Until the end of 18th century, the role of the cerebellum remained obscure. The turning point occurred when Luigi Galvani showed that muscle contraction is due to electricity and Alessandro Volta produced the battery, an apparatus based on the pairing of silver and zinc plates separated by brine soaked paper disks, capable to generate electricity. Luigi Rolando, at beginning of 19th century, was impressed by these two observations. He thought that, since the brain generates the movement, it must contain a device generating electricity. As a battery, it should be formed by overlapping disks and the cerebellum for Rolando seemed to be the right structure for such a characteristic laminar organization. He argued that, if the cerebellum is the battery that produces electricity for muscle activity, its removal would produce paralysis. Consequently, Rolando removed the cerebellum in a young goat and observed that the animal, before dying, could no longer stand up. He concluded that the cerebellum is a motor structure as it generates the electricity which produces the movement. The conclusions of Rolando were criticized by Marie-Jean-Pierre Flourens who observed that animals undergoing cerebellectomy were still able to move, even if with problems of balance. Flourens concluded that the role of the cerebellum “is to put in order or to coordinate movements wanted by certain parts of the nervous system, excited by others”. It was necessary to wait up to 1891 when Luigi Luciani, observing a dog survived the cerebellectomy, described a triad of symptoms , unquestionably of cerebellar origin. It was believed that cerebral ventricles contained the psychic pneuma or vital spirit or animal spirit, a sort of special and light substance endowed with the power to perform sensory, motor and mental activities. The most widely accepted version of this theory was that the synthesized information from the all five senses was located in the front ventricle. Between the front ventricle and the middle ventricle was a storage space for representing previously perceived objects; the space was called the faculty of imagination or representation. The middle ventricle was believed to be involved in cognition and cognitions were thought to be transferred to the rear ventricle, under the cerebellum, for storage with the faculty of memory [This f memory .The ventricular theory was challenged from the early 16th century by several European scientists, although some remnants of this theory survived in medicine until the 18th century. In fact, up to the end of that century, the role of the brain structures within the posterior cranial fossa, cerebellum included, remained obscure.Still in the early 1800s, Franz Joseph Gall 1758–1828), the creator of phrenology, argued that cerebellum is the area of self-preservation of the species [8, the crThe turning point occurred thanks to two Italian scientists, Luigi Galvani and Alessandro Volta.Luigi Galvani 1737–1798), during the 1780’s, performed experiments at the University of Bologna involving electricity and frogs. He noticed that frogs’ legs hung from brass hooks on his metallic bannister twitched whenever the breeze made them knock against the ironwork  was professor of experimental physics at the University of Pavia, from 1779 for almost 40 years. In 1792, Volta came to know of Galvani’s experiments on animal electricity. He initiated to repeat the experiments and at first his results agreed with those of Galvani. However, analyzing more closely the experimental conditions, Volta gradually became convinced that the contractions of the frog’s muscles were not due to the presence of electricity generated in the animal, but to some external electricity caused by the contact of the two metals. He concluded that different kinds of metals had electro-motive power at the point where they are in contact with the frog. He summarized his ideas with the expression: “It’s the difference in metals that does it”.In late 1799, Volta produced the apparatus which made him famous: the battery, based on the pairing of silver and zinc plates separated by brine soaked paper disks Fig. . This onIt is at this moment that comes into play another Italian scientist, Luigi Rolando 1773–1831), who in 1804 became professor of physiology at the University of Sassari Rolando was impressed by the two main observations of Galvani and Volta: muscle contraction is due to electricity and to generate electricity is necessary a battery. His reflection was the following: since the brain generates the movement, it must contain a device generating electricity. In his book published in 1809 , he writarbor vitae. Probably the term was coined by the Danish anatomist Jacob B. Winsløw (1669 –1760) for the similarity of cerebellar folia with the profile of leaves of the North American tree Thuja occidentalis or Eastern Arborvitae, introduced in France in 1534 by French explorers. It seems that the tree was named “l’arbre de vie” by the King Francis I [For Rolando this part of the brain, as a battery, should be formed by overlapping disks and the cerebellum seemed to be the right structure given its characteristic overlapping laminae, forming the so-called Winsløw 169 –1760 se dunque l’organo elettrico torpedinale e quelli del Siluro e del Ginnoto, fatti di sostanza albumino-gelatinoso-cartilaginea e simili attissimi sono a preparare, ed a sviluppare una quantità grandissima di fluido elettrico sufficiente per dare grandissime scosse, perché non potrà separarsi un principio consimile, quale si è il nerveo fluido dalle numerose lamine di sostanza midollare, giallognola, e cinerea del cervelletto? Quale maggiore evidenza potrassi desiderare per stabilire, che il cervelletto è un organo, la cui struttura è affatto consimile a quella dell’apparecchio del Volta?” .Rolando writes “Qual maggior prova per dimostrare, che dal suddetto viscere si separa un fluido analogo a quello, che dallo strumento citato si sviluppa? Qual più retta conseguenza, se esportato guasto o distrutto il cervelletto cessa ogni influsso del fluido nerveo nei muscoli destinati alla locomozione?” .Rolando concluded that, if the cerebellum is the battery that generates electricity for muscle activity, its removal would produce paralysis. He writes “non altrimenti che se fosse paralitico” . The animal survived for 24 h and died probably for postoperative sepsis.Rolando, consequently, removed the cerebellum in a young goat and observed that the animal could no longer stand up “Rolando concluded that the cerebellum is a motor structure as it generates the electricity which produces the movement.dans le cervelet réside une propriété dont rien ne donnait encore l’idée en physiologie, et qui consiste a ordonner ou coordonner le mouvements voulus par certaines parties du système nerveux, excités par d’autres” .The conclusions of Rolando were criticized by Marie-Jean-Pierre Flourens 1794–1867), professor of physiology at the Collège de France in Paris  and its application in clinical medicine, initially by Joseph Lister (1827–1912), with the use of carbolic acid as an antiseptic, and subsequently by Lawson Tait (1845–1899) and Ernst von Bergmann (1836–1907) which went from antisepsis to asepsis. These medical advances have allowed Luigi Luciani (1840–1919), in that period professor of physiology at the University of Florence, to publish in 1891 [29–1895 aThe first systematic description of the symptoms of cerebellar lesions in man was carried out by the British neurologist Gordon Morgan Holmes (1876 –1965). During World War I he was neurologist with the British Expeditionary Forces and working in a field hospital he had the opportunity to investigate the effects of traumatic lesions involving the cerebellum. In 1922 Holmes’ observations on patients with cerebellar wounds as well as tumors were published in his Croonian Lectures to the Royal College of Physicians .The Cerebellum as a Neuronal Machine [Cerebrocerebellar communication systems [The general conclusion reached before World War II was that the main role of the cerebellum is to detail the different aspects of a movement, not to initiate movements or to decide which movements to execute. After the war, there was a significant increase in knowledge of circuitry and electrophysiology of the cerebellum, summarized in 1967 in a book,  Machine , written systems , writtenIn the same years it was suggested that the cerebellum is involved in motor learning. Most theories that attempt to explain the role of cerebellar circuits in motor learning are derived from the ideas of British neuroscientist and psychologist David C. Marr (1945–1980) and of American engineer James S. Albus (1935–2011). Both attributed an important role to climbing fiber activity capable to cause synchronously activated parallel fiber inputs, to be strengthened for Marr  and to bCerebellar Cognitive Affective Syndrome, characterized by impairment of executive functions, difficulties with spatial cognition, personality change and language deficits. Table Up to the 1990s the cerebellum was almost universally believed to be primarily involved in movement, but latest results have led to consider that view too restrictive. Imaging studies have allowed to detect cerebellar activation in relation to cognitive activities and numerous correlations between the cerebellum and non-motor regions of the cerebral cortex were highlighted. Moreover, in patients with lesions restricted to the cerebellum, non-motor symptoms have been frequently recognized. In 1998, the American neurologist Jeremy D. Schmahmann  describesubstantia gelatinosa of Rolando in the spinal cord, the fissure of Rolando or central sulcus, the Rolandic operculum or post-central operculum, the Rolandic artery or central sulcal artery, the Rolandic vein i.e., the vein posterior to Trolard’s vein draining the parietal lobe, the pre-Rolandic artery or precentral sulcal artery, and the Rolandic epilepsy or benign childhood epilepsy with centrotemporal spikes (BCECTS), the most common epilepsy syndrome in childhood.Luigi Rolando devoted his life to the study of the brain. Despite his outlandish theory on the cerebellum, he provided a major contribution to the advancement of neurosciences and many neural entities are named after him: the


