Home About us Contact
|
Home About us Contact | ||
|
|
||
Extensive Experience (extensive + experience)
Selected AbstractsFrom Adjuvant Therapy to Breast Cancer Prevention: BCPT and STARTHE BREAST JOURNAL, Issue 3 2001Barbara K. Dunn MD Abstract: The continued widespread prevalence of breast cancer supports placing a high priority on research aimed at its primary prevention, particularly among women who are at increased risk for developing this disease. The suggestion of potential agents for the primary chemoprevention of breast cancer evolved out of the treatment setting. Extensive experience with tamoxifen, a first-generation selective estrogen receptor modulator (SERM) showing efficacy, first, in the treatment of advanced breast cancer and, subsequently, as adjuvant therapy for early stage disease established the safety of this agent. Cumulative data from multiple adjuvant studies documented the efficacy of tamoxifen in reducing second primary breast cancers in the contralateral breast, supporting its potential as a chemopreventive agent for breast cancer. The safety and second primary data on tamoxifen, together with extensive information on its pharmacokinetics, metabolism, and antitumor effects, as well as its potentially beneficial effects on lipid metabolism and osteoporosis, led the National Surgical Adjuvant Breast and Bowel Project (NSABP) to select tamoxifen for testing in the first prospective randomized phase III trial of the efficacy of a chemopreventive agent for preventing breast cancer in women at increased risk of the disease. Accordingly, in 1992 the NSABP started the Breast Cancer Prevention Trial (P-1) in which 13,388 women 35 years of age who were at increased risk of breast cancer according to Gail model risk factors [family history, age, and personal history (i.e., age at first birth, age at menarche, previous breast biopsies)] were randomized to tamoxifen 20 mg/day or placebo for 5 years. Through 69 months of follow-up tamoxifen reduced the risk of invasive breast cancer, primarily estrogen receptor-positive tumors, by 49% (two-sided p < 0.00001). Tamoxifen reduced the risk of noninvasive breast cancer by 50% (two-sided p < 0.002). In addition, tamoxifen reduced fractures of the hip, radius, and spine, but it had no effect on the rate of ischemic heart disease. As previously shown, the rates of endometrial cancer and vascular events increased with tamoxifen. With the P-1 results establishing tamoxifen as the standard of care for the primary chemoprevention of breast cancer in high-risk women, concern over the side effects of tamoxifen has prompted a continuing search for an agent that displays a more desirable efficacy/toxicity profile. Raloxifene, a second-generation SERM approved for the prevention of osteoporosis in postmenopausal women, displays antiestrogenic properties in the breast and possibly the endometrium, and estrogenic effects in the bone and on the lipid profile, suggesting it as a candidate for comparison with the chemopreventive standard, tamoxifen. Raloxifene will be compared to tamoxifen in an equivalency trial, the Study of Tamoxifen and Raloxifene (STAR) NSABP P-2, which began in July 1999 at almost 500 centers in North America. The plan is to randomize 22,000 postmenopausal women 35 years of age at increased risk of breast cancer by Gail criteria to tamoxifen 20 mg/day or raloxifene 60 mg/day for 5 years. Study endpoints include invasive and noninvasive breast cancer, cardiovascular disease, endometrial cancer, bone fractures, and vascular events. [source] Tolerogenic Dendritic Cells: All Present and Correct?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010A. W. Thomson Although well-recognized for their sentinel role and, when activated, their immunostimulatory function, bone marrow-derived dendritic cells (DC) possess inherent tolerogenic (tol) ability. Under quiescent conditions, these cells maintain central and peripheral self tolerance. When appropriately conditioned, in vitro or in vivo, they inhibit innate and adaptive immunity to foreign antigens, including memory T-cell responses. This suppressive function is mediated by various mechanisms, including the expansion and induction of antigen-specific regulatory T cells. Extensive experience in rodent models and recent work in nonhuman primates, indicate the potential of pharmacologically-modified, tol DC (tolDC) to regulate alloimmunity in vivo and to promote lasting, alloantigen-specific T-cell unresponsiveness and transplant survival. While there are many questions yet to be addressed concerning the functional biology of tolDC in humans, these cells offer considerable potential as natural, safe and antigen-specific regulators for long-term control of the outcome of organ and hematopoietic cell transplantation. This minireview surveys recent findings that enhance understanding of the functional biology and therapeutic application of tolDC, with special reference to transplantation. [source] How can you help organizations change to meet the corporate responsibility agenda?CORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 3 2004David Lyon As corporate responsibility (CR) has developed over the past decade, companies have developed and communicated their formal values relating to environment, employees, stakeholders and governance through public statements. Many of