Home About us Contact
|
Home About us Contact | ||
|
|
||
Secondary Goal (secondary + goal)
Selected AbstractsDefense of Breast Cancer Malpractice ClaimsTHE BREAST JOURNAL, Issue 2 2001FACOG, Samuel Zylstra MD Abstract: The goal of this study was to determine whether factors associated with the successful defense and cost of malpractice cases involving the failure to diagnose breast cancer could be identified in medical and legal records. Secondary goals were to develop a multidisciplinary clinical algorithm utilizing National Comprehensive Cancer Network (NCCN) practice guidelines with practitioner risk management strategies. Physician deviations from these guidelines were tracked to identify high-risk areas in the diagnosis of breast cancer. A multidisciplinary clinical algorithm was introduced and practitioner risk management issues were addressed. In this study specific medical, legal, and cost factors were retrospectively abstracted and analyzed to identify associations between medical and legal factors and medicolegal outcome. ProMutual handled 156 malpractice cases involving breast cancer between January 22, 1986, and November 20, 1997. Of the total, 124 cases involving 212 defendants were closed. The closed cases were analyzed, using multivariable stepwise logistic and linear regression, to identify associations between clinical factors and case outcome. Women's health practitioners (WHPs), including obstetrician-gynecologists (OB-GYNs), family medicine, and internal medicine clinicians, were the largest group of defendants (97). Others included radiologists (43), surgeons (33), and pathologists (3). OB-GYNs accounted for 31% of these defendants, with a cost of more than $16 million. The greatest number of specialists represented in the open cases were radiologists, with 38% of the total. The defense model predicts that the probability of successful defense is lessened with inadequate record keeping, a patient that has metastasis and is alive, and a delay in diagnosis of 12 months or more. The overall indemnity model predicts a higher indemnity with the spread of disease at the time of evaluation, a patient who has metastasis and is alive, and a date of occurence closer to the present. Indemnity is less in patients who have had a lymph node dissection, who have died, or who are alive without metastasis. The WHP model predicts an increased overall indemnity with the spread of disease at the time of evaluation and the presence of a mass without pain. Indemnity decreases with a history of pregnancy, absence of presenting symptoms, or presentation with pain with or without a mass, and the performance of a lymph node dissection. [source] Posttraumatic stress disorder and the perceived consequences of seeking therapy among U.S. Army special forces operators exposed to combatJOURNAL OF PSYCHOLOGICAL ISSUES IN ORGANIZATIONAL CULTURE, Issue 1 2010Jessica M. Espinoza Psy.D. The goal of this study was to ascertain the level of PTSD symptoms experienced by Special Forces Operators (SFOs) who have been exposed to combat and compare these rates to the PTSD rates of the general U.S. population and general military population. A secondary goal was to discover whether SFOs were aware that therapy was available to them through the U.S. Army and, if so, whether they would seek this therapy for PTSD. The last goal was to discover whether SFOs who chose not to seek therapy while still serving did so because they feared negative consequences. Data were collected from 68 SFOs who had been exposed to combat. Results indicated that SFOs are experiencing symptoms of PTSD at a rate that is higher than that of the general U.S. population and somewhat lower than that of the general military population. Also, results indicated that a large percentage of the sample would not seek treatment for PTSD due to perceived negative consequences. [source] Ramifications of North Korean Leader Kim Jong Il ,s Declaration of Independence from the International CommunityPACIFIC FOCUS, Issue 2 2006C. Kenneth Quinones The United States and Japanese governments' reactions to North Korea's launching of several ballistic missiles in early July 2006 was either completely misunderstood by North Korea watchers in Washington and Tokyo, are they simply preferred to ignore yongyang's underlying motives. Actually, North Korea has been relatively transparent about its intentions regarding not just its ballistic missile but also nuclear programs. Since February 2005, ranking North Korean officials and Foreign Ministry spokesmen have made it North Korea's intentions clear. It aspires to strengthen its "deterrence capability." In other words, North Korea is striving to counter the US-Japan alliance by matching its military capability not just with conventional but also nuclear weapons. The United States and Japan need to recognize this. Otherwise, their efforts to compel North Korea's submission using economic pressure will back fire. Pyongyang's priority is national defense through deterrence. Economic revitalization is a secondary goal. As the United States concentrates on the Middle East and gradually withdraws from Northeast Asia, Japan would do well to assess its relations with its neighbors China and the two Koreas. If Japan's new prime minister perpetuates Japan's commitment to the US-Japan alliance, it could find itself increasingly estranged from its neighbors. This became evident when Japan