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Longitudinal Approach (longitudinal + approach)
Selected AbstractsTeaching Evidence-based Medicine to Medical StudentsACADEMIC EMERGENCY MEDICINE, Issue 12 2004Richard B. Ismach MD Evidence-based medicine (EBM) is the rubric for an approach to learning and practicing medicine that applies skills from clinical epidemiology, library science, and information management to clinical practice. Teaching EBM effectively requires a longitudinal approach throughout medical education. This presents many opportunities for academic emergency physicians, especially in the setting of an emergency medicine clerkship. EBM is best taught at the bedside, although this depends on a skilled and interested faculty. Bedside teaching of EBM also requires ready access to modern information resources. Other venues for teaching EBM include morning report, teaching conferences, and journal clubs. Many tools can be used to aid the process, including Web-based sources such as UpToDate, textbooks, and Web-based tutorials, educational prescriptions, and critically appraised topics. [source] Disruptiveness, peer experiences and adolescent smoking: a long-term longitudinal approachADDICTION, Issue 4 2009Roy Otten ABSTRACT Aims This study examined links of peer experiences (i.e. social status and affiliation with disruptive peers) throughout childhood with respect to adolescent smoking trajectories, after controlling for childhood disruptiveness. Specifically, we tested four models regarding links of peer experiences and deviant behaviours. Design Prospective community sample. Participants A total of 312 children, aged 6.17 years at baseline. Measurements Growth parameters of own disruptive behaviour, disruptive behaviour of friends and social status measured at ages 7,12 years as predictors of smoking assessed at ages 13,15 years, while controlling for own disruptive behaviour at age 6 years. Findings We found three groups with distinct profiles of smoking. One group displayed hardly any or no smoking at all; a second group showed a trajectory of increased smoking; and a third group that showed high smoking rates initially and increased in smoking intensity over time. Results support the assumption of the selection model that the link between disruptive peers and smoking is spurious and due to shared variances with own early disruptiveness. Moreover, support was found for the popularity,socialization model supporting the assumption that age-related increases in social status are associated with smoking. Conclusions The findings emphasize that early disruptiveness is predictive of later smoking. In addition, it was shown that smoking becomes less deviant over time, in line with group norms. Future prevention programmes should emphasize the need to change these norms. [source] One-year longitudinal evaluation of sensorimotor functions in APP751SL transgenic miceGENES, BRAIN AND BEHAVIOR, Issue 2008C. Le Cudennec Intracerebral amyloid-beta (A,) peptide deposition is considered to play a key role in Alzheimer's disease and is designated as a principal therapeutic target. The relationship between brain A, levels and clinical deficits remains, however, unclear, both in human patients and in animal models of the disease. The purpose of the present study was to investigate, in a transgenic mouse model of brain amyloidosis, the consequences of A, deposition on basic neurological functions using a longitudinal approach. Animals were phenotyped at different ages corresponding to graded neuropathological stages (from no extracellular A, deposition to high amyloid loads). Sensory functions were evaluated by assessing visual and olfactory abilities and did not show any effects of the amyloid precursor protein (APP) transgene. Motor functions were assessed using multiple experimental paradigms. Results showed that motor strength was considerably reduced in APP transgenic mice compared with control animals. No deficit was noted in a motor coordination test although APP transgenic mice displayed decreased locomotion on a stationary beam. Hypolocomotion was also observed in the standard open-field test. Measures of anxiety obtained in the elevated plus-maze show some evidence of hyperanxiety in 15-month-old transgenic mice. Some of the neurological impairments showed by APP mice had an early onset and worsened with progressive aging, in parallel to gradual accumulation of A, in brain parenchyma. Relationships between neuropathologically assessed amyloid loads and behavioral deficits were further explored, and it was observed that motor strength deficits were correlated with cortical amyloid burden. [source] Starting a New Job: The Social and Emotional Experience of People with Intellectual DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 5 2009Andrew Jahoda Background, Employment is viewed by policy makers as both a human right and as a means of changing the marginalized status of people with intellectual disabilities, with important social and emotional benefits. However, there has been little longitudinal research examining the experience of people with intellectual disabilities in the workplace. Methods, Thirty-five individuals with mild to borderline intellectual disabilities participated in this study. They were recruited from supported employment agencies in Scotland. A longitudinal approach was adopted, with the participants being interviewed around the time of starting their jobs, and again 9,12 months later. Results, The content analyses of the semi-structured interviews indicated that the participants perceived continuing benefits from entering mainstream employment, including more purposeful lives and increased