these companies have produced formal reports covering their performance on environmental and social issues. Continued improvement and delivery of commitments depends on buy-in not just from senior management (and the CR manager), but from managers and staff across the organization. This is only possible if there is a culture that is supportive of corporate responsibility. One key aspect of making this change is understanding how the company's culture affects corporate responsibility performance. This paper discusses some areas of organizational culture that affect CR performance including rewards and recognition, learning and managing change, awareness and involvement, questioning culture and flexibility underpinned by mutual respect. It also provides an overview of our approach for assessing and fostering a supportive culture. This is based on working with clients to manage their licence to operate in addition to extensive experience in innovation culture and safety culture. Copyright © 2004 John Wiley & Sons, Ltd and ERP Environment. [source] Plasticity of ability to form cross-modal representations in infant Japanese macaquesDEVELOPMENTAL SCIENCE, Issue 3 2009Ikuma Adachi In a previous study, Adachi, Kuwahata, Fujita, Tomonaga & Matsuzawa demonstrated that infant Japanese macaques (Macaca fuscata) form cross-modal representations of conspecifics but not of humans. However, because the subjects in the experiment were raised in a large social group and had considerably less exposure to humans than to conspecifics, it was an open question whether their lack of cross-modal representation of humans simply reflected their lower levels of exposure to humans or was caused by some innate restrictions on the ability. To answer the question, we used the same procedure but tested infant Japanese macaques with more extensive experience of humans in daily life. Briefly, we presented monkeys with a photograph of either a monkey or a human face on an LCD monitor after playing a vocalization of one of these two species. The subjects looked at the monitor longer when a voice and a face were mismatched than when they were matched, irrespective of whether the preceding vocalization was a monkey's or a human's. This suggests that once monkeys have extensive experience with humans, they will form a cross-modal representation of humans as well as of conspecifics. [source] Gravity bias in young and adult chimpanzees (Pan troglodytes): tests with a modified opaque-tubes taskDEVELOPMENTAL SCIENCE, Issue 3 2007Masaki Tomonaga Young human children at around 2 years of age fail to predict the correct location of an object when it is dropped from the top of an S-shape opaque tube. They search in the location just below the releasing point (Hood, 1995). This type of error, called a ,gravity bias', has recently been reported in dogs and monkeys. In the present study, we investigated whether young and adult chimpanzees also show such a gravity bias in a modified version of the original opaque-tube task. The original task by Hood and colleagues required the subject to search in a location after the object had fallen, while in the task reported here, subjects were required to predict the location before the object was dropped. Thus the present procedure does not involve explicit invisible displacement operations, one of the important components of the original procedure. In Experiment 1 both young (1.5,2.5-year-old) and adult chimpanzees predicted the location of falling food items below the releasing point even when crossed tubes were used. These gravity errors remained after the extensive experience of using the tubes themselves. Experiment 2 further tested adult and 4-year-old chimpanzees under the set-up in which the straight and crossed tubes were simultaneously presented. The results were the same as those in the previous test, suggesting that developmental changes and learning effect do not affect the gravity bias in chimpanzees. [source] The Politics of Hostage Rescue: Is Violence a Route to Political Success?JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 2 2001Joseph Scanlon Over the years, law enforcement agencies have acquired extensive experience with hostage incidents, and most Western countries have officers trained in all aspects of hostage resolution. There are also articles and manuals outlining how to deal with the media coverage of hostage takings (Scanlon, 1989). However, because hostage rescue efforts can provide dramatic visuals that attract enormous audiences, the media have steadily intensified their coverage of such incidents. Today, a group of previously obscure persons can suddenly dominate the media agenda by successfully resisting an armed assault or by seizing hostages and calling themselves terrorists. After defining a hostage incident and looking at the strategy for dealing with such incidents, this article examines the implications of two fatal incidents: the stand-off involving religious fanatics at Waco, Texas; and the Air France hijacking that started in Algiers and ended in Marseille, France. Both became number one on the Western media agenda, and both became political crises involving the head of state; one threatening a president's credibility, the other enhancing a president's status. Together they suggest that the escalating media coverage of such incidents raises