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Hospital accreditation standards have changed from focusing on capability to actual performance and outcomes. This shift in emphasis requires organization leaders and staff members to make significant paradigm shifts. In this series of articles, the authors will discuss the functional standards for 1994-1995 and their implications.
The concept of paradigm as a set of ontological and epistemological benchmarks is the basis for a discussion of the influence the Newtonian mechanistic paradigm has exerted over special education theory, research, and practice. Discussions of "malcontents" with the mechanistic paradigm across the social sciences and within special education are noted. Recent literature in the field of special education is critiqued for renaming theories as paradigms, thereby leaving mechanistic assumptions in place. The contours are then drawn of theoretical reorientations and of the emerging alternative holistic paradigm and its importance for special education. It is concluded that we do not have paradigms or paradigm shifts within the field, but that the field is part of a paradigm that is undergoing change across the sciences and social sciences.
The etiological heterogeneity of idiopathic diabetes has been recognized for 25 years, and subdivision into type 1 and type 2 diabetes is fundamental to the way we think about the disease. Review of the literature suggests that the concept of type 1 diabetes as an immunemediated disease emerged rapidly over the period from 1974 to 1976 and showed many of the features of a classic paradigm shift. A few key observations triggered recognition and acceptance of the new paradigm, but the necessary context was provided by scientific developments in areas mainly unrelated to diabetes. The disease paradigm established by 1976 is still widely accepted, and its essential features have been modified only in detail by the revolution in molecular biology that has occurred over the intervening period. Notwithstanding, some of the underlying assumptions remain imprecise, unchallenged, or unconfirmed. Appreciation of the historical origin and subsequent evolution of these fundamental concepts could stimulate critical analysis and help prepare the way for a new paradigm.
1. Consumers who elect to use natural products are electing to do more than simply use a product. Their choice is an act of self-empowerment. 2. Education is necessary because these products most often are not being obtained in a professional, consultative setting but rather in chain discount department stores and supermarkets. 3. If consumers choose to address their health concerns using a natural-based treatment plan, consultation with a health care practitioner who shares this shift in perspective and who follows the literature is important. 4. A paradigm shift could be on the health care horizon, which when complete would make herbs and other natural products part of mainstream health care practice.
Hospital accreditation standards have changed from focusing on capability to actual performance and outcomes. This shift in emphasis requires organization leaders and staff members to make significant paradigm shifts. In this series of articles, the authors will discuss the functional standards for 1994-1995 and their implications.
BACKGROUND The mental health literature attests to a paradigm shift from an emphasis on treatment towards a focus on fostering recovery. This paradigm emphasizes many constructs familiar to occupational therapists, including quality of life, empowerment, hope, meaningful activities and work. Occupational therapists are not only familiar with these terms, but have addressed recovery-related constructs in both research and practice. METHOD AND PURPOSE: Literature on the recovery paradigm, mental health and occupational therapy was reviewed to gain an understanding of this paradigm and its relationship to occupational therapy in mental health. RESULT: Core occupational therapy beliefs and assumptions are strikingly similar to those purported to be important to fostering recovery. IMPLICATIONS: Occupational therapists should consider taking a keen interest in the construct of recovery. By virtue of professional beliefs and assumptions, occupational therapists are uniquely positioned to assume a leadership role in the area of recovery-related research and practice.
This study focuses on the ability of preschool children with specific language impairment (SLI) to extract target regularities from recurring nonverbal stimuli. As a step beyond previous methodologies, we also assessed their ability to shift and extract other regularities after feedback indicated that their choices were no longer correct. This step was motivated by Connell and Stone's (1994) hypothesis that difficulties manifested by children with SLI in extracting nonverbal "rules" from multiple problem sets may reflect difficulties in "flexible reconceptualization," that is, in the ability to flexibility shift across regularities. Thirty 4- and 5-year-olds with SLI and 30 age-matched children developing language normally participated in a discrimination learning-shift paradigm. Findings indicated that both language groups were successful in extracting regularities and making shifts. In fact, language groups did not differ in number of regularities extracted, number of shifts completed, or trials to criterion. As a consequence, findings failed to provide evidence that children with SLI are limited in either the ability to extract nonverbal regularities or to flexibly reconceptualize them. From a larger theoretical perspective, the findings fail to support theories positing that generalized "rule-induction" deficits underlie the verbal and nonverbal impairments of SLI.
A novel experimental method, shift-rate recovery, was developed and used in a series of three experiments. These examined the extent to which 6-month-old infants (N = 131) find perceptual cues such as density and length useful in the discrimination of linearly arranged sets containing large numbers of objects. Results showed that infants discriminated between arrays that differ in number and density, with length held constant, when the arrays were presented either simultaneously or successively. On the other hand, infants discriminated only between arrays that differ in number and length, with density held constant, when the arrays were presented simultaneously. Infants were, however, able to perform a successive length discrimination when the arrays were continuous rather than consisting of discrete items. These findings support the conclusion that infants are able to discriminate between large number sets by relying on absolute cues such as density (but not length) and on relative cues such as optical one-to-one correspondence.
