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Active Involvement (active + involvement)
Selected AbstractsWarrior nurse: duality and complementarity of role in the operational environmentJOURNAL OF ADVANCED NURSING, Issue 1 2008Lauren Griffiths Abstract Title.,Warrior nurse: duality and complementarity of role in the operational environment Aim., This paper is a report of a study to explore the nature of military nursing in an environment of war, in particular the union of personal, professional and organizational tenets and to identify the actual or potential effect this had on the nursing role in this unique environment. Background., The history of nursing is intrinsically linked with war. There is an irony to this relationship. Active involvement with military activities has provided a vehicle in which nursing has developed, albeit through fostering war, which itself destroys health and contravenes the ethos of nursing. Military nurses, one would assume, are able to reconcile the dichotomy existing between their caring role and being a member of an organization associated with conflict. Methods., A grounded theory design was adopted and the data were collected from 1999 to 2002 using a series of in-depth interviews and focus group with of 24 military nurses. Findings., Three categories were identified: ,It's Just Different Levels', ,That Double Hat' and ,It's Who We Are!' The first illustrates the reality of conflict. ,That Double Hat' outlines the military nurses dual role: those of caring and the military. ,It's Who We Are!' demonstrates the transition from nurse-to-warrior. These integrate to create the core category: ,Caring for War: Transition to Warrior'. Conclusion., The symbiotic relationship of carer and warrior arises as a consequence of strategies used by military nurses to embrace their dual role. Further research is needed to explore the essence of the caring role within a conflict zone from military and civilian perspectives. [source] Examining the role of the forest industry in collaborative ecosystem management: implications for corporate strategyCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 1 2005Jennifer Dyke Abstract The North American timber industry owns or controls a substantial amount of commercial timberland, and it is within this privately held acreage that major portions of critical natural habitat and areas of biodiversity are found. Because significant ecosystem components and processes lie within the ownership of forestry operations, industry participation in collaborative ecosystem management initiatives is vital to protect the integrity of ecological units at the landscape scale. This article analyzes and identifies the role of industry in ecosystem management projects, industry's willingness to participate in collaborative ecosystem management and the motivations behind company participation. Companies indicated active involvement in collaborative ecosystem management as both project initiators and collaborators. Motivations for participating in collaborative ecosystem management initiatives include the desires to decrease governmental regulations, collect data, develop relationships and improve current practices. Many companies also feel that participation is financially beneficial because it positively impacts corporate public relations. We discuss the implications of these results for developing an effective corporate environmental strategy associated with resource-based industries. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment. [source] Benchmarking Innovation: A Short ReportCREATIVITY AND INNOVATION MANAGEMENT, Issue 1 2000Zoe Radnor A project is reported that benchmarked ,best practice' mature organisations, with a base in the United Kingdom, on the processes and practices that they perceive underpinned successful innovation projects. The majority of organisations had director level personnel involved in the innovation process but only three had active involvement of the top management. However, the majority saw the greatest level of innovation being obtained through the use of cross-functional teams. Five key innovation supports were identified during the benchmarking exercise. These were top management support for, and involvement in the process; the appointment of an innovation champion or sponsor; rewards for innovative behaviours and ideas; and finally a positive attitude to building on creative ideas, irrespective of their source. It is suggested that benchmarking can play a role in identifying best-practice innovation structures and procedures. [source] Active Learning through Modeling: Introduction to Software Development in the Business Curriculum,DECISION SCIENCES JOURNAL OF INNOVATIVE EDUCATION, Issue 2 2004Boris Roussev ABSTRACT Modern software practices call for the active involvement of business people in the software process. Therefore, programming has become an indispensable part of the information systems component of the core curriculum at business schools. In this paper, we present a model-based approach to teaching introduction to programming to general business students. The theoretical underpinnings