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Background Teams are essential to a wide array of applications and organizations often utilize varying interventions to improve the effectiveness of their teams. Due to their collaborative and modifiable characteristics, escape rooms are being increasingly utilized as an avenue to both deliver team interventions and to function as testbeds in research. Escape rooms are complex, interdependent activities which warrant careful planning to be effectively implemented. Despite the growing literature base concerning escape rooms, there is still limited practical guidance to inform the development of an escape room. Aim The purpose of this article is to provide seven considerations that are relevant to the development, implementation, and effectiveness of an escape room. Specifically, guidance is provided in determining the objectives, identifying a theme, assigning the roles, establishing participant interdependence, selecting a venue, designing the puzzles, and creating the assessments. Conclusion The considerations provided in this article can advance the science underlying the use of escape rooms and preclude difficulties associated with their use.

Background Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team-based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data.

Although the detrimental effects of the opioid epidemic on individuals’ health and well-being have been well documented, we know little about how it has affected the family contexts in which children live. We assess how the opioid epidemic, as measured by a rise in the opioid overdose death rate, has affected the rates at which children live in different family arrangements: two married parents, two cohabiting parents, single mother, single father, or another configuration. Our local fixed-effects models show that higher local overdose death rates are associated with fewer children living with two married parents and with an increase in children living in family structures that tend to be less stable, such as those led by cohabiting parents or a single parent. These changes in family arrangements have potential long-term implications for the well-being of future generations.

Today’s workforce is dependent on teams. Organizations are interested in positively influencing antecedents to team effectiveness such as team composition. While many factors have been studied thoroughly concerning team composition and effectiveness, team roles have not received comparable attention. Team roles refer to groups of generalizable, goal-directed behaviors that support team performance. Current team role assessments are reliant on surveys and peer ratings. To explore avenues that would enable comparisons between survey-based measures of team roles with benchmarks of observable behavior, we developed a behavior observation tool based on a team role taxonomy known as Team Role Experience and Orientation (TREO). We present the first iteration of this tool based on our review of team role literature, results of an inter-rater reliability assessment, and discuss its potential impact concerning future research and organizational utility. More work is needed to develop a construct-valid behavioral team role assessment.

We developed an in-situ interprofessional simulation program to study system factors to establish a congenital cardiac arrest activation tree and test it using human factors engineering principles. We used the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model to understand the structure, processes, and outcomes related to the congenital cardiac arrest activation tree (CCCAT) and discuss the Promoting Excellence and Reflective Learning in Simulation (PEARLS) for systems integration framework for our systems focused debriefing (SFD).

Objective An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post-escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results Sixty-two teams participated (n = 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) = 24.10, p 2 = .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums.

Objective: To evaluate feasibility and acceptability of a neuropsychologically-based vocational intervention with increased follow-up support for women with multiple sclerosis. Design: Single-blinded parallel-group randomized controlled trial with 12-month follow-up. Setting: Tertiary-care multiple sclerosis center. Participants: Forty-nine employed women with multiple sclerosis meeting criteria on measures of cognitive dysfunction (Symbol Digit Modalities Test), fatigue (Fatigue Severity Scale), and/or depression (Beck Depression Inventory/Patient Health Questionnaire). Interventions: Participants received either neuropsychological testing and phone feedback regarding findings and tailored recommendations (standard-care treatment), or testing, in-person feedback, and two calls from a care-coordinator (experimental treatment). Measures: Feasibility measures included enrollment and attrition rates, and compliance to recommendations at 12-months between groups. Acceptability was evaluated by participants’ report of benefit from interventions. Secondary analyses included evaluation of symptom changes (cognition, fatigue, depression) from baseline to 12-months. Results: Of 49 women meeting screening measure thresholds, 44 were randomized to treatment groups (attrition: standard-care = 8, experimental = 6), and 30 completed the study (standard-care = 14, experimental = 16). Recommendation adherence rates did not significantly differ between standard-care and experimental groups (31% vs 49%). However, 16/16 experimental participants at least partially completed given recommendations as compared to 8/14 in the standard-care group. Participants across groups (97%) reported benefit from participation. No significant differences in symptom outcomes between groups at 12-months. Conclusion: In-person feedback and care-coordinator calls were feasible and acceptable additions to a neuropsychological intervention and may serve to increase recommendation adherence. Given high drop-out rate, particularly prior to testing, future research may explore avenues to improve completion rates and maximize benefits of such interventions.