The ultimate goal of current chlamydial vaccine efforts is to utilise either conventional or modern vaccinology approaches to produce a suitable immunisation regimen capable of inducing a sterilising, long-lived heterotypic protective immunity at mucosal sites of infection to curb the severe morbidity and worldwide prevalence of chlamydial infections. This lofty goal poses tremendous challenges that include the need to clearly define the relevant effectors mediating immunity, the antigens responsible for inducing these effectors, the anti-chlamydial action(s) of effectors, and establishment of the most effective method of vaccine delivery. Tackling these challenges is further compounded by the biological complexity of chlamydia, the existence of multiple serovariants, the capacity to induce both protective and deleterious immune effectors, and the occurrence of asymptomatic and persistent infections. Thus, novel molecular, immunological and genetic approaches are urgently needed to extend the frontiers of current knowledge, and develop new paradigms to guide the production of an effective vaccine regimen. Progress made in the last 15 years has culminated in various paradigm shifts in the approaches to designing chlamydial vaccines. The dawn of the current immunological paradigm for antichlamydial vaccine design has its antecedence in the recognition that chlamydial immunity is mediated primarily by a T helper type1 (Th1) response, requiring the induction and recruitment of specific T cells into the mucosal microenvironment. Additionally, the ancillary role of humoral immune response in complementing the Th1-driven protective immunity, through ensuring adequate memory and optimal Th1 response during a reinfection, has been recognised. With continued progress in chlamydial genomics and proteomics, select chlamydial proteins, including structural, membrane and secretory proteins, are being targeted as potential subunit vaccine candidates. However, the development of an effective adjuvant, delivery vehicle or system for a potential subunit vaccine is still an elusive objective in these efforts. Promising delivery vehicles include DNA and virus vectors, bacterial ghosts and dendritic cells. Finally, a vaccine still represents the best approach to protect the greatest number of people against the ocular, pulmonary and genital diseases caused by chlamydial infections. Therefore, considering the urgency and the enormity of these challenges, a partially protective vaccine preventing certain severe sequelae would constitute an acceptable short-term goal to control Chlamydia. However, more research efforts and support are needed to achieve the worthy goal of protecting a significant number of the world's population from the devastating consequences of chlamydial invasion of the human mucosal epithelia.
This article chronicles the development of nursing theory and research over the past 30 years as it parallels the author's own development as a theorist-researcher. Dorothy Johnson and Martha Rogers are considered the contemporary forerunners of a shift from an emphasis on medical knowledge to an emphasis on distinctly nursing knowledge. The paradigm shift Rogers called for was largely misunderstood at the time of its inception, resulting in attempts to force holistic thinking into reductionistic methods of research. The epistemology of nursing research lagged behind the ontology of the discipline. Moreover, the absence of an agreed-upon focus of the discipline created a void in the development of theory specific to nursing practice. The author asserts that the focus and paradigm of the discipline of nursing are now clear. The core, purpose, and societal commitment of nursing as a practice discipline are captured in the phrase, caring in the human health experience. Research methods that reflect a unitary, transformative paradigm make it possible to develop theory that structures practice.
The future development of the neurosurgical operative environment is driven principally by concurrent development in science and technology. In the new millennium, these developments are taking on a Jules Verne quality, with the ability to construct and manipulate the human organism and its surroundings at the level of atoms and molecules seemingly at hand. Thus, an examination of currents in technology advancement from the neurosurgical perspective can provide insight into the evolution of the neurosurgical operative environment. In the future, the optimal design solution for the operative environment requirements of specialized neurosurgery may take the form of composites of venues that are currently mutually distinct. Advances in microfabrication technology and laser optical manipulators are expanding the scope and role of robotics, with novel opportunities for bionic integration. Assimilation of biosensor technology into the operative environment promises to provide neurosurgeons of the future with a vastly expanded set of physiological data, which will require concurrent simplification and optimization of analysis and presentation schemes to facilitate practical usefulness. Nanotechnology derivatives are shattering the maximum limits of resolution and magnification allowed by conventional microscopes. Furthermore, quantum computing and molecular electronics promise to greatly enhance computational power, allowing the emerging reality of simulation and virtual neurosurgery for rehearsal and training purposes. Progressive minimalism is evident throughout, leading ultimately to a paradigm shift as the nanoscale is approached. At the interface between the old and new technological paradigms, issues related to integration may dictate the ultimate emergence of the products of the new paradigm. Once initiated, however, history suggests that the process of change will proceed rapidly and dramatically, with the ultimate neurosurgical operative environment of the future being far more complex in functional capacity but strikingly simple in apparent form.