questions not only about the effectiveness of current response strategies, but also about political leadership. This article discusses a number of strategies that have been tried or suggested. It also debates whether involvement has a positive or negative effect on political leaders. It concludes that, from the evidence available, a successful hostage rescue can yield political rewards. [source] The Reader in the WriterLITERACY, Issue 2 2000Myra Barrs This article discusses the role of reading, especially the reading of literature, in the development of writing. It suggests that the direct teaching of written language features is no substitute for extensive experience of written language. It gives a brief preliminary account of a recent centre for language in Primary Education (CLPE) research project on the influence of children's reading of literature on their writing at KS2. Through analysis of children's writing, the project explored the influence of children's reading on their writing. Its findings highlighted the value of children working and writing in role in response to literary texts. It looked closely at the kinds of teaching which made a significant difference to children's writing and documented the impact on teachers' practice of the introduction of the National Literacy Strategy. [source] For Hearth and Home: African Ceramics from the Keith Achepohl CollectionMUSEUM ANTHROPOLOGY, Issue 1 2007Mary S. Thieme Mary S. Thieme is a museum anthropologist and ethnographer with extensive experience studying the pottery traditions of Mexico. In the 1960s she spent two years in Western Nigeria. In addition to assisting her ethnomusicologist husband in his Yoruba music research, collecting and documenting musical instruments for the Smithsonian Institution and the Nigerian National Museum, she studied drum making and researched and collected pottery and textiles for the Smithsonian. After a 30-year career working in museums, including the Smithsonian and the Museum of African Art, she is now retired and lives in Panama City, Florida. [source] Stridor is not a scientifically valid outcome measure for assessing airway injuryPEDIATRIC ANESTHESIA, Issue 2009JOSEF HOLZKI MD Summary Since about a decade cuffed intubation is becoming more popular in pediatric anesthesia. Studies supporting cuffed intubation compared cuffed and uncuffed intubation by using stridor as main outcome measure after extubation. No differentiations were made between benign (oedema) and severe (ulceration of mucosa) lesions. Stridor was considered to represent all relevant injuries. Far reaching conclusions for daily practice were drawn from these studies. Pediatric endoscopists and , ENT-surgeons with extensive experience in this field have warned against this opinion because significant injury of the airway is not always accompanied by stridor! The symptom of stridor might develop weeks and months after injury when silent ulcerations of the mucosa retract to significant stenosis. Only endoscopy can evidently detect all airway injuries. Studies describing airway injury by endoscopic control are urgently needed to find the best way of preventing airway injury by intubation. [source] Major Players: Bureaucracies In American GovernmentPUBLIC ADMINISTRATION REVIEW, Issue 1 2001Herbert Kaufman For more than 50 years, Herbert Kaufman has been an astute observer of public bureaucracies. In this essay, Kaufman draws on his extensive experience in explaining the role of public bureaucracies in the American political system. Kaufman was motivated to write the essay because of his concern that public bureaucracies are not given adequate attention in American government textbooks. We hope that PAR readers will use the essay to educate students and others about the important role of public bureaucracies in American government.,LDT [source] Addressing soil gas vapor intrusion using sustainable building solutionsREMEDIATION, Issue 4 2009Ellen Moyer Soil gas vapor intrusion (VI) emerged in the 1990s as one of the most important problems in the investigation and cleanup of thousands of sites across the United States. A common practice for sites where VI has been determined to be a significant pathway is to implement interim building engineering controls to mitigate exposure of building occupants to VI while the source of contamination in underlying soil and groundwater is assessed and remediated. Engineering controls may include passive barriers, passive or active venting, subslab depressurization, building pressurization, and sealing the building envelope. Another recent trend is the emphasis on "green" building practices, which coincidentally incorporate some of these same engineering controls, as well as other measures such as increased ventilation and building commissioning for energy conservation and indoor air quality. These green building practices can also be used as components of VI solutions. This article evaluates the sustainability of engineering controls in solving VI problems, both in terms of long-term effectiveness and "green" attributes. Long-term effectiveness is inferred from extensive experience using similar engineering controls to mitigate intrusion of radon, moisture, mold, and methane into structures. Studies are needed to confirm that engineering controls to prevent VI can have similar long-term