Background. Modern organizations are increasingly reliant on teams, and many organizations are subsequently concerned with the development of interventions that can improve the performance of teams. Escape rooms are beginning to receive attention as a potential avenue to facilitate team-based research. Escape rooms are team-based recreational activities that require a team of individuals to work together and think critically in order to solve a series of puzzles or challenges to escape a room.Purpose. This article provides considerations for researchers and organizations alike concerning the development of an escape room for team-based research, its methodological applications, and challenges associated with the use of escape rooms in research. Developmental considerations include issues such as an escape room’s location and size, financial considerations, theme development, other characteristics of the escape room, the development of puzzles and challenges, prototyping efforts, and the development of hints.Conclusion. Research considerations include the use of observational and survey methods in data collection, measurement of team processes and team performance, and how elements of an escape room influence teamwork and problem solving. Various challenges associated with the use of escape rooms in team-based research include considerations for dealing with cheating behavior, providing hints to participants, and resetting the room between experimental trials.

In the social upheaval arising from the coronavirus disease 2019 (COVID-19) pandemic, we do not yet know how union formation, particularly marriage, has been affected. Using administration records—marriage certificates and applications—gathered from settings representing a variety of COVID-19 experiences in the United States, the authors compare counts of recorded marriages in 2020 against those from the same period in 2019. There is a dramatic decrease in year-to-date cumulative marriages in 2020 compared with 2019 in each case. Similar patterns are observed for the Seattle metropolitan area when analyzing the cumulative number of marriage applications, a leading indicator of marriages in the near future. Year-to-date declines in marriage are unlikely to be due solely to closure of government agencies that administer marriage certification or reporting delays. Together, these findings suggest that marriage has declined during the COVID-19 outbreak and may continue to do so, at least in the short term.

In our response to Raskin, we caution that combining incompatible vocabularies usually results in a linguistic muddle from which it becomes increasingly difficult to escape. Although omnibus terms such as “psychosocial” and “biopsychosocial” sound reasonable, they function merely as slogans, without any clear meaning or explanatory power. We recommend tailoring a linguistically consistent system to meet our needs as psychologists. We also warn against the tendency for some to blur the distinction between client input and professional perspectives.

This commentary serves as a reply to Hoffart and Johnson’s article contending that psychodynamic psychotherapy (PDT) models cannot be examined with regard to mechanism of change or represent within-person causal relationships. Hoffart and Johnson cite purportedly paradigmatic examples of PDT and cognitive therapy and examine them with respect to Kazdin’s requirements for investigation of mechanisms of change. We highlight inaccuracies in Hoffart and Johnson’s representation of PDT and, in doing so, provide reasoning in support of the empirical examinability of PDT. We conclude by recommending a metatheoretical system (i.e., functionalism) and empirical methodologies that clinical scientists may consider when investigating mechanisms of PDT in the future.

This article describes Department of Defense (DoD) Systems Engineering Research Center (SERC) efforts leading to and supporting the DoD Digital Engineering (DE) initiative. Topics include the SERC’s initial collaboration with Naval Air Systems Command (NAVAIR) in 2013 as well as ongoing SERC DE research. The article also identifies future research needed to continue to develop the DE ecosystem for system of systems acquisition, which will require rapidly changing mission strategies to address ever-evolving threats.

