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System Change (system + change)
Kinds of System Change Selected AbstractsSystem Change through Collaboration,Eight Steps for Getting from There to HereJUVENILE AND FAMILY COURT JOURNAL, Issue 4 2002JUDGE SHARON S. TOWNSEND ABSTRACT Family courts and child welfare agencies across the country are charged with protecting the safety of our children. That mission has become more challenging with increasing federal legislation and decreasing funding. In Buffalo, N.Y., the Family Court and the Department of Social Services have teamed up to respond to this challenge. With minimal additional staffing and resources, they have led a collaboration of agencies and service providers to change the way business is done in child welfare. By engaging each other in an interagency system change effort, the amount of time children spend in foster care has been reduced. The collaboration has been able to accomplish in a relatively short time what no agency had previously been able to accomplish on its own. The beneficiaries have been the children and families of Erie County. [source] Political Economy of Economic System Change in the Age of Neoliberalism: A Comparative Study of Germany and KoreaPACIFIC FOCUS, Issue 2 2003Young-Tae Jung This paper explores the plausibility of the neoliberal convergence theory, by exploring recent developments in the German and Korean economies. These two countries are the focus of this paper largely because their original economic systems had many features which contrasted with and were distinctive from the Anglo-American economic system; however, it appears that they have now moved toward the Anglo-American system. It will be argued that the neoliberal convergence theory is too simplistic and, therefore, misleading for both theoretical and empirical reasons. Rather, the reality is that different countries and institutions undergo different degrees of change toward the neoliberal model of political economic organization largely due to distinctive characteristics of prior established institutions-more precisely, due to different configurations of socio-political forces. It will be suggested that there may be two alternative development strategies open to the two countries in question for the future. One is that they may have to transform their underlying cultural factors and their ,superstructures'- i.e., political institutions and practices-if an Anglo-American economic system is really recognized as the best for them. The other is that they may have to modify the Anglo-American system to make it more suitable for their societies if the latter is not really the best, but just one of many best, economic systems. [source] The Transition from Excess Capacity to Strained Capacity in U.S. HospitalsTHE MILBANK QUARTERLY, Issue 2 2006GLORIA J. BAZZOLI After many years of concern about excess hospital capacity, a growing perception exists that the capacity of some hospitals now seems constrained. This article explores the reasons behind this changing perception, looking at the longitudinal data and in-depth interviews for hospitals in four study sites monitored by the Community Tracking Study of the Center for Studying Health System Change. Notwithstanding the differences for individual hospitals, we observed that adjustments to the supply of hospital services tend to be slow and out of sync with changes in the demand for hospital services. Those hospitals reporting capacity problems are often teaching hospitals, located near previously closed facilities or in population growth areas. These findings suggest therefore that approaches to dealing with capacity problems might best focus on better matching individual hospitals' supply and demand adjustments. [source] How does the mirror neuron system change during development?DEVELOPMENTAL SCIENCE, Issue 5 2007James M. Kilner No abstract is available for this article. [source] "It's a Balancing Act!": Exploring School/Work/Family Interface Issues Among Bilingual, Rural Nebraska, Paraprofessional EducatorsFAMILY RELATIONS, Issue 3 2006Rochelle L. Dalla Abstract: Nebraska's rural school districts have a rapidly growing Spanish-speaking student body and few qualified instructors to meet their educational needs. This investigation examined factors that promote and challenge the ability of rural Nebraska paraprofessional educators to complete an online B.S. program in elementary education, with a K-12 English as a second language endorsement. Interviews focused on the interface between school, work, and family, with special attention on family system change and adaptation. Twenty-six bilingual paraprofessional educators enrolled (or formerly enrolled) in the education program were interviewed. Twenty were first- (n= 15) or second-generation (n= 5) immigrant Latino/as. Influences of program involvement on the marital and parent-child relationships are discussed, as are implications for future work with unique populations. [source] Environmentally-friendly Aspects and Innovative Lightweight Traction System Technologies of the Shinkansen High-speed EMUsIEEJ TRANSACTIONS