Complementary and alternative medicine (CAM) and traditional medicine (TM) are important social phenomena. This article reviews the sociological literature on the topic. First, it addresses the question of terminology, arguing that the naming process is a glimpse into the complexities of power and history that characterize the field. Second, focusing on the last 15 years of scholarship, it considers how sociological research on users and practitioners of TM/CAM has developed in that time. Third, it addresses two newer strands of work termed here the ‘big picture’ and the ‘big question’. The big picture includes concepts that offer interpretation of what is happening at a societal level to constrain and enable observed patterns of social practice . The big question, ‘Does it work?’, is one of epistemology and focuses on two developing fields of critical enquiry – first, social critiques of medical science knowledge production and, second, attempts to explain the nature of interventions, i.e. how they work. Finally, the article examines the role of sociology moving forward. Complementary and alternative medicine (CAM) and traditional medicine (TM) are important social phenomena. National and regional studies in the ‘developed’ world have shown high usage of CAM, especially for those with chronic diseases, such as cancer , which is a rather indecisive term given that the difference between a state of complementarity, where two things mutually enhance each other's qualities, and positioning a practice as an ‘alternative’ are very different, both practically and sociologically. The absent presence here is, of course, biomedicine; a practice must be alternative or complementary to something. Biomedical dominance continues to frame the language with which we engage with issues of health, illness and healing. Highlighting this is not new; in 1988, Meg Stacey published ‘The Sociology of Health and HealingThe second point is that dichotomous terms are present throughout this literature. Those studying historical events tend to use the terms ‘quackery’, ‘irregulars’, ‘sectarianism’ or ‘folk medicine’, which are contrasted with the ‘regular’ or ‘orthodox profession’, or ‘allopathy’. Sociological accounts of contemporary society tend to use the terms ‘complementary’, ‘alternative’, ‘heterodox’ or ‘holistic’, to contrast with ‘conventional’, ‘orthodox’ or ‘biomedicine’. The terms ‘folk’, ‘indigenous’ or ‘traditional’ medicine are commonly used to describe long-established, empirically-adapted healing practices originating in a geographically specific area and contrasted with ‘modern’ or ‘professional’ medicine. Another common dichotomy is between ‘Western’ medicine (singular) and ‘other’ medicines – a dichotomy that, apart from reflecting the colonialism implicit in many constructions of medicine, is also historically inaccurate. For instance, practices like osteopathy and homeopathy, while frequently othered, in fact both originated in Western societies (United States and Germany respectively).While there are clearly differences and variation between medical and healing practices globally, the neat binaries implied in many discussions are problematic. First, definitions change over time, as do alliances. Brindle and Goodrick , for insMuch of the early sociological research in the field focused on users. In an early review of the field in 1999, Siahpush argued that many studies had focused on why people use CAM, with six main types of explanation emerging: dissatisfaction with the health outcomes of orthodox medicine; dissatisfaction with the medical encounter/doctor–patient relationship; preference for the way alternative therapists treated their patients, including being caring, individualized attention, ample time and information; the emergence of a new philosophy around nature and holism related to a postmodern value system; the heterogeneity of an individual's social network, resulting in exposure to a wider range of information and values; and finally, that alternative therapies fulfilled a psychological need in the wake of the waning of organized religion, providing an alternative framework for making sense of illness, suffering and misfortune. He suggested that more sophisticated quantitative research, including multivariate analysis, to substantiate these claims was required  and shen , respectively, are discursive markers of expertise. Others have discussed the management of tensions in the therapeutic encounter, such as the management of sexuality in bodywork  and the deployment of power at the micro-level in clinical practice, and provide the building blocks for consideration of wider societal trends.As the sociology of CAM and TM has matured, researchers have increasingly tried to make links to wider theories of societal change, drawing where appropriate on historical research, and to be more theoretically rigorous. I will first examine the concept of medical pluralism, which has been for many years the most widely adopted ‘big picture’ concept and then look at three emerging concepts: integration, hybridity and activism. For each concept, I will examine the structural forms that they describe, the social trends they relate to, and relate these back to how they are negotiated at a micro level by social actors.Medical pluralism draws attention to the diversity of practices in a health system and can be distinguished from medical monism where there would be unity of practice or medical dualism where there would be a binary opposition of practices. Published in 1999, Cant and Sharma's seminal monograph, ‘A new medical pluralism’, reignited the debate about pluralism. They pointed out that medical pluralism has a long history. In the UK, it had its roots in the purveyance of patent medicines in the 19th century, which the regular profession fought hard to wipe out because it was a challenge to their hegemony Loeb . More reAn important strand in this work has been the ways in which pluralism is embodied and enacted by the users or consumers of medical care who, some have argued, tend to make choices based on pragmatism and perceived therapeutic effectiveness rather than philosophy or scientific evidence  individuation Broom : 1032.However, some have argued that we have moved ‘beyond’ both dualism and pluralism to a ‘grudging acceptance’ then ‘integration’ of CAM and ‘orthodox’ medicine  dominating patient charting, referrals and diagnostic tests; (b) regulating CAM practitioners to a specific “sphere of competence”; (c) appropriating certain CAM techniques from less powerful CAM professions; and (d) using biomedical language as the primary mode of communication. CAM practitioners, in turn, perform usurpationary closure strategies, by: (a) employing their own “esoteric knowledge” in relation to biomedicine and other CAM professions; (b) appropriating biomedical language and terminology; (c) increasing their professional status by working with biomedicine; and (d) referring among CAM practitioners to increase patient flow  are untenable sociologically Keshet , not leaThe myth may, however, also be a result of asocial naivety: concepts of science are developed through lay and professional socialization processes and may not be reflexively considered by social actors. These unchallenged assumptions about the world and knowledge are what Bourdieu , 1990 woqi, shen, vital force or energy, arguing that these things cannot be reduced to biomedical notions of reality and must be altered or balanced to achieve healing. The sociological scrutiny of both ‘sides’ of this argument has been limited, but there are some promising developments that deserve further research. To quote Wahlberg, an anthropologist:This leads onto the second  dimension in the ‘big question’ arguments: the importance of embodiment and intersubjectivity. A classic argument in the decrier camp is that CAM is ‘just placebo’. The proponents of CAM counter with claims about alternative conceptions of the body, be it If pharmacologists and clinicians have corporeally located the concept of efficacy in terms of bio-availability, pharmacodynamics and pharmacokinetics, and herbalists in terms of a herbal revitalizing of the body's own vis medicatrix naturae, from the early 20th century onwards medical anthropologists  have built up an equally rigorous theory of symbolic efficacy in terms of narratives, symbols and a kind of cognitive homeostasis Wahlberg :177.undo that power’ (Hence, there is no ‘just’ about