Health-e-Access, an urban telemedicine service, enabled 6,511 acute-illness telemedicine visits over a 7-year period for children at 22 childcare and school sites in Rochester, NY.
The aims of this ...article were to (1) describe provider attitudes and perceptions about efficiency and effectiveness of Health-e-Access and (2) assess hypotheses that (a) providers will complete a large proportion of the telemedicine visits attempted and (b) high levels of continuity with the primary care practice will be achieved.
This descriptive study focused on the 24-month Primary Care Phase in the development of Health-e-Access, initiated by the participation of 10 primary care practices. Provider surveys addressed efficiency, effectiveness, and overall acceptability. Performance measures included completion of telemedicine visits and continuity of care with the medical home.
Among survey respondents, the 30 providers who had completed telemedicine visits perceived that decision-making required slightly less time and total time required was slightly greater than for in-person visits. Confidence in diagnosis was somewhat less for telemedicine visits. Providers were comfortable collaborating with telemedicine assistants and confident that communications met parent needs. Among the 2,554 consecutive telemedicine visits attempted during the Primary Care Phase, 2,475 (96.9%) were completed by 47 providers. For visits by children with a participating primary care practice, continuity averaged 83.2% among practices (range, 28.1-92.9%).
Providers perceived little or no advantage in efficiency or effectiveness to their practice in using telemedicine to deliver care; yet they used it effectively in serving families, completing almost all telemedicine visits requested, providing high levels of continuity with the medical home, and believing they communicated adequately with parents.
Recent scholarship on Native American boarding schools has focused on drawing out the complexities of boarding school history and emphasizing the plurality of experiences of students. This thesis ...examines how Native American boarding school stories have been displayed using two current museum exhibits: “Away from Home: American Indian Boarding School Stories” at the Heard Museum, and the Phoenix Indian School Visitors Center, a small gallery in one of the remaining school buildings. For this analysis I interviewed key players in both current exhibits and did close readings of the exhibits themselves, in conjunction with archival research about two model schoolhouse exhibits at world’s fairs. Each of these exhibits, old and new, was engaged with the anthropology and museum theory of the time. The two current exhibits offer updated scholarship and multivocal narratives but designed for and aimed at audiences of very different backgrounds.
This paper contrasts the traditional method of teaching college reading, based on behaviorist theory, with the modern model, based on psycholinguistic theory. It categorizes 20 current, popular ...reading textbooks as traditional, modern, or mixed. Although reading instruction has changed more slowly than the related field of writing instruction, the advantages of the modern model of reading are so considerable that the model will probably dominate the reading textbooks and the reading classes of the next century.
We designed a telemedicine model for diagnosis of common, acute illness to compare telemedicine and in-person evaluations on reproducibility of diagnosis and treatment.
Subjects were seen by usual ...physicians in ambulatory settings. Subjects were also evaluated separately by experienced general pediatricians (study physicians), either in person or via telemedicine, based on random assignment. The primary measure of reproducibility was study physician agreement with usual physician on primary diagnosis. Analysis compared reproducibility for telemedicine versus in-person evaluations. Relevance of agreement on primary diagnosis was measured by comparing agreement on prescribed medications.
Agreement on diagnosis of study physicians with usual physicians for the 492 visits studied was 89%. The difference in the proportion of visits with disagreements between telemedicine study and in-person study evaluations (13.8% vs 8.3%, respectively) bordered on significance (
P = .051). Disagreement proportions for prescriptions were similar (32.2% vs 27.4%), however. Telemedicine evaluation for children with upper respiratory tract (URI)-ear symptoms involved unique technical requirements and clinical judgments. For this largest subgroup of 202 visits, disagreement on diagnosis for telemedicine occurred more often than for in-person evaluation (17.6 vs 6.3%,
P < .02). For the remaining 290 visits, telemedicine and in-person study physicians disagreed on diagnosis about equally (11.5 vs 9.9%).