effectiveness. This article demonstrates that using engineering controls to prevent VI is "green" in accelerating redevelopment of contaminated sites, improving indoor air quality, and minimizing material use, energy consumption, greenhouse gas emissions, and waste generation. It is anticipated that engineering controls can be used successfully as sustainable solutions to VI problems at some sites, such as those deemed technically impracticable to clean up, where remediation of underlying soil or groundwater contamination will not be completed in the foreseeable future. Furthermore, green buildings to be developed in areas of potential soil or groundwater contamination may be designed to incorporate engineering controls to prevent VI. © 2009 Wiley Periodicals, Inc. [source] Financial Indicators for Critical Access HospitalsTHE JOURNAL OF RURAL HEALTH, Issue 3 2006George H. Pink PhD ABSTRACT:,Context: There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). CAHs differ from other hospitals on a number of dimensions that might affect appropriate indicators of performance, including differences in Medicare reimbursement, limits on bed size and average length of stay, and relaxed staffing rules. Purpose: To develop comparative financial indicators specifically designed for CAHs using Medicare cost report data. Methods: A technical advisory group of individuals with extensive experience in rural hospital finance and operations provided advice to a research team from the University of North Carolina at Chapel Hill. Twenty indicators deemed appropriate for assessment of CAH financial condition were chosen and formulas determined. Issues 1 and 2 of the CAH Financial Indicators Report were mailed to the chief executive officers of 853 CAHs in the summer of 2004 and 1,092 CAHs in the summer of 2005, respectively. Each report included indicator values specifically for their CAH, indicator medians for peer groups, and an evaluation form. Findings: Chief executive officers found the indicators to be useful and the underlying formulas to be appropriate. The multiple years of data provide snapshots of the industry as a whole, rather than trend data for a constant set of hospitals. Conclusions: The CAH Financial Indicators Report is a useful first step toward comparative financial indicators for CAHs. [source] Protocol Biopsies in Renal Transplantation: Insights into Patient Management and PathogenesisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2007M. Mengel A 1-day symposium on the application of protocol biopsies in renal transplantation was held in Boston, 21 July 2006. Representatives from centers with extensive experience in the use of protocol biopsies for routine patient care and research reported results on the pathological findings and their value in patient management. The consensus was that protocol biopsies, in experienced hands, are a safe and valuable means of detecting subclinical disease that can benefit from modification of therapy. Furthermore, molecular studies reveal evidence of activity or progression not readily appreciated by histological techniques. Wider application is expected in multicenter clinical trials to predict and validate outcomes. The principal barrier to wider use of protocol biopsies is knowledge of the benefits of intervention. [source] The effects of age and professional expertise on working memory performanceAPPLIED COGNITIVE PSYCHOLOGY, Issue 3 2009Elena Cavallini Differences in professional choice and experience may explain age differences in working memory performance of elderly people. The aim of this study was to examine whether expertise and prolonged practice in verbal and visuo-spatial abilities reduce age differences in laboratory working memory tasks. The effects of age and expertise on working memory performance were examined in three age groups in two different experiments. Firstly, the role of visuo-spatial expertise was analysed by examining age differences in architects. Secondly, people with extensive experience in verbal abilities (literary people) were tested in order to evaluate the effect of professional verbal experience. Architects and literary people outperformed a group of unselected age peers on tasks related to professional expertise only, but not on general working memory tests. There was no interaction between age and experience, suggesting that professional experience does not increase differences between experts and non experts and cannot modulate age-related effects. Copyright © 2008 John Wiley & Sons, Ltd. [source] Prognostic Factors for Adult Patients Receiving Extracorporeal Membrane Oxygenation as Mechanical Circulatory Support,A 14-Year Experience at a Medical CenterARTIFICIAL ORGANS, Issue 2 2010Chinchun Lan Abstract Extracorporeal membrane oxygenation (ECMO) is a resource-consuming and highly invasive treatment. There were 1100 ECMO cases at the National Taiwan University Hospital between August 1994 and November 2008. Of these, 607 were adults (>18 years old) who received ECMO as mechanical circulatory support. In this study, patient characteristics and complications during the ECMO course were evaluated for their correlation with prognosis. The following factors were significantly different between survivors and nonsurvivors: age, coronary artery disease, diabetes mellitus, brain death, stroke during ECMO, the need