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PubMed2002

Atypical trajectories of number development: a neuroconstructivist perspective.

Despite the fact that number deficits are as prevalent as literacy deficits, research on basic numerical skills lags seriously behind the successful studies identifying low-level deficits in dyslexia. We review current debates on number, discussing how the competing theories pertain to mathematical disabilities in normal children and numeracy deficits in genetic disorders. We stress the need to consider these issues within the framework of a developing system rather than from the neuropsychological perspective of focal damage. The earlier the exploration of atypical trajectories in very basic numerical skills, the better we will be able to chart their developmental impact on subsequent, higher-level arithmetic abilities.

Journal Article↗
PubMed1998

In-training assessment in postgraduate training for general practice.

Assessment within general practice training curricula is necessary to both guide learning and to make certification decisions about competence to practise without supervision in the community, but there is a risk that the two roles could become confused. This paper proposes a conceptual framework that explains the relationship between formative assessment, in-training assessment and end-point assessment, as adopted by the Royal Australian College of General Practitioners Training Programme. The literature is reviewed to suggest assessment formats that could provide a means of making decisions about progress through training without harming the important role of providing feed-back to guide learners.

Australia↗
PubMedDate not supplied

Theories of spouse abuse: relevance to African Americans.

This article reviews several sociocultural theories of spouse abuse. However, their relevance to ethnic people of color, and African Americans in particular, is questionable because of different cultural and historical experiences. It is suggested that the use of unidimensional sociocultural theories may not adequately explain spousal abuse cross culturally. Recommendations are made for the development and testing of multidimensional theoretical frameworks that consider the unique cross-cultural variations related to abusive relationships among ethnic people of color. Additionally, studies that are conducted by culturally competent researchers may better explain cultural similarities and differences regarding spouse abuse and thus ultimately lead to more culturally competent nursing care.

Black or African American↗
PubMed2004

Movement trajectories in the presence of a distracting stimulus: evidence for a response activation model of selective reaching.

Consistent with action-based theories of attention, the presence of a nontarget stimulus in the environment has been shown to alter the characteristics of goal-directed movements. Specifically, it has been reported that movement trajectories veer away from (Howard & Tipper, 1997) or towards (Welsh, Elliott, & Weeks, 1999) the location of a nontarget stimulus. The purpose of the experiments reported in this paper was to test a response activation model of selective reaching conceived to account for these variable results. In agreement with the model, the trajectory changes in the movements appear to be determined by the activation levels of each competing response at the moment of response initiation. The results of the present work, as well as those of previous studies, are discussed within the framework of the model of response activation.

Adult↗
PubMed1995

Shared governance. From vision to reality.

Quality patient care is best provided by competent clinical staff members who are committed to their work, organizational values, and goals, and who maintain employment over time. Shared governance has provided the framework for clinical nurses to become more committed to their practice through decision making and to assume accountability for the outcomes of their decisions. At a tertiary teaching facility, shared governance resulted in increased job satisfaction, commitment, and retention among staff nurses. The authors describe the journey from creation of the shared governance vision to reality, and the impact of the changes.

Adult↗
PubMed1999

Medical application of engineering risk analysis and anesthesia patient risk illustration.

The engineering risk analysis method can be extended to include some human and organizational factors and can be used in the medical domain; this transfer is illustrated by a description of a study of anesthesia patient risk. This study involves first a dynamic analysis of accident risks. The model is then extended by relating the basic events of accident scenarios to the state of the practitioner described by the probability of personal problems that may affect his or her level of competence and alertness. These potential problems, in turn, are linked (by probabilistic relations) to the way the system is managed. This extension of the analytical framework allows assessment of the effect of particular types of practitioner problems and therefore of corresponding risk mitigation measures on the probability of the different accident scenarios. The risk analysis model can then be used as a management tool that permits setting priorities among patient safety measures, based either on the sole benefits of the corresponding decrease of patient risk or on a cost-to-benefit ratio. This probabilistic approach constitutes a departure from the classic risk studies exclusively based on statistical frequencies because it involves both available statistics and expert opinions. It is commonly used in engineering for systems for which there is not enough information at the time when decisions need to be made. I show here how the probabilistic model can be used in the medical field to support patient safety decisions before complete data sets can be gathered or in cases in which some key factors are not directly observable.

Anesthesia↗
PubMedDate not supplied

Application of critical pathways in the maternity nursing orientation process.

The creation of an individualized, systematic, and comprehensive clinical orientation is essential for the newly hired nurse, the nurse preceptor, and nursing managers. The development, implementation, and use of "orientation pathways" provides a framework that will produce an individualized orientation based on clinical experience, focus on specific criteria for patient care and unit duties, ensure completion of skill competency criteria within a specified time frame, and assist with identification of problems and/or weaknesses the nurse orientee may be experiencing.

Critical Pathways↗
PubMed2006

Consultation with children in hospital: children, parents' and nurses' perspectives.

