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Terms modified by Nationwide Selected AbstractsEnterprise Risk Management: Theory and PracticeJOURNAL OF APPLIED CORPORATE FINANCE, Issue 4 2006Brian W. Nocco The Chief Risk Officer of Nationwide Insurance teams up with a distinguished academic to discuss the benefits and challenges associated with the design and implementation of an enterprise risk management program. The authors begin by arguing that a carefully designed ERM program,one in which all material corporate risks are viewed and managed within a single framework,can be a source of long-run competitive advantage and value through its effects at both a "macro" or company-wide level and a "micro" or business-unit level. At the macro level, ERM enables senior management to identify, measure, and limit to acceptable levels the net exposures faced by the firm. By managing such exposures mainly with the idea of cushioning downside outcomes and protecting the firm's credit rating, ERM helps maintain the firm's access to capital and other resources necessary to implement its strategy and business plan. At the micro level, ERM adds value by ensuring that all material risks are "owned," and risk-return tradeoffs carefully evaluated, by operating managers and employees throughout the firm. To this end, business unit managers at Nationwide are required to provide information about major risks associated with all new capital projects,information that can then used by senior management to evaluate the marginal impact of the projects on the firm's total risk. And to encourage operating managers to focus on the risk-return tradeoffs in their own businesses, Nationwide's periodic performance evaluations of its business units attempt to refl ect their contributions to total risk by assigning risk-adjusted levels of "imputed" capital on which project managers are expected to earn adequate returns. The second, and by far the larger, part of the article provides an extensive guide to the process and major challenges that arise when implementing ERM, along with an account of Nationwide's approach to dealing with them. Among other issues, the authors discuss how a company should assess its risk "appetite," measure how much risk it is bearing, and decide which risks to retain and which to transfer to others. Consistent with the principle of comparative advantage it uses to guide such decisions, Nationwide attempts to limit "non-core" exposures, such as interest rate and equity risk, thereby enlarging the firm's capacity to bear the "information-intensive, insurance- specific" risks at the core of its business and competencies. [source] Productivity in Malagasy rice systems: wealth-differentiated constraints and prioritiesAGRICULTURAL ECONOMICS, Issue 2007Bart Minten rice productivity; poverty; technology adoption; Madagascar Abstract This study explores the constraints on agricultural productivity and priorities in boosting productivity in rice, the main staple in Madagascar, using a range of different data sets and analytical methods, integrating qualitative assessments by farmers and quantitative evidence from panel data production function analysis and willingness-to-pay estimates for chemical fertilizer. Nationwide, farmers seek primarily labor productivity enhancing interventions, e.g., improved access to agricultural equipment, cattle, and irrigation. Shock mitigation measures, land productivity increasing technologies, and improved land tenure are reported to be much less important. Research and interventions aimed at reducing costs and price volatility within the fertilizer supply chain might help at least the more accessible regions to more readily adopt chemical fertilizer. [source] Motor laterality asymmetry and nonmotor symptoms in Parkinson's disease,MOVEMENT DISORDERS, Issue 1 2010Esther Cubo Abstract Background: In patients with Parkinson's disease (PD), asymmetric motor signs provide an interesting model to evaluate whether asymmetric nigrostriatal degeneration can affect neuropsychological function and other nonmotor symptoms (NMS). This study was designed to evaluate the predominant laterality of motor symptoms and its relationship with cognition and other NMS in idiopathic PD. Methods: Nationwide, longitudinal, and multicenter study (ELEP Registry) using outpatients with PD. Left PD (LPD) and right PD (RPD) was defined based on the motor signs on the SCOPA-motor scale. To include the clinical spectrum of asymmetric PD patients, we considered two groups of patients with mild-moderate and extreme asymmetry. Predominant LPD or RPD with mild-moderate versus extreme asymmetry were compared using the following scales: cognition, psychosis (Parkinson Psychosis Rating Scale), anxiety/depression, sleep (and autonomic dysfunction at baseline and 1 year later. Nonparametric tests were used for comparison. Results: One hundred forty-nine PD patients (74 RPD and 75 LPD) with mild-moderate asymmetry and 90 (47 RPD and 43 LPD) with extreme asymmetry and a mean age of 64.5 (10.4) years were included. Extreme RPD had higher Parkinson Psychosis Rating Scale scores over time (P = 0.005) compared with LPD, but no significant differences were observed between LPD and RPD in terms of other NMS. Conclusions: These findings suggest that damage to left-hemisphere plays a disproportionately greater role in PD-related psychosis over time. In