Capturing the emotion of the March for Racial Justice

We examined the validity of the interpersonal exchange model of sexual satisfaction for sexual-minority women (SMW) with a range of sexual identities (lesbian, bisexual, queer, unlabeled, questioning). Participants, 898 (192 who were dating, 439 who were cohabitating) SMW in a romantic relationship of at least 3 months, completed an online survey that included the Interpersonal Exchange Model of Sexual Satisfaction Questionnaire. The results provide support for the validity of the model for SMW in that all the model components (relationship satisfaction, balance of sexual rewards and costs, balance of relative sexual rewards and costs, equality of rewards, equality of costs) were significantly associated with sexual satisfaction. All of the components, except equality of sexual costs, contributed uniquely to the prediction of sexual satisfaction. Neither relationship stage (dating vs. cohabiting) nor sexual identity (lesbian vs. other sexual-minority identity) moderated these associations. Women daters reported a significantly higher level of sexual rewards, sexual costs, and sexual satisfaction than did women cohabiters. The interpersonal exchange model may be used by clinicians as a framework for exploring experiences of low sexual satisfaction with a couple. The results also add to an emerging positive picture of the sexual relationships of SMW at both stages; this information can be used to counter negative stereotypes. Online supplemental files are available at http://journals.sagepub.com/doi/suppl/10.1177/0361684316679655 .

Medical care providers recognize nonadjustable examination tables in clinics as a barrier to comprehensively and safely providing routine healthcare for disabled, elderly and obese patients. The aim of this study was to understand how the availability of the adjustable examination table may affect the medical care provider’s perception of the quality of care provided to patients who need physical assistance. Fifty providers answered questionnaires to report their perceptions of two different examination tables’ usability. The first one is a mid-century industrial designed table and the other adjustable and ADA compliant, as used in a community health clinic. Before implementation of the new adjustable examination table, 34 medical care providers provided feedback on their experiences with nonadjustable examination tables. A second survey was administered approximately six months after implementation of the new adjustable examination tables to 16 medical care providers (with 2 indicating participation in the prior-to-implementation survey) for their feedback on experiences with the new adjustable examination tables. Providers reported significantly (p

A roboticist by the name of Rodney Brooks once said, “the benefits of having robots could vastly outweigh the problems.” While this may be true, it is important to assess these problems and understand how they may be mitigated. The use of robots is growing in many industries and can be found in areas such as manufacturing, healthcare, agriculture, food preparation and national defense. Within healthcare, robots are commonly used in surgery to perform procedures such as sacrocolpopexies, prostatectomies, hysterectomies, hernia repairs and nephrectomies. The benefits of robotic-assisted surgery (RAS) are similar to laparoscopy and include decreased blood loss, faster recovery time, and shorter lengths of stay at the hospital. Unlike purely laparoscopic surgery, the robot provides wrist dexterity, allowing for more complex surgeries to be performed in a minimally invasive fashion by surgeons who may not have expertise in laparoscopy. However, recent reports have heightened challenges facing RAS operating room (OR) teams. Effects of the OR layout, team communication, team coordination, disruptions to workflow, and equipment malfunctions were among the issues observed in a variety of RAS procedures. Issues such as disruptions to the workflow trigger delays and inefficiencies, which in turn could affect patient safety and quality of care. As part of a wider study to implement and evaluate multiple interventions associated with improving efficiency and safety of RAS, a literature search was conducted to investigate issues experienced by the OR team in RAS and the interventions developed and tested to resolve these issues. The literature search excluded studies concerned with laparoscopic and open surgery; proficiency training; and articles that were not written in English. Commentaries, editorials, and abstracts were further excluded. At the conclusion of the literature search, 17 articles involving the implementation or evaluation of interventions surrounding RAS were evaluated and categorized based on the issues that were addressed. Seven articles discussed disruptions to the OR team’s workflow; five articles discussed issues with patient safety, surgical complications, or risk assessment; three papers discussed issues with teamwork; and the remaining articles discussed issues with communication, efficiency, cognitive load, and surgical performance. Despite the number of articles that were found to discuss issues in RAS, only four of the 17 articles implemented interventions. The interventions primarily included the use of checklists and nontechnical skills training. The scarce number of articles focusing on interventions aimed at improving the safety, quality, and efficiency of RAS demonstrates the wide gap that exists between known problems and potential solutions. As the number of robotic-assisted procedures continue to grow, it is important to improve OR team efficiency and patient care. The current study is part of a five-year, four-site study investigating the nature of issues that exist in RAS. The larger study will also design and implement interventions based on RAS observations conducted by the researchers in an effort to ensure that the benefits of robotic surgery truly do outweigh the existing problems.

