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Current Discussions (current + discussion)
Selected AbstractsImplementation of NIAAA College Drinking Task Force Recommendations: How Are Colleges Doing 6 Years Later?ALCOHOLISM, Issue 10 2010Toben F. Nelson Background:, In 2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) College Drinking Task Force issued recommendations to reduce heavy drinking by college students, but little is known about implementation of these recommendations. Current discussion about best strategies to reduce student drinking has focused more on lowering the minimum legal drinking age as advocated by a group of college and university presidents called the Amethyst Initiative than the NIAAA recommendations. Methods:, A nationally representative survey of administrators was conducted at 351 4-year colleges in the United States to ascertain familiarity with and progress toward implementation of NIAAA recommendations. Implementation was compared by enrollment size, public or private status, and whether the school president signed the Amethyst Initiative. Results:, Administrators at most colleges were familiar with NIAAA recommendations, although more than 1 in 5 (22%) were not. Nearly all colleges use educational programs to address student drinking (98%). Half the colleges (50%) offered intervention programs with documented efficacy for students at high risk for alcohol problems. Few colleges reported that empirically supported, community-based alcohol control strategies including conducting compliance checks to monitor illegal alcohol sales (33%), instituting mandatory responsible beverage service (RBS) training (15%), restricting alcohol outlet density (7%), or increasing the price of alcohol (2%) were operating in their community. Less than half the colleges with RBS training and compliance checks in their communities actively participated in these interventions. Large colleges were more likely to have RBS training and compliance checks, but no differences in implementation were found across public/private status or whether the college president signed the Amethyst Initiative. Conclusions:, Many colleges offer empirically supported programs for high-risk drinkers, but few have implemented other strategies recommended by NIAAA to address student drinking. Opportunities exist to reduce student drinking through implementation of existing, empirically based strategies. [source] Mapping global inequalities: Beyond income inequality to multi-dimensional inequalitiesJOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 8 2009Ben Crow Abstract Current discussions of global inequality are trapped by their core reliance on measures of income. While our field has become ever-knowledgeable on poverty's multi-faceted nature (e.g. the Human Development Index, based on Sen and other's work on the capabilities approach), discussions and debates over global inequalities give short shrift to measurements and understandings of inequality beyond income. The papers in this issue all lend insight to how we may start the long-term process of moving beyond income inequality to re-think common understandings of inequality and to present new questions and opportunities in order to work towards a fuller understanding of the shape and pathways of global inequalities. Copyright © 2009 John Wiley & Sons, Ltd. [source] An Economic Analysis of Auto Compensation Systems: Choice Experiences From New Jersey and PennsylvaniaJOURNAL OF RISK AND INSURANCE, Issue 4 2003Joan T. Schmit Nearly since the first automobile traveled on U.S. soil, questions about how best to compensate people injured by their use have been raised. As early as in 1932, in fact, the tort system of imposing costs on negligent drivers was strongly criticized, and a system of compensation without regard to negligence recommended. Yet despite various efforts to identify and implement improved systems during the past more than 70 years, no clear best compensation mechanism has been found. Current discussions have focused on the "choice" system, under which insureds are allowed to select either a tort system or a no-fault system of compensation at the time of insurance purchase. New Jersey and Pennsylvania, which implemented very similar choice programs in 1989 and 1990, respectively, offer an opportunity to observe the effects of choice on outcomes such as: use of attorneys, speed of payment, and consistency (equity) of payment. Our results indicate outcomes consistent with expectations in New Jersey (NJ), which switched from no-fault to choice, but inconsistent with expectations in Pennsylvania (PA), which switched from tort to choice. Furthermore, analysis of tort versus no-fault selectors postchoice in New Jersey and Pennsylvania does not offer clear evidence of no-fault's lower administrative costs and speedier, more equitable payment in these jurisdictions. [source] RESPONSES OF ECONOMIC SYSTEMS TO ENVIRONMENTAL CHANGE: PAST EXPERIENCESAUSTRALIAN ECONOMIC HISTORY REVIEW, Issue 1 2010Jean-Pascal Bassino climate change; economic systems; environment; institutions; markets Current discussions of climate change are overly focused on the science underpinning environmental impact, with little attention to socioeconomic consequences. The economics of environmental change in particular is insufficiently informed by the lessons that past experiences can yield. Drawing on case studies from Europe and Asia, this special issue underlines the importance of historical context, as well as markets, institutions, technology, and