Cancers: Evidence For The Existence Of Distinctive Patterns Of Genetic Evolution That Are Common To Tumors From Different Patients, Stanley E. Shackney, Agnese A. Pollice, Charles A. Smith, Laura E. Janocko, Lillian Sweeney, Kathryn A. Brown, Sarita G. Singh, Lingping Gu, Robert Yakulis, Joseph F. Lucke
Intracellular Coexpression Of Epidermal Growth Factor Receptor, Her-2/Neu, And P21ras In Human Breast Cancers: Evidence For The Existence Of Distinctive Patterns Of Genetic Evolution That Are Common To Tumors From Different Patients, Stanley E. Shackney, Agnese A. Pollice, Charles A. Smith, Laura E. Janocko, Lillian Sweeney, Kathryn A. Brown, Sarita G. Singh, Lingping Gu, Robert Yakulis, Joseph F. Lucke
Joseph Lucke
Multiparameter flow cytometry studies were performed on cells from the primary tumors of 94 patients with breast cancer. Correlated cellular measurements of cell DNA content, Her-2/neu, epidermal growth factor receptor (EGFR), and p21ras levels were performed on each of 5,000 to 100,000 cells from each tumor. When criteria for positivity were matched with those in common use for immunohistochemical studies, 28 of 94 (30\%) breast cancers were classified as positive for Her-2/neu overexpression. When similar criteria were applied to the EGFR measurements, 23 of 94 (24\%) cases were classified as positive for EGFR overexpression. Similarly, 23 of 94 (24\%) cases …
Neuroendocrine Aspects Of Primary Endogenous Depression Xv. Mathematical Modeling Of Nocturnal Melatonin Secretion In Major Depressives And Normal Controls, L. Kathleen Sekula, Joseph F. Lucke, E. Kevin Heist, R. Kenneth Czambel, Robert T. Rubin
Neuroendocrine Aspects Of Primary Endogenous Depression Xv. Mathematical Modeling Of Nocturnal Melatonin Secretion In Major Depressives And Normal Controls, L. Kathleen Sekula, Joseph F. Lucke, E. Kevin Heist, R. Kenneth Czambel, Robert T. Rubin
Joseph Lucke
We previously reported a trend toward a higher mean nocturnal serum melatonin (MEL) concentration, based on 30-min blood sampling over 24 h, in 23 female definite endogenous depressives compared to 23 matched normal female control subjects, and no significant difference in 15 male depressives compared to their controls (Rubin et al., 1992). In both groups of patients vs. their controls, there also were trends toward an earlier MEL rise time, by about 30 min, and a later MEL peak time, by about 90 min. Because the offset of MEL secretion was not estimated in that study, the total duration of …
Student's T-Test And The Glasgow Coma Scale, Joseph Lucke
Student's T-Test And The Glasgow Coma Scale, Joseph Lucke
Joseph Lucke
Study Objective: To explore how Student's t test, which assumes normal errors, is affected by the nonnormal distribution of Glasgow Coma Scale (GCS) scores.
Methods: A sample of 145,295 GCS scores from the Pennsylvania Trauma Systems Foundation was assumed to represent the true GCS distribution. Four Monte Carlo simulations, each based on 40,000 replications, were conducted to approximate the distribution of t values arising from samples drawn from the GCS distribution, using sample sizes of 10, 30, 60, and 100 per group.
Results: The histograms of t values derived from the GCS distribution resembled the corresponding Student t distributions for …
Seizure Threshold In Electroconvulsive Therapy: I. Initial Seizure Threshold, C. Edward Coffey, Joseph Lucke, Richard D. Weiner, Andrew D. Krystal, Michael Aque
Seizure Threshold In Electroconvulsive Therapy: I. Initial Seizure Threshold, C. Edward Coffey, Joseph Lucke, Richard D. Weiner, Andrew D. Krystal, Michael Aque
Joseph Lucke
We measured initial seizure threshold by means of a structured stimulus dosage titration procedure in a clinical sample of 111 depressed patients undergoing brief-pulse, constantcurrent electroconvulsive therapy (ECT). Initial seizure threshold was approximately 60 millicoumbs (mc) (10 Joules) on average, but varied widely (6-fold) across patients. Initial seizure threshold was predicted by four variables: electrode placement (higher with bilateral), gender (higher in men), age (higher with increasing age), and dynamic impedance (inverse relationship). Use of neuroleptic medication was associated with a lower seizure threshold. EEG seizure duration was inversely related to initial seizure threshold, but no other relations with seizure …
Seizure Threshold In Electroconvulsive Therapy (Ect): Ii. The Anticonvulsant Effect Of Ect, C. Edward Coffey, Joseph Lucke, Richard D. Weiner, Andrew D. Krystal, Michael Aque
Seizure Threshold In Electroconvulsive Therapy (Ect): Ii. The Anticonvulsant Effect Of Ect, C. Edward Coffey, Joseph Lucke, Richard D. Weiner, Andrew D. Krystal, Michael Aque
Joseph Lucke
To measure the anticonvulsant effects of a course of electroconvulsive therapy (ECT), we used a flexible stimulus dosage titration procedure to estimate seizure threshold at the first and sixth ECT treatments in 62 patients with depression who were undergoing a course of brief pulse, constant current ECT given at moderately suprathreshold stimulus intensity. Seizure threshold increased by approximately 47% on average, but only 35 (56%) of the 62 patients showed a rise in seizure threshold. The rise in seizure threshold was associated with increasing age, but not with gender, stimulus electrode placement, or initial seizure threshold. Dynamic impedance decreased by …
Assessing Sequential Oncogene Amplification In Human Breast Cancer, Laura E. Janocko, Joseph F. Lucke, David W. Groft, Kathryn A. Brown, Charles A. Smith, Agnese A. Pollice, Sarita G. Singh, Robert Yakulis, Robert J. Hartsock, Stanley E. Shackney
Assessing Sequential Oncogene Amplification In Human Breast Cancer, Laura E. Janocko, Joseph F. Lucke, David W. Groft, Kathryn A. Brown, Charles A. Smith, Agnese A. Pollice, Sarita G. Singh, Robert Yakulis, Robert J. Hartsock, Stanley E. Shackney
Joseph Lucke
Studies of amplification and/or overexpression of c-myc, HER-2/neu, and H-ras in breast cancer have shown that each is associated with a poor prognosis. The purpose of this study was to explore the possibility that there is a preferred sequence of amplification of these oncogenes in breast cancer. The frequencies of amplification and patterns of co-amplification of c-myc, HER-2/neu, and H-ras were studied in a group of 84 breast cancers. The data suggested a preferred sequence of amplification that consisted of c-myc amplification-HER-2/neu amplification-H-ras amplification. This model was supported by loglinear analysis. In addition, the levels of amplification of JC-A, a …
Testing The Null Hypothesis In Small Area Analysis, Kevin Cain, Paula Diehr
Testing The Null Hypothesis In Small Area Analysis, Kevin Cain, Paula Diehr
Paula Diehr
The goal of small area analysis is often to demonstrate that hospital admission rates or procedure rates vary greatly among regions, suggesting the occurrence of unnecessary admissions or procedures in some regions. Recent articles have shown that such variation may be largely due to chance, even if no underlying differences exist among the small areas; thus, it is important to test if the observed variation is larger than expected by chance. In this article we discuss how the appropriate method for testing the null hypothesis depends on the distribution of the number of admissions at the person level. If it …