placebo; it is a complex and embodied social process. Sointu  uses thet power’ .Another dimension of placebo is that belief in the effectiveness of a treatment can itself cause the effect, yet the pragmatic approach of many users does not necessarily support that argument. From the methodological perspective, it is difficult with cross-sectional studies to know whether ideological beliefs, such as ‘postmodern values’, are the cause or the consequence of the use of CAM Siahpush . With a ex vivo concepts could potentially enrich and expand the discipline's theoretical basis. Finally, Scott's (However, many practitioners argue that there is more to their treatment than the intersubjective effects of the therapeutic encounter. There have been sociological discussions of how practitioners and lay people construct expertise in CAM (Hirschkorn  Scott's  sociologin TM/CAM through efforts to support practitioners, professional bodies and educators in their goals to improve the quality of care. It may include work on interprofessional education (Shneerson et al. why social phenomena are as they are and to uncover patterns of power and injustice. Here particularly, the challenge to avoid reproducing biomedical dominance in terminology and analysis is vital. Critical perspectives have long been a strong strand of medical sociology and similar analysis can be applied to TM and CAM as conventional medicine. A key question might be: to what extent does CAM contribute to or challenge health inequalities? Finally, public sociology would seek to use sociological insights to stimulate public discussion about our health and illness,Over the last 15 years, sociologists have continued to engage critically with CAM and TM and contributed numerous empirical studies of the social phenomenon. The focus has been much more strongly on qualitative rather than quantitative methodology, in contrast to many of Siahpush's suggestions for further research in 1999. Looking forward, I would argue that there are a few directions that sociologists could go. Burawoy  makes th


Women living with HIV have increased prevalence of medical and psychological comorbidities that could be adversely affected by alcohol consumption. Little is known about their unique motivations for drinking or perceptions of HIV-related consequences. In preparation for an alcohol intervention study, we sought to better understand reasons for drinking and perceived consequences of alcohol consumption among a sample of women living with HIV.Four focus groups, with a total of 24 adult women , were conducted in Jacksonville, FL, Washington, DC and Chicago, IL. Focus group discussions were tape-recorded and transcribed verbatim; a conventional content analysis approach was used to identify themes, that were then grouped according to a biopsychosocial model.Regarding reasons for drinking, women described themes that included biological , psychological , and social . Themes related to consequences from alcohol included biological , psychological , and social . When discussing how their drinking impacted their health, women focused on broader issues, rather than HIV-specific issues.Many women living with HIV are drinking alcohol in order to self-manage pain or emotions, and their perceived consequences from drinking extend beyond HIV-specific medical issues. Most participants described themes related to psychological issues and situations that are common in women living with HIV. Interventions to address drinking should inquire more specifically about drinking to manage pain or emotion, and help women to recognize the potential adverse impact of alcohol on comorbid health issues, including their own HIV infection. HIV infection remains a prominent issue for women in the United States. In 2014, the Centers for Disease Control and Prevention reported that one in five people living with HIV (PLWH) are female [Hazardous alcohol consumption is adversely associated with several relevant HIV health behaviors and outcomes, including non-adherence to ART, risky sexual behavior, HIV disease progression, liver disease, and earlier death –10. AlcoInterventions to reduce hazardous drinking are widely recommended but they do not always address reasons for drinking . Women mWe obtained qualitative data using focus groups , and useWe sought to include a range of women affected by alcohol and HIV infection in three locations where we were planning to conduct an alcohol intervention study. We first conducted two focus groups in Chicago in 2007. Focus group participants were recruited from the ongoing Women’s Interagency HIV Study (WIHS) , a cohorPrior to data collection, we received approval from Institutional Review Boards at the University of Florida (Jacksonville), Rush University (Chicago), and Georgetown University (Washington DC). Written informed consent was obtained at the Washington DC site, whereas verbal consent was obtained from participants in Jacksonville and Chicago. All participants were informed that the objective of the focus groups was to learn more about alcohol and HIV infection in women.We created a list of semi-structured, open-ended questions to enhance discussion Table . The queFocus groups were conducted by a primary facilitator, who reviewed the consent document, answered questions, reaffirmed that participation was voluntary, and reminded persons not to make any statements that would identify themselves or another individual. In Chicago and Washington DC, information about participants’ demographic characteristics and drinking history was obtained from their most recent WIHS cohort data, whereas in Jacksonville we only had information about race and age. The focus groups were recorded and transcribed by a professional transcriptionist.Data from four focus groups including 24 women were included for analysis. Two members of the research team conducted an initial coding analysis of the transcriptions, using an inductive, exploratory approach to identify themes related to reasons for drinking and consequences of drinking . Transcrn = 23); most had HIV infection (n = 21), and their ages ranged from 22–59 years. Themes that encapsulated the reasons that women drink and the perceived consequences of drinking are summarized in Table italics below. The themes and examples are not presented in any specific order, but are meant to be inclusive of the full range of ideas that were raised by study participants.Nearly all of the 24 women who participated in the focus groups were African-American  can bring me out of my shell sometimes; you know, compensating for all those feelings of inferiority that were pretty much inherent.Many women drank in order to feel control over their surroundings, and several noted the use of alcohol to help them feel more courageous. Women also frequently noted use of alcohol as a type of self-management of their mood, to cope with stress or life issues, and to cover up their low self-esteem.We go to bars or at each others’ house to start. Same places; just different scenarios. Just want to party and have fun.Before I started hanging out with my friends, yes. Because I was very anti-drinking. They would drink, and I knew that they drank, but I had martial arts and, I had martial arts 6 days a week, so I was always busy. And sometimes on Sunday I had a tournament, so I wasn’t partying with them, but I had gotten hurt in martial arts, so for about 2 or 3 months I stopped and started to socialize with my friends a little bit more, and went to a party and that’s where I started the drinking.My mom considered herself to be a functioning alcoholic. And I’ve never really seen her too many days when she wasn’t drunk or high, you know, that’s what she did every day. She woke up, she didn’t have a water, she drunk beer like that was what she had. So it was normal for me, I guess, my everyday life.Many women reported drinking for social reasons, such as being in the company of someone drinking, having fun, or being in places where people were drinking. Family and peer influences were also commonly cited, and some women noted how they started drinking at an early age or adolescence due to family exposures or peer influences.Alcohol interferes with their HAART medication and that could be really damaging, it could make them become resistant to medication, it’s not good, it’s not good to gamble.I had drunk so much at one time that I had a pancreatic ulcer I didn’t care about that ulcer I had. I was tripping, I was so sick. It was like, I walked like a square block, each square that I walked past on the block, it seemed like I was gagging and throwing up. I went to the hospital, and the doctor did like that and I about jumped off the bed. He said, you got ulcers, no more drinking for you. And people don’t realize that, it can eat up your liver you know, you just don’t know.You’re really not going to take care of yourself, you know. I mean they’re incompatible and an alcoholic doesn’t take care, of course they can drink and like, you know have a drink once a year. Even a person with HIV can do that, but that person with a problem drinking, problem drug use, if I’m using drugs, everything else is completely out the window. I mean my health, my medication, any responsibility that I have, I don’t even eat. I’m doing good to keep myself hydrated at all. Everything goes.If you have HIV and you drink, don’t