Striking levels of spatial organization exist among and within interphase cell chromosomes, raising the possibility that other nuclear molecular components may also be organized in ways that facilitate nuclear function. To further examine molecular distributions and organization within cell nuclei, we utilized Raman spectroscopy to map distributions of molecular components, with a focus on cellular lipids. Although the vast majority of cellular lipids are associated with membranes, mapping the 2870/2850 cm−1 lipid peak ratios revealed that the most highly ordered lipids within interphase cells are found within cell nuclei. This finding was seen in cells from multiple tissue types, noncancerous cells, and in cancer cell lines of different metastatic potential. These highly ordered lipids colocalize with nuclear chromatin, are present throughout the nuclear volume, and remain colocalized with chromatin through mitosis, when the nuclear envelope has dissociated. Phosphatidylinositol is a major component of the highly ordered lipids. The presence of phosphatidylinositol and other lipids in the nuclear interior is well established, but their highly ordered packing has not been reported and represents a unique finding. The molecular interactions involved in the formation and maintenance of these highly ordered lipids, and their potential effects on nuclear activities, remain to be discovered.

To help explain variation in Asian immigrant women’s employment, we examine the association between women’s employment and the presence and characteristics of adult extended household members for seven Asian immigrant groups: Chinese, Korean, Asian Indian, Pakistani, Filipina, Vietnamese, and Japanese. Using the American Community Survey 2009-2011 pooled data, we find that married, first-generation Asian immigrant women’s employment rates are higher when they live with parents or parents-in-law. Furthermore, hampered by housework and care work, these women apparently receive some support in particular from female extended adults providing child care assistance—especially in families with young children. On the other hand, we find a negative association between the presence of disabled adults and employment, but only for Koreans, and employed extended adults’ support varies across nationality groups. Variations in these dynamics across Asian groups suggest the need for further study.

This article addresses the argument that there is variation between races in the biological basis for social behavior. The article uses Nicholas Wade’s popular book, A Troublesome Inheritance, as the point of departure for a discussion of attendant issues, including the extent to which human races can be definitively demarcated biologically, the extent to which genetics is related to contemporary definitions of race, and the role of natural selection as a possible mechanism for change in modern societies. My critical review of the theory and evidence for an evolutionary view of racial determinism finds that genetics does not explain the relative status and well-being of today’s racially identified groups or their broader societies.