the role of international trade in understanding how economic systems have responded to environmental changes. Past economies have responded dynamically to environmental change rather than simply constrained deterministically by the climatic and ecological events that have engulfed them. [source] The Influence of Critical Care Medicine on the Development of the Specialty of Emergency Medicine: A Historical PerspectiveACADEMIC EMERGENCY MEDICINE, Issue 9 2005David Somand MD Abstract Through their largely concurrent development, the specialties of emergency medicine and critical care medicine have exerted a great deal of influence on each other. In this article, the authors trace the commonalities that emergency medicine and critical care medicine have shared and report on the historical relationship between the two specialties. As issues between emergency medicine and critical care medicine continue to emerge, the authors hope to inform the current discussion by bringing to light the controversies and questions that have been debated in the past. [source] Skin bleaching: highlighting the misuse of cutaneous depigmenting agentsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2009OE Dadzie Abstract Hydroquinone and other cutaneous depigmenting agents are widely used by dermatologists to treat pigmentary disorders. On 29 August 2006, the US Food and Drug Administration (FDA) published a monograph in the US Federal Register proposing to ban all hydroquinone products that have not been approved via a New Drug Application process. Reports in the scientific literature on the occurrence of exogenous ochronosis, in relation to the use of hydroquinone, was one of the concerns expressed by the FDA in relation to this agent. However, a review of the English-language scientific literature reveals that most of the reported cases of hydroquinone-induced exogenous ochronosis occurs in Africa, where the cultural practice of skin bleaching is highly prevalent. Skin bleaching is the practice of applying hydroquinone and/or other depigmenting agents to specific or widespread areas of the body, the primary function being to lighten normally dark skin. This practice typically occurs in men and women with Fitzpatrick skin phototypes IV to VI. It is a dangerous practice associated with a diverse range of side-effects, including mercury poisoning. Thus, this current discussion within the dermatological community on the safety of hydroquinone provides a unique opportunity to raise awareness about skin bleaching. [source] Baddeley revisited: The functional approach to autobiographical memoryAPPLIED COGNITIVE PSYCHOLOGY, Issue 8 2009Susan Bluck In Baddeley's (1988) classic article he challenged researchers to take a functional approach by asking, for their phenomenon of interest, "but what the hell is it for?" In twenty years, how far has the field advanced in addressing this question, particularly in examining the functions of autobiographical memory? This introductory article provides an overview of the functional approach. Next, eight core articles appear, each framed to address Baddeley's question. The core articles are written by experts on distinct empirically established autobiographical memory phenomena: each presents a synopsis of current research in their area and then examines the function that their specific autobiographical memory phenomenon serves in human activity and adaptation. The issue ends with two commentaries by scholars who provide analyses of the functional approach from unique perspectives. Revisiting Baddeley provides an opportunity for a current discussion of the strengths and challenges of taking a functional approach to autobiographical memory. Copyright © 2009 John Wiley & Sons, Ltd. [source] Results from the International Cataract Surgery Outcomes StudyACTA OPHTHALMOLOGICA, Issue thesis2 2007Jens Christian Norregaard MD Abstract It is widely accepted that cataract extraction with intraocular lens implantation is a highly effective and successful procedure. However, quality assessments and studies of effectiveness should still be undertaken. As with any surgical treatment modality, complications may occur, leading to suboptimal outcomes, additional health costs and deterioration in patients' functional capacity. International variation in clinical practice patterns and outcomes can serve as important pointers in the attempt to identify areas amenable to improvements in quality and cost-effectiveness. Once demonstrated, similar clinical results obtained in different health care systems can improve the level of confidence in a clinical standard against which the quality of care can be evaluated. The International Cataract Surgery Outcomes Study was established in 1992. The objective of this international comparative research project was to compare cataract management, outcomes of surgery and quality of care in four international sites. The study was conducted in the 1990s, since when many developments and refinements have emerged within cataract surgery. The actual figures reported in this thesis may no longer be of specific relevance as a decade has passed since their collection. However, the research questions and methods used in the study are still highly important and justify the publication of this report. The report deals with problems related to quality assessment, benchmarking, and the establishment and design of nationwide clinical databases , issues that are currently the focus of much attention. Moreover, the problems related to cross-national comparisons are increasingly