drink if you love life, continue to take your medicine. Because that’s double jeopardy, the medicine and the alcohol on your liver, that’s double jeopardy.Participants identified several biological consequences of drinking, including some more immediate consequences . Several women noted that they did not take good care of themselves when drinking. Many women recalled severe consequences of drinking from their past. When discussing how their drinking impacted their health, the participants focused on broad issues rather than HIV-specific issues, unless they were specifically asked about HIV infection.Because you know you get drunk and you want to go do Sally husband, and Sally don’t play.I stopped for like a year and I started back gradually drinking beer and everything. Now I like to drink a lot of beer, I would drink liquor if somebody pissed me off, but I try to give people fair warning, if I start drinking you ain’t going to like me, that keep people back off me. Let me go ahead and do my thing. Now really, like I said, I just drink beer, that’s every day, every night.I woke up and didn’t know where I was and I was in the bed with a guy that I didn’t know.Women noted several psychological consequences of drinking, including effects on emotions, decisions, and behaviors. Specific psychological consequences included out of control behavior, criminal activity, bad choices, and risky sexual behavior. Some women noted that they had different consequences from different types of alcoholic beverages, with liquor having a different effect than beer, for example.Your job, you neglect your family, you can have your children taken away from you, and all kinds of things.Yes, because it was causing more problems at the time. I lost everything. I lost a job, relationship, respect, respect from family, I lost everything, and at the time, yes, certainly, I would have done it. And even when I went to AA, I’m sitting around people where I’m like, wow, my life isn’t that bad, but even realizing it, it was, I had hit bottom, and that’s where I sat.When I drink, I break out in handcuffs. That’s what happens when I drink…(When you say ‘break out in handcuffs’ what do you mean?) I mean I’m pretty much going to do something stupid, and I’m going to end up in jail. I just lose complete control of myself. It’s going to be either other drugs and then I’m going to be in real trouble.But socially, I will drink a lot when I’m you know, like I said, I’ve gotten a couple DWIs, blew a .12 and really I didn’t feel like I was drunk, you know… I almost got a third one, one time, and that time I really was drunk because I was sick, and they didn’t give me a DWI, thank God that time.Women identified numerous social consequences of drinking. For example, some women discussed how drinking aversely affected their relationships with their family or their friends, or how they were later embarrassed about things they had done or said. Also, several women identified social consequences related to breaking the law or societal rules.Because alcohol can adversely affect a range of HIV-related health outcomes, many experts suggest better integration of substance abuse interventions into HIV primary care . SuggestFor example, many women cited alcohol use as a self-management strategy for addressing pain, including both physical and emotional pain. Pain is common among individuals with HIV infection, and persons often drink alcohol to self-manage or mask ongoing physical or psychological pain or distress –31. If wRegarding drinking consequences, we sought to identify whether participants perceived that alcohol had an effect on any HIV-specific health issues. For the most part, women in this study identified more general and immediate health consequences, or health issues from their past, rather than current consequences specific to HIV infection. Although alcohol consumption can affect HIV medication adherence, HIV disease progression, HIV comorbidities, and increases in viral load –10, few Women also noted several behavioral and social consequences of drinking. Links between alcohol consumption and sexual behavior were commonly noted, a connection that is especially relevant to HIV transmission in women . SeveralFew other studies have examined reasons for drinking or drinking consequences in persons with HIV, regardless of gender. One recent study compared reasons for drinking to the amount of alcohol consumption in a HIV clinic population in New York . The invSome limitations of the study warrant mention. First, the specific questions in the interview guide varied somewhat across sites, although at each site women were specifically asked about reasons that they drank and to identify perceived consequences of drinking. In order to protect anonymity, we did not set up a system that would allow us to link statements to demographic or health information from specific participants, and therefore could not make comparisons according to individual factors. Similarly, we could not compare responses of women with HIV to the few women without HIV in this study, and therefore we cannot conclude whether or not women with HIV infection have distinct benefits or consequences compared to similar women without HIV infection. The limited number of women from each setting precluded the ability to make comparisons across sites. The interviews were done in preparation for a clinical trial, and thus we did not confirm whether thematic saturation was achieved. Finally, some participants may have been uncomfortable discussing their individual HIV-specific reasons and consequences of drinking within a focus group setting.We identified reasons for drinking and consequences of drinking among women living with HIV. Many of the themes are currently relevant, including the use of alcohol to manage pain, emotional symptoms, or to gain confidence. Clinicians and public health personnel who conduct alcohol interventions should inquire about reasons for drinking, because women may be drinking to self-manage another conditions such as pain or depression . Family


The productive combination of adjectives, nouns, verbs, and other linguistic elements corresponds to the productive combination of perceptual symbols for properties, entities, processes, and other conceptual elements”  lead to alteration in brain cortical structure and cognitive impairment, but it also conducts to deep changes in both visual system organization and vision-based performances  assessments, the real involvement of language “function” in the deficits found in patients with AD or a-MCI can be questioned. As we will see later, AD can lead to several visual processing impairments that influence higher-level cognitive performance so that checking for normal or corrected-to-normal visual acuity is not sufficient to control for lower-level influence on cognitive performance. Typically, whether in neuropsychology or in speech therapy, language abilities in AD are often evaluated by tests involving the visual “function”. For instance, in the naming tests, patients have to orally produce the word represented by a drawing picture. Similarly, oral comprehension tests ask patients to indicate, among several pictures, which corresponds to a word or a sentence read by the examiner. In other words, patients have to visually recognize a picture (as in the naming tests) based on an oral description. The matching category tests also require patients to choose—among several visual items—the one that is semantically associated with a target item. Finally, tests that focus on graphic abilities  also rely on visual “functions”.When performances are altered in the tests such as those described above, any earlier level of information processing can be involved Greene, . AlthougIf cognitive—and especially memory—disorders are a hallmark of AD, it is less widely known but well established, that many visual processes are also altered at multiple levels of the nervous system in AD.The lens , the retina , macula (volume decrease), the retinal nerve fiber layer (reduction in thickness at the optic nerve head), the optic nerve , the lateral geniculate nucleus , the superior colliculus [amyloid plaque and neurofibrillary tangle (NFT) accumulation], the pulvinar (amyloid plaques and neuritic plaques), the visual cortex—possibly at later stages of the disease— have been found to be affected in AD , Cronin-Golomb et al.  demonstrIn this context, and given the extent of visual alteration in AD, much care should be taken when considering language performances, especially if the task requires conceptual production from visual stimulation.the perception and the interpretation of a visual scenario. Disentangling the language production impairments from other disorders in this kind of settings implies to (i) more thoroughly examine potential differences in visual and eye movement performances between patients and controls through the use of appropriate visual/visuomotor tests, and (ii) consider those performances as covariates in any further group comparison concerning cognitive abilities, namely when the cognitive test requires the processing of visual information. This is needed to better understand and characterize the cascade of alterations associated with AD; especially because AD patients “are less likely than healthy elderly individuals to report vision problems to their