Purpose: To evaluate visibility, artifacts, and distortions of various commercial markers in magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound imaging used for radiotherapy planning and treatment guidance. Methods: We compare 2 solid gold markers, 4 gold coils, and 1 polymer marker from 3 vendors. Imaging modalities used were 3-T and 1.5-T GE MRIs, Siemens Sequoia 512 Ultrasound, Phillips Big Bore CT, Varian Trilogy linear accelerator (cone-beam CT [CBCT], on-board imager kilovoltage [OBI-kV], electronic portal imaging device megavoltage [EPID-MV]), and Medtronic O-ARM CBCT. Markers were imaged in a 30 × 30 × 10 cm3 custom bolus phantom. In one experiment, Surgilube was used around the markers to reduce air gaps. Images were saved in Digital Imaging and Communications in Medicine (DICOM) format and analyzed using an in-house software. Profiles across the markers were used for objective comparison of the markers’ signals. The visibility and artifacts/distortions produced by each marker were assessed qualitatively and quantitatively. Results: All markers are visible in CT, CBCT, OBI-kV, and ultrasound. Gold markers below 0.75 mm in diameter are not visible in EPID-MV images. The larger the markers, the more CT and CBCT image artifacts there are, yet the degree of the artifact depends on scan parameters and the scanner itself. Visibility of gold coils of 0.75 mm diameter or larger is comparable across all imaging modalities studied. The polymer marker causes minimal artifacts in CT and CBCT but has poor visibility in EPID-MV. Gold coils of 0.5 mm exhibit poor visibility in MRI and EPID-MV due to their small size. Gold markers are more visible in 3-T T1 gradient-recalled echo than in 1.5-T T1 fast spin-echo, depending on the scan sequence. In this study, all markers are clearly visible on ultrasound. Conclusion: All gold markers are visible in CT, CBCT, kV, and ultrasound; however, only the large diameter markers are visible in MV. When MR and EPID-MV imagers are used, the selection of fiducial markers is not straightforward. For hybrid kV/MV image-guided radiotherapy imaging, larger diameter markers are suggested. If using kV imaging alone, smaller sized markers may be used in smaller sized patients in order to reduce artifacts. Only larger diameter gold markers are visible across all imaging modalities.

This article examines why American consumption has boomed over the past three decades, even as wages have stagnated and debt has risen. Although many analysts characterize rising spending as a product of a “culture of consumerism,” these analyses suggest that much of this spending growth is on well-being-essential products, whose prices have been rising quickly. Nonessential consumption growth is primarily occurring at the top of the US income pyramid, while the strains of paying for basic essentials may push lower income households into greater debt. America's purported inability to restrain consumption spending may be attributable to policy-induced structural factors that make basic necessities expensive, and less a product of modern marketing, media, or some other cultural phenomenon.

Background: Fingolimod was the first oral disease-modifying treatment for relapsing–remitting multiple sclerosis. It has previously been associated with the development of lymphoma. Objective: To describe a case of lymphomatoid papulosis, a CD30+ cutaneous lymphoproliferative disorder, in a patient taking fingolimod. Methods: Case study. Results: Our patient developed lymphomatoid papulosis 2 months after starting fingolimod. Histology confirmed the diagnosis. The drug was withdrawn. Resolution began only 2 days later. Conclusions: Lymphomatoid papulosis is a benign subtype of cutaneous T-cell lymphoma, but up to 20% of cases can transform to a malignant course. Patients on fingolimod and physicians caring for them should be mindful of the need to monitor the skin.

We examine workplace-level sources of gender inequality to explore the link between organizational change and levels of workplace gender integration over time. To do so, we analyze the gender division of labor and key structural aspects of U.S. private-sector work establishments, using longitudinal data from the U.S. Equal Employment Opportunity Commission from 1975 to 2005. We find that women's presence in managerial positions is positively related to gender integration, as is both establishment size and growth. Additionally, the results show that trends toward gender integration are due to change within workplaces rather than new, relatively integrated workplaces entering the population overtime. Our results also provide compelling evidence that the effect of female managers varies dramatically across organizational contexts, with the strongest desegregating effects in larger and growing establishments. Finally, the effect of women's access to organizational power structures has sharply diminished overtime.

Trends toward gender equality largely stalled in the 1990s, but the progress of women in management was mixed. Given the importance of managers as actors in the reproduction of inequality, and managerial positions as rewards in their own right, this study investigates the relative status of women in management over the past two decades, using U.S. Decennial Census data from 1980 to 2000. The authors find that women’s entry into management occupations slowed markedly in the 1990s. Furthermore, after decreasing in the 1980s, gender segregation among managers rebounded sharply upward in the 1990s. However, greater segregation coincided with a decreasing gender earnings gap, which largely resulted from narrowing gaps within integrated or male‐dominated managerial occupations. Finally, there remains a substantial earnings penalty for managers who work in female‐dominated occupations.