clashed with China over the UN resolution that censured North Korea's missile launchings. Japan's stance regarding issues rooted in history, such as prime ministerial visits to Yasukuni Shrine, if unaltered, will intensify Japan's isolation in Northeast Asia. This will work to North Korea's benefit. [source] Skin Cancer Prevention in the Primary Care Setting: Assessment Using a Standardized PatientPEDIATRIC DERMATOLOGY, Issue 2 2007M.P.H., Robin L. Hornung M.D. A secondary goal was to test the feasibility of this technique as a measure of actual physician behaviors in the outpatient setting. We used a convenience sample of 15 primary care physicians. The standardized patient was an 18-year-old woman with skin phototype I. She presented to physicians as needing a general physical examination for a summer lifeguard job at a beach. She stated a family history of skin cancer. Physician performances were rated using a standard checklist completed by the standardized patient following each visit. We found that none of the physicians asked questions specifically related to skin phototype or sun exposure habits such as childhood sunburns. Only 13% asked about mole changes. For counseling, 67% of physicians recommended sunscreen use; only 7% discussed sunscreen types or procedures for effective use. Only 13% counseled other skin protective behaviors. No significant differences by physician gender were found in these areas; however, female physicians counseled more global health behaviors than male physicians (p , 0.01). Our pilot data suggest that little skin cancer primary prevention counseling is performed for high-risk patients. The standardized patient technique worked well in obtaining outcome data for physicians' preventive practices. [source] Why Induction Is No Cure For BaldnessPHILOSOPHICAL INVESTIGATIONS, Issue 4 2004Yuval Dolev The paper aims at establishing that the premises of both the inductive and the multi-premised versions of the sorites argument are not apparently acceptable and that, therefore, sorites-type arguments do not constitute logical or conceptual paradoxes. Rather, it is suggested that such arguments are most properly and fruitfully described as skeptical challenges. A secondary goal of the paper is to focus attention to the unduly neglected inductive version of the argument. [source] Differences between peer victimization in cyber and physical settings and associated psychosocial adjustment in early adolescencePSYCHOLOGY IN THE SCHOOLS, Issue 10 2009Allison G. Dempsey The increasing use of cyberspace as a social networking forum creates a new medium for youth to become victims of peer aggression. This study used factor analysis techniques to confirm whether survey questions about frequency of cyber victimization formed a distinct latent construct from questions about relational and overt victimization information in a large (N = 1,665) sample of middle school students. A secondary goal was to relate experiences of cyber victimization to symptoms of depression and social anxiety. Results indicate that cyber victimization is separate latent factor from overt and relational victimization. Experiences of cyber victimization were weakly associated with symptoms of social anxiety, but not depression. These results signify that cyber victimization deserves future empirical and clinical attention. © 2009 Wiley Periodicals, Inc. [source] Further analysis of the population history of ancient EgyptiansAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 2 2009Michael A. Schillaci Abstract The origins of state formation in ancient Egypt have been the focus of recent research utilizing biological data to test hypotheses regarding in situ development of local groups, or large-scale in-migration, possibly by an invading army. The primary goal of the present research is to further test these hypotheses. Our secondary goal is to compare different distance measures and assess how they might affect interpretation of population history. We analyze craniodental nonmetric data using several different measures of biological distance, as well as a method for estimating group diversity using multidimensional scaling of distance estimates. Patterns of biological variation and population relationships were interpreted in temporal and geographic contexts. The results of our analyses suggest that the formation of the ancient Egyptian state likely included a substantial in situ process, with some level of contribution by outside migrants probable. The higher level of population structure in Lower Egypt, relative to Upper Egypt, suggests that such influence and migration by outsiders may not have been widespread geographically. These findings support, but serve to refine further those obtained by the second author in a previous study. Moreover, our comparison of distance measures indicates that the choice of measure can influence identification and interpretation of the microevolutionary processes shaping population history, despite being strongly correlated with one another. Am J Phys Anthropol 2009. © 2009 Wiley-Liss, Inc. [source] A functional magnetic resonance imaging study of cortical asymmetry in bipolar disorderBIPOLAR DISORDERS, Issue 3 2004Michael P Caligiuri Objectives:, Individuals with bipolar disorder (BPD) exhibit motor, perceptual, and cognitive disturbances involving predominantly right hemisphere dysfunction. This asymmetry has been used