relevant as more international databases are established. The study makes suggestions on how to report and compare objective as well as subjective criteria for surgery. The issue of how to report subjective criteria is a particular subject of current discussion. Four sites with high-quality health care systems were examined in this study: the USA, Denmark, the Province of Manitoba (Canada), and Barcelona (Spain). The design of the international research programme was based on methods developed by the US National Cataract Surgery Outcomes Study conducted by the US Cataract Patients Outcomes Research Team. The International Cataract Surgery Outcomes Study comprised three separate studies: a survey of ophthalmologists; a prospective cohort study, and a retrospective register-based cohort study. The survey study was based on data generated by a self-administered questionnaire completed by ophthalmologists in the four study areas. The questionnaire examined routine clinical practice involving patients considered for cataract surgery, and included questions on anaesthesia, monitoring and surgical techniques. The prospective cohort study was a large-scale, longitudinal observational study of patients undergoing first-eye cataract surgery in each study site. Patients were sampled consecutively from multiple clinics and followed for 4 months postoperatively. The retrospective cohort study was based on the Danish National Patient Register and claims data from the USA. This study could not be carried out in Barcelona or Manitoba as no suitable administrative databases were available. The papers based on register databases deal with retinal detachment and endophthalmitis but are not included in this thesis as the material was previously reported in my PhD thesis. The application of the studies was highly co-ordinated among the four sites and similar methods and instruments were used for data collection. The development of the data collection strategy, questionnaires, clinical data forms and data analyses were co-ordinated through weekly telephone conferences, annual in-person conferences, correspondence by mail or fax, and the exchange of sas programs and data files via the Internet. The survey study was based on responses from 1121 ophthalmologists in the four sites and results were presented in two papers. Within the previous year the participating ophthalmologists had performed a total of 212 428 cataract surgeries. With regard to preoperative ophthalmic testing, the present study reveals that refraction, fundus examination and A-scanning were performed routinely by most surgeons in all four sites. Other tests were reported to be performed routinely by some surgeons. It is unclear why any surgeon would use these other tests routinely in cataract patients with no ocular comorbidity. It appears that if this recommendation from the US Clinical Practice Guidelines Panel was broadly accepted, the use of these procedures and costs of care could be reduced, especially in Barcelona, the USA and Canada. Restricted use of medical screening tests was reported in Denmark. If this restricted screening were to be implemented in the USA, Canada and Barcelona, it would have significant resource implications. The most striking finding concerned the difference in monitoring practice between Denmark and each of the other three sites. In Denmark, monitoring equipment is seldom used and only occasionally is an anaesthesiologist present during cataract surgery. By contrast, in the other study sites, the presence of an anaesthesiologist using monitoring equipment is the norm. Adopting the Danish model in other sites would potentially yield significant cost savings. The results represent part of the background data used to inform the decision to conduct the two large-scale, multicentre Studies of Medical Testing for Cataract Surgery. The current study is an example of how surveys of clinical practice can pinpoint topics that need to be examined in randomized clinical trials. For the second study, 1422 patients were followed from prior to surgery until 4 months postoperatively. Preoperatively, a medical history was obtained and an ophthalmic examination of each patient performed. After consent had been obtained, patients were contacted for an in-depth telephone interview. The interview was repeated 4 months postoperatively. The interview included the VF-14, an index of functional impairment in patients with cataract. Perioperative data were available for 1344 patients (95%). The 4-month postoperative interview and clinical examination were completed by 1284 patients (91%). Main reasons for not re-evaluating patients were: surgery was cancelled (3%); refusal to participate (2%); lost to follow-up (1%), and death or being too sick (1%). The results have been presented in several papers, of which four are included in this thesis. One paper compared the preoperative clinical status of patients across the four sites and showed differences in both visual acuity (VA) and VF-14 measures. The VF-14 is a questionnaire scoring disability related to vision. The findings suggest that indications for surgery in comparable patients were similar in the USA and Denmark and were more liberal than in Manitoba and Barcelona. The results highlight the need to control for patient case mix when making comparisons among providers in a clinical database. This information is important when planning national databases that aim to compare quality of care. A feasible method may be to use one of the recently developed systems for case severity