contrast, motor laterality does not consistently affect other NMS, suggesting that NMS are related to a more widespread brain disorder. © 2009 Movement Disorder Society [source] Upper -extremity musculoskeletal symptoms and physical health related quality of life among women employed in poultry processing and other low -wage jobs in Northeastern North Carolina,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2009C.S. McPhee MSPH Abstract Background The purpose of this study was to evaluate the association between upper -extremity musculoskeletal symptoms (MS ) and diminished physical health related quality of life (PHRQoL ) in a population of women, mostly African -American working in poultry processing and other low -wage jobs in rural northeastern North Carolina. Methods A cross -sectional analysis was performed on baseline data of self -reported PHRQoL and musculoskeletal symptoms for 291 poultry processing workers and 299 community comparison women. Logarithmic binomial regression was performed to assess the relationship between moderate to severe MS on low PHRQoL. Results Prevalence of poor PHRQoL was 35.5 % among poultry processing workers, and 14.7 % among community comparison group. Moderate to severe upper -extremity musculoskeletal symptoms were present in 34.4 % of the poultry workers and 10.7 % of the comparison group. After adjusting for age and other chronic conditions, moderate to severe musculoskeletal symptoms were associated with low PHRQoL in both groups. Although the observed effect was stronger among the comparison group (adjusted prevalence ratios (95 % confidence interval ): poultry workers , = ,1.89 (1.36, 2.64 ), community comparison , = ,4.26 (2.51, 7.24 ), the population attributable risk percent was similar (poultry workers , = ,28.9, community comparison , = ,31.3 % ) ) due to the higher prevalence of moderate to severe symptoms in the poultry workers. Conclusions Significant upper-extremity musculoskeletal symptoms were associated with poor PHRQoL among both groups of women employed in low -wage jobs. Nationwide, poultry work is over -represented by minorities and immigrants. Though challenging, we need to search for ways to improve the conditions of these women as a matter of social justice. Am. J. Ind. Med. 52:331,340, 2009. © 2009 Wiley-Liss, Inc. [source] PARTISAN COMPETITIVENESS IN POST-1990 U.S. HOUSE DISTRICTSPOLITICS & POLICY, Issue 4 2000John W. Swain This research looks at redistricting in terms of the partisan competitiveness of U.S. House election districts by creating a measure of partisan competitiveness based on the 1988 presidential election results for the two major parties. Nationwide, regional, and state means of district partisan competitiveness are computed for pre- and post-1990 congressional districts, and changes in those means are analyzed. This method holds constant all other factors besides redistricting. Post-1990 districts are less competitive between the two major parties than pre-1990 districts, despite predictions to the contrary. A regression model, predicting states' change in mean district partisan competitiveness, shows that states required to preclear their election districts under the Voting Rights Act and states gaining from reapportionment decline in mean district partisan competitiveness to a statistically significant degree. Surprisingly, one-party control of redistricting is associated with increased competitiveness to a statistically significant degree. [source] Molecular characterization of CTX-M-15-producing clinical isolates of Escherichia coli reveals the spread of multidrug-resistant ST131 (O25:H4) and ST964 (O102:H6) strains in NorwayAPMIS, Issue 7 2009UMAER NASEER Nationwide, CTX-M-producing clinical Escherichia coli isolates from the Norwegian ESBL study in 2003 (n=45) were characterized on strain and plasmid levels. BlaCTX-M allele typing, characterization of the genetic environment, phylogenetic groups, pulsed field gel electrophoresis (PFGE), serotyping and multilocus sequence typing were performed. Plasmid analysis included S1 -nuclease-PFGE, polymerase chain reaction-based replicon typing, plasmid transfer and multidrug resistance profiling. BlaCTX-M-15 (n=23; 51%) and blaCTX-M-14 (n=11; 24%) were the major alleles of which 18 (78%) and 6 (55%), respectively, were linked to ISEcp1. Thirty-two isolates were of phylogenetic groups B2 and D. Isolates were of 29 different XbaI-PFGE-types including six regional clusters. Twenty-three different O:H serotypes were found, dominated by O25:H4 (n=9, 20%) and O102:H6 (n=9, 20%). Nineteen different STs were identified, where ST131 (n=9, 20%) and ST964 (n=7, 16%) were dominant. BlaCTX-M was found on ,100 kb plasmids (39/45) of 10 different replicons dominated by IncFII (n=39, 87%), FIB (n=20, 44%) and FIA (n=19, 42%). Thirty-nine isolates (87%) displayed co-resistance to other classes of antibiotics. A transferable CTX-M phenotype was observed in 9/14 isolates. This study reveals that the majority of CTX-M-15-expressing strains in Norway are part of the global spread of multidrug-resistant ST131 and ST-complex 405, associated with ISEcp1 on transferrable IncFII plasmids. [source] Rise in maternal mortality in the NetherlandsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2010JM Schutte Please cite this paper as: Schutte J, Steegers E, Schuitemaker N, Santema J, de Boer K, Pel M, Vermeulen G, Visser