ON ELECTRICAL AND ELECTRONIC ENGINEERING, Issue 2 2008Yoshiyasu Hagiwara Member Abstract In 1964, the Tokaido Shinkansen marked the start of the world's first commercial service high-speed railway that operates at over 200 km/h. Since then, the Tokaido Shinkansen has demonstrated successful business and technological advancement. With the speeding-up of the Shinkansen, environmental matters such as noise and vibration have become critical issues. Measures taken to counter noise and vibration,such as weight reduction and aerodynamics,also effect global environmental measures to reduce energy consumption and CO2 emission. With the introduction of the Series 300, there was a system change of applying an AC drive system, and the lightweight body realized performance improvement over the earlier Series 0. The high-speed EMUs have readily taken advantage of technological innovation such as those achieved in electronics technology. In particular, an innovative AC drive system comprising a power converter with a GTO thyristor and asynchronous motors realized a high-performance and lightweight traction system for high-speed EMUs in the 1990s. Furthermore, recent innovations in electronics technology, such as low switching loss power devices and high-power permanent magnets, have improved the AC drive systems of the high-speed EMUs of the 21st century. This article starts out by introducing environmentally friendliness of the Shinkansen trains in terms of low energy consumption by means of traction system change, and then proceeds to describe the recent technological innovations that have given birth to lightweight traction systems, such as the Permanent Magnet Synchronous traction Motor (PMSM) and power converters with train-draft-cooling systems. The article concludes by summing up the environmentally friendly aspects of the Tokaido Shinkansen. Copyright © 2008 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc. [source] ADHD: The need for system changeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2005D Efron No abstract is available for this article. [source] A model for quantitative evaluation of an end-to-end question-answering systemJOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 8 2007Nina Wacholder We describe a procedure for quantitative evaluation of interactive question-answering systems and illustrate it with application to the High-Quality Interactive Question-Answering (HITIQA) system. Our objectives were (a) to design a method to realistically and reliably assess interactive question-answering systems by comparing the quality of reports produced using different systems, (b) to conduct a pilot test of this method, and (c) to perform a formative evaluation of the HITIQA system. Far more important than the specific information gathered from this pilot evaluation is the development of (a) a protocol for evaluating an emerging technology, (b) reusable assessment instruments, and (c) the knowledge gained in conducting the evaluation. We conclude that this method, which uses a surprisingly small number of subjects and does not rely on predetermined relevance judgments, measures the impact of system change on work produced by users. Therefore this method can be used to compare the product of interactive systems that use different underlying technologies. [source] A Second Republic for Italy?POLITICAL STUDIES REVIEW, Issue 1 2003Mark Donovan Radical change in the representative dimension of Italy's political system was expected to bring a transition to a ,Second Republic' in Italy. That has not happened. Nevertheless, after three consultations using the new parliamentary electoral system, studies focusing on the ,input' side of Italian politics are beginning to agree that substantial change has occurred. It is, however, too early to identify the extent of change in public administration and centre,local government relations, whilst even in parliament it is argued that consensual decision-making continued at least into the late 1990s. The impact of party system change on policy-making has thus been shown to be less direct than many expected, providing rich material for research into the relationship between institutional and policy change. Nevertheless, institutional change continues, particularly with regard to the decentralisation of government, and some studies suggest that this is the key to Italy's political transformation, rather than electoral reform or even change in the form of government. Still, the election of Italy's first right-wing majority government in 2001 may yet bring change in parliamentary practice and policy-making more generally. [source] Path Dependency and the Reform of English Local GovernmentPUBLIC ADMINISTRATION, Issue 1 2005Francesca Gains This paper uses the concept of path dependency to examine the changes to the political management structures of English local government. We note how the possible experience of decreasing returns among some local authority actors combined with the powerful intervention of politicians within New Labour at the national level led to a significant break from past policy and the imposition