PRICES AND PRICING POLICIES FOR SMALL ANIMAL AND EQUINE VETERINARY SERVICES: A STUDY OF TEACHING HOSPITALS AND MICHIGAN PRIVATE PRACTICES DURING 2000

Prices are a key determinant of financial performance for virtually any business in either the public or private sector, and the Veterinary Teaching Hospital at Michigan State University (MSU-VTH) offers no exception. To achieve consistent success, it is critical that a business understands the prevailing conditions in the marketplace when setting prices for its goods and services. Important issues to address include: 1. What are the prices of similar goods and services produced by other firms? 2. How important is price as a choice factor when customers select a source of these goods and services? 3. How do staff members view prices at the point-of-sale? 4. How are prices determined? These questions are especially crucial in small businesses such as those typical of the veterinary profession, where the decision-makers tend to be technical experts rather than trained business managers. Without this information, these decision-makers often have very little basis on which to develop a pricing policy.Teaching/Communication/Extension/Profession,

Students\u27 use of personal technology in the classroom: analyzing the perceptions of the digital generation

Faculty frequently express concerns about students’ personal use of information and communication technologies in today’s university classrooms. As a requirement of a graduate research methodology course in a university in Ontario, Canada, the authors conducted qualitative research to gain an in-depth understanding of students’ perceptions of this issue. Their findings reveal students’ complex considerations about the acceptability of technology use. Their analysis of the broader contexts of students’ use reveals that despite a technological revolution, university teaching practices have remained largely the same, resulting in ‘cultural lag’ within the classroom. While faculty are technically ‘in charge’, students wield power through course evaluations, surveillance technologies and Internet postings. Neoliberalism and the corporatisation of the university have engendered an ‘entrepreneurial student’ customer who sees education as a means to a career. Understanding students’ perceptions and their technological, social and political contexts offers insights into the tensions within today’s classrooms

Forgiveness takes place on an attitudinal continuum from hostility to friendliness: Toward a closer union of forgiveness theory and measurement.

Researchers commonly conceptualize forgiveness as a rich complex of psychological changes involving attitudes, emotions, and behaviors. Psychometric work with the measures developed to capture this conceptual richness, however, often points to a simpler picture of the psychological dimensions in which forgiveness takes place. In an effort to better unite forgiveness theory and measurement, we evaluate several psychometric models for common measures of forgiveness. In doing so, we study people from the United States and Japan to understand forgiveness in both nonclose and close relationships. In addition, we assess the predictive utility of these models for several behavioral outcomes that traditionally have been linked to forgiveness motives. Finally, we use the methods of item response theory, which place person abilities and item responses on the same metric and, thus, help us draw psychological inferences from the ordering of item difficulties. Our results highlight models based on correlated factors models and bifactor (S-1) models. The bifactor (S-1) model evinced particular utility: Its general factor consistently predicts variation in relevant criterion measures, including 4 different experimental economic games (when played with a transgressor), and also suffuses a second self-report measure of forgiveness. Moreover, the general factor of the bifactor (S-1) model identifies a single psychological dimension that runs from hostility to friendliness while also pointing to other sources of variance that may be conceived of as method factors. Taken together, these results suggest that forgiveness can be usefully conceptualized as prosocial change along a single attitudinal continuum that ranges from hostility to friendliness. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Time-to-diagnosis and symptoms of myeloma, lymphomas and leukaemias: A report from the Haematological malignancy Research Network