of the new approach are metaphor, abstraction, modeling, Bloom's classification of cognitive skills, and active learning. We employ models to introduce the basic programming constructs and their semantics. To this end, we use statecharts to model object's state and the environment model of evaluation as a virtual machine interpreting the programs written in JavaScript. The adoption of this approach helps learners build a sound mental model of the notion of computation process. Scholastic performance, student evaluations, our experiential observations, and a multiple regression statistical test prove that the proposed ideas improve the course significantly. [source] Five-year follow-up during antipsychotic treatment: efficacy, safety, functional and social outcomeACTA PSYCHIATRICA SCANDINAVICA, Issue 2007E. Lindström Objective:, Explore the long-term course of schizophrenia and related disorders. Method:, Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. Results:, Stable symptomatology and side effects were observed. Clinician GAF scores were 55,61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked full-time. One in four had no social contacts except with staff. Eight patients died during the 5 years. Conclusion:, The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment. [source] Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trialADDICTION, Issue 3 2009Kimberly S. Walitzer ABSTRACT Aim This study evaluated two strategies to facilitate involvement in Alcoholics Anonymous (AA),a 12-Step-based directive approach and a motivational enhancement approach,during skills-focused individual treatment. Design Randomized controlled trial with assessments at baseline, end of treatment and 3, 6, 9 and 12 months after treatment. Participants, setting and intervention A total of 169 alcoholic out-patients (57 women) assigned randomly to one of three conditions: a directive approach to facilitating AA, a motivational enhancement approach to facilitating AA or treatment as usual, with no special emphasis on AA. Measurements Self-report of AA meeting attendance and involvement, alcohol consumption (percentage of days abstinent, percentage of days heavy drinking) and negative alcohol consequences. Findings Participants exposed to the 12-Step directive condition for facilitating AA involvement reported more AA meeting attendance, more evidence of active involvement in AA and a higher percentage of days abstinent relative to participants in the treatment-as-usual comparison group. Evidence also suggested that the effect of the directive strategy on abstinent days was mediated partially through AA involvement. The motivational enhancement approach to facilitating AA had no effect on outcome measures. Conclusions These results suggest that treatment providers can use a 12-Step-based directive approach to effectively facilitate involvement in AA and thereby improve client outcome. [source] Public and stakeholder participation in European water policy: a critical review of project evaluation processesENVIRONMENTAL POLICY AND GOVERNANCE, Issue 1 2006Nuno Videira Abstract The recent reform of the European water policy recognizes the importance of developing effective mechanisms to support public and stakeholder participation in river basin decision-making processes. This paper critically reviews the evaluation processes of different types of water related project in five European countries (Portugal, Greece, The Netherlands, the United Kingdom and Spain), with respect to participatory criteria. The horizontal comparison of these cases accounted for criteria such as the political and institutional context, the design, the implementation and the evaluation of the outcomes of participation. The results indicated that, in the majority of the case studies, participation was simply adopted to conform to the requisites of the Environmental Impact Assessment Directive. Thus, there was truly no room for the active involvement and collaboration of the interested parties. The development of guidelines, drawing from the analysis of past experiences, is expected to support the implementation of the participatory objectives of the EU water policy. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source] Human resource development in remote island communities: an evaluation of tour-guide training in VanuatuINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 2 2002Rosemary Black Abstract About 30% of visitors to Vanuatu visit the outer islands, where ecotourism has recently emerged as a small-scale but significant activity. In the face of increasing competition from comparable Asia,Pacific destinations, there has been pressure on tourism operators and the Vanuatu Government to improve product quality through mechanisms such as the development of high-quality tours. One way to enhance product quality is through the provision of appropriate professional training for tourism sector employees, including local tour guides. The paper outlines a tour-guide training programme delivered on the outer islands, which received financial assistance from several foreign aid agencies. The programme is an