BACKGROUND: The last decade has witnessed a rapid expansion of biomedical knowledge. Despite this, fashions in medical education over the same period have shifted away from factual (didactic) teaching and towards contextual, or problem-based, learning (PBL). This paradigm shift has been justified by studies showing that PBL improves reasoning and communication while being associated with few if any detectable knowledge deficits. DISCUSSION: Analysis of the literature indicates that the recent rapid rise of PBL has closely paralleled the timing of the information explosion. The growing dominance of PBL could thus worsen the problems of information management in medical education via several mechanisms: first, by creating the impression that a defined spectrum of core factual knowledge suffices for clinical competence despite ongoing knowledge expansion (quality cost); second, by dissuading teachers from refining the educational utility of didactic modalities (improvement cost); and third, by reducing faculty time for developing reusable resources to impart factual knowledge more efficiently (opportunity cost). SUMMARY: These costs of PBL imply a need for strengthening the knowledge base of 21st-century medical graduates. New initiatives towards this end could include the development of more integrated cognitive techniques for facilitating the comprehension of complex data; the design of differentiated medical curricula for producing graduates with defined high-priority skill sets; and the encouragement of more cost-effective faculty teaching activities focused on the prototyping and testing of innovative commercializable educational tools.
Inflammatory bowel disease (IBD) is characterised by a chronic, but frequently remitting, clinical course involving significant morbidity. As medical and surgical advances have occurred, focus has shifted from merely reducing mortality to efforts on decreasing morbidity and improving health status. With this paradigm shift has come the need for qualitative and quantitative assessment of outcomes important to the individual patient. Existing disease activity measures fall short in this area. Health-related quality of life encompasses the areas of physical function, somatic sensation, psychological state and social interactions that are affected by one's health status. Instruments have recently been developed for both generic and disease-specific health states, such as IBD. These psychometric measures have proven to be useful tools for patient assessment. Both medical and surgical trials have incorporated these measures as salient outcomes. An additional outcome that has come under closer scrutiny is the cost of medical interventions. The literature on the cost of IBD is sparse but is likely to increase logarithmically in the future. Quality of life and cost issues are becoming central to the study of not just IBD but all of medicine.
Two major shifts in medicine are radically altering the medical profession worldwide: the shift from a professional to a business ethic, and the shift from a hands-one therapeutic approach to one which is technology-dependent. These paradigm shifts affect the traditional medical ethics and principles of professional autonomy, beneficence (doing what is best for patients) and justice. Constructive responses that will help to protect these important ethical ideals include reflection on professional values, involvement in health policy and nurture of the profession's young and "idealistic" members.
This study was aimed at identifying the impaired attentional components in patients who had sustained a severe CHI several years before. A group of 14 CHI patients and a Control group (matched for age, sex and education) were tested. Experiment 1 used a dual-task paradigm (Umiltà et al., 1992). The double task-single task difference was greater for the CHI group, indicating a specific damage at a central executive stage where decision are made and responses are coordinated. Experiment 2 used a task-shifting paradigm (Morra and Roncato, 1986). The cost of shifting from one task to the other was greater for the CHI group, but only in the Short Series Condition where a new task-program could be pre-activated. Experiment 3 studied visual selective attention using Navon paradigm (1977); in this case, there was no difference between patients and controls.
The effects of systemic injections of the dopamine receptor antagonist, cis-flupenthixol were tested on intracranial self-stimulation at electrode sites in the medial forebrain bundle and the medial prefrontal cortex. Changes in the reward effectiveness of the brain stimulation were assessed using a curve-shift paradigm. Low to moderate doses of cis-flupenthixol (0.05, 0.1 and 0.15 mg/kg) consistently produced larger upward shifts in the rate-frequency function for medial forebrain bundle than for medial prefrontal self-stimulation. At the highest doses of cis-flupenthixol (0.15 and 0.2 mg/kg), some of the medial forebrain bundle rats failed to respond, whereas all medial prefrontal rats responded at these doses. These results demonstrate that medial forebrain bundle self-stimulation is much more dependent on dopamine systems than is prefrontal cortex self-stimulation.
Two paradigm shifts are occurring in health care: managed care and community partnerships. The distinct principles and trends of each paradigm are certain to determine the future practice of advanced practice nurses (APNs). The impact of managed care and community partnerships will affect the resource management, clinical decision making, and time management of APNs. Concomitantly, APNs will have opportunities to influence practice guidelines, individual and community decision making, cultural competence, and the cost-effectiveness of care in communities. Capitalizing on these opportunities will enhance the value of APNs to their managed care plan employer and their community.
The Guidelines for Exercise Training initially developed by the American College of Sports Medicine in 1978 and updated in 1990 have served as the foundation for most recommendations regarding physical activity program design for the general public. These guidelines have proven to be very useful by providing a specific regimen for enhancing aerobic capacity and body composition. As data supporting a causal link between increased activity or fitness and health status have evolved, questions have been raised about potential limitations of these guidelines for promoting physical activity to increase the health status of sedentary adults. The major issues have involved the necessity to achieve the values for each of the program parameters, especially the intensity, duration, and frequency of exercise, in order to improve health status. To address these issues, a paradigm shift from exercise training to promote physical fitness to physical activity to promote health has been introduced. This new paradigm is based on the results from numerous studies indicating that a generally active life style is associated with better health and performance and greater longevity and a certain set of assumptions, yet to be fully tested. The following article provides some background leading to the development of the ACSM guidelines and presents some of those issues we understand and some we do not regarding the characteristics of daily physical activity or exercise training that are likely to improve the physical health status of sedentary persons.