grading before cataract surgery. In another paper, perioperative clinical practice and rates of early complications following cataract surgery were compared across the four health care systems. Once again, the importance of controlling for case mix was demonstrated. Significant differences in clinical practice patterns were revealed, suggesting a general trend towards slower diffusion of new medical technology in Europe compared with North America. There were significant differences across sites in rates of intra- and early postoperative events. The most important differences were seen for rates of capsular rupture, hyphaema, corneal oedema and elevated pressure. Rates of these adverse events might potentially be minimized if factors responsible for the observed differences could be identified. Our results point towards the need for further research in this area. In a third paper, 4-month VA outcomes were compared across the four sites. When mean postoperative VA or crude proportions of patients with a visual outcome of <,0.67 were compared across sites, a much poorer outcome was seen in Barcelona. However, higher age, poorer general health status, lower preoperative VA and presence of ocular comorbidity were found to be significant risk factors associated with increased likelihood of poorer postoperative VA. The proportions of patients with these risk factors varied across sites. After controlling for the different distributions of these factors, no significant difference remained across the four sites regarding risk of a poor visual outcome. Once again the importance of controlling for case mix was demonstrated. In the fourth paper, we examined the postoperative VF-14 score as a measure of visual outcomes for cataract surgery in health care settings in four countries. Controlling for case mix was also necessary for this variable. After controlling for patient case mix, the odds for achieving an optimal visual function outcome were similar across the four sites. Age, gender and coexisting ocular pathology were important predictors of visual functional outcome. Despite what seemed to be an optimal surgical outcome, a third of patients still experienced visual disabilities in everyday life. A measure of the VF-14 might help to elucidate this issue, especially in any study evaluating the benefits of cataract surgery in a public health care context. [source] LAND-USE DYNAMICS BEYOND THE AMERICAN URBAN FRINGE,GEOGRAPHICAL REVIEW, Issue 3 2001DAVID M. THEOBALD ABSTRACT. A deficiency common to both the historical debates over loss of agricultural land and the current discussions of urbanization and sprawl is a limited understanding of land-use dynamics beyond the urban fringe. Data aggregated at the county level poorly capture the fine-grained pattern of land-use change beyond the dynamic urban-rural interface. Furthermore, current urban-based definitions are poorly suited to delineate these areas, and low-density, exurban land use is difficult to measure using existing land-cover databases. Urbanization and the conversion of once-agricultural or other natural resource lands to other uses has traditionally been tracked using urban areas, as delimited in the U.S. census. Urban densities are typically defined as areas with more than 1,000 people per square mile, or 1.6 people per acre (U.S. Census Bureau 2000). Assuming an average of 2.5 people per housing unit, this translates to roughly 0.7 units per acre, or approximately 1 unit per 1.6 acres. The analytical units used in the census, however, both overbound and underbound areas with urban densities. About one-third of urban areas in 1990 comprised lower-than-urban housing density, thanks to overbounding. But, then, one-third of locations that had urban-level housing densities failed to be included in urban areas as a result of underbounding, which, if counted, would have constituted another 18 million acres of urban area. An increase over time of the average number of acres required per housing unit in exurban and higher-density locations occurred in roughly one-third of U.S. counties from 1960 to 1990 and persisted from 1990 to 2000. In 2000 roughly 38 million acres were settled at urban densities, and nearly ten times that much land was settled at rates from low, exurban density (as low as one house per 40 acres) to higher rates (up to one per 10 acres). This represents a continuing encroachment on land previously given over to other uses,habitat or agriculture. Practitioners of natural resource management need to recognize the ubiquity of exurban development and better incorporate the fine-scale patterns of land use beyond the urban fringe. [source] What Is Ecological Validity?INFANCY, Issue 4 2001A Dimensional Analysis Ecological validity has typically been taken to refer to whether or not one can generalize from observed behavior in the laboratory to natural behavior in the world. Although common in current discussions of research, the idea of ecological validity has a long history in psychological thought. A brief historical examination of this idea reveals that concerns with ecological validity are evident in multiple dimensions of experimental work, including the nature of the experimental setting, the stimuli under investigation, and the observer's response employed as the measure. One problem with this multidimensionality, however, is that no explicit criteria have been offered for applying this concept to an evaluation of research. One consequence of this problem is that concerns with ecological validity can be raised in most