for dialysis during ECMO, pre-ECMO infection, hypoglycemia, acidosis, alkalosis, the need for a distal perfusion catheter, and the amount of red blood cells transfused. Six independent predictors of mortality were identified: age, stroke, the need for dialysis during ECMO, pre-ECMO infection, hypoglycemia, and alkalosis. Our institution has comparatively extensive experience with adult patients, which may be quite different from other medical centers with respect to distribution of patient age. The findings should lead to better utilization of ECMO for adult patients in the future. [source] Improving the prognosis of patients after radical cystectomy.BJU INTERNATIONAL, Issue 6 2007Part I: the role of lymph node dissection The first two reviews are from the same unit in Germany and describe the well-known but still much discussed ways of improving the prognosis of patients undergoing cystectomy for bladder cancer. The authors review the roles of lymph node dissection and perioperative chemotherapy, and draw conclusions which will be of help for patients having this form of therapy. In a further review, authors from Egypt debate the requirement for a refluxing or non-refluxing uretero-ileal anastomosis in low-pressure reservoirs, drawing on their extensive experience in this field. The optimum treatment for patients with muscle-invasive bladder cancer remains a matter of intense debate; some authors still question the role of radical cystectomy (RC) per se, as it can be a potentially mutilating procedure with subsequent impairment in quality of life. However, the impairment has not been investigated using validated quality-of-life studies. By contrast, it is commonly accepted that no alternative treatment yields similar long-term survival data to RC. However, survival rates after RC are far from satisfying, particularly for patients with ,,pT3 and/or pN+ disease. Therefore, various strategies were introduced to improve survival in these patients, i.e. extension of lymph node dissection during radical surgery and perioperative chemotherapy. Both strategies are analysed and discussed in two mini-reviews, based on data from current publications and from theoretical considerations. [source] The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomyBJU INTERNATIONAL, Issue 6 2004M. Menon Much of the current interest in robotic surgery in urology has been caused by the results of the work from the Vattikuti Urology Institute in Detroit, and these authors describe their extensive experience in the technique of radical prostatectomy; specifically their modified single running suture urethrovesical anastomosis. They ascribe their ability to remove the urethral catheter at 4 days, and to have an excellent continence rate, to this technique, and to their apical dissection. The European Randomised Study for Screening of Prostate Cancer will generate much interesting information over the nest few years and will in itself become one of the landmark urological studies. The authors from Amsterdam evaluated (-7-5)proPSA and hK2 in a subset of patients from this study for detecting and grading prostate cancer, and found that their impact in these areas remains limited. Screening for prostate cancer is a controversial but very interesting topic for those involved in urological oncology. Although many countries have not advocated a national screening programme, and indeed some have advised against screening of any kind for this condition, "backdoor" screening does in fact take place. The authors from Belfast have reviewed PSA testing in Northern Ireland from 1990 to 1999, finding that many men have an elevated PSA level, with a resulting requirement for further evaluation. OBJECTIVE To describe the technique of dissecting the apex of the prostate and a modified single running-suture urethrovesical anastomosis in patients undergoing robot-assisted radical prostatectomy for organ-confined prostate cancer. PATIENTS AND METHODS Over 550 robot-assisted radical prostatectomies have been undertaken using Vattikuti Institute Prostatectomy (VIP) technique in patients with localized carcinoma of the prostate. We present a critical analysis of the first 120 procedures by one surgeon (M.M.) at our institution using this newly developed technique of urethrovesical anastomosis preceded by dissecting the apex of the prostate. RESULTS The mean time for the urethrovesical anastomosis was 13 min. All but 24 patients had their catheter removed 4 days after surgery, as indicated by a cystogram. The catheter was removed successfully at 7 days in the remaining 24 patients who had a mild leak on cystography. Two patients had urinary retention within a week of removing the catheter and had to be re-catheterized. Continence was evaluated using standardized criteria before and after the procedure. The patients also replied to a mailed validated questionnaire survey; 96% were continent at 3 months and the remaining 4% used a thin pad for security. CONCLUSIONS We report a technique of dissecting the apex of the prostate and prostatovesical junction for dividing the bladder neck, and a modified single running-suture urethrovesical anastomosis, in patients undergoing robot-assisted radical prostatectomy for organ-confined cancer of the prostate. The same principles can also be applied for the anastomosis during pure laparoscopic