W, van Roosmalen J, the Netherlands Maternal Mortality Committee. Rise in maternal mortality in the Netherlands. BJOG 2009;117:399,406. Objective, To assess causes, trends and substandard care factors in maternal mortality in the Netherlands. Design, Confidential enquiry into the causes of maternal mortality. Setting, Nationwide in the Netherlands. Population, 2,557,208 live births. Methods, Data analysis of all maternal deaths in the period 1993,2005. Main outcome measures, Maternal mortality. Results, The overall maternal mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the maternal mortality ratio of 9.7 in the period 1983,1992 (OR 1.2, 95% CI 1.0,1.5). The most frequent direct causes were (pre-)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4,4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre-eclampsia (91%) and in immigrant populations (62%). Conclusions, Maternal mortality in the Netherlands has increased since 1983,1992. Pre-eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve maternal health care. [source] A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcomeACTA PAEDIATRICA, Issue 5 2009Rolf AA Pelleboer Abstract Aims: To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants. Methods: All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005. Results: Nationwide 158 cases reported, correspond to an incidence of 58/y/100 000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100 000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11,25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge. Conclusion: The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose. [source] Update on epidemiology of pollinosis in Japan: changes over the last 10 yearsCLINICAL & EXPERIMENTAL ALLERGY REVIEWS, Issue 1 2010K. Nakae Summary A nationwide epidemiologic survey of atopic diseases including allergic pollinosis was conducted in 9656 Japanese otorhinolaryngologists and their family members during the Japanese cedar pollen dispersion season in 2008 using methods identical to a previous survey that was performed in 1998. The survey response rate was 37.7% (compared with 42.8% in 1998). The overall prevalence rate of Japanese cedar pollinosis was 26.5%, which is an increase of approximately 9% from that noted in 1998. Similar increases were observed in all age groups, and the prevalence rate was similar between male and female respondents. A unimodal distribution was observed in male and female subjects, with a peak in both men and women aged in their 40s. Nationwide, a consistent positive relation was observed between the prevalence of Japanese cedar pollinosis and the regional Japanese cedar pollen counts. The prevalence rate of pollinosis other than Japanese cedar pollinosis and of perennial allergic rhinitis was 15.4% and 23.3%, respectively; both disease entities tended to occur more frequently in male than in female subjects. The prevalence rate of asthma, atopic dermatitis, and food allergy was 5.2%, 14.1%, and 3.9%, respectively. Our results suggest that the prevalence rates of atopic diseases including Japanese cedar pollinosis are dramatically increasing across all age groups in Japan. In particular, the increasing prevalence rate of Japanese cedar pollinosis seems to reflect higher exposure to the Japanese cedar pollen antigen in many prefectures. [source] The Long Road to Better ACHD CareCONGENITAL HEART DISEASE, Issue 3 2010Gary Webb MD ABSTRACT The care of adult patients with congenital heart defects in the United States is spotty at best, and needs to improve greatly if the needs of these patients are to be met. The care of American children with congenital heart defects is generally excellent. Pediatric cardiac services are well established and well supported. The care of adults with congenital heart disease (CHD) is well established in only a few American centers. While there are an increasing number of clinics, they are generally poorly resourced with relatively few patients. If located in adult cardiology programs, they are usually minor players. If located in pediatric cardiac programs, they are usually minor players as well. Training programs for adult CHD (ACHD) caregivers are few, informal, and poorly funded. To improve the situation, we need perhaps 25 well-resourced and well-established regional ACHD centers in the United States. We need to stop the loss to care of CHD patients at risk of poor outcomes. We need to educate patients and families about the need for lifelong and skilled surveillance and care. We need to effect an orderly transfer from pediatric to adult care. We need to strengthen the human resource infrastructure of ACHD care through the training and hiring of healthcare professionals of a quality equivalent to those working in the pediatric care environment. We need to demonstrate that adult care is high quality care. We need more high-quality ACHD research. The ACHD community needs to establish its credibility with pediatric cardiac providers, adult cardiology groups, with governments, with professional organizations, and with research funding agencies. Accordingly, there is a need for strong political action on behalf of American ACHD patients. This must be led by patients and families. These efforts should be supported by pediatric cardiologists and children's hospitals, as well as by national professional organizations, governments, and health insurance