Most previous research on gender inequality and management has been concerned with the question of access to managerial jobs and the “glass ceiling.” We offer the first largescale analysis that turns this question around, asking whether the gender characteristics of managers-specifically, the gender composition and relative status of female managers-affect inequality for the nonmanagerial workers beneath them. Results from three-level hierarchical linear models, estimated on a unique nested data set drawn from the 2000 Census, suggest that greater representation of women in management does narrow the gender wage gap. Model predictions show, however, that the presence of high-status female managers has a much larger impact on gender wage inequality. We conclude that the promotion of women into management positions may benefit all women, but only if female managers reach relatively high-status positions.

The expansion of market relations into new arenas, reflecting the bourgeois need to “nestle everywhere, settle everywhere, establish connections everywhere” (Marx and Engels 1998: 39), is not just geographic. Colonization begins at home, as seen in the progressive commodification of women’s previously unpaid labor. Thus, even as women slowly improved the gender division of housework (Bianchi et al. 2000), more and more unwaged labor was moving into low-wage jobs in the service economy (Duffy 2005). Women’s waged work is still gendered and segregated, tainted by a traditional and ongoing association with devalued characteristics such as caring (Cohen and Huffman 2003; Folbre 2001). Nevertheless, paid workers are more interchangeable than unpaid workers— just ask a male fast-food cook—and that could be good for gender inequality. These two books bring much needed attention to the problems of gender inequality in labor markets themselves, and also in other arenas in an era dominated by expanding market reach.

Although many researchers have documented higher levels of black-white inequality in areas with a high concentration of blacks, the mechanisms underlying this finding have been elusive. Black underrepresentation in management may be one such mechanism. We ask whether black workers' underrepresentation in managerial jobs is especially pronounced in labor markets with a larger black population. Using a unique, two-level data set that combines a large data set of private sector firms with Census data on local labor markets, the authors' hierarchical logistic models strongly support this hypothesis. Net of establishment and labor market-level controls, the likelihood that an establishment exhibits a significant underrepresentation of blacks in management is substantially increased when it operates in a high-proportion black labor market context.

Neoliberal discourse often produces the impression that the world has undergone a wholesale shift toward laissez-faire and that this shift has produced economic prosperity. This article examines national economic data to discern the degree to which (1) governments have in fact retreated from the market and (2) countries have enjoyed increasing economic prosperity over a period in which they have supposedly been liberalizing. The evidence is mixed on both counts. Although international capital mobility and trade liberalism appears to have grown over the past two decades, there is little evidence of a broad scaling back of governments. Over the same period, countries have not experienced any appreciable improvement in growth, cross-national equality, employment, or national debt loads, although there is some evidence of improved price stability near the end of the 1990s.

The periodontal pathogen Porphyromonas gingivalis (Pg) is a potent inducer of the production of pro-inflammatory cytokines by neutrophils, monocytes, and macrophages, and can desensitize immune cells in vitro and in vivo. We analyzed the ability of Pg lipopolysaccharide (LPS) to induce endotoxin tolerance. Treatment of dendritic cells (DC), the human macrophage cell line THP-1, and monocytes (antigen-presenting cells, APC) with Pg.LPS inhibited APC maturation assessed by CD80 and CD86 expression, and inhibited chemokine (CCL3 and CCL5) production. Pre-treatment with glucocorticoids (GC) and interleukin-10 (IL-10) abolished the effect of Pg.LPS on CD80, CD83, and CD86, and on CCL3 and CCL5 production. We also showed that Pg.LPS enhanced the tolerogenic properties of APCs and up-regulated ILT-3 and B7-H1 expression.