instructive example of an attempt to implement a human resource strategy in a developing country arising from the recommendations of a national tourism masterplan that sought the active involvement of international funding agencies in the implementation phase. The paper evaluates the effectiveness of the training programme and outlines the challenges of programme delivery. Copyright © 2002 John Wiley & Sons, Ltd. [source] Jordanian baccalaureate nursing students' perception of their learning stylesINTERNATIONAL NURSING REVIEW, Issue 1 2005F. A. Abu-Moghli rn Aim:, The purpose of this descriptive study was to determine Jordanian nursing students' perception of their learning styles. Method:, All nursing students enrolled in four universities offering a baccalaureate degree in nursing at the time of the research project (n = 420) were approached. A structured self-administered questionnaire (Autonomous Learner Index) developed by the researchers was used for data collection. The questionnaire was pilot tested on a sample of nursing students who were not included in the study. The tool was reliable with an alpha coefficient of 0.89. Findings:, The majority of Jordanian nursing students perceived themselves as independent learners. The vast majority of students indicated that they have a desire to learn new things, are curious to learn, and can identify their goal independently. However, a low percentage of students indicated having good study skills, ability to concentrate while studying and using their study time efficiently. The two-tailed t -test indicated no significant differences at alpha 0.05 levels between students' learning preferences and the selected demographic variables. Conclusion:, Based on the study findings, it is suggested that nurse educators should provide positive reinforcement of students' active involvement in the learning process, which will stimulate continued self-direction. Moreover, courses on study skills, writing skills, and literature searching skills should be introduced early in nursing curricula. [source] Older people's expectations regarding ageing, health-promoting behaviour and health statusJOURNAL OF ADVANCED NURSING, Issue 1 2009Su Hyun Kim Abstract Title.,Older people's expectations regarding ageing, health-promoting behaviour and health status. Aim., This paper is a study to explore the influence of expectations regarding ageing on physical and mental health status, and to examine the mediating effects of health-promoting behaviour on the relationship between these expectations and physical and mental health. Background., To achieve healthy ageing, it is necessary for older people to play an active role in maintaining good health. Without any expectations for healthy ageing among older people themselves, encouraging them to participate in health-promoting behaviour and thereby to maintain good health would be unsuccessful. Method., A convenience sample of 99 community-residing Korean older people was surveyed in 2007 via questionnaire using a short version of the Expectations Regarding Aging questionnaire, Health Promoting Lifestyle Profile II, and Medical Outcomes Study 12-item short form. Findings., Having a higher expectation about ageing was associated with better physical and mental health, after adjusting for age, gender and education. Expectations about ageing were partially mediated through the health-promoting behaviour that influenced physical and mental health. Conclusion., It may be necessary for nurses to make an effort to improve older people's expectations about ageing to help them achieve good health. Nursing interventions to improve these expectations need to be used in conjunction with an emphasis on older people's active involvement in health-promoting behaviour. [source] Nutritional care: the effectiveness of actively involving older patientsJOURNAL OF CLINICAL NURSING, Issue 2 2005Preben Ulrich Pedersen RN PhD Aims and objectives., The purpose of the study was to test the effectiveness of nursing care based on active involvement of patients in their nutritional care. It was hypothesized that this type of care could improve energy and protein intake in elder orthopaedic patients. Background., Protein and energy malnutrition and deterioration in nutritional status is a common but neglected problem in hospital patients. Methods., The design was quasi-experimental with an intervention and control group. The study included 253 patients aged 65 and above admitted for hip fracture, hip or knee replacement. Food intake was recorded on a daily basis during the hospital stay. Results., The daily intake of energy increased with 23% (P = 0.001) and of protein with 45% (P = 0.001). The intake increased from the very first day after the operation. The intake of energy and protein was not correlated with the patient's age, body mass index or type of surgery. Conclusions., The care based on patients' active involvement in their own nutritional care and was found to be an effective method to raise the intake of energy and protein among elder orthopaedic patients. Relevance to clinical practice., This way of organizing the care identifies patients