© 2013 Howell et al. Background: Prior to diagnosis, patients with haematological cancers often have multiple primary care consultations, resulting in diagnostic delay. They are less likely to be referred urgently to hospital and often present as emergencies. We examined patient perspectives of time to help-seeking and diagnosis, as well as associated symptoms and experiences. Methods: The UK's Haematological Malignancy Research Network (www.hmrn.org) routinely collects data on all patients newly diagnosed with myeloma, lymphoma and leukaemia (>2000 annually; population 3.6 million). With clinical agreement, patients are also invited to participate in an on-going survey about the circumstances leading to their diagnosis (presence/absence of symptoms; type of symptom(s) and date(s) of onset; date medical advice first sought (help-seeking); summary of important experiences in the time before diagnosis). From 2004–2011, 8858 patients were approached and 5038 agreed they could be contacted for research purposes; 3329 requested and returned a completed questionnaire. The duration of the total interval (symptom onset to diagnosis), patient interval (symptom onset to help-seeking) and diagnostic interval (help-seeking to diagnosis) was examined by patient characteristics and diagnosis. Type and frequency of symptoms were examined collectively, by diagnosis and compared to UK Referral Guidelines. Results: Around one-third of patients were asymptomatic at diagnosis. In those with symptoms, the median patient interval tended to be shorter than the diagnostic interval across most diseases. Intervals varied markedly by diagnosis: acute myeloid leukaemia being 41 days (Interquartile range (IQR) 17–85), diffuse large B-cell lymphoma 98 days (IQR 53–192) and myeloma 163 days (IQR 84–306). Many symptoms corresponded to those cited in UK Referral Guidelines, but some were rarely reported (e.g. pain on drinking alcohol). By contrast others, absent from the guidance, were more frequent (e.g. stomach and bowel problems). Symptoms such as tiredness and pain were common across all diseases, although some specificity was evident by sub-type, such as lymphadenopathy in lymphoma and bleeding and bruising in acute leukaemia. Conclusions: Pathways to diagnosis are varied and can be unacceptably prolonged, particularly for myeloma and some lymphomas. More evidence is needed, along with interventions to reduce time-to-diagnosis, such as public education campaigns and GP decision-making aids, as well as refinement of existing Referral Guidelines

Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy

<p>Abstract</p> <p>Background</p> <p>Haematological malignancies are a common, heterogeneous and complex group of diseases that are often associated with poor outcomes despite intensive treatment. Research surrounding end-of-life issues, and particularly place of death, is therefore of paramount importance, yet place of death has not been formally reviewed in these patients.</p> <p>Methods</p> <p>A systematic literature review and meta-analysis was undertaken using PubMed to identify all studies published between 1966 and 2010. Studies examining place of death in adult haematology patients, using routinely compiled morbidity and mortality data and providing results specific to this disease were included. 21 studies were identified with descriptive and/or risk-estimate data; 17 were included in a meta-analysis.</p> <p>Results</p> <p>Compared to other cancer deaths, haematology patients were more than twice as likely to die in hospital (Odds Ratio 2.25 [95% Confidence Intervals, 2.07-2.44]).</p> <p>Conclusion</p> <p>Home is generally considered the preferred place of death but haematology patients usually die in hospital. This has implications for patients who may not be dying where they wish, and also health commissioners who may be funding costly end-of-life care in inappropriate acute hospital settings. More research is needed about preferred place of care for haematology patients, reasons for hospital deaths, and how these can be avoided if home death is preferred.</p

Disease-related factors affecting timely lymphoma diagnosis : a qualitative study exploring patient experiences

Background Expediting cancer diagnosis is widely perceived as one way to improve patient outcomes. Evidence indicates that lymphoma diagnosis is often delayed, yet understanding of issues influencing this is incomplete. Aim To explore patients' and their relatives' perceptions of disease-related factors affecting time to diagnosis of Hodgkin and non-Hodgkin lymphoma. Design and setting Qualitative UK study involving patients with indolent and aggressive lymphomas, and their relatives, from an established population-based cohort in the north of England. Method Semi-structured interviews with 35 patients and 15 of their relatives. Interviews were audiorecorded and transcribed, and qualitative descriptive analysis was undertaken. Results Participant accounts suggest that certain features of lymphoma can impact on patients' and healthcare providers' (HCPs) responses to disease onset. Three characteristics stand out: disease occurrence (rare), manifestation (varied), and investigative options (often inconclusive). Interviewees described how they, and some HCPs, lacked familiarity with lymphoma, seldom considering it a likely explanation for their symptoms. Symptoms reported were highly variable, frequently non-specific, and often initially thought to be associated with various benign, self-limiting causes. Blood tests and other investigations, while frequently able to detect abnormalities, did not reliably indicate malignancy. Interviewees reported the potential for improvements among HCPs in information gathering, communication of uncertainty, and re-presentation advice for non-resolving/ progressive health changes. Conclusion This study demonstrates the complex characteristics of lymphoma, perceived by patients as prolonging time to diagnosis, often despite significant effort by themselves, their relatives, and HCPs to expedite this process. The findings also illustrate why simple solutions to delayed diagnosis of lymphoma are lacking

Palliative care specialists' perceptions concerning referral of haematology patients to their services : findings from a qualitative study