AIMS AND OBJECTIVES: To explore children's, parents' and nurses' views on participation in care in the healthcare setting. BACKGROUND: Children have a right to be consulted and involved in their care. DESIGN: The grounded theory method was used and data were collected through in-depth interviews, questionnaires and observation. Sample consisted of 11 children, 10 parents and 12 nurses from four paediatric wards in two hospitals in England. RESULTS: Parents felt that children should be involved in the decision-making process thereby enhancing and promoting children's self-esteem and positive self-regard, which would consequently enhance their overall welfare. Likewise, children expressed the need for consultation and information so that they could understand their illness; be involved in their care, and prepare themselves for procedures. However, children's own opinions and views were underused and they had varying experiences of being consulted about their care and treatment. Nurses appeared to hold varying and discrepant views on the involvement of children in decisions and for some nurses, the child's involvement seemed to be dependent on the child's cognitive maturity and being defined as a rational subject. CONCLUSION: Health professionals' communication behaviour may reflect recognition of children's cognitive abilities rather than their competence to understand. The fact that children's nurses appeared to make decisions about involving children in decision making in the absence of a reliable framework was a significant finding and highlights a real problem in the current climate. RELEVANCE TO CLINICAL PRACTICE: Nurses faced with workforce pressures may encounter considerable challenges to facilitating children's involvement in decisions about their care. Hence it is imperative that nurses' examine the basis of their decisions and use more explicit criteria for determining children's involvement.

Attitude of Health Personnel↗
PubMed2005

Intrinsic and environmental response pathways that regulate root system architecture.

Root system development is an important agronomic trait. The right architecture in a given environment allows plants to survive periods of water of nutrient deficit, and compete effectively for resources. Root systems also provide an optimal system for studying developmental plasticity, a characteristic feature of plant growth. This review proposes a framework for describing the pathways regulating the development of complex structures such as root systems: intrinsic pathways determine the characteristic architecture of the root system in a given plant species, and define the limits for plasticity in that species. Response pathways co-ordinate environmental cues with development by modulating intrinsic pathways. The current literature describing the regulation of root system development is summarized here within this framework. Regulatory pathways are also organized based on their specific developmental effect in the root system. All the pathways affect lateral root formation, but some specifically target initiation of the lateral root, while others target the development and activation of the lateral root primordium, or the elongation of the lateral root. Finally, we discuss emerging approaches for understanding the regulation of root system architecture.

Cell Cycle↗
PubMed1991

Molecular and cellular aspects of immunologic tolerance.

This review seeks to explain the most exciting recent data concerning the nature of self/non-self discrimination by the immune system in a manner accessible to a biochemical readership. The nature of recognition in the two great lymphocyte families, B cells and T cells, is described with special emphasis on the nature of the ligands recognized by each. The history of the field of immunologic tolerance is surveyed, as are the key experiments on conventional mice which provided a conceptual framework. This suggested that tolerance was essentially due to 'holes' in the recognition repertoires of both the T and B cell populations so that lymphocytes competent to react to self antigens were not part of the immunologic dictionary. There were essentially two ways to achieve this situation. On the one hand, self antigens might 'catch' developing lymphocytes early in their ontogeny and delete the cell, a process of clonal abortion. On the other hand, self antigens might signal lymphocytes (particularly immature cells) in a negative manner, reducing or abolishing their capacity for later responses, without causing death. This process is referred to as clonal anergy. Evidence for both processes exists. Special emphasis is placed on a wave of experimentation beginning in 1988 which imaginatively uses transgenic mouse technology to study tolerance. Transgenic manipulations can produce mice which synthesize foreign antigens in a constitutive and/or inducible manner, sometimes only in specific locations; mice which possess T or B lymphocytes almost all expressing a given receptor of known specificity; and mice which are an immunologic time bomb in that the antigen is present and so too are lymphocytes all endowed with receptors for that antigen. These experiments have vindicated the possibility of both clonal abortion and clonal anergy in both T and B cell populations, the choice of which phenomenon occurs depending on a number of operational circumstances. For T cell tolerance, clonal abortion occurs if the self antigenic determinant concerned is present within the thymus; if not, clonal anergy is more likely. For B cell tolerance, the strength of the negative signal and therefore the choice between abortion and anergy depends on the molar concentration of the self antigen, the capacity for multivalent presentation to a B cell, and the affinity of the B cell's receptor for the antigen in question. Some B cells with low affinity for self antigens certainly escape censorship and remain capable of secreting low affinity anti-self antibodies, which however do no harm.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1989

Patient education for people with schizophrenia.

This paper presents a rationale for greater nursing involvement in patient education for people with schizophrenia--specifically, providing information about the illness and ways to adapt to it (psychoeducation). It includes a conceptual framework for such education within the context of the nurse-patient relationship, plus an outline of suggested content. The proposed model is within the competency of professional psychiatric nurse generalists.

Adaptation, Psychological↗
PubMedDate not supplied

Disparities and quality improvement: federal policy levers.