physicians” and that “sensory deficits can be hidden and may masquerade as higher order deficits”  in order to control for any effect of lower-level process  impairment over higher-level cognitive “functions” . This is critical when the protocol involves Beyond the specific case of language, the proposed approach asks basic questions about our conception of cognitive processes. The discussed effects remind us how much cognition is situated, grounded, embodied in specific perceptual (Goldstone and Barsalou, The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Nine years ago, the American business community and government formed a partnership to promote a national quality improvement campaign and established the structure and endowment launching the Malcolm Baldrige National Quality Award. The Award, created in 1987 by public law, continues to promote an understanding of quality business practices, greater awareness of continuous improvement as a crucial competitive element, the sharing of information and successful strategies through publications, such as the Winners’ Profiles, and public activities. The most prominent of these activities is the annual Quest for Excellence Conference.Each year, the Quest for Excellence Conference, the official conference of the Malcolm Baldrige National Quality Award, provides a forum for quality-conscious business leaders worldwide to hear and question the most recent Baldrige Award recipients. For the last 8 years, business executives have come to this conference to learn about the quality journeys of Award-winning companies and how to adapt and implement total quality management practices to their own organizations. Conference participants view the current and prior Award winners as quality practices benchmarks for American business.The eighth annual Quest for Excellence Conference was held in Washington, DC , operated under the joint sponsorship of the American Society for Quality Control (ASQC), the Association for Quality and Participation, the Council on Competitiveness, and the National Institute of Standards and Technology’s Office of Quality Programs. The conference provided a number of firsts for the audience of 1100. This was the first time the current Baldrige winning companies were honored in a conference kick-off ceremony at which each company received the Baldrige flag. It was the first Quest for Excellence not led by the first Director of the Baldrige Program, Dr. Curt W. Reimann,This year’s conference featured the two 1995 winners of the Malcolm Baldrige National Quality Award: Armstrong World Industries, Inc., Building Products Operations (BPO), and the Telecommunications Products Division of Corning Incorporated (Corning TPD). Both were winners in the manufacturing category.5BPO is the world’s largest manufacturer and marketer of acoustical ceiling systems for commercial and residential markets. In 1994, sales totaled $628 million. BPO U.S. operations has 2500 employees working at its headquarters in Lancaster, PA, and in seven manufacturing facilities: Beaver Falls and Marietta, PA; Hilliard, OH; Mobile, AL; Macon, GA; Pensacola, FL; and St. Helens, OR. Each year for the past 5 years, BPO has had more than 250 improvement teams operating at any given time. “Best practices” generated by these teams are shared among plants through conference calls, computer networks, and “Functional Excellence” conferences. Output per manufacturing employee and annual sales per manufacturing employee are critical measures of performance for BPO. As a result of employee involvement, recognition, gainsharing, and eliminating “non-value-added” activities, since 1991 output per manufacturing employee has improved by 39 % and annual sales per manufacturing employee have risen by 40 %.Using technology developed and patented by its parent, Corning Incorporated, Corning TPD was formed in 1983 to manufacture optical fiber that uses pulses of light to carry large amounts of information over great distances at a low cost.Corning TPD uses a formal, documented process management system to control and continuously improve over 800 processes throughout its business and manufacturing operations. Fifty of these processes are designated “Core Business Processes” and are “owned” and managed by Corning TPD’s key business leaders. One measure of satisfaction is the quality of products shipped to customers, expressed as parts-per-million product returns. In 1994, returns were at or below the 250 parts-per-million level, meaning that only 250 reels of fiber out of every 1 million reels were returned.In addition to the 1995 Winners’ presentations on “Lessons Learned” and “Category 7: Customer Focus and Satisfaction,” this year’s conference devoted the final day to two additional concurrent sessions. These additional sessions were an all day meeting for each of the two 1995 pilot programs, health care and education, and an afternoon session on state and local quality awards.Dr. Harry Hertz“The 1995 Baldrige Award Winners,” Secretary Brown observed, “exemplify just how important it is to stretch for lofty goals. They also illuminate the rest of us as we find pathways to success in the 21st century … investments in people, in innovations, and in public-private partnerships.” Secretary Brown illustrated his point by highlighting BPO’s innovations—its computer-based, three-dimensional product modeling system, maximum use of recycled materials, safety record, and partnering arrangements. He also complimented Corning TPD on its four-pronged “Plan to Win,” 98 % customer satisfaction track record, dramatic reduction of defects, and significantly increased productivity.Citing the strong track record of business community success with the Baldrige Award, Secretary Brown regretted the lack of Congressional support for the health care and education pilot programs which adapted the Baldrige Criteria for use by American organizations from these two important sectors.Honoring the retirement of Dr. Curt W. Reimann, Secretary Brown characterized Dr. Reimann as a hard working, dedicated, and underappreciated civil servant. The Secretary’s comments provoked a standing ovation by the audience.Noting that the annual public investment of less than $3 million dollars in the Baldrige Program has leveraged over $100 million dollars in private sector benefits, Secretary Brown observed the rarity of this achievement as private and public investment in research and development (R&D) have been anemic with alarming downward trends during this last decade. Secretary Brown stated that this decline in American R&D and the declining support on the part of the U.S. Congress of public-private R&D partnerships “ignores the realities of the marketplace where public and private investments in technology and innovation since World War II have been responsible for as much as one half of our nation’s economic growth. This is at a time when countries such as Japan are increasing their public investment in and encouragement of industrial research and development. Using Japan as just one example of a positive government climate, each year the country invests 35 % more than the United States on a per capita basis and recently announced plans to double the country’s R&D efforts investment by the year 2000.”Secretary Brown punctuated his keynote address by asking the leaders of this year’s Baldrige winning companies to come up on stage to receive the official Baldrige flag. Secretary Brown presented a Baldrige flag to BPO’s representatives, Henry A. Bradshaw, President, Worldwide Building Products Operations, and John F. McClay, Manager of Quality Management. From Corning TPD, Robert C. Forrest, Senior Vice President and General Manager, and Gerald J. McQuaid, Division Vice President and Director Business Systems, accepted the Baldrige flag. These flags are flown with pride over the headquarters and operations of Baldrige Award recipients. Another standing ovation led the recipients off the stage and ushered in the premier showing of the latest Quest for Excellence videotape.10At the close of the videotape, Dr. Hertz introduced the leadership section of the conference by noting that, “Leadership is the focal point within the Criteria for a company to describe its values, performance expectations, and leadership system to create and sustain customer focus and to achieve expectations. The personal involvement of senior leadership is critical in developing and maintaining the leadership system. Leadership sets the tone for the company’s contribution as a corporate citizen and for meeting its public responsibilities.”The conference’s first speaker, BPO’s Henry Bradshaw, thanked the Baldrige examination team, “who spent the better part of last year learning about us and evaluating our strengths and areas for improvement. During our site visit, the examiners were tenacious in their quest for facts, but they were also considerate guests in our house.”“Armstrong’s leaders—including me—have attended Quest conferences since they began with the 1988 Baldrige Award winners, and we’ve learned from every one of them. One very important lesson we’ve learned is that to advance your quality culture, you need a leader who does two things: first, understand your quality culture so you can continue to change it for the better. Second, know how to build on your organization’s existing strengths to develop new capabilities.