Excluding the URI-ear group, reproducibility of telemedicine diagnosis did not differ from that of in-person diagnosis. For the URI-ear group, reproducibility of diagnosis by telemedicine and in-person evaluation varied significantly.
Mast cells are important effector cells in asthma and atopic disease. Upon IgE receptor cross‐linking, they release potent inflammatory mediators, cytokines, and chemokines. Mast cells can also be ...activated by IgE‐independent signals, including the anaphylatoxin C5a, adenosine, and other agents. The human mast cell line, HMC‐1, expresses the Gαi‐coupled C5a receptor, along with Gαi‐coupled adenosine receptors A1R (low levels) and A3R, the Gαs coupled A2aR, and the Gαs/Gαq coupled A2bR. We found that HMC‐1 cells exhibited a potent synergistic induction of chemokine release, coupled to NFAT activation, when exposed to C5a in combination with the adenosine analog, NECA. To elucidate the receptor(s) mediating this response, two strategies were employed. First, a panel of specific adenosine receptor agonists was tested in combination with C5a for synergy of chemokine release. Agents selective for A1R or A2aR did not stimulate chemokine production, while an A3R selective agonist induced low levels of chemokine production only in combination with C5a. To investigate the role of A2bR, for which no selective agonist was available, an siRNA approach was employed. Knockdown of A2bR, but not A2aR, significantly reduced NECA‐induced second messenger accumulation (cAMP and IP3) and chemokine production, and inhibited the synergy with C5a. To identify downstream signaling molecules important for this response, a broad‐based phospho‐protein screen was performed, which revealed signaling to SRC phosphorylation is enhanced upon C5a and NECA costimulation. These data suggest a cooperative signaling node in adenosine and C5a costimulation of mast cells resulting from the activation of their respective GPCRs coupled to Gαq and Gαi.
Balance dysfunction is commonly observed following traumatic brain injury. There are many proposed predictors of functional outcome in the traumatic brain injury population. It was hypothesized that ...the degree of balance dysfunction on admission to rehabilitation would be a significant predictor of the need for assistance at discharge, as measured by the Functional Independence Measure (FIM). This study involved 237 cases of traumatic brain injury patients admitted to a rehabilitation unit between November 1989 and September 1996. Using a multiple regression model, controlling for age, initial Glasgow Coma Score (GCS), rehabilitation admission strength, sitting balance and standing balance, it was found that the degree of impairment in sitting balance at admission to rehabilitation was a significant predictor of Discharge FIM-Total (FIM-T) score (p < 0:0001) and also of selected elements from the Discharge FIM-Motor (FIM-M) score (p < 0:0005). The combination of age, initial admission GCS, rehabilitation admission strength, standing balance and sitting balance accounted for 29% of the variance in the Discharge Total FIM score. Among these, sitting balance was the second most powerful predictor of both selected elements of the Discharge FIM motor score and discharge FIM-T. Sitting balance predictive capacity was exceeded in power only by age. Impairments in sitting balance appear to have a significant impact on functional outcome. Emphasis on unique rehabilitation techniques to treat balance dysfunction in the adult TBI population is warranted.
Rapid proliferation of squamous cell carcinomas of the head and neck (SCCHN) during therapy may contribute to treatment failure. We have investigated the presence of p53 abnormalities in patients ...with SCCHN as a correlate of proliferation rate and other pathologic and clinical variables. p53 Mutation, as determined by polymerase chain reaction and single‐strand conformation polymorphism analysis of microdissected frozen sections of tumor biopsies, was significantly associated with a high labeling index, as determined by in vivo infusion of IUdR and BrdU (P = 0.017). p53 Protein expression was detected by immunohistochemistry with two different antibodies, followed by quantitative image analysis. Many cases exhibited strong p53 protein expression in the absence of mutations within the conserved region of the gene, and expression was not related to proliferation. The presence of p53 mutations was related to tumor differentiation in this group of patients.