who do not consume enough energy and protein according to their current requirements and to take appropriate actions to prevent further malnutrition. [source] Cognitive therapy integrated with life review techniques: an eclectic treatment approach for affective symptoms in older adultsJOURNAL OF CLINICAL NURSING, Issue 1 2004William J. Puentes DNSc Background., An important aspect of nursing theory development has been the adaptation of theory from other disciplines within the metaparadigm of nursing. This eclectic approach to theory development enhances the broad humanistic theory base on which effective, professional nursing practice is based. Aims and objectives., The aim of this article is to describe the process of integrating two distinct psychotherapeutic approaches into one coherent mental health nursing intervention for the treatment of affective symptoms in older adults. Guidelines for using this integration process in psychiatric mental health nursing clinical practice are presented and illustrated through the case study approach. Methods., A case study is presented describing a clinical situation in which life review techniques were used to enhance the outcomes of a cognitive therapy experience for older adults enrolled in outpatient psychotherapy treatment for acute adjustment disorder with an affective component. Conclusions and relevance to clinical practice., The advanced practice psychiatric mental health nurse who approaches psychotherapeutic interventions with older adult clients from an eclectic approach can achieve successful outcomes by having a clear understanding of (i) the dynamics of the various psychotherapeutic approaches, (i) the skill level of the practitioner, (iii) the psychosocial sophistication of the client, and (iv) the pathology being treated. In addition, active involvement by the client in a treatment process that matches his/her psychosocial skill and coping resource level will contribute to effective resolution of pathology. A cognitive therapy approach supplemented by life review techniques is an excellent example of an effective, eclectic treatment approach of affective disorders in older adults. [source] Installing the communities that care prevention system: implementation progress and fidelity in a randomized controlled trialJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2008Rose K. Quinby This article describes the degree to which high fidelity implementation of the Communities That Care (CTC) prevention operating system was reached during the first 18 months of intervention in 12 communities in the Community Youth Development Study, a 5-year group randomized controlled trial designed to test the efficacy of the CTC system. CTC installation in these communities included the delivery of six CTC trainings from certified CTC trainers at each site, the active involvement of locally selected and community-based CTC community coordinators, ongoing monitoring of progress using the CTC milestones and benchmarks, and proactive technical assistance and coaching. CTC implementation fidelity ratings averaged across three groups of raters show that between 89% and 100% of the CTC milestones in the first four phases of CTC implementation were "completely met" or "majority met" in the 12 intervention communities, indicating that the first four phases of the CTC system have been well implemented in the communities in this trial. © 2008 Wiley Periodicals, Inc. [source] WHAT DO ECONOMISTS TELL US ABOUT VENTURE CAPITAL CONTRACTS?JOURNAL OF ECONOMIC SURVEYS, Issue 1 2007Tereza Tykvová Abstract Venture capital markets are characterized by multiple incentive problems and asymmetric information. Entrepreneurs and venture capitalists enter into contracts that influence their behaviour and mitigate the agency costs. In particular, they select an appropriate kind and structure of financing and specify the rights as well as the duties of both parties. The typical features of venture capital investments are an intensive screening and evaluation process, active involvement of venture capitalists in their portfolio companies, staging of capital infusions, use of special financing instruments such as convertible debt or convertible preferred stock, syndication among venture capitalists or limited investment horizon. [source] Relatives of persons with recently discovered serious mental illness: in need of support to become resource persons in treatment and recoveryJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2010K. NORDBY cand. polit. rpn Accessible summary ,,Relatives want the health workers to regard the patient not only as sick but also regard him/her as a person. Parents want to get involved at an early stage and find it important that their opinions and experiences are heard. The staff also express that relatives possess knowledge that should be important for them to receive. ,,The relatives underline the importance of an opening for hope to be present at all time, else you do not have the strength to cope with the situation. No matter how pessimistic the staff are, hope must be expressed. ,,The relatives want to know what happens after