Using a quality improvement framework to address racial and ethnic disparities in health care highlights multiple opportunities for federal and state governments to exert policy leverage, particularly through their roles as purchasers and regulators. Under such a framework, federal and state governments can expand their roles in collecting race/ethnicity data; define universal and meaningful race/ethnicity categories; more broadly disseminate standards for cultural competence; and demand the reduction of disparities through leveraging their status as collectively the largest U.S. health care payer.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

Dietetic Internship: Evaluation of an Integrated Model.

The purpose of this study was to utilize graduate and employer perceptions of outcomes of the Mount Saint Vincent University (MSVU) Co-operative Education (Co-op) Dietetics program to determine if an integrated model was an acceptable alternate method of dietetic education. Acceptable alternate was defined as: "facilitating achievement of entry level competence for dietetic practice". A self-administered, validated and piloted questionnaire was utilized to collect qualitative and quantitative information concerning employability, professional preparedness and program outcomes. Surveys were mailed to all program graduates (1989-1993) (n=24) and their first employers (n=19). Response rates were 96% and 89% respectively. Close-ended questions were analyzed quantitatively by determining frequency distributions. Data were also subjected to Chi-square to identify dependent factors. Qualitative responses to open-ended questions were analyzed by thematic content analysis. Results revealed all graduates were employed by six months after graduation. Competency development, a component of professional preparedness, was rated as average or above average by the majority of graduates and employers. Analysis of open-ended responses indicated that the introduction of experience while students were establishing theoretical foundations was perceived as beneficial. An integration of qualitative findings led to the development of a model depicting how professional competency development, readiness for practice, a realistic approach to dietetic practice and a high standard of practice were developed within an evolving personal and contextual framework. Socialization and mentoring opportunities, evaluation processes and the integration of theory and practice influenced professional development. In conclusion, both employer and graduate responses indicated overall program satisfaction suggesting that the Co-op program is an acceptable alternate method of dietetic education.

Journal Article↗
PubMedDate not supplied

When to ally & when to acquire.

Acquisitions and alliances are two pillars of growth strategy. But most businesses don't treat the two as alternative mechanisms for attaining goals. Consequently, companies take over firms they should have collaborated with, and vice versa, and make a mess of both acquisitions and alliances. It's easy to see why companies don't weigh the relative merits and demerits of acquisitions and alliances before choosing horses for courses. The two strategies differ in many ways: Acquisition deals are competitive, based on market prices, and risky; alliances are cooperative, negotiated, and not so risky. Companies habitually deploy acquisitions to increase scale or cut costs and use partnerships to enter new markets, customer segments, and regions. Moreover, a company's initial experiences often turn into blinders. If the firm pulls off an alliance or two, it tends to enter into alliances even when circumstances demand acquisitions. Organizational barriers also stand in the way. In many companies, an M&A group, which reports to the finance head, handles acquisitions, while a separate business development unit looks after alliances. The two teams work out of different locations, jealously guard turf, and, in effect, prevent companies from comparing the advantages and disadvantages of the strategies. But companies could improve their results, the authors argue, if they compared the two strategies to determine which is best suited to the situation at hand. Firms such as Cisco that use acquisitions and alliances appropriately grow faster than rivals do. The authors provide a framework to help organizations systematically decide between acquisition and alliance by analyzing three sets of factors: the resources and synergies they desire, the marketplace they compete in, and their competencies at collaborating.

Attitude↗
PubMed2005

[What makes a mental ill violent?].

From numerous tests it is clearly to be concluded that between severe mental health problems and the act of violence exists a moderate, but reliable association. With this conclusion, neither old fears of "an unpredictable insane person" should be reactivated nor stigmatisation are to be carried out. Particularly since the whole of humans with psychological disturbances does not exhibit an increased act of violence risk in relation to the average population. It is however necessary to identify subgroups with increased tendency for self- and other aggressive behaviour, to describe aggression-aroused and reducing factors and to appreciate the positive influence of the psychiatric therapy and the social rehabilitation. After today's level of knowledge it is to be proceeded from the following risk indicators: Diagnosis of a paranoid disturbance, male sex, correlation with personality disorder and substance abuse, lack of treatment, increasing social disintegration with a longer treatment process and uncertain competence for the support. Extensive psychiatric treatments reduce the risk clearly. The deinstitutionalisation does not have negative influence with secured ambulatory support. The legal accommodation framework, which is discussed on the basis of the Austrian law situation, is an important modifying factor. Relating to the mental health problem there is just a little relation to the aggressive behaviour in comparison to the average population.

Aggression↗
PubMed1994

Caring for people with Alzheimer's disease using the conceptual model of progressively lowered stress threshold in the clinical setting.

Care of the people with Alzheimer's disease and related disorders (ADRD) has been fraught with controversy, often resulting in competing philosophies about what constitutes the "correct" approach. Whether developing an individualized plan of care or specialized programming, it is helpful to use a conceptual framework. The Progressively Lowered Stress Threshold (PLST) conceptual model has been used extensively for planning individualized care for patients with ADRD, developing specialized environments and programming, evaluating outcomes of interventions, and serving as the theoretical framework for nursing research. This article describes use of the PLST model in a clinical setting.

Adaptation, Psychological↗