As the Maurice Papon trial got underway, journalist and historian Éric Conan cited a candid remark which had been made by one of the lawyers representing the civil plaintiffs: "Magistrates don't ...change: under the Occupation, they did what Pétain asked of them: today, they do what public opinion demands of them. But what matters is that Papon should be brought before an Assizes Court (cour d'assises)."(11) There was no doubt that public sentiment was, by late 1997, registering a desire to see Maurice Papon in the dock. Any doubts that were expressed largely invoked the accused's advanced age, the problem of evidence after more than fifty years, or the regret that higher Vichy functionaries -- like former police chief René Bousquet or his henchman Jean Leguay -- had not lived to face the same legal fate. Civil plaintiffs had been lobbying for this outcome since the early 1980s, and in the intervening years public opinion had not only rallied to this campaign, but the demand that Papon face his accusers in court had become the latest focus of the "memorial militancy" that had gripped France since the early 1990s. Fueled by the Touvier trial of 1994, Mitterrand's public pronouncements about his wartime activities, President Chirac's "Vél d'Hiv" speech of 16 July 1995 which accepted French responsibility for crimes committed by the Vichy state, and many other ongoing revelations and controversies relating to the Vichy era, Papon's prosecution had become a clarion call in the ongoing battle over how France should deal with Vichy's role in the Final Solution.(12) The few voices that expressed reservations about the use of the courts for these symbolic, pedagogic or commemorative purposes tended to be drowned out in the louder clamor for a legal showdown. But doubts that this trial would also accomplish "the application of the law, the dispensation of justice and the punishment of the guilty" proved to be well founded.(13) In the emphatic words of Éric Conan: "On the plane of History and morality, the condemnation of Maurice Papon is indisputable."(44) And as reactions to the verdict made clear, the decision to convict Papon of complicity in crimes against humanity, despite evidential gaps in the prosecution case, was a clear articulation of the jury's moral condemnation of his failure to extricate himself from this "chain of responsibility" and to exercise the right to disobey orders. In this respect, the resonances of the verdict may well be a salutary lesson for today's functionary, who, as historian François Baédarida noted, is increasingly enmeshed in complex administrative systems which have the tendency "by virtue of the compartmentalization of functions and tasks, to dilute personal responsibility and to develop an entirely administrative and professional logic -- technical, even technocratic -- as if acts were deprived of meaning within a soulless mechanical apparatus."(45) Contemporary societies, Bédarida continued, must make it their urgent task to define the duty to disobey faced with certain orders, just as the individual must learn how to assume moral responsibility for his or her acts rather than hiding behind the excuse of impersonal administrative authority. But if these are undoubtedly moral imperatives for the present and future,(46) how do they square with the legal task of the Bordeaux Assizes Court which was to judge Papon for specific past acts of which he was accused? On the one hand, the fact that the jury found Papon guilty in arrests and sequestrations relating to four out of eight convoys cited in the indictment suggests that the balance of evidence implicated him directly in the fate of the individuals whom the civil plaintiffs represented.(47) And on this basis, it seems right that he should have been convicted. On the other hand, if the assertion of Libération editor Serge July is also true -- that Papon "has just been condemned...for his actions as an authoritarian high functionary, efficient and indifferent to the consequences of his actions,"(48) then one cannot help agreeing with Michael R. Marrus's post-trial observation that, from this perspective, thousands of ordinary functionaries escaped justice. Echoing Henry Rousso's reservations about celebrating the trial's symbolic function, Marrus maintained that "the goal of a trial is to seek justice, not history... I don't think that the Papon trial was a vehicle for historical explanation."(49)
This paper will address the importance of engaging business students in new approaches to problem solving that will enhance their ability to create vibrant economies and collaborate with other ...professionals in an effort to sustain development in a global economy. These approaches include service-learning opportunities, teaching about micro-enterprises, and applying business principles to social entrepreneurship. A review of the literature regarding how service learning can benefit business students is included.
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