This article explores the effect of women’s movement into the labor market on the gender segregation of work, using the Current Population Survey from 1972 to 1993. The author includes as working those respondents who were “keeping house” and codes keeping house as an occupation. The results show higher estimates of gender segregation, and slightly steeper declines over time, than were seen in previous studies. Analysis of one-year longitudinal changes reveals less movement out of female-dominated occupations when keeping house is included as an occupation. Finally, a decomposition of the segregation trend shows that the movement of women away from keeping house contributed as much to the overall decline in gender segregation as did the desegregation of paid occupations. The author concludes that the movement of women’s work from the household to the labor market has been a driving force in the changing nature of gender inequality.

This paper presents a four-stage model of career decision-making based on an existential theoretical perspective. Existential themes such as freedom, responsibility, meaning, and authenticity are examined for their applicability to career decision-making across the life span. The author submits that career satisfaction and stability is obtained when there is a correspondence between the vocation and the meaning and opportunities for authentic existence that the vocation provides. Failure to acquire opportunities for meaning and authentic existence in individual's occupations result in an existential vacuum and existential guilt, respectively. Conceptualization of career decision-making from an existential perspective may be particularly beneficial for individuals making mid-career changes. Case studies are provided to elucidate the stages of the model and to specify the career counseling interventions that are most relevant for the various stages. Research implications as well as limitations of this model are also discussed.

This article estimates the marriage effect on men's earnings using an alternate definition of marital status in which cohabitation is added as an additional category and using data from the 1976-1999 Current Population Surveys. Results show that the downward trend in the “marriage premium” is not as steep when cohabitors are excluded from the never-married reference group. The findings suggest that men's benefits from marriage have not declined as sharply as has been thought and highlight the importance of the diversity of family forms in studies of inequality. Future research that considers marital status should take into account the growing population of cohabitors.

This article examines multigenerational living arrangements of white, black, and Latino individuals using data from the Current Population Surveys. We describe people in multigenerational households as “hosts” or “guests.” In terms of resources, guests have no home of their own, whereas hosts maintain an important source of independence. By age, the proportion of adults living as guests peaks in the late twenties, then declines until the late seventies. In contrast, hosting rates peak in the fifties. Men have higher guest rates and women have higher host rates at almost all ages. While blacks and Latinos are more likely than whites to live in multigenerational households, those with higher incomes are less likely to live in multigenerational households and if they are living in multigenerational households are less likely to be guests, regardless of race-ethnicity. We interpret this as consistent with the assumption that residential independence is generally preferred.

We retrospectively reviewed the outcomes of 40 patients who had undergone outpatient uvulopalatopharyngoplasty (UPPP) for the treatment of moderate to severe obstructive sleep apnea (OSA) in order to determine the safety of the procedure in an outpatient setting. Postoperatively, 36 of the 40 patients (90%) were discharged home the day of surgery without morbidity; 3 other patients stayed overnight for nonmedical reasons, and 1 patient who was already an inpatient remained hospitalized for unrelated medical issues. No postoperative complications occurred, and all patients reported a resolution of OSA symptoms and improvement in sleep. Based on a combination of our data and those of previous studies, we conclude that patients with significant OSA can safely undergo UPPP as an outpatient procedure. We recommend that guidelines regarding the perioperative care of patients with OSA be adjusted to include consideration of treatment in an outpatient setting.

Using data from the 1993 Consumer Expenditure Survey to examine housework-related service consumption, the author finds that spending on housekeeping services and meals out—which helps relieve women's housework burden—is affected by dynamics within marriages as well as by family class and race-ethnicity. Other things equal, families in which women have more relative power, as reflected in their income and occupational status, consume more housekeeping services and spend more of their food dollars on meals out, as do wealthier families and white families. Along with housework itself, which is well studied, these results suggest that housework service consumption is also an arena for gendered negotiation and conflict within families, and one way that gender relations vary by class and race-ethnicity.