social status. However, over the follow-up period the participants reported few social opportunities that extended beyond the workplace, and an anxiety about their competence to meet employers' demands remained a concern for some. Conclusions, The discussion addresses the importance of understanding work in relation to the participants' wider lives, along with the longer-term role for supported employment agencies to help people achieve their social and emotional goals in a vocational context. [source] Corporate Governance and Financial Constraints on Strategic Turnarounds*JOURNAL OF MANAGEMENT STUDIES, Issue 3 2006Igor Filatotchev abstract The paper extends the Robbins and Pearce (1992) two-stage turnaround response model to include governance factors. In addition to retrenchment and recovery, the paper proposes the addition of a realignment stage, referring specifically to the realignment of expectations of principal and agent groups. The realignment stage imposes a threshold that must be crossed before the retrenchment and hence recovery stage can be entered. Crossing this threshold is problematic to the extent that the interests of governance-stakeholder groups diverge in a crisis situation. The severity of the crisis impacts on the bases of strategy contingent asset valuation leading to the fragmentation of stakeholder interests. In some cases the consequence may be that management are prevented from carrying out turnarounds by governance constraints. The paper uses a case study to illustrate these dynamics, and like the Robbins and Pearce study, it focuses on the textile industry. A longitudinal approach is used to show the impact of the removal of governance constraints. The empirical evidence suggests that such financial constraints become less serious to the extent that there is a functioning market for corporate control. Building on governance research and turnaround literature, the paper also outlines the general case necessary and sufficient conditions for successful turnarounds. [source] Medical error: a discussion of the medical construction of error and suggestions for reforms of medical education to decrease errorMEDICAL EDUCATION, Issue 9 2001Helen Lester Introduction There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors. [source] Cognitive, Linguistic and Adaptive Functioning in Williams Syndrome: Trajectories from Early to Middle AdulthoodJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2010Patricia Howlin Background, Little is known about trajectories of cognitive functioning as individuals with Williams syndrome (WS) move though adulthood. Method, The present study investigated cognitive, linguistic and adaptive functioning in adults with WS aged 19,55 years, using both cross-sectional and longitudinal approaches. Results, Data from the cross-sectional study (n = 92; mean age = 32 years) indicated that IQ was comparable across age groups (Full-Scale IQ mean = 56,57) with Verbal IQ being slightly higher than Performance IQ. Daily Living Skills (as measured by the Vineland Adaptive Behavior Scales) were significantly higher in older individuals. Language abilities showed no consistent age-related differences. On formal tests of language, comprehension scores were higher than expressive language scores for almost all individuals, although this pattern was not replicated on the Vineland. In the longitudinal study, a follow-up of 47 individuals (mean age = 37 years) first assessed 12 years previously, similar trajectories were found. IQ remained very stable (FSIQ = 61,62 at both time points); there were significant improvements on the Social and Daily Living domains of the Vineland and significant decreases in Maladaptive scores. There were no improvements in language over time. Conclusions, The data indicate that adults with WS (at least up to the age of 50 years) show no evidence of deterioration in cognitive skills. Adaptive abilities continue to develop although language shows relatively little improvement with time. [source] Modeling Longitudinal Data with Nonparametric Multiplicative Random Effects Jointly with Survival DataBIOMETRICS, Issue 2 2008Jimin Ding Summary In clinical studies, longitudinal biomarkers are often used to monitor disease progression and failure time. Joint modeling of longitudinal and survival data has certain advantages and has emerged as an effective way to mutually enhance information. Typically, a parametric longitudinal model is assumed to facilitate the likelihood approach. However, the choice of a proper parametric model turns out to be more elusive than models for standard longitudinal studies in which no survival endpoint occurs. In this article, we propose a nonparametric multiplicative random effects model for the longitudinal process, which has many applications and leads to a flexible yet parsimonious nonparametric random effects model. A proportional hazards model is then used to link the biomarkers and event time. We use B-splines to represent the nonparametric longitudinal process, and select the number of knots and degrees based on a version of the Akaike information criterion (AIC). Unknown model parameters are estimated through maximizing the observed joint likelihood, which is iteratively maximized by the Monte Carlo Expectation Maximization (MCEM) algorithm. Due to the simplicity of the model structure, the proposed approach has good numerical stability and compares well with the competing parametric longitudinal approaches. The new approach is illustrated with primary biliary cirrhosis (PBC) data, aiming to capture nonlinear patterns of serum bilirubin time courses and their relationship with survival time of PBC patients. [source] | ||||||||||