experimental situations. This article includes a discussion of some demands of ecological validity and the nature of these different dimensions, as well as a critical evaluation of research on the development of mobility with respect to these constraints. [source] Current situation of German care homesINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 4 2008Barbara Klein Dipl-Soz, Dr. Phil Aim., The aim of this paper is to explore the situation of and current developments in the German care home sector. Background., Germany, like other Western countries, faces demographic change and subsequently tries to develop structures and processes to achieve a care system which can tackle the increasing number of people in need of care with a variety of quality services. Policy strives to set up structures and instruments to enhance the quality of service provision. Discussion., Figures show that the structures in the care sector are changing in favour to increased privatization of homes, a slight increase in size and improved building structures. In order to tackle the expected changes, a mix of low and high skilled qualification and new job profiles arise in the care sector. Other changes to be observed are the development of new living arrangements and the utilization of new technologies to support the care process. Conclusion., This contribution looks at the socio-demographic changes in care, the statutory developments and the structures of care homes as well as current discussions on future developments. [source] Beauty Spot, Blind Spot: Romantic WalesLITERATURE COMPASS (ELECTRONIC), Issue 3 2008Mary-Ann Constantine Romantic-period Wales was a fascinating place: part literary construct, part tourist destination, it appears in the work of many writers as a locus of alternative possibilities, both political and personal. Welsh landscape, language and literature attracted poets, artists, antiquarians and historians alike, and an energetic literary cultural revival within Wales produced a rich blend of texts, legends and fabrications which would inspire makers of both fiction and history on either side of the border. The questions of national and cultural allegiance at the heart of this revival are of profound importance to current discussions of ,British' identity, particularly in the light of so-called ,four nations' criticism. This article argues that the Welsh contribution to British Romanticism has been seriously neglected by Romantic studies in general. It suggests reasons for this neglect, surveys recent work in the field, and points to future possible directions for research. [source] Optimization and its discontents in regulatory design: Bank regulation as an exampleREGULATION & GOVERNANCE, Issue 1 2010William H. Simon Abstract Economists and lawyers trained in economics tend to speak about regulation from a perspective organized around the basic norm of optimization. In contrast, an important managerial literature espouses a perspective organized around the basic norm of reliability. The perspectives are not logically inconsistent, but the economist's view sometimes leads in practice to a preoccupation with decisional simplicity and cost minimization at the expense of complex judgment and learning. Drawing on a literature often ignored by economists and lawyers, I elaborate the contrast between the optimization and reliability perspectives. I then show how the contrast illuminates current discussions of the reform of bank regulation. [source] Lost in the field: ensuring student learning in the ,threatened' geography fieldtripAREA, Issue 1 2010Clare Herrick As a result of its importance to the discipline's identity and epistemology, the nature of fieldwork and the fieldtrip itself have recently come under close scrutiny in the education and geographical literature. Moreover, not only is their pedagogical importance being debated, but also their future viability at a time of increasing pressure on institutions to minimise potential risk situations in the field, offer value for money to students as well as following the increasingly common and popular trend of long-haul fieldtrips. This paper therefore critically interrogates the role and use of fieldwork within geographical teaching and learning in the light of its changing and increasingly contested status within the discipline in three parts. First, it outlines and reflects upon the current debate surrounding the threat to the primacy of fieldtrips in geography at a time of ongoing upheaval in higher education. Second, through the empirical example of personal experiences teaching on second-year undergraduate urban geography fieldtrips to San Francisco in December 2007 and 2008, the paper engages with the current discussions of the pedagogical importance of fieldtrips. Third, the paper asks, to what extent teaching in ,the field' might foster the ,experiential' or ,active' learning needed to inspire the kind of ,deep learning' approaches that hold the kind of ,transformative' potential envisaged as a key goal of education more broadly. Through exploring these ideas with reference to recent and relevant experience, the paper aims to critically interrogate the role and value of fieldtrips at a time when their potential demise is being cast as a fundamental assault on geography's founding identity and pedagogical traditions. The paper concludes that despite the threats it faces, the pedagogical significance of fieldwork means that it must remain a fundamental tenet of the geographical educational experience. [source] | |||||||||||||