of measures to establish a separate executive that was claimed as a radical step forward for local democracy. Using survey data from the Evaluating Local Governance research team (http://www.elgnce.org.uk), we explore the establishment of a separate political executive in all major local authorities and map out the style of decision-making that is emerging. We find that some established institutional patterns reasserted themselves in the process of implementation, but that increasing returns are not as great as some theorists of path dependency would suggest and they may be a force for system change as well as for stability. [source] Working in East German Socialism in 1980 and in Capitalism 15 Years Later: A Trend Analysis of a Transitional Economy's Working ConditionsAPPLIED PSYCHOLOGY, Issue 4 2000Doris Fay Many studies document the changes that have taken place in the new German states, the former German Democratic Republic (GDR), since the end of socialism. Most research looks at the changes that took place after the unification of East and West Germany, but little is known about the differences between the present, somewhat settled situation in the new German states and the stable situation in the GDR before the system change. The goal of this study was to enlarge our knowledge on these differences. With a trend analysis, aspects of work in the GDR in 1980 (n=337) were compared with the new German states in 1995 (n=168). Results showed that there was more job control and complexity, more activity in work improvement and better work organisation in the new German states than in the GDR. There was no difference in stress variables and social support by colleagues between both groups. Relationships with supervisors and appreciation for suggestions for work improvement were better in the GDR than after the introduction of capitalism. Beaucoup d'e´tudes portent sur les changements qui ont eu lieu depuis la fin du socialisme dans les nouveaux La¨nder allemands, à savoir l'ancienne Re´publique De´mocratique d'Allemagne (R.D.A.). La plupart des recherches s'occupent des changements apparus après la re´unification, mais on sait peu de choses des diffe´rences entre la situation actuelle, plus ou moins stabilise´e, et la situation telle qu'elle e´tait avant l'effondrement du système. Ce travail avait pour objectif d'approfondir nos connaissances sur ces diffe´rences. On a compare´ des dimensions du travail en R.D.A. en 1980 (N=337) et dans les nouveaux Länder en 1995 (N=168). Les re´sultats montrent qu'en R.D.A. le travail e´tait moins complexe, moins contrôle, moins bien organise´ avec un moindre souci d'ame´lioration. Aucune diffe´rence n'est apparue entre les deux groupes quant à la tension nerveuse et au soutien social apporte´ par les collègues. Les relations avec le supe´rieur et la reconnaissance pour les suggestions concernant les am¨eliorations à apporter au travail étaient moins satisfaisantes après l'introduction du capitalisme qu'elles ne l'e´taient antérieurement en R.D.A. [source] An audit of the prevalence of recorded nicotine dependence treatment in an Australian psychiatric hospitalAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Paula Wye Abstract Objectives: To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status. Method: A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six-month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one-page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD-10-AM diagnoses coding was used. Results: From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0-0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses. Conclusions: Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder. Implications: Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained. [source] INCLUSION: Confusion about inclusion: patching up or system change?BRITISH JOURNAL OF SPECIAL EDUCATION, Issue 3 2008Klaus Wedell In this article, Klaus Wedell, Emeritus Professor at the Institute of Education, University of London, looks back over 35 years of developments in the worlds of special and inclusive education. He engages directly with the complexities , for example, the tensions between the standards agenda and policy on inclusion , that have led some commentators to adopt controversial positions and that have engendered heated debate. Klaus Wedell also discusses a dilemma that is emerging as a key issue in the field , the relationships between ,difference', stigma, equality of opportunity and ,special' or separate provision. The response provided here takes, as a starting point, the notion of a flexible education system that could recognise diversity among learners while making provision for all. Klaus Wedell explores this possibility in terms of the curriculum, pedagogy, school structures and local authorities. He indicates points at which policies contradict one another and where practice has not evolved to address the challenges raised by innovative thinking. He provides evidence of the need for systemic change. He argues that all young people should be valued as individuals so that the differences between them can be