“Without those two elements of leadership,Robert Forrest described leadership at Corning TPD as going beyond the traditional notion of leadership setting and communicating direction. At Corning TPD, leadership also provides the creation of linkages (such as between TPD people and TPD business objectives) and ensures integration of the “Plan to Win”Gerald J. McQuaid described Corning TPD’s quality journey as three parallel and interconnected tracks: motivation, systems, and infrastructure. He noted, “In a simpler and more tidy world, you would sort out your motivation, select your system’s approach, and go about building the required infrastructure sequentially. It didn’t happen that way for us, and it may not be happening that way for you.” McQuaid noted that these parallel tracks evolved through four distinct phases: product focus, total quality, cherry picking, and integration.McQuaid observed that early in the quality journey, TPD had “one foot in the Baldrige boat and one foot in the business as usual boat.” With no real wake-up call, McQuaid explained that TPD “cherry picked” its way through its first Baldrige feedback report (1989), picking and choosing which comments to work on and which to table. By 1993, it became clear that TPD could not continue with feet in different boats. Business was good and complacency was becoming a strong possibility. This began TPD’s integration phase, a nonlinear weaving of the Baldrige Criteria into the fabric of everyday TPD life, and McQuaid noted that is where Corning TPD is still today.Robert Forrest supplemented McQuaid’s comments with, “Our decision to adopt the Baldrige Criteria in 1989 was not motivated by a wake-up call, we were not in trouble. The decision was business driven through and through. It [the Baldrige Criteria] was the best business model we had found. The feedback from our first Baldrige application in 1989 provided the basis for many of the systems in place today. The 40-page feedback report we just got from our winning application will form the foundation for future improvements.”Quality needs to be integrated into the basic business fabric. As Forrest explained, “Let me warn you, you won’t hear our people mention the word “quality” very often. If you ask them to show you Corning TPD’s quality strategy, they will share with you our business strategy. If you want to look at our quality plans, they will take you through our business plans. If you ask them what their quality objectives are, they will show you their business objectives. And if you ask me for our quality organization chart, I’ll give you the name of everyone in TPD. Business and quality, at TPD, they’re not two separate things. They’re neither complementary nor supplementary. Rather they are one and the same, integrated and indistinguishable. In our experience, that’s how it works best and that’s how we won the Baldrige Award. And that’s how we win every day in the optical fiber industry.“People ask us how do we have the time or make the time for quality. My answer is if you think about quality stuff, then you are in trouble. You have to think about business stuff. Quality has to be integrated into the business fabric and all business factors, otherwise quality will not take hold.”Describing lessons learned on the way to winning the Baldrige Award, L. R. Kishpaugh, Corning TPD’s Manager of Customer Services, observed: “When your quality objectives become your business objectives, when your quality teams become your business teams, when your quality award programs are replaced with business-linked reward systems, then you’ll know you’re integrated.”Kishpaugh also cited increased customer focus as another lesson learned. “.… our customers seemed satisfied, and we were making money. As the saying goes: if it ain’t broke, why fix it? Thanks to Baldrige, however, we discovered places where it wasn’t broken, but had developed some pretty serious cracks. Customer focus was one of the areas with developing cracks. Our response led to increasing our customer focus, not just in sales and customer service, but also in new product development and a number of business processes.”Another lesson Corning TPD learned was that people need to feel valued and that it was easy to lose sight of people in a highly technological business. Kishpaugh concluded, “No matter how technical your product, no matter how advanced your process, every business begins with a valued person.”John McClay, Armstrong BPO’s Manager of Quality Management, noted this as being his third Quest For Excellence conference. At the first one, in 1989, after listening to Globe, Westinghouse, and Motorola,“I see the Quest for Excellence conferences as a great way to informally assess your company’s progress against the Baldrige Criteria. When you hear what Baldrige-winning companies are doing, and where they’ve been on their quality journey, you get a “big picture” view of where you are and how far along your company has come.” McClay described the five phases that BPO took in its quality journey from instituting a Philip Crosby style quality management system in 1983 to the present Phase V, Business Excellence Process, and its three components to drive, process, and support changes.William B. McBee, BPO’s Director, Corporate Quality, spoke about lessons learned at BPO and observed that the first hurdle was to decide how to measure the overall effectiveness of the quality interventions. According to McBee, the Baldrige Criteria were given a trial test to learn if they could “improve our ability to manage and even accelerate the speed of our improvement process.” This was a hard won trial test since Armstrong’s Corporate Quality Council (with business leaders and corporate staff heads forming the membership) had concerns such as: the Baldrige Award Criteria were seen as a foreign language, and the council noted that “we don’t need more jargon to add noise in the channel.” The Criteria represented additional work, and “we were already lean and working long hours.” The value of the Criteria was not apparent up front, “like jogging, eating right, lifting weights, benefits are down the road.” The fact that the Criteria were U.S.-based made selling their use to “our European operations very difficult.”In 1989, the Corporate Quality Council reached an agreement to experiment with the Criteria as a self-assessment tool in 30 operations. “But,” according to McBee, “I can tell you it was Baldrige on trial.” The Baldrige-based self-assessments revealed both opportunities for improvement and a clearer definition of patterns of strengths and weaknesses. Armstrong learned more about leadership, quality values, customer input, and more challenging goals. McBee noted that observing the senior leadership of previous Baldrige winners “helped us develop our own stretch goal program we called 80 in 5.” Along with stretch goals went benchmarking, and McBee noted that “benchmarking was a relatively new term for us in 1990 as we were not systematically seeking best practices and benchmarking data to set meaningful goals.”McBee concluded that “the types of changes we made as a result of our Baldrige Criteria assisted self-assessment and had a direct impact on both our business and the speed of our culture change.” “Another important lesson learned,” according to McBee was that, “the value of using the Criteria is proportional to how willing and able leadership is to act upon the feedback. We were fortunate. Our leaders were not defensive and took a personal role in leading the changes.”According to McBee, BPO’s first Baldrige application in 1993, following the experience of a 1992 application to Armstrong’s internal award process, was written by those closest to the work, and afforded BPO a site visit, which provided several important lessons. “Our human resource strategy was not fully deployed, we needed to make better use of competitive comparisons and outside benchmarks to provide a rationale for our stretch goals, and our corporate staff groups were not as closely focused as they should be on BPO’s quality and performance improvement plans. Addressing these weaknessesLooking around the room as he closed his address to the full conference audience, McBee shared, “Looking back at how we navigated our way through the quality journey, I have one last lesson learned. One does not become world-class by just focusing on weaknesses and correcting them. If you’re not careful, you may still end up an average company with less problems. To leverage your improvement efforts, focus on your strengths and take those to new heights. The Baldrige Criteria tell you the difference.”When Henry Bradshaw was asked what’s next after winning the Malcolm Baldrige National Quality Award, his answer provided an effective wrap-up to this year’s Quest for Excellence Conference and a conclusion to this report. Henry Bradshaw responded, “…for the same reasons that we started in 1983 with the quality management process. We knew companies were getting better at that time and, although we were a leader in our industry, we wanted to maintain that leadership. I read somewhere that those who won the Baldrige in the past have only scored around 700 points. That means that there are 300 more points yet that we can work on, and we are definitely going to do that by continuously improving all our processes.”


