Nurses’ Experience of Leadership in Assisted Living: A Situational Analysis

This study concentrates on the voice of registered nurses as they describe their experiences of leadership within the nontraditional, non-institutional, non-hospital environment of assisted living. It further expounds upon regulatory and corporate information as context for the nurses’ leadership experiences. The desire to hear nurses describe their personal experiences of leadership influenced the decision to use grounded theory as a methodological process. The belief that voice requires context to be most effectively understood influenced, in turn, the addition of a situational analysis approach to the grounded theory methodology. As a result, interviews and scrutiny of contextual elements form the core of this study. The expectation that registered nurses will assume a leaderly presence has increased during the past 20 years as significant changes in the overall climate of health care have taken place. The study identifies many of the factors included in this change, specifically an alteration in the locus of care from hospitals exclusively to more diverse settings. Because of the limited presence of physicians in the extra-hospital world, nurses and administrators now form a leadership dyad in these settings and are charged with managing organizations delivering complex chronic patient care. Assisted living is a creative residential option that has been developed for elders who prefer individual choice in addition to physical care support. This study analyzes the themes and overriding influences explicated in personal interviews with nursing leaders in a variety of assisted living communities in one state. It also describes the contributing elements inherent in the healthcare and assisted living environments for their contextual implications. One important aspect of this study is its separation of nurse and physician leadership elements. It seeks to highlight those factors that emerge as supporting or denigrating nursing leadership experiences in an environment that is not itself mired in the conventional role expectations of the traditional healthcare world. It is anticipated that this study will bring to light the pressure that nurses feel as they are caught between the inherent value of patient advocacy and the corporate and regulatory requirements of assisted living communities. The electronic version of the dissertation is accessible at the Ohiolink ETD center http://www.ohiolink.edu/etd

Motivation et adaptation psychosociale des élèves du secondaire selon la localisation socioéconomique de leur école

L’objectif de cette recherche était de vérifier si la motivation à apprendre et l’adaptation psychosociale se distinguent selon le sexe et la localisation socioéconomique de l’école. Au total, 5 692 élèves de 24 écoles secondaires de divers milieux socioéconomiques ont rempli un questionnaire. Les analyses multivariées et univariées montrent que l’école a moins d’attrait pour les élèves de milieu favorisé, qu’ils sont moins orientés vers la tâche, plus orientés vers soi et ont une plus faible adaptation psychosociale que les élèves d’autres milieux. Quant aux élèves des écoles de milieu défavorisé, ils percevraient moins l’utilité de l’école. Ces résultats contredisent plusieurs idées généralement admises.The purpose of this study was to verify if students’ achievement motivation and school psychosocial adaptation differ according to sex and to the school’s socio-economic status. The subjects included 5692 students from 24 public secondary French schools who answered a self-report questionnaire about achievement motivation and psychosocial adaptation. Multivariate (MANOVA) and univariate analyses (ANOVA) showed that students from schools in high SES milieu have less attraction toward school, are less task-oriented and are more ego-oriented. Also, they tend to be less adapted than other students. For their part, students from schools in low SES milieu perceive less school utility. These results partially contradict general public perceptions about schools located in low SES areas.El objetivo del presente estudio es averiguar si la motivación para aprender y la adaptación psicosocial son distintas según el género y la ubicación socioeconómica de la escuela. En total, 5 692 alumnas y alumnos de 24 escuelas secundarias de diversos medios socioeconómicos llenaron un cuestionario. Los análisis multivariados y univariados demuestran que la escuela atrae menos a los alumnos de medio favorecido, que estos son menos orientados hacia la tarea, más orientados hacia sí mismo y tienen un nivel de adaptación psicosocial más bajo que los alumnos de otros medios. En cuanto a los alumnos procedentes de medio desfavorecido, perciben menos la utilidad de la escuela. Estos resultados contradicen varias ideas generalmente vinculadas

Estimation de l’effet-école et de l’effet-classe sur la motivation des élèves du secondaire

Cette étude vise à estimer l’ampleur de l’effet de l’environnement scolaire sur la motivation et le rendement scolaire de 7 433 élèves de la première à la cinquième secondaire provenant de 54 écoles publiques du Québec. Les résultats des analyses multiniveaux montrent que la variance expliquée dans la motivation des élèves par l’effet de l’école varie de 0,2 % à 2,5 %, alors que celle due à la classe varie de 2,0 % à 7,2 %. Enfin, l’effet de l’école sur le rendement des élèves est aussi plus faible que celui de la classe, mais les deux sont plus importants que ceux observés sur la motivation.The goal of this study is to examine the respective importance of school and classroom effects on students’ motivation and achievement. 7433 junior and senior high school students enrolled in 54 public schools from the province of Quebec agreed to participate. Results of the multilevel analyses showed that the variance of school effects on students’ motivation ranged from 0,2 % to 2,5 % whereas the variance of the effects of classroom ranged from 2,0 % to 7,2 %. Although the school effect on students’ achievement was also weaker than the effect of the classroom, both effects were stronger than they were on motivation.El estudio tiene por propósito estimar la amplitud del efecto del ámbito escolar sobre la motivación y el rendimiento escolar de 7 433 alumnos del primer al quinto grado de la secundaria procedentes de 54 escuelas públicas de Quebec. Los resultados de los análisis multiniveles muestran que la varianza en la motivación de los alumnos debida al efecto de la escuela oscilan entre 0,2 % y 2,5 %, mientras que la debida a la clase varía de 2,0 % à 7,2 %. Por terminar, el efecto de la escuela sobre el rendimiento de los alumnos es también más bajo que él de la clase, pero los dos resultan ser más importantes que los que fueron observados sobre la motivación