acknowledged without prejudice. Only in this way, suggests Klaus Wedell, can the artificial separation of special educational needs policy and mainstream thinking be ended. [source] Improving quality of care by system changeBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2008T. A. Lees Change based on evidence [source] Accelerated nervous system development contributes to behavioral efficiency in the laboratory mouse: A behavioral review and theoretical proposalDEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2001Ian Q. Whishaw Abstract The emergence of the laboratory mouse as a favored species for genetic research has posed a number of problems for scientists interested in the reflection of genetic influences in mouse behavior. It is commonly thought that rat behavior, which has been studied more extensively than mouse behavior, could be easily generalized to mice. In this article, a number of categories of behavior displayed by the mouse (motor, spatial, defensive, social) are reviewed and contrasted with the same categories of behavior displayed by the rat. The comparison suggests that mouse behavior is simpler and more dependent upon elementary actions than the behavior of the rat. We suggest that the behavioral simplification in the mouse adapts it for a different ecological niche than that occupied by the rat. We propose that this simplification may be mediated by accelerated brain maturation during development. We further propose that this developmental acceleration in the mouse renders it less dependent upon complex social behavior and plastic nervous system changes associated with learning than the rat. This difference poses problems for the development of relevant methods of behavioral analysis and interpretation. Since the mouse's biological adaptations will be reflected in laboratory behavior, suggestions are made for behavioral approaches to the study and interpretation of mouse behavior. © 2001 John Wiley & Sons, Inc. Dev Psychobiol 39: 151,170, 2001 [source] Participation and/or/versus sustainability?ENVIRONMENTAL POLICY AND GOVERNANCE, Issue 4 2005Austria, Tensions between procedural, substantive goals in Two Local Agenda 21 processes in Sweden Abstract Local Agenda 21 (LA21) is committed to two types of goal: procedural goals substantiated primarily in the requirement to encourage greater participation in local decision making and substantive goals predominantly attached to the call for a sustainable development. In this article, we report on the LA21 processes of two communities, Helsingborg, Sweden, and Vienna, Austria. We analyse what kind of normative tension the two communities have experienced by concurrently striving for democracy and sustainability. We also discuss what impact the two LA21 processes have on local governance structures and what potentials for more fundamental system changes they hold. Our analysis shows that the challenge of actually reconciling possibly conflicting goals is far from easy. In Helsingborg, the apparent harmony of goals has been achieved partly by falling back on political rhetoric, partly by interpreting the two goals in a narrow way, i.e. sustainability policy has been reduced to environmental issues and citizen participation has been equated with ,paternalistic' consultation. The Viennese LA21 process has managed to implement the two goals in a more comprehensive way, but this has come at the cost of being marginalized by the central political actors. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment. [source] Energy and exergy system analysis of thermal improvements of blast-furnace plantsINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 2 2006Andrzej Zi Abstract The blast-furnace process dominating in the production of steel all over the world is still continuously improved due to its effectiveness (exergy efficiency is about 70%). The thermal improvement consist in an increase of the temperature of the blast and its oxygen enrichment, as well as the injection of cheaper auxiliary fuels. The main aim is to save coke because its consumption is the predominating item of the input energy both in the blast-furnace plant and in ironworks. Besides coke also other energy carriers undergo changes, like the consumption of blast, production of the chemical energy of blast-furnace gas, its consumption in Cowper-stoves and by other consumers, as well as the production of electricity in the recovery turbine. These changes affect the whole energy management of ironworks due to the close connections between energy and technological processes. That means the production of steam, electricity, compressed air, tonnage oxygen, industrial water, feed water undergo changes as well. In order to determine the system changes inside the ironworks a mathematical model of the energy management of the industrial plant was applied. The results of calculations of the supply of energy carriers to ironworks can then be used to determine the cumulative energy and exergy consumption basing on average values of cumulative energy and exergy indices concerning the whole country. Such a model was also used in the system