Self-disclosure by clients is regarded as a fundamental component of counseling, with increased self-disclosure being related to positive outcome of treatment; however, scant attention has focused on environmental characteristics that may facilitate self-disclosure among clients. An evaluation of prior research in this area leads to suggestions for studies on environmental factors and self-disclosure.

Obesity is known to be a risk factor for the development of type 2 diabetes mellitus and the metabolic syndrome. Thus, it is important to understand the factors that modulate adipogenesis. Adipogenesis requires the nuclear hormone receptor (NHR) peroxisome proliferator-activated receptor gamma (PPARgamma). NHRs recruit coactivators (CoAs) in the presence of agonists to increase gene transcription; in addition, some NHRs also recruit nuclear receptor corepressors (CoRs) under certain circumstances. CoRs, such as the nuclear corepressor protein (NCoR) and the silencing mediator of retinoid and thyroid hormone receptors (SMRT), recruit a histone deacetylase complex to repress gene transcription. Using a RNA interference system to decrease SMRT and NCoR expression in 3T3-L1 cells, we have previously shown that CoRs repress adipogenesis and decrease the expression of adipocyte-specific proteins by modulating PPARgamma transcriptional activity. We have additionally shown that the intracellular balance of CoRs and CoAs dictates the ability of thiazolidinediones (TZDs), which are PPARgamma ligands used clinically in the treatment of diabetes mellitus, to stimulate adipocyte differentiation. To define the mechanisms of CoR recruitment by PPARgamma in 3T3-L1 cells, we have now focused on the corepressor SMRT. SMRT contains two interacting domains (IDs) that are required for interactions with NHRs. Interestingly, and contrary to other NHRs, PPARgamma interacts with SMRT specifically via the SMRT C-terminal ID (SMRT ID1). To define the amino acids important in specifying the ability of ID1 to function, residues within this domain were mutated to the corresponding residues in the proximal SMRT ID (ID2). Interestingly, a single amino acid within ID1, which is not conserved in ID2, appears to be vital in the recruitment of SMRT by PPARgamma. In contrast, this specific sequence is not required for SMRT interactions with the retinoic acid receptor (RAR), another NHR that interacts strongly with SMRT. Thus, the ability of PPARgamma to recruit the corepressor SMRT is dependent on specific residues within the SMRT C-terminal ID that are distinct from amino acids important for interactions with other NHRs. We have shown that the ability of TZDs to up-regulate PPARgamma-mediated processes is dependent on the balance of CoRs and CoAs. These data also suggest that it might be possible to specifically alter PPARgamma-SMRT interactions to modify TZD action on adipogenesis.

The nuclear receptor corepressors NCoR and SMRT repress gene transcription by recruiting a histone deacetylase complex. Their roles in PPARγ action have been controversial. Recent evidence, however, suggests that NCoR and SMRT repress PPARγ-mediated transcriptional activity on specific promoters in the adipocyte. In addition, by repressing PPARγ action, these corepressors inhibit the ability of adipocyte differentiation to proceed. A further understanding of corepressor action in the adipocyte will provide insight into the balance of forces regulating adipogenesis, insulin sensitivity, and Type 2 diabetes mellitus.

Although abundant evidence documents pay penalties for female-dominated jobs, there is also substantial variation in gender inequality across U.S. metropolitan areas. These lines of research are united by exploring whether occupational gender segregation at the labor market level exacerbates the wage penalty associated with female-dominated jobs, and investigating the association between gender composition and the size of within-job gender gaps. Results show that the penalty accruing to female-dominated jobs is weaker in more integrated labor markets, but only among men, and that labor market integration does not significantly influence the association between the gender composition of jobs and within-job inequality. Further, even women in completely segregated jobs benefit from a context of occupational integration. It is concluded that, although gender devaluation is widespread and systematic, variation in gender composition effects across local contexts is an important dimension of gender inequality.