Why and How Political Science Can Contribute to Public Health? Proposals for Collaborative Research Avenues

Written by a group of political science researchers, this commentary focuses on the contributions of political science to public health and proposes research avenues to increase those contributions. Despite progress, the links between researchers from these two fields develop only slowly. Divergences between the approach of political science to public policy and the expectations that public health can have about the role of political science, are often seen as an obstacle to collaboration between experts in these two areas. Thus, promising and practical research avenues are proposed along with strategies to strengthen and develop them. Considering the interdisciplinary and intersectoral nature of population health, it is important to create a critical mass of researchers interested in the health of populations and in healthy public policy that can thrive working at the junction of political science and public health

Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

International audienceABSTRACT: BACKGROUND: Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs) remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET) comparing costs and outcomes when clinicians adhered to CPGs and when they did not. METHODS: Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhone-Alpes region of France (in 2005/2006) or in the Veneto region of Italy (in 2007). Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach). All costs were expressed in euros at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER) was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method. RESULTS: A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%). Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%. CONCLUSIONS: Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of sarcoma

Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery

This article presents the experience of a rehabilitation program that un- dertook the challenge to reorganize its services to address accessibility issues and im- prove service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to im- prove the quality of services provided to children with disabilities, their families, and their communities

CD47 fusion protein targets CD172a+ cells in Crohn’s disease and dampens the production of IL-1β and TNF

In mice, the transfer of CD172a(+) (SIRP-α) dendritic cells (DCs) elicits T cell–driven colitis, whereas treatment with CD47-Fc protein, a CD172a-binding agent, confers protection. The aim of this study was to elucidate the nature and functional properties of human CD172a(+) DCs in chronic intestinal inflammation. Here, we show that CD172a(+)CD11c(+) cells accumulate in the mesenteric lymph nodes (mLNs) and inflamed intestinal mucosa in patients with Crohn’s disease (CD). These cells are distinct from resident DCs and may coexpress markers typically associated with monocyte-derived inflammatory DCs such as CD14 and/or DC-SIGN, E-Cadherin, and/or CX(3)CR1. Spontaneous IL-1β and TNF production by HLA-DR(+) cells in CD tissues is restricted to those expressing CD172a. An avidity-improved CD47 fusion protein (CD47-Var1) suppresses the release of a wide array of inflammatory cytokines by CD172a(+) cells, which may include HLA-DR(−)CD172a(+) neutrophils, in inflamed colonic explant cultures and impairs the ability of HLA-DR(+)CD172a(+) cells to activate memory Th17 but not Th1 responses in mLNs. In conclusion, targeting CD172a(+) cells may represent novel therapeutic perspectives for patients with CD

Le musée, un lieu éducatif

This anthology contains essays on various aspects of museum education, by 35 members of the Special Interest Group on Education and Museums (SIGEM). Originally presented at a conference held in Montreal in 1995, the essays in this book address a wide range of issues related to the educational function of museums. Topics discussed include: educational, scientific and museological research; the value of guided tours and visual arts workshops; the question of evaluation; and relationships between museums and schools. 21 diagrams and 19 charts. 4 texts in English 31 texts in French. Circa 480 bibl. ref

Expert consensus document: Clinical and molecular diagnosis, screening and management of Beckwith-Wiedemann syndrome: an international consensus statement.

Beckwith-Wiedemann syndrome (BWS), a human genomic imprinting disorder, is characterized by phenotypic variability that might include overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycaemia, lateralized overgrowth and predisposition to embryonal tumours. Delineation of the molecular defects within the imprinted 11p15.5 region can predict familial recurrence risks and the risk (and type) of embryonal tumour. Despite recent advances in knowledge, there is marked heterogeneity in clinical diagnostic criteria and care. As detailed in this Consensus Statement, an international consensus group agreed upon 72 recommendations for the clinical and molecular diagnosis and management of BWS, including comprehensive protocols for the molecular investigation, care and treatment of patients from the prenatal period to adulthood. The consensus recommendations apply to patients with Beckwith-Wiedemann spectrum (BWSp), covering classical BWS without a molecular diagnosis and BWS-related phenotypes with an 11p15.5 molecular anomaly. Although the consensus group recommends a tumour surveillance programme targeted by molecular subgroups, surveillance might differ according to the local health-care system (for example, in the United States), and the results of targeted and universal surveillance should be evaluated prospectively. International collaboration, including a prospective audit of the results of implementing these consensus recommendations, is required to expand the evidence base for the design of optimum care pathways