analysis of exergy losses. Copyright © 2005 John Wiley & Sons, Ltd. [source] Research Agenda for Frailty in Older Adults: Toward a Better Understanding of Physiology and Etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2006Jeremy Walston MD Evolving definitions of frailty, and improved understanding of molecular and physiological declines in multiple systems that may increase vulnerability in frail, older adults has encouraged investigators from many disciplines to contribute to this emerging field of research. This article reports on the results of the 2004 American Geriatrics Society/National Institute on Aging conference on a Research Agenda on Frailty in Older Adults, which brought together a diverse group of clinical and basic scientists to encourage further investigation in this area. This conference was primarily focused on physical and physiological aspects of frailty. Although social and psychological aspects of frailty are critically important and merit future research, these topics were largely beyond the scope of this meeting. Included in this article are sections on the evolving conceptualization and definitions of frailty; physiological underpinnings of frailty, including the potential contributions of inflammatory, endocrine, skeletal muscle, and neurologic system changes; potential molecular and genetic contributors; proposed animal models; and integrative, system biology approaches that may help to facilitate future frailty research. In addition, several specific recommendations as to future directions were developed from suggestions put forth by participants, including recommendations on definition and phenotype development, methodological development to perform clinical studies of individual-system and multiple-system vulnerability to stressors, development of animal and cellular models, application of population-based studies to frailty research, and the development of large collaborative networks in which populations and resources can be shared. This meeting and subsequent article were not meant to be a comprehensive review of frailty research; instead, they were and are meant to provide a more-targeted research agenda-setting process. [source] Age-related myelin dynamics revealed by increased oligodendrogenesis and short internodesAGING CELL, Issue 2 2009Jurate Lasiene Summary Aging is associated with many functional and morphological central nervous system changes. It is important to distinguish between changes created by normal aging and those caused by disease. In the present study we characterized myelin changes within the murine rubrospinal tract and found that internode lengths significantly decrease as a function of age which suggests active remyelination. We also analyzed the proliferation, distribution and phenotypic fate of dividing cells with Bromodeoxyuridine (5-bromo-2-deoxyuridine, BrdU). The data reveal a decrease in glial cell proliferation from 1 to 6, 14 and 21 months of age in gray matter 4 weeks post-BrdU injections. However, we found an increase in gliogenesis at 21st month in white matter of the spinal cord. Half of newly generated cells expressed NG2. Most cells were positive for the early oligodendrocyte marker Olig2 and a few also expressed CC1. Very few cells ever became positive for the astrocytic markers S100, or GFAP. These data demonstrate ongoing oligodendrogenesis and myelinogenesis as a function of age in the spinal cord. [source] Breaking New Ground in Juvenile Justice Settings: Assessing for Competencies in Juvenile OffendersJUVENILE AND FAMILY COURT JOURNAL, Issue 2 2005JULIETTE R. MACKIN ABSTRACT The field of juvenile justice has made great strides in developing a research base of effective practices and principles, including an understanding of risk factors and needs that contribute to juvenile offending. However, the research base and practice of systematic assessment has not yet fully incorporated youth, family, and community strengths. To address this need, three juvenile justice agencies in the northwestern United States participated in a pilot study to develop and implement an assessment tool (the Youth Competency Assessment) and process that would identify and utilize strengths to help balance the risk and needs focus of their assessment and case planning practices. This article provides descriptions and implementation strategies of the three pilot sites. The article concludes with recommended system changes and policy interventions to support ongoing utilization of this kind of strength-based tool in juvenile justice settings, and a clear set of recommendations for other communities wishing to implement strength-based assessment in their own agencies. [source] The effect of anthropogenic habitat usage on the social behaviour of a vulnerable species, Cyclura nubilaANIMAL CONSERVATION, Issue 1 2003Kathryn E. Lacy With the increasing human population world-wide, animals and humans are sharing more habitat. In this study, we consider the consequences of this habitat usage overlap on the behaviour patterns and social structure of a threatened species. Specifically, we used focal animal samples to