discharge. They do not always know what questions to ask before discharge as challenges are discovered gradually. They want to know how to behave and what to say to their family member with a psychiatric illness. When parents can impart their concerns and receive adjusted counselling their level of stress is reduced. ,,It is important to consider relatives as resource persons. The staff consider themselves as experts on psychosis and the parents as experts on their own children. Abstract A considerable amount of research on the treatment of young people suffering from serious mental illnesses states that good collaboration with relatives is essential for reducing relapse, improving recovery and enhancing quality of life for patients and relatives. The aim of this study was to explore and describe what facilitates active involvement for relatives in the treatment and rehabilitation of their family member. The present study is a part of a larger cooperative inquiry project carried out in a mental hospital in southern Norway focusing on improving practices for collaboration with relatives. This sub-study presents results from eight focus group interviews with relatives and staff members. Data were analysed by means of qualitative content analysis. The results showed that the relatives had mostly positive experiences from their encounters with the staff, although some negative experiences were articulated. Both relatives and staff underlined the importance of developing a good encounter characterized by sharing information, giving guidance and support according to the relatives' needs as well as addressing existential issues. This was perceived as a necessary basis for the relatives to become active participants in the treatment and rehabilitation process. To activate this basis, the relatives are dependent on the staff members' ability to convey and nurture hope related to the patient's recovery and quality of life. [source] Active patient involvement in the education of health professionalsMEDICAL EDUCATION, Issue 1 2010Angela Towle Context, Patients as educators (teaching intimate physical examination) first appeared in the 1960s. Since then, rationales for the active involvement of patients as educators have been well articulated. There is great potential to promote the learning of patient-centred practice, interprofessional collaboration, community involvement, shared decision making and how to support self-care. Methods, We reviewed and summarised the literature on active patient involvement in health professional education. Results, A synthesis of the literature reveals increasing diversity in the ways in which patients are involved in education, but also the movement's weaknesses. Most initiatives are ,one-off' events and are reported as basic descriptions. There is little rigorous research or theory of practice or investigation of behavioural outcomes. The literature is scattered and uses terms (such as ,patient'!) that are contentious and confusing. Conclusions, We propose future directions for research and development, including a taxonomy to facilitate dialogue, an outline of a research strategy and reference to a comprehensive bibliography covering all health and human services. Medical Education 2010: 44: 64,74 [source] Unapocalyptic Theology: History and Eschatology in Balthasar's Theo-DramaMODERN THEOLOGY, Issue 2 2001Steffen Lösel In this essay, I evaluate the claim that Hans Urs von Balthasar's interpretation of trinitarian doctrine undermines the importance of history for the Christian God. Where other critics argue that the very distinction between immanent and economic Trinity robs the economy of salvation of theological significance, I contend that the underlying problem lies in how Balthasar restricts the theo-drama to an event between heaven and earth on the cross of Golgotha. Through this limitation of God's active involvement in history to a single event, Balthasar's theo-drama becomes an "unapocalyptic theology", which devalues God's salvific history with the world and the biblical expectation of an eschatological end of history. Furthermore, Balthasar underplays the messianic-political dimension of the Christian concept of salvation and thereby cements the status quo of a yet unredeemed world. [source] Sequential model of phage PRD1 DNA delivery: active involvement of the viral membraneMOLECULAR MICROBIOLOGY, Issue 5 2002A. Marika Grahn Summary DNA translocation across the barriers of recipient cells is not well understood. Viral DNA delivery mechanisms offer an opportunity to obtain useful information in systems in which the process can be arrested to a number of stages. PRD1 is an icosahedral double-stranded (ds)DNA bacterial virus with an internal membrane. It is an atypical dsDNA phage, as any of the vertex spikes can be used for receptor recognition. In this report, we dissect the PRD1 DNA entry into a number of steps: (i) outer membrane (OM) penetration; (ii) peptidoglycan digestion; (iii) cytoplasmic membrane (CM) penetration; and (iv) DNA translocation. We present a model for PRD1 DNA entry proposing that the initial stage of entry is powered by the pressure