companies. The goal of this political action should be to see that ACHD patients can receive high-quality lifelong surveillance, that we lose fewer patients to care, and that the staff and other services needed are available nationwide. [source] The Measurement of Daily Surge and Its Relevance to Disaster PreparednessACADEMIC EMERGENCY MEDICINE, Issue 11 2006Melissa L. McCarthy MS This article reviews what is known about daily emergency department (ED) surge and ED surge capacity and illustrates its potential relevance during a catastrophic event. Daily ED surge is a sudden increase in the demand for ED services. There is no well-accepted, objective measure of daily ED surge. The authors propose that daily and catastrophic ED surge can be measured by the magnitude of the surge, as well as by the nature and severity of the illnesses and injuries that patients present with during the surge. The magnitude of an ED surge can be measured by the patient arrival rate per hour. The nature and severity of the surge can be measured by the type (e.g., trauma vs. infection vs. biohazard) and acuity (e.g., triage level) of the surge. Surge capacity is defined as the extent to which a system can respond to a rapid and sizeable increase in the demand for resources. ED surge capacity includes multiple dimensions, such as systems, space, staffing, and supplies. A multidimensional measure is needed that reflects both the core components and their relative contribution to ED surge capacity. Although many types of factors may influence ED surge capacity, relatively little formal research has been conducted in this area. A better understanding of daily ED surge capacity and influencing factors will improve our ability to simulate the potential impact that different types of catastrophic events may have on the surge capacity of hospital EDs nationwide. [source] The effect of different educational interventions on schoolchildren's knowledge of earthquake protective behaviour in IsraelDISASTERS, Issue 1 2010Yechiel Soffer Knowledge of appropriate behaviour during an earthquake is crucial for prevention of injury and loss of life. The Israeli Home Front Command conducts a yearly earthquake education programme in all Israeli schools, using three types of educational interventions: lectures, drills and a combination of the two. The aim of this study was to evaluate the effectiveness of these interventions in providing students with knowledge. We distributed a questionnaire to 2,648 children from the 5th and 6th grades in 120 schools nationwide. Knowledge scores for both 5th and 6th grades were increased, regardless of type of intervention, compared to the non-exposure group. A combined intervention of lectures and drills resulted in the highest knowledge scores. Our findings suggest that for the age group studied a combination of lectures and drills will likely prepare students best for how to behave in the event of an earthquake. [source] Resistant readers 8 months later: energizing the student's learning milieu by targeted counsellingDYSLEXIA, Issue 2 2006Anne Brit Andreassen Abstract Several studies have reported that an alarming large subgroup of poor readers seems to be treatment resistant. This group obviously needs attention beyond standard special education instructions. In Norway, the National Centre for Reading Education and Research has been assigned the task of assisting the school psychological services nationwide in severe cases of reading disabilities. The aim of the present study of a clinical sample of students with severe dyslexia, due to phonological deficits, was to evaluate effects of counselling 8 months after a 2-day assessment at the centre. Sixty-five students, with a mean age of 12.3 years, participated. A thorough assessment of each student's strengths and problems was conducted at the centre. Additional information was obtained from the school psychological services, the teachers, and the parents. Diagnostic reports and proposals for remediation were forwarded to the school psychological services. Students', parents', and teachers' evaluation of the students' reading abilities 8 months after the assessment was retrieved for 75% of cases. Of these, 80% reported clear progress in the students' reading abilities. The progress could not be related to age, cognitive level, place of residence, or previous special education received, but instead to improved motivation. Copyright © 2006 John Wiley & Sons, Ltd. [source] STILL A PATCHWORK QUILT: A NATIONWIDE SURVEY OF STATE LAWS REGARDING STEPPARENT RIGHTS AND OBLIGATIONSFAMILY COURT REVIEW, Issue 3 2010Susan L. Pollet This article surveys state laws regarding stepparents and stepchildren throughout the United States with regard to custody and visitation rights, child support obligations, adoption and inheritance rights. It provides background information, statistics and general definitions regarding stepparents, a review of some of the psychological and legal literature, information regarding websites and articles for the general public on the topic, and a description of the survey of the states nationwide. Finally, it provides some suggestions regarding future goals for the law in this arena. [source] Examining Risk Factors Associated With Family Reunification for Runaway Youth: Does Ethnicity Matter?FAMILY RELATIONS, Issue 3 2003Sanna J. Thompson This study investigated the likelihood