Just as Wikipedia evolves over time based on contributions from participants, we envision an evolving survey driven by contributions from respondents. We develop three general principles that underlie wiki surveys: they should be greedy, collaborative, and adaptive. Building on these principles, we develop methods for data collection and data analysis for one type of wiki survey, a pairwise wiki survey. Using two proof-of-concept case studies involving our free and open-source website www.allourideas.org, we show that pairwise wiki surveys can yield insights that would be difficult to obtain with other methods.In the social sciences, there is a longstanding tension between data collection methods that facilitate quantification and those that are open to unanticipated information. Advances in technology now enable new, hybrid methods that combine some of the benefits of both approaches. Drawing inspiration from online information aggregation systems like Wikipedia and from traditional survey research, we propose a new class of research instruments called  Just as Wikipedia grows and improves over time based on contributions from participants, we envision an evolving survey driven by contributions from respondents.In the social sciences, there is a longstanding tension between data collection methods that facilitate quantification and those that are open to unanticipated information. For example, one can contrast a traditional public opinion survey based on a series of pre-written questions and answers with an interview in which respondents are free to speak in their own words. The tension between these approaches derives, in part, from the strengths of each: open approaches  enable us to learn new and unexpected information, while closed approaches  tend to be more cost-effective and easier to analyze. Fortunately, advances in technology now enable new, hybrid approaches that combine the benefits of each. Drawing inspiration both from online information aggregation systems like Wikipedia and from traditional survey research, we propose a new class of research instruments called Although the tension between open and closed approaches to data collection is currently most evident in disagreements between proponents of quantitative and qualitative methods, the trade-off between open and closed survey questions was also particularly contentious in the early days of survey research –3. AlthoThe dominance of closed questions, however, has led to some missed opportunities, as open approaches may provide insights that closed methods cannot –8. For eProjects that depend on crowdsourcing and user-generated content, such as Wikipedia, suggest an alternative approach. What if a survey could be constructed by respondents themselves? Such a survey could produce clear, quantifiable results at a reasonable cost, while minimizing the degree to which researchers must impose their pre-existing knowledge and biases on the data collection process. We see wiki surveys as an initial step toward this possibility.Wiki surveys are intended to serve as a complement to, not a replacement for, traditional closed and open methods. In some settings, traditional methods will be preferable, but in others we expect that wiki surveys may produce new insights. The field of survey research has always evolved in response to new opportunities created by changes in technology and society –16, and www.allourideas.org, we show that pairwise wiki surveys can yield insights that would be difficult to obtain with other methods. The paper concludes with a discussion of the limitations of this work and possibilities for future research.In this paper, we develop three general principles that underlie wiki surveys: they should be greedy, collaborative, and adaptive. Building on these principles, we develop methods for data collection and data analysis for one type of wiki survey, a pairwise wiki survey. Using two proof-of-concept case studies involving our free and open-source website greedy, collaborative, and adaptive.Online information aggregation projects, of which Wikipedia is an exemplar, can inspire new directions in survey research. These projects, which are built from crowdsourced, user-generated content, tend to share certain properties that are not characteristic of traditional surveys –20. Thesgreedy in the sense that they should capture as much or as little information as a respondent is willing to provide.Traditional surveys attempt to collect a fixed amount of information from each respondent; respondents who want to contribute less than one questionnaire’s worth of information are considered problematic, and respondents who want to contribute more are prohibited from doing so. This contrasts sharply with successful information aggregation projects on the Internet, which collect as much or as little information as each participant is willing to provide. Such a structure typically results in highly unequal levels of contribution: when contributors are plotted in rank order, the distributions tend to show a small number of heavy contributors—the “fat head”—and a large number of light contributors—the “long tail” , 22 Fig. For exacollaborative in that they are open to new information contributed directly by respondents that may not have been anticipated by the researcher, as often happens during an interview. Crucially, unlike a traditional “other” box in a survey, this new information would then be presented to future respondents for evaluation. In this way, a wiki survey bears some resemblance to a focus group in which participants can respond to the contributions of others his relates to two areas. So plugging ships into electricity grid, so that’s one, in terms of energy and sourcing energy. And it relates to freight.  Correct, so freight is something that we’re looking closer at. … And emissions, reducing emissions, is something that’s an overall goal of the plan. … So this has a lot of value to it for us to learn from” .Other user-contributed ideas suggested alternative framings for existing ideas. For instance, the creators of the OECD wiki survey noted that high-scoring, user-contributed ideas like “Teach to think, not to regurgitate” “wouldn’t be formulated in such a way [by the OECD]. … [I]t’s very un-OECD-speak, which we liked” . More generally, OECD staff noted that “what for me has been most interesting is that … those top priorities [are] very much couched in the language of principles[. …] It’s sort of constitutional language” . PlaNYC’s wiki survey creators also described the importance of user-contributed ideas being expressed in unexpected ways. The top-scoring idea in PlaNYC’s wiki survey, contributed by a respondent, was “Keep NYC’s drinking water clean by banning fracking in NYC’s watershed”; Mayor’s Office staff indicated that the office would have used more general language about protecting the watershed, rather than referencing fracking explicitly: “[W]e talk about it differently. We’ll say, ‘protect the watershed.’ We don’t say, ‘protect the watershed from fracking’” .Taken together, these two case studies suggest that pairwise wiki surveys can provide information that is difficult, if not impossible, to gather from more traditional surveys or interviews. This unique information comes from high-scoring user-contributed ideas, and may involve both the content of the ideas and the language used to frame them.wiki surveys. By combining insights from traditional survey research and projects such as Wikipedia, we propose three general principles that all wiki surveys should satisfy: they should be greedy, collaborative, and adaptive. Designing an instrument that satisfies those three criteria introduces a number of challenges for data collection and data analysis, which we attempt to resolve in the form of a pairwise wiki survey. Through two case studies we show that pairwise wiki surveys can enable data collection that would be difficult with other methods. Moving beyond these proof-of-concept case studies to a fuller understanding of the strengths and weaknesses of pairwise wiki surveys, in particular, and wiki surveys, in general, will require substantial additional research.In this paper we propose a new class of data collection instruments called One next step for improving our understanding of the measurement properties of pairwise wiki surveys would be additional studies to assess the consistency and validity of responses. Consistency could be assessed by measuring the extent to which respondents provide identical responses to the same pair and provide transitive responses to a series of pairs. Assessing validity would be more difficult, however, because wiki surveys tend to measure subjective states, such as attitudes, for which gold-standard measures rarely exist . DespiteAnother area for future research about pairwise wiki surveys is improving the statistical methods used to estimate the opinion matrix—either by choosing pairs more efficiently or developing more flexible statistical models. First, one could develop algorithms that would choose pairs so as to maximize the amount learned from each respondent. However, maximizing the amount of information per response –65 may nAnother important next step is to combine pairwise wiki surveys with probabilistic sampling methods, something that was logistically impossible in our case studies. If one thinks of survey research as a combination of sampling and interacting with respondents , then pawww.allourideas.org. Further, the website enables researchers to download detailed data from their survey which can be analyzed in any way that researchers find appropriate. Finally, we have made all of the code that powers www.allourideas.org available open-source so that anyone can modify and improve it. We hope that these concrete steps will stimulate the development of pairwise wiki surveys. Further, we hope that other researchers will create different types of wiki surveys, particularly wiki surveys in which respondents themselves help to generate the questions [Given the significant amount of work that remains to be done, we have taken a number of concrete steps to facilitate the future development of pairwise wiki surveys. First, we have made it easy for other researchers to create and host their own pairwise wiki surveys at uestions , 72. We All data collection and protection procedures were approved by the Institutional Review Board of Princeton University (protocol 4885).S1 Text(PDF)Click here for additional data file.S2 Text(PDF)Click here for additional data file.