build-up during DNA packaging. The viral protein P11 is shown to function as the first DNA delivery protein needed to penetrate the OM. We also report a DNA translocation machinery composed of at least three viral integral membrane proteins, P14, P18 and P32. [source] An Active Learning Experience in Health Policy for Baccalaureate Nursing StudentsPUBLIC HEALTH NURSING, Issue 5 2004Mary E. Byrd R.N., Ph.D. Abstract Nurses have the potential to promote the public's health through active involvement in shaping health and social policy. Preparing nursing students to influence public policy is a major component of the curriculum in public/community health nursing. A series of learning experiences was designed to engage students in this process. First, students participate in information sessions at the State Health Department and the State House. This provides them with opportunities to engage in dialogue with public health leaders as well as advocates from both professional organizations and community groups. Next, students identify the legislators who represent them in the community and write a narrative that describes the legislators' interest and commitment to health-related legislation. Lastly, students work in clinical groups to analyze a public health problem that can be addressed through public policy interventions. This has led to the students testifying at legislative hearings and working with community groups involved with the issue. The students present their findings to their peers and to the wider college community. Through these learning experiences, students gain practical experience in understanding the political process that leads to important policy change. This in turn prepares them for their roles as professional nurses and involved citizens. [source] Determinants of integrated product development diffusionR & D MANAGEMENT, Issue 1 2006Todd Boyle Integrated product development (IPD) is an approach for developing new products focused on the early and active involvement of design, manufacturing, marketing and other key new product development (NPD) stakeholders in order to achieve cross-functional integration and concurrent execution of various NPD activities. The benefits of IPD are well known in both the academic literature and popular press, including significant reductions in NPD cycle time and costs. However, in spite of these benefits, for the majority of manufacturing organizations, IPD is not used on 100% of NPD projects. This research develops a model of the organizational contextual factors influencing the diffusion of IPD in organizations. Results of surveying 269 NPD managers indicate that the complexity of certain IPD practices and support for IPD directly influence IPD diffusion, while an innovative organizational climate and the complexity of the organization's NPD activities indirectly influence IPD diffusion through IPD support. [source] International Institutions and Compliance with AgreementsAMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 4 2007Sara McLaughlin Mitchell The ultimate litmus test of compliance theories occurs in situations where states' interests are directly opposed, such as competing interstate claims over territory, maritime areas, and cross-border rivers. This article considers the extent to which the involvement of international institutions in the settlement of contentious issues between states bolsters compliance with agreements that are struck. Institutions may influence the prospects for compliance actively and passively. Active institutional involvement in the conflict management process increases the chances for compliance with agreements, particularly for binding institutional activities, relative to the active involvement of noninstitutional third parties. More passively, joint membership in peace-promoting institutions enhances the likelihood that states will comply with peaceful agreements to resolve contentious issues. Empirical analyses demonstrate the relevance of international institutions for resolving contentious interstate issues both actively and passively, although the results suggest that institutions are more effective conflict managers when they choose binding settlement techniques. [source] Vascular Mimicry of Granulosa Cells: a New Concept of Corpeus Luteum Development?ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 2005R. M. Hirschberg So far, it was generally accepted that newly formed blood vessels are exclusively comprised of endothelial cells, and complemented by pericyte and myocyte recruitment during vessel maturation. Accordingly, participation of non-endothelial cells in the formation of blood vessels has rarely been suggested. Recently, evidence supporting the existence of tumour vessels lined by non-endothelial cells has emerged. Consequently, the concept of the inherent capacity of non-endothelial cells to behave like endothelial cells has been discussed for tumours, and this pathomechanism has been termed vascular mimicry. The corpus luteum is one of the most intensely vascularized tissues, and angiogenesis in the corpus luteum is more effective than in highly malignant tumours. Our