of family reunification across ethnic groups of 14,419 youth using runaway shelter services nationwide. Among White, African American, Hispanic, Native American, and Asian ethnic groups, youths who reported abuse or neglect by their parental figures or had parent(s) who were unemployed were less likely to reunify following a runaway episode. However, completing youth shelter services markedly increased the likelihood of reunification. Implications for cultural sensitivity in service delivery, particularly regarding family issues, are discussed. [source] China's South-to-North Water Transfer Project: Is it Needed?GEOGRAPHY COMPASS (ELECTRONIC), Issue 9 2010Chansheng He China has started the construction of the South-to-North Water Transfer Project (SNWTP; its magnitude is even greater than the Three Gorges Dam Project), to deliver about 45 billion m3 of water from the Yangtze River to the water starving North China Plain. Is the project needed given the multiple socioeconomic, engineering, and environmental challenges and controversies it is facing and the effects of demand management programs China has been implementing in recent years? This article, through the analysis of the water shortage problems in the North China Plain and the Yellow River basin, demonstrates that considering China's current economic base, technological capacity, and income levels, the SNWTP, while facing multiple challenges, is still needed to relieve the water deficit problems in the North China Plain. However, the SNWTP is only a partial solution to North China's chronic water shortage problem. China should continue to actively implement and enforce its demand management programs nationwide to ensure that its limited fresh water resources are used to meet the multiple needs of human societies and ecosystems in a socially responsible, economically viable, and environmentally sustainable way. [source] Patient and clinician collaboration in the design of a national randomized breast cancer trialHEALTH EXPECTATIONS, Issue 1 2004Jo Marsden MD FRCS (Gen Surgery) Abstract Objective, To show breast cancer patient involvement in the design of a national randomized trial of hormone replacement therapy (HRT) in symptomatic patients will increase accrual. Setting and participants, Three stakeholder groups [(1) researchers from the Lynda Jackson Macmillan Centre, (2) the Consumers' Advisory Group for Clinical Trials (CAG-CT), (3) clinicians responsible for a pilot randomized HRT study in breast cancer patients] developed this collaborative study. Methods, (1) Nine focus group discussions were conducted to identify issues relevant to breast cancer patients about HRT and a national trial: six involved women from breast cancer support groups nationwide and three patients who had previously participated in the pilot randomized HRT study. (2) Recommendations from the focus groups (analysed by Grounded Theory) were debated by the research stakeholders and focus group representatives at a 1-day meeting and consensus reached (using a voting system) on mutual priorities for incorporation into the design of a national HRT trial. (3) Representatives from the CAG-CT and focus groups participated in subsequent national HRT steering committee meetings to ensure that these priorities were accounted for and the resulting trial design summary was circulated to the CAG-CT and all focus group representatives for comment. Results, Focus groups demonstrated that the complexity of factors relating to trial participation was not just restricted to the research topic in question. Patient,clinician interaction provided a platform for negotiating potential conflicts over trial design and outcomes. Patient feedback suggested that mutually agreed priorities were accounted for in the trial design. Interpretation, Clinical research planning should involve all research stakeholders at the outset. Quantifying the impact of patient involvement in terms of trial accrual may be too simple given the complexity of their motivations for participating in trials. [source] Technical issues affecting the implementation of US Environmental Protection Agency's proposed fish tissue-based aquatic criterion for selenium,INTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 4 2007A Dennis Lemly Abstract The US Environmental Protection Agency is developing a national water quality criterion for selenium that is based on concentrations of the element in fish tissue. Although this approach offers advantages over the current water-based regulations, it also presents new challenges with respect to implementation. A comprehensive protocol that answers the "what, where, and when" is essential with the new tissue-based approach in order to ensure proper acquisition of data that apply to the criterion. Dischargers will need to understand selenium transport, cycling, and bioaccumulation in order to effectively monitor for the criterion and, if necessary, develop site-specific standards. This paper discusses 11 key issues that affect the implementation of a tissue-based criterion, ranging from the selection of fish species to the importance of hydrological units in the sampling design. It also outlines a strategy that incorporates both water column and tissue-based approaches. A national generic safety-net water criterion could be combined with a fish tissue,based criterion for site-specific implementation. For the