collect data on the Cuban rock iguana, Cyclura nubila, in six field sites. Three of these sites are subject to considerable anthropogenic habitat usage, whereas three are in relatively low anthropogenic usage areas. Individuals in high anthropogenic usage sites were more closely assembled, with more males and females sharing a smaller amount of space. These animals exhibited even more aggressive behaviour and social interactions than expected when taking into account the larger number of possible interactants. High anthropogenic usage sites also had more male,male interactions and fewer males interacting with females. We suggest that social and mating system changes have occurred. Ramifications of these recent changes in the behavioural repertoires on the long-term survival of the species are discussed. [source] Age-related changes in leukocytes and T cell subsets in peripheral blood of Japanese Black cattleANIMAL SCIENCE JOURNAL, Issue 3 2008Sachi TANAKA ABSTRACT It is well known that the immune system changes with age during development and maturation in Holstein cattle. But age-related changes in leukocytes and T cell subsets in peripheral blood of Japanese Black cattle still remain unclear. The aim of the present study was to investigate comparative changes of leukocytes (granulocytes, monocytes, B cells and T cells) and T cell subsets (CD4+, CD8+, ,,, CD8+,, and WC1+,, T cells) in Japanese Black cattle aged 0.5, 1, 2, 6, 18 and 36,41 (adult) months on flow cytometry using specific monoclonal antibodies for the cell surface markers. T cell proportion was approximately 40% in 2-month-old cattle and decreased to 20.6% in adults. In contrast, B cell proportion significantly increased from 7.4% to 28.2% with age. In T cell subsets the percentage of CD4+ T cells significantly increased from 40.5% to 60%, but that of WC1+,, T cell subset significantly decreased with age. The percentages of CD8+ and CD8+,, T cells did not change. The present study details the proportional changes in leukocyte and T cell subsets with age in the peripheral blood of Japanese Black cattle and these findings are similar to those described for Holstein cattle. [source] Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy?,ANNALS OF NEUROLOGY, Issue 6 2009Anne Louise Oaklander MD Neurologist S. Weir Mitchell first described "causalgia" following wartime nerve injury, with its persistent distal limb burning pain, swelling, and abnormal skin color, temperature, and sweating. Similar post-traumatic symptoms were later identified in patients without overt nerve injuries after trauma. This was labeled reflex sympathetic dystrophy (RSD; now complex regional pain syndrome type I [CRPS-I]). The pathophysiology of symptoms is unknown and treatment options are limited. We propose that persistent RSD/CRPS-I is a post-traumatic neuralgia associated with distal degeneration of small-diameter peripheral axons. Small-fiber lesions are easily missed on examination and are undetected by standard electrophysiological testing. Most CRPS features,spreading pain and skin hypersensitivity, vasomotor instability, osteopenia, edema, and abnormal sweating,are explicable by small-fiber dysfunction. Small fibers sense pain and temperature but also regulate tissue function through neuroeffector actions. Indeed, small-fiber,predominant polyneuropathies cause CRPS-like abnormalities, and pathological studies of nerves from chronic CRPS-I patients confirm small-fiber,predominant pathology. Small distal nerve injuries in rodents reproduce many CRPS features, further supporting this hypothesis. CRPS symptoms likely reflect combined effects of axonal degeneration and plasticity, inappropriate firing and neurosecretion by residual axons, and denervation supersensitivity. The resulting tissue edema, hypoxia, and secondary central nervous system changes can exacerbate symptoms and perpetuate pathology. Restoring the interest of neurologists in RSD/CRPS should improve patient care and broaden our knowledge of small-fiber functions. Ann Neurol 2009;65:629,638 [source] Burning mouth syndrome and psychological disordersAUSTRALIAN DENTAL JOURNAL, Issue 2 2009LM Abetz Abstract Burning mouth syndrome (BMS) is an oral dysaesthesia that causes chronic orofacial pain in the absence of a detectable organic cause. The aetiology of BMS is complex and multifactorial, and has been associated in the literature with menopause, trigger events and even genetic polymorphisms. Other studies have found evidence for mechanisms such as central and peripheral nervous system changes, with clinical and laboratory investigations supporting a neuropathologic cause. These physiological explanations notwithstanding, there is still much evidence that BMS aetiology has at least some psychological elements. Somatoform pain disorder has been suggested as a mechanism and factors such as personality, stress, anxiety, depression and other psychological, psychosocial and even psychiatric disorders play a demonstrable role in BMS aetiology and symptomatology. In order to treat BMS patients, both physiological and psychological factors must be managed, but patient