results indicate active involvement of granulosa cells in luteal angiogenesis, and the aim of this study was to shed more light on this exciting prospect. The study was based on cultured granulosa cells isolated from the bovine ovary in different stages of follicle maturation. Morphology of angiogenic granulosa cells was studied by phase contrast, transmission electron and scanning electron microscopy. Expression of angiogenesis-regulating factors and their receptors was demonstrated by polymerase chain reaction (RT-PCR). Cultured granulosa cells underwent changes reminiscent of endothelial angiogenesis, i.e., migration, proliferation, differentiation and three-dimensional organization, and expressed angiogenesis-regulating factors and their receptors. Our results suggest a tight regulatory and structural association of endothelial and granulosa cells in luteal angiogenesis, suggesting physiological vascular mimicry in the ovary. [source] Guidelines for patient selection and performance of carotid artery stentingANZ JOURNAL OF SURGERY, Issue 6 2010The Carotid Stenting Guidelines Committee Abstract Background:, The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS. Methods:, We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC). Results:, Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programs. These standards should apply in the public and private health care settings. Conclusion:, These guidelines represent the consensus of an inter-collegiate committee in order to direct appropriate patient selection and the range of cognitive and technical requirements to perform CAS. Advances in endovascular technologies and the results of randomized controlled trials will guide future revisions of these guidelines. [source] Managers' Active Support when Implementing Teams: The Impact on Employee Well-BeingAPPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 3 2009Karina Nielsen Research has shown that a variety of organisational change interventions can be effective but the powerful positive results of an intervention do not always generalise to other similar settings. Problems with implementation and a difficult intervention context have been shown to undermine the effectiveness of promising interventions. The impact that middle managers have on the change process and intervention outcomes has not been widely researched. This longitudinal intervention study was carried out in the elderly care sector in a large Danish local government organisation (N = 188), where poor social support, and lack of role clarity and meaningful work had been identified as significant problems. To tackle these problems, teamwork was implemented, with teams having some degree of self-management. It examined whether middle managers' active support for the intervention mediated its impact on working conditions, well-being and job satisfaction. Structural equation modelling showed that middle managers' active involvement in implementing the change partially mediated the relationship between working conditions at time 1 and time 2. Working conditions at time 2 were in turn related to time 2 job satisfaction and well-being. These results suggest that the degree to which employees perceive their middle managers to play an active role in implementing change is related to intervention outcomes. [source] Mature antigen-experienced T helper cells synthesize and secrete the B cell chemoattractant CXCL13 in the inflammatory environment of the rheumatoid jointARTHRITIS & RHEUMATISM, Issue 11 2008Antonio Manzo Objective Synovial B cells play a critical role in rheumatoid arthritis (RA), being involved in autoantibody synthesis, T cell activation, and cytokine production. CXCL13 is a B cell chemoattractant that is instrumental in synovial B cell organization; the regulatory determinants of CXCL13 in inflammation are poorly characterized. This study was undertaken to investigate the functional involvement of synovial T cells in the ectopic expression of CXCL13 in RA. Methods CXCL13 production and regulation were addressed using immunohistochemistry, in situ hybridization, quantitative polymerase chain reaction, multicolor flow cytometry, and enzyme-linked immunosorbent assay, by in situ,ex vivo analysis and in vitro functional assays with rheumatoid synovial tissue and primary cells. Results CXCL13 messenger RNA and protein expression and spontaneous CXCL13 secretion were detected in RA synovial fluid T cells but were not detected (or were detected only occasionally) in peripheral blood T cells. Analysis of tissue expression confirmed cytoplasm localization of CXCL13 in T lymphocytes infiltrating B cell follicles and small perivascular aggregates. Multicolor characterizations in synovial fluid demonstrated CXCL13 expression in antigen-experienced T helper cells, frequently characterized by terminal differentiation and the lack of the follicular helper T cell markers CXCR5 and BCL6 protein. In vitro functional assays revealed the enhancing effect of T cell receptor,CD28 engagement on CXCL13 production and secretion in primary cells. Conclusion Our findings define a new functional property of synovial T