majority of waters nationwide, National Pollution Discharge Elimination System permitting and other activities associated with the Clean Water Act could continue without the increased expense of sampling and interpreting biological materials. Dischargers would do biotic sampling intermittently (not a routine monitoring burden) on fish tissue relative to the fish tissue criterion. Only when the fish tissue criterion is exceeded would a full site-specific analysis including development of intermedia translation factors be necessary. [source] Experienced and Less-Experienced Nurses Diagnostic Reasoning: Implications for Fostering Students' Critical ThinkingINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2003Catherine G. Ferrario DNSc PURPOSE. To compare the use of mental representations (heuristics) in diagnostic reasoning of expert (,5 years' experience) and novice (<5 years' experience) emergency nurses. METHODS. Clinical simulations were completed by a nationwide randomly selected sample of 173 experienced and 46 less-experienced emergency nurses (N =229). FINDINGS. Experienced nurses used the heuristic, Judging by Causal Systems (diagnostic inferences deduced from systems of causal factors) significantly more did than less-experienced nurses. PRACTICE IMPLICATIONS. Standardized nursing diagnoses may cut short the time needed to develop representational thinking and spare cognitive reserves for reasoning needed for complex patients. Faculty need to promote students' cognitive development through strategies that promote active, reflective, and integrative learning. Search terms: Clinical experience, diagnostic reasoning [source] Quality of medical care of patients with acne vulgaris in Germany , nationwide survey of pharmacy clientsJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 12 2009Nadine Franzke Summary Background: No empirical "real world" data on the health care of patients with acne vulgaris in Germany currently exist. The objective of this study was to get an informative basis of health care of patients with acne vulgaris in Germany, taking into account both doctor-prescribed medication and self-medication. Patients and Methods: Surveying both medically and self-treated patients, n = 504 patients with acne vulgaris were interviewed in 48 pharmacies nationwide. In addition to socio-demographic data, the duration of illness, localization and therapy as well as patient-relevant outcomes such as patient benefit, psychological strain and markers of compliance were evaluated. The participation and significance of individual treatment providers were also evaluated. Results: A large percentage of the patients found acne vulgaris to be burdensome. Despite the longstanding necessity of treatment and the chronic course of the illness, the treatment of acne vulgaris was deemed a rather satisfactory experience by most of those affected. Dermatologists were most frequently consulted for treatment. A great number of medicinal products were further acquired through self-medication or after consulting with a pharmacist. The medically regulated therapies predominantly complied with the latest guidelines. Conclusions: Acne vulgaris is a burdensome, socio-economically relevant illness, and dermatologists treat most cases in Germany. Surveying across a network of pharmacies offers a unique access to relevant treatment data. Selection effects, particularly by choice of doctors and self-medication, were minimized. [source] A long-term follow-up study on the natural course of oral leukoplakia in a Swedish population-based sampleJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 2 2007A. Roosaar Aim:, To assess the natural course of screening-detected oral leukoplakia (OL) among non-consulting individuals. Methods:, A cohort of 555 individuals with OL, confirmed in 1973,1974 during a population-based survey, were followed through January 2002 via record linkages with nationwide and essentially complete registers. A sample of 104 drawn from the 297 surviving cohort members who still were living in the area in 1993,1995 was invited to a re-examination. Sixty-seven of them attended. Results:, At the time of re-examination OL had disappeared in 29 (43%) individuals. There was a statistically significant association between cessation of/no smoking habits in 1993,1995 and the disappearance of OL. Never/previous daily smokers were thus over-represented among individuals whose OL had disappeared compared to those with persisting OL [n = 23 (82%) vs. n = 18 (47%), P < 0.01]. Eighteen (78%) of the twenty three non-smokers with disappearing OL had quit after the initial examination. One man and two women developed oral cancer during follow-up while 0.7 and 0.07, respectively, were expected. Conclusion:, Smoking cessation was associated with an increased disappearance of OL. Hence, at least one-fourth had lesions that could be classified as tobacco-related. Small observed and expected numbers prohibited firm conclusions about a possible excess risk of developing oral cancer. [source] On the natural course of oral lichen lesions in a Swedish population-based sampleJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 5 2006A. Roosaar Objectives:, The aim was to assess the natural course of oral lichen lesions (OLL) among unselected, non-consulting individuals. Subjects and methods:, A cohort of 327 subjects with OLL, confirmed in 1973,1974 