procedures and for urethro-neovesical anastomosis in patients undergoing robotic radical cystoprostatectomy for carcinoma of the bladder. [source] Longterm results after phacovitrectomy and foldable intraocular lens implantationACTA OPHTHALMOLOGICA, Issue 8 2009Wensheng Li Abstract. Purpose:, This study aimed to evaluate the longterm results of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co-existing vitreoretinal diseases. Methods:, We carried out a retrospective study of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity (VA), preoperative data, and intraoperative and postoperative complications. Results:, The most common indications for surgery were non-diabetic vitreous haemorrhage and proliferative diabetic retinopathy. Preoperative vision ranged from 0.6 to light perception; postoperative vision ranged from 1.2 to no light perception. Postoperatively, in 162 eyes (87.1%) VA improved by , 3 lines on the decimal chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased by the last follow-up. Postoperative complications included elevated intraocular pressure and posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis, neovascular glaucoma. Conclusions:, Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities co-existing with cataract. Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract. [source] Automated quality evaluation of digital fundus photographsACTA OPHTHALMOLOGICA, Issue 6 2009Herman Bartling Abstract. Purpose:, Retinal images acquired by means of digital photography are often used for evaluation and documentation of the ocular fundus, especially in patients with diabetes, glaucoma or age-related macular degeneration. The clinical usefulness of an image is highly dependent on its quality. We set out to develop and evaluate an automatic method of evaluating the quality of digital fundus photographs. Methods:, A method for making a numerical quantification of image sharpness and illumination was developed using MatlabÔ image analysis functions. Based on their sharpness and illumination measures, 1000 fundus photographs, randomly selected from a clinical database, were assigned to four predefined quality groups (not acceptable, acceptable, good, very good). Six independent observers, comprising three experienced ophthalmologists and three ophthalmic nurses with extensive experience in fundus image acquisition, classified a selection of 100 of these images into the corresponding quality groups. Results:, Automatic quality evaluation was more sensitive than evaluation by human observers in terms of ability to discriminate between good and very good images. The median concordance between the six human observers and the automatic evaluation was substantial (kappa = 0.64). Conclusions:, The proposed method provides an objective quality assessment of digital fundus photographs which agrees well with evaluations made by qualified human observers and which may be useful in clinical practice. [source] Modalities of Microfinance Delivery in Asia and Latin America: Lessons for ChinaCHINA AND WORLD ECONOMY, Issue 1 2006Heather Montgomery O19; G21; D02 Abstract Microfinance, the provision of small size loans and other financial services to low income households, is often seen as the key innovation of the last 25 years in terms of means of reaching out to the poor and vulnerable. There is extensive experience in microfinance provision in both Asia and Latin America, but as yet relatively little use of the approach in China. This paper assesses different approaches to microfinance delivery using a threefold distinction, the credit union approach, the non-government organization approach and the banking approach, to generalize across recent Asian and Latin American experience and discuss the role of microfinance in poverty reduction in a theoretical framework. Considering the current state of microfinance in China and international experience, we suggest the banking approach as the way to best increase outreach of micro-financial services in China. (Edited by Xiaoming Feng) [source] Proposed Curriculum for an "Observational" International Emergency Medicine Fellowship ProgramACADEMIC EMERGENCY MEDICINE, Issue 4 2000C. James Holliman MD Abstract. This article presents information on considerations involved in setting up and conducting fellowship training programs in emergency medicine (EM) for physicians from other countries. General goals for these programs are to assist in providing physicians from other countries with the knowledge and skills needed to further develop EM in their home countries. The authors report their opinions, based on their cumulative extensive experiences, on the necessary and optional structural elements to consider for international EM fellowship programs. Because of U.S. medical licensing restrictions, much of the proposed programs' content would be "observational" rather than involving direct "hands-on" clinical EM training. Due to the very recent initiation of these programs in the United States, there has not yet been reported any scientific evaluation of their structure or efficacy. International EM fellowship programs involving mainly observational EM experience can serve as one method to assist in EM development in other countries. Future studies should assess the impact and efficacy of these programs. [source] | ||||||||||||||||||||||