cells, demonstrating their active involvement in the local production of B cell chemoattractants, and support a direct contribution of the adaptive immune system and antigen-dependent signals in the mechanisms of B cell localization in RA. [source] Patient Protection and Affordable Care Act of 2010: Summary, Analysis, and Opportunities for Advocacy for the Academic Emergency PhysicianACADEMIC EMERGENCY MEDICINE, Issue 7 2010Jeffrey A. Kline MD ACADEMIC EMERGENCY MEDICINE 2010; 17:E69,E74 © 2010 by the Society for Academic Emergency Medicine Abstract The Patient Protection and Affordable Care Bill, commonly referred to as the "Health Care Bill" or the "Health Care Reform Bill," was enacted in March 2010. This article is a review and analysis of the sections of this Act that are relevant to researchers and teachers of emergency care. The purpose of this document is to serve as a citable reference for interested parties and a reference to quickly locate the sections of the Bill relevant to academic emergency physicians. When appropriate, text was copied verbatim from the Bill. The source of the downloaded Act, and the page numbers of the text sections, are provided to help the reader to find the sections described. This review is presented in two parts. Part I presents 11 sections extirpated from the Act, with short interpretations of the significance of each section. Part II presents an analysis of the sections that the authors believe represent opportunities for emergency care researchers and teachers to make the most impact, through active involvement with the various departments and agencies of the federal government that will be charged with interpreting and implementing this Act. The Act contains sections that could lead to new funding opportunities for research in emergency care, especially for comparative clinical trials and clinical studies that focus on integration and efficiency of health care delivery. The Act will establish several new institutes, centers, and committees that will create policies highly relevant to emergency care. The authors conclude that this Act can be expected to have a profound influence on research and training in emergency care. [source] Management Support for Portfolio Companies of Venture Capital Firms: An Empirical Study of German Venture Capital InvestmentsBRITISH JOURNAL OF MANAGEMENT, Issue 3 2001Michael Schefczyk To date, there is a dearth of research on strategic antecedents and consequences of management support activities which German venture capital firms (VCFs) provide for the portfolio companies (PCs) they have invested in. This article provides insights regarding such support practices, their main determinants and impacts on the economic performance of PCs. Hypotheses were derived regarding usage of various types of management support, typical functional foci of management support and the influence of VCF and PC characteristics on management support practice. Hypotheses also cover relationships between type, intensity, and frequency of management support and PC performance. Data for 103 PCs of 12 German VCFs indicate the VCFs can improve the performance of their PCs by providing consultative management support, including active involvement in key functional decisions. [source] Listen to me, too!CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2007Lessons from involving children with complex healthcare needs in research about multi-agency services Abstract Background, Children with complex healthcare needs are often excluded, both from active involvement in research projects and from direct consultation in services. During a 3-year research study into multi-agency services for children with complex healthcare needs, the authors involved children in a number of innovative ways and endeavoured to discover what impact, if any, multi-agency working made to them. Methods, The researchers ,spent time' with 18 children with complex healthcare needs. They used a variety of methods to engage with the children in a meaningful way. More than half of the children had no verbal communication, so it was necessary in some cases to work with an advocate, usually the parent, to aid the process. Results, Children with complex healthcare needs can take part in research as long as the research is set up sensitively and flexibly. In terms of the impact of multi-agency working, the authors concluded significant advances had been achieved for this group: almost all the children were living at home and attending school. However, there were significant gaps in addressing children's human rights in relation to communication, independence and relationships. In addition, many of the children had very little effective direct consultation with the multi-agency services. Conclusions, There are significant advances in involving disabled children in research and in service delivery, but there is still some way to go in involving those with complex healthcare needs. The challenges are considerable, but the benefits far outweigh these, not least being the value that parents, carers and the children themselves place upon being listened to. [source] | ||||||||||||||||||||||