during a population-based survey in two Swedish municipalities, was followed through January 2002 via record linkages with nationwide and essentially complete registers. A sample of 80 drawn from the 194 surviving subjects who still resided in the area in 1993,1995 was invited for interview and oral re-examination. Results:, At the end of follow-up, one case of oral cancer was detected, while 0.4 were expected. The overall mortality among subjects with OLL was not significantly different from that in the 15 817 OLL-free subjects who participated in the initial population based survey in 1973,1974. The lesion had disappeared in 14 (39%) of 36 re-examined subjects with white OLLs in 1973,1974, and four (11%) had transformed into red types. In the corresponding group of 19 with red forms initially, five (26%) had become lesion free and four (21%) had switched to white types. Although the cohort size does not permit firm conclusions regarding oral cancer risk, the natural course over up to 30 years appears to be benign in the great majority. [source] Implementing a Tobacco Assisted Referral Program in Dental PracticesJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2009Sally J. Little RDH Abstract Objectives: The objectives of this study are to design and implement a system-level tobacco-control intervention in a large prepaid dental group practice and assess effects on staff performance measures and patient satisfaction. Methods: We matched 14 dental facilities on size, socioeconomic status, smoking rate, and periodontal status, and then randomly assigned them to intervention or usual-care control. We trained intervention staff in an "Assisted Referral" team approach for assessing tobacco use, providing tailored advice and brief counseling, and encouraging smokers to talk by telephone with a specially trained tobacco counselor. Patients could call from the office or ask that the counselor call them later. Telephone counselors helped patients explore motivations and barriers for quitting; review available cessation-support strategies, programs, and medications; and identify next steps. Results: During the 14-month study period, 66,516 members had annual- or new-patient examinations. Both intervention and control sites had high rates of tobacco assessment (97 percent) and advice (93 percent). Intervention patients were more likely than controls (69 percent versus 3 percent, P < 0.01) to receive additional chair-side tobacco counseling and assistance, and 11 percent agreed to receive additional telephone counseling. Intervention patients were more satisfied than controls with the dental team's tobacco-control efforts (P < 0.03). Referral rates varied substantially for different staff. Conclusions: The Assisted Referral approach was successfully integrated into routine dental care, was well received by patients, and resulted in increased patient satisfaction. Because free telephone-based tobacco counseling is now available nationwide, the approach may be a practical strategy for most dental-care settings. [source] Mind the Gaps: The Evolution of Regional Earnings Inequalities in the U.K., 1982,1997JOURNAL OF REGIONAL SCIENCE, Issue 2 2002Gilles Duranton In this paper we apply earnings equations for U.K. regions over 1982,1997. We find evidence of rapid convergence across regions regarding the determinants of individual wages (i.e., regional fixed-effects, gender gaps, and returns to education and experience). In contrast, data on average regional earnings point to a worsening of U.K. regional inequalities and a rise in the North-South gap. Education accounts for most of the discrepancy between aggregate divergence and disaggregated convergence. First, London gained because its workforce became relatively more educated over the period. Second, returns to education increased nationwide, which favored the most educated regions (i.e., London). Third, returns to education were initially lower in London but they (partially) caught up with the rest of the country. Had returns to education and their distribution across U.K. regions remained stable over the period, the U.K. North-South divide would have decreased. [source] From nationwide standardized testing to school-based alternative embedded assessment in Israel: Students' performance in the matriculation 2000 projectJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 1 2003Yehudit J. Dori Matriculation 2000 was a 5-year project aimed at moving from the nationwide traditional examination system in Israel to a school-based alternative embedded assessment. Encompassing 22 high schools from various communities in the country, the Project aimed at fostering deep understanding, higher-order thinking skills, and students' engagement in learning through alternative teaching and embedded assessment methods. This article describes research conducted during the fifth year of the Project at 2 experimental and 2 control schools. The research objective was to investigate students' learning outcomes in chemistry and biology in the Matriculation 2000 Project. The assumption was that alternative embedded assessment has some effect on students' performance. The experimental students scored significantly higher than their control group peers on low-level assignments and more so on assignments that required higher-order thinking skills. The findings indicate that given adequate support and teachers' consent and collaboration, schools can transfer from nationwide or statewide standardized testing to school-based alter-native embedded assessment. © 2003 Wiley Periodicals, Inc. J Res Sci Teach 40: 34,52, 2003 [source] Family and Community Involvement in Schools: Results From the School Health Policies and Programs Study 2006JOURNAL OF SCHOOL HEALTH, Issue 8 2007Shannon Michael MPH ABSTRACT Background:, Family and community involvement in schools is linked strongly to improvements in the academic achievement of students, better school attendance, and improved school programs and quality. Methods:, The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of school districts (n = 461). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n = 1029) and with a nationally representative sample of teachers of required health education classes and courses (n = 912) and required physical education classes and courses (n = 1194). Results:, Although family and community involvement in states, districts, and schools was limited, many states, districts, and schools collaborated with community groups and agencies to promote and support school health programs. More than half of districts and schools communicated information to families on school health program components. Teachers in 55.5% of required health education classes and courses and 30.8% of required physical education classes and courses gave students homework or projects that involved family members. Conclusions:, Although family and community involvement occurred at all levels, many schools are not doing some of the fundamental things schools could do to increase family involvement. Improvements in family and community involvement can support school health programs in states, districts, schools, and classrooms nationwide. [source] Project SOAR: A Training Program to Increase School Counselors' Knowledge and Confidence Regarding Suicide Prevention and InterventionJOURNAL OF SCHOOL HEALTH, Issue 10 2000Keith A. King ABSTRACT: School counselors are often the lead individuals in school suicide prevention programs. All school counselors in Dallas, Texas, receive training through Project SOAR (Suicide, Options, Awareness, and Relief), a suicide prevention program. This study assessed Dallas school counselors' knowledge of suicidal risk factors and perceived ability to initiate appropriate steps when confronted with a suicidal student. A two-page, 44-item survey was distributed to all Dallas school counselors attending a mandatory meeting in spring 1999. A total of 186 school counselors (75%) responded. Most had been a school counselor for less than 10 years and one-half received initial SOAR training less than four years ago. The majority strongly agreed that they could recognize suicidal warning signs, assess a student's risk for suicide, and offer support to a suicidal student. In addition, most knew the intervention steps to take when a student assessed at high suicidal risk. When compared to school counselors nationwide, these counselors reported increased confidence in identifying students at suicidal risk. [source] Tribute to Justice SouterJOURNAL OF SUPREME COURT HISTORY, Issue 1 2010SANDRA DAY O'CONNOR When the U.S. Supreme Court Justices took their seats at the beginning of the 2009 Term, the Bench looked different. Gone from the Bench, after nineteen years, was David H. Souter. He returned to his home in New Hampshire, a state he likes enormously. Justice Souter will be missed by his former colleagues and by advocates before the Court, by legal scholars nationwide and by all who follow the Court's work and activities. [source] Juvenile Court Clinical Services: A National DescriptionJUVENILE AND FAMILY COURT JOURNAL, Issue 4 2005THOMAS GRISSO ABSTRACT There have been few studies of the manner in which juvenile courts obtain clinical evaluations and consultation by juvenile court clinicians in order to identify and respond to youths with mental health problems. This study involved a telephone survey of professionals associated with juvenile court clinic (JCC) services in 87 of the largest juvenile court jurisdictions nationwide, providing data on their professional staff, functions, procedures, organizational and financial structures, and methods for providing evaluations to juvenile courts. We identified three models of JCC service delivery systems. Differences between the JCC service models offer hypotheses pertaining to potential differences in efficiency and quality of services and service delivery. [source] Reeling in Disengaged Students: An Assessment of a Countywide Juvenile Court Attendance ProgramJUVENILE AND FAMILY COURT JOURNAL, Issue 2 2003DAVID MUELLER PH.D. ABSTRACT On any given day, thousands of youths are absent from school; many are absent without a legitimate excuse and thus deemed truant. Truancy has been linked to various problem behaviors including academic failure, delinquency, and school dropout. Thus, the prevention of truancy is assumed to have beneficial effects far into the future. This study provides an overview of an innovative truancy abatement program operating in southwestern Idaho known as the Ada County Attendance Court. Qualitative and quantitative data are presented to show how the program operates, its effects, and how it differs from other truancy prevention programs nationwide. [source] | ||||||||||||||||||||||||||||||||||||||||||||||