In light of the growing emphasis on individualization in healthcare, it is vital to take the diversity of inhabitants and users into consideration. Thus, identifying shared perceptions among group members may be important in improving healthcare that is relevant to the particular group, but also perceptions of the staff with whom interactions take place. This study investigates how motherhood is perceived among three groups: Somali-born mothers; Swedish-born mothers; and nurses at Swedish child health centers. Inequities in terms of access and satisfaction have previously been identified at the health centers.Participants in all three groups were asked to finalize two statements about motherhood; one statement about perfect motherhood, another about everyday motherhood. The responses were analyzed using qualitative coding and categorization to identify differences and similarities among the three groups.The responses to both statements by the three groups included divergences as well as convergences. Overall, biological aspects of motherhood were absent, and respondents focused almost exclusively on social matters. Working life was embedded in motherhood, but only for the Somali-born mothers. The three groups put emphasis on different aspects of motherhood: Somali-born mothers on the community; the Swedish-born mothers on the child; and the nurses on the mother herself. The nurses – and to some extent the Swedish-born mothers – expected the mother to ask for help with the children when needed. However, the Somali-born mothers responded that the mother should be independent, not asking for such help. Nurses, more than both groups of mothers, largely described everyday motherhood in positively charged words or phrases.The findings of this paper suggest that convergences and divergences in perceptions of motherhood among three groups may be important in equitable access and utilization of healthcare. Individualized healthcare requires nuance and should avoid normative or stereotypical encounters by recognizing social context and needs that are relevant to specific groups of the population. These and similar responses were common among all three groups, irrespective of addressing perfect or everyday motherhood.”, or to be “caring, creative, inventive, friendly.”Despite these similarities, there were also group-specific responses to motherhood. The nurses typically thought of a mother as someone capable of asking others for help. For instance, by “admit[ting] to her surroundings when it’s tough and hard work…”, or to “understand when she needs to ask for help.” Often “the partner” – or more rarely, “the father” – or parents-in-law were mentioned as providing this help. Moreover, the nurses often focused on motherhood in relation to the characteristics of mothers’ themselves, predominately by using positively charged words, such as “being lovingSwedish-born mothers also used “positive” terms to describe the mother’s characteristics. Some Swedish-born mothers responded that a perfect mother “felt good.” Feeling good was expressed in relation to the child; a perfect mother should take good care of herself so she can take care of the child rather than for her own sake. Unlike the nurses’ focus on the mothers, the Swedish-born mothers talked about motherhood almost exclusively from the child’s perspective: “mak[ing] sure that one’s child is feeling okay”, or “… that she develops in every way and that she becomes a safe individual with good self-esteem and self-confidence.”Somali-born mothers typically responded that a mother possessed a certain degree of stamina and was supposed to be active, “never get tired”, and always “make an effort.” Different from both the nurses’ and the Swedish-born mothers’ perceptions, the Somali-born mothers typically talked about motherhood as embedded in a community context, as mothers should have “good contact with school, teachers, school nurse, and physicians”.To a great extent, the responses for perfect and everyday motherhood overlapped. However, a few differences were identified. The nurses used “positive” terms to describe the characteristics of both perfect and everyday motherhood. Swedish-born mothers were more nuanced when describing everyday motherhood, often using both negative and positive wording in tandem: “Often headache. Often feeling insufficient when the children are screaming. But then there is a glimmer and emotions of joy takes over, the pride and the happiness.”not well-educated, did not get by economically and relied on society’s help. She was conceived as someone prioritizing her own life over the child’s life.More than the other groups, Somali-born mothers emphasized negative aspects of everyday motherhood more than they did for perfect motherhood. Here, motherhood was associated with having a “bad character,” “lying,” “being angry,” “lazy,” “tired,” “absent,” “impatient,” or “not taking care of herself.” Furthermore, she was Research on motherhood often emphasizes biological aspects, such as pregnancy , post-naFocusing on biological aspects has been criticized for neglecting interests and power relations that have made women responsible for parenting , 62. Forone group is of course a simplification. However, it is argued that the indigenous philosophies are deeply embedded in Somali societies – both within Somalia and the Somali diaspora – and in governing Somali peoples’ way of life [Various healthcare studies emphasize the community’s pivotal role for Somali refugees , 71. To  of life . Vital i of life , 73. Con of life –76. Cons of life . This maIn contrast, the child health nurses generally focused on the mother herself when talking about perfect and everyday motherhood. This is somewhat surprising, given the official position , 29 thatshould cooperate with others in raising children, not least the parents-in-law. The Swedish-born mothers mentioned cooperation, but limited to the partner.A related deviation among the groups was their expectations (or not) of a mother’s ability to share childcare responsibilities. Despite talking about motherhood within a wider community context, the Somali-born mothers believed that a perfect mother as well as an everyday mother was not supposed to ask others for help when it came to taking care of the child. She was expected to be independent and to manage child-rearing herself. Previous research has suggested that parenting responsibilities are shared to a greater extent between Somali couples living in Finland than is normally the case in Somalia . Studiesperfect motherhood may be biased as it could be interpreted as being a stereotypical standard of perfection to which their own mothering should be measured. The stereotype of perfection was frequently addressed by Swedish-born mothers as well as nurses in responses such as, ”there’s no such thing as a perfect mother.” But almost every time the impossibility of perfection was mentioned, it was followed by a statement along the lines of “…but she is doing the best she can,” or “…but she always tries her best.” In this sense, the ideal of motherhood is argued not to exist in “real life” but rather as a stereotype yet it impacts the expectations of mothering, as exemplified in the previous quotations that she is always, and in every situation, supposed to do her best given her circumstances. From the nurses’ perspective, the perfect mother also realized when it was time to seek help, or when she could not manage to take care of the child herself. Previous scholars have focused on motherhood as being filled with stress, ambivalence, frustration, and self-blame [meta-mother – a woman who instinctively knows how and when to act, and who is always giving her maximum in her role as a mother.Asking the respondents to complete the statement about lf-blame , 79. OurThe differences and similarities described among the groups in this study may affect the individual meeting between the nurse and the visiting mother at a child health center. A good meeting has been identified as a prerequisite for the child health nurse to find out what the mother desires and to fulfill her expectations . HoweverThe findings of this study suggest that increased knowledge about perceptions of motherhood and engagement with the local communities may help to improve equitable access to healthcare through approaches that are embedded in the local community context. Thus, information about child health services should not be limited to the centers, but disseminated in the wider community , 17. Givwithout a partner. Previous research highlights the fact that single-parent families are increasingly common in Sweden, and investigators have reported resulting disadvantages for the health of the child [Of the 35 responding nurses, ten indicated the belief that a partner is part of parenting. A few nurses mentioned the sex of this other being as male, but most mentioned a sexless “partner.” A reason most nurses did not heteronormatively assume the partner to be male may be due to child health service guidelines putting attention on family constellations other than heterosexual families . Howeverhe child , as wellhe child .wonderful and beautiful. Swedish-born mothers responded about perfect motherhood in “positive” terms. However, their responses concerning everyday motherhood were much more nuanced. Somali-born mothers rarely mentioned “positive” characteristics of everyday motherhood. There is a risk that the needs of mothers who express fatigue or being irritated will not be met by nurses at the centers. Given the potential impact of the “meta-mother,” nurses should be aware of the stereotype of the “perfect mother” and therefore be ready to support mothers where they are.Some normative perceptions were explicit. For instance, the nurses expected the mother to ask for help concerning her child. However, Somali-born mothers’ perceptions of ideal motherhood were of someone capable of taking care of the child herself, not asking for help. Moreover, the nurses’ expressions of everyday motherhood were described in rather dashing terms, such as In recent years, Scandinavian scholars have focused attention on fathers’ perceptions, and parental experiences , 32. StiThe intent of the current study was to understand perceptions of motherhood in three groups in Western Sweden with participants completing open-ended statements about ideal and everyday motherhood. As such, the scope was limited and therefore caution should be exercised when generalizing the results and conclusions to other populations. Neither should the results be generalized to all Somali-born or Swedish-born women in Sweden.As with all qualitative studies, there are limitations with smaller sample sizes and nonrandom sampling. In this case, the Somali-born sample was much smaller due to translation resource intensity and logistical constraints of accessing the mothers at a time convenient to them. Data was collected at different sites by necessity in order to access mothers and nurses who were willing to participate in the study.The responses of the Somali-born mothers were translated into Swedish by an interpreter. The Swedish translations were then translated into English by EE. Consequently, there is a greater risk that information has been lost in translation or somewhat distorted for the Somali-born mothers than for the other two groups (for which translation only took place once).No demographic information was collected for the nurses. Previous research  has suggWith the growing emphasis on individualization in healthcare comes a need to acknowledge the social context, including societal structures and norms. This paper suggests that between groups of people – and not solely between single individuals – there are differences and similarities in perceptions of motherhood which potentially may have implications for health services access and utilization. In this study, Somali-born and Swedish-born mothers, as well as nurses expressed differences in the focus of motherhood: the community, the child, and the mother herself. Potential convergences and divergences of beliefs by mothers and staff may constitute a source of misunderstanding, and normative or stereotypical encounters. However, recognition of the existence of gendered and cultural constructions may be a first step to avoiding such encounters. Because healthcare encounters do not take place in a social vacuum, healthcare needs to be provided that is relevant to specific groups of the population and that is grounded within their social context.Moreover, group perceptions should be used constructively. When healthcare providers design services that satisfy the needs of a diversity of users, equity in healthcare may be enhanced.