acceptance of possible components of psychological disease basis is a major hurdle. Clinical signs of patient stress, anxiety or depression are a useful reinforcement of clinical discussions. The current paper proposes a number of clinical signs that may be useful for both clinical assessment and subsequent patient discussions by providing visible supportive evidence of the diagnosis. [source] Physically Abused Children's Regulation of Attention in Response to HostilityCHILD DEVELOPMENT, Issue 5 2005Seth D. Pollak The present study examines the effects of early emotional experiences on children's regulation or strategic control of attention in the presence of interpersonal hostility. Abused children's reactions to the unfolding of a realistic interpersonal emotional situation were measured through multiple methods including autonomic nervous system changes and overt behavioral performance. Although physically abused and non-physically abused 4-year-old children did not differ in terms of their baseline levels of arousal, marked differences in physically abused children's regulatory responses to background anger emerged. These data suggest that the emergence of anger leads to increases in anticipatory monitoring of the environment among children with histories of abuse. Results are discussed in terms of risk factors in the development of psychopathology. [source] Evolution of the Minangkabau's shifting cultivation in the West Sumatra highland OF Indonesia and its strategic implications for dynamic farming systemsLAND DEGRADATION AND DEVELOPMENT, Issue 1 2005A. Dendi Abstract This paper explores the evolution of the shifting cultivation of the Minangkabau, the biggest matrilineal society in Indonesia, and examines factors underlying the instability and vulnerability of farmers' livelihoods and the degradation of their resource base using an extended factor analysis technique, in order to understand how development strategies might be modified towards a more dynamic farming system. The study distinguished three main phases of the farming system's changes and found that these changes highly corresponded with the emerging market and institutional incentives. Furthermore, the factor analysis generated a six-factor model suggesting strategic interventions to foster the improvement of farmers' livelihoods and environment in future. In addition, consistent with the results of these factors analysis, we argue that, provided land tenure is conducive, there are substantial possibilities for policies and interventions that focus first on agricultural diversification and then on organization building, to assist in dealing with farmers' vulnerability and environmental degradation in the uplands. Copyright © 2004 John Wiley & Sons, Ltd. [source] Multilevel Analysis of the Chronic Care Model and 5A Services for Treating Tobacco Use in Urban Primary Care ClinicsHEALTH SERVICES RESEARCH, Issue 1 2009Dorothy Y. Hung Objective. To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services. Methods. Cross-sectional surveys were used to obtain data from 497 health care providers in 60 primary care clinics serving low-income patients in New York City. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate the probability of full 5A service delivery, adjusting for provider covariates and clustering effects. We examined associations between provider delivery of 5A services, clinic implementation of CCM elements tailored for treating tobacco use, and the degree of CCM integration in clinics. Principal Findings. Providers practicing in clinics with enhanced delivery system design, clinical information systems, and self-management support for cessation were 2.04,5.62 times more likely to perform all 5A services ( p<.05). CCM integration in clinics was also positively associated with 5As delivery. Compared with none, implementation of one to six CCM elements corresponded with a 3.69,30.9 increased odds of providers delivering the full spectrum of 5As ( p<.01). Conclusions. Findings suggest that the CCM facilitates provider adherence to the Public Health Service 5A clinical guideline. Achieving the full benefits of systems change may require synergistic adoption of all model components. [source] Leading the development of nursing within a Nursing Development Unit: The perspectives of leadership by the team leader and a professor of nursingINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 4 2003Iain Graham RN Leadership within nursing is receiving unprecedented focus and development. This reflective narrative explores the nature of leadership, termed scholarly leadership, by an academic and a clinical leader of a Nursing Development Unit. The narrative explores the characteristics of such leadership and highlights how it empowered a nursing team to further reach its potential. Two areas, patient-centered care and the characteristics of practice, are focused upon to highlight the leadership style that the clinical leader adopted. The paper concludes by suggesting what structural and systems changes need to be put in place in order to bring about change. [source] | |||||||||||||||||||||||||