to advance the hypothesis that the pathogenesis of bipolar disorder may be related to disturbances of the right cerebral hemisphere. We employed functional magnetic resonance imaging to examine hemispheric asymmetries in manic and depressed BPD. A secondary goal of the study was to examine effects of psychotropic medications on blood volume changes in the motor cortices. Methods:, We studied 18 right-handed BPD and 13 right-handed normal healthy comparison subjects. Blood oxygen level dependent (BOLD) responses in the primary motor area (M1) and supplementary motor area (SMA) of both hemispheres were elicited during reaction time (RT) tasks. Results:, Healthy subjects activated the SMA in a reciprocal fashion with significantly greater activity in the left SMA for right hand trials and the right SMA for left hand trials. Depressed BPD subjects failed to show this normal reciprocity indicating a failure to suppress unwanted activity in the ipsilateral right SMA, whereas manic BPD subjects failed to suppress unwanted ipsilateral SMA activity in both hemispheres. Manic and depressed BPD subjects exhibited greater activity in the left primary motor area suggesting increased cortical excitability. BPD subjects treated with antipsychotics or mood-stabilizing medications exhibited longer RTs, lower BOLD responses in M1 and SMA, and a loss of normal hemispheric asymmetry in the SMA than untreated subjects. Conclusions:, The presence of a right hemisphere disturbance in BPD is consistent with the hypothesis that the right hemisphere may be dominant in mood regulation. The presence of both left and right hemisphere disturbances in mania may explain the coexisting psychotic and affective symptoms observed in this condition. [source] A sociotechnical approach to achieve zero defect manufacturing of complex manual assembliesHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 2 2007Kitty Hong Traditional approaches to defect reduction in manufacturing environments rely heavily on the introduction of technology-based detection techniques that require significant investments in equipment and technical skills. In this article, the authors outline a novel, alternative approach that utilizes the largely untapped abilities of assembly-line operators. Targeting zero-defect manufacturing, the SEISMIC (stabilize, evaluate, identify, standardize, monitor, implement, and control) methodology developed herein is a sociotechnical-based system built on the decentralization of technical knowledge and the transfer of responsibility for product quality from technical staff to manual operators. Along with defect reduction, important secondary goals of the SEISMIC methodology are improved operator performance and job satisfaction. The SEISMIC methodology provides a quantitative approach for classifying assembly environments and determining their required skill sets. Effective methods for transferring the identified skills throughout the production team are also provided. A pilot application of the protocol in an automotive assembly environment has achieved promising results in the target areas of defect reduction and operator performance. © 2007 Wiley Periodicals, Inc. Hum Factors Man 17: 137,148, 2007. [source] Clinical and metabolic evaluation of subjects with erectile dysfunction: a review with a proposal flowchartINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 3 2009C. Foresta Summary Erectile function is a haemodynamic phenomenon depending on the integrity of neurological, vascular, endocrinological, tissue (corpora cavernosa), psychological and relational factors; changes in any one of these components may lead to erectile dysfunction (ED). ED and its comorbid conditions share common risk factors such as endothelial dysfunction, atherosclerosis and metabolic and hormonal abnormalities. Furthermore, although cross-sectional studies have shown a clear age-dependent association between ED, diabetes mellitus, hypertension, metabolic syndrome (MetS) and cardiovascular diseases, longitudinal evidence has recently emphasized that ED could be an early marker of these conditions. Recently, the European Association of Urology and American Urology Association provided consensus guidelines for the management of ED patients. However, the metabolic aspect of ED is rather neglected or not sufficiently treated. In this study, more emphasis will be placed on the presence of ED comorbid metabolic factors. The primary and secondary goals of therapy, according to current guidelines and to prevent their clinical evolution, will also be provided. We review the concepts of metabolic diseases related to ED and their treatment. Criteria for the diagnosis and treatment of hypogonadism, metabolic and vascular disease related to ED were analysed. ED can mark the starting point for the evaluation and prevention of significant severe diseases (such as diabetes, MetS, dyslipidaemia, arteriosclerosis, hypertension, ischaemic cardiopathy, neuropathy, etc.) hitherto unknown by the patients. Most widely used criteria for the diagnosis and treatment of these diseases were reported. We suggest a clinical approach which allows the identification of metabolic and others systemic pathologies contributing to the development of ED. This approach may constitute an improvement in disease prognosis and either induce a spontaneous reduction of ED or facilitate its specific therapy. [source] | |||||||||||||