Background: Haematological malignancies (leukaemias, lymphomas and myeloma) are complex cancers that are relatively common, affect all ages and have divergent outcomes. Although the symptom burden of these diseases is comparable to other cancers, patients do not access specialist palliative care (SPC) services as often as those with other cancers. To determine the reasons for this, we asked SPC practitioners about their perspectives regarding the barriers and facilitators influencing haematology patient referrals. Methods: We conducted a qualitative study, set within the United Kingdom’s (UK’s) Haematological Malignancy Research Network (HMRN: www.hmrn.org), a population-based cohort in the North of England. In-depth, semistructured interviews were conducted with 20 SPC doctors and nurses working in hospital, community and hospice settings between 2012 and 2014. Interviews were digitally audio-recorded, transcribed and analysed for thematic content using the ‘Framework’ method. Results: Study participants identified a range of barriers and facilitators influencing the referral of patients with haematological malignancies to SPC services. Barriers included: the characteristics and pathways of haematological malignancies; the close patient/haematology team relationship; lack of role clarity; late end of life discussions and SPC referrals; policy issues; and organisational issues. The main facilitators identified were: establishment of interdisciplinary working patterns (co-working) and enhanced understanding of roles; timely discussions with patients and early SPC referral; access to information platforms able to support information sharing; and use of indicators to ‘flag’ patients’ needs for SPC. Collaboration between haematology and SPC was perceived as beneficial and desirable, and was said to be increasing over time. Conclusions: This is the first UK study to explore SPC practitioners’ perceptions concerning haematology patient referrals. Numerous factors were found to influence the likelihood of referral, some of which related to the organisation and delivery of SPC services, so were amenable to change, and others relating to the complex and unique characteristics and pathways of haematological cancers. Further research is needed to assess the extent to which palliative care is provided by haematology doctors and nurses and other generalists and ways in which clinical uncertainty could be used as a trigger, rather than a barrier, to referral. Keywords: Cancer, Leukaemia, Lymphoma, Myeloma, Haematology, Specialist palliative care, End of life, Hospice, Qualitativ

Nitrative and Oxidative Stress in Toxicology and Disease

Persistent inflammation and the generation of reactive oxygen and nitrogen species play pivotal roles in tissue injury during disease pathogenesis and as a reaction to toxicant exposures. The associated oxidative and nitrative stress promote diverse pathologic reactions including neurodegenerative disorders, atherosclerosis, chronic inflammation, cancer, and premature labor and stillbirth. These effects occur via sustained inflammation, cellular proliferation and cytotoxicity and via induction of a proangiogenic environment. For example, exposure to the ubiquitous air pollutant ozone leads to generation of reactive oxygen and nitrogen species in lung macrophages that play a key role in subsequent tissue damage. Similarly, studies indicate that genes involved in regulating oxidative stress are altered by anesthetic treatment resulting in brain injury, most notable during development. In addition to a role in tissue injury in the brain, inflammation, and oxidative stress are implicated in Parkinson's disease, a neurodegenerative disease characterized by the loss of dopamine neurons. Recent data suggest a mechanistic link between oxidative stress and elevated levels of 3,4-dihydroxyphenylacetaldehyde, a neurotoxin endogenous to dopamine neurons. These findings have significant implications for development of therapeutics and identification of novel biomarkers for Parkinson's disease pathogenesis. Oxidative and nitrative stress is also thought to play a role in creating the proinflammatory microenvironment associated with the aggressive phenotype of inflammatory breast cancer. An understanding of fundamental concepts of oxidative and nitrative stress can underpin a rational plan of treatment for diseases and toxicities associated with excessive production of reactive oxygen and nitrogen species

NGC 2207/IC 2163: A Grazing Encounter with Large Scale Shocks

Radio continuum, Spitzer infrared, optical and XMM-Newton X-ray and UVM2 observations are used to study large-scale shock fronts, young star complexes, and the galactic nuclei in the interacting galaxies NGC 2207/IC 2163. There are two types of large-scale shock fronts in this galaxy pair. The shock front along the rim of the ocular oval in IC 2163 has produced vigorous star formation in a dusty environment. In the outer part of the companion side of NGC 2207, a large-scale front attributed to disk or halo scraping is particularly bright in the radio continuum but not in any tracers of recent star formation or in X-rays. This radio continuum front may be mainly in the halo on the back side of NGC 2207 between the two galaxies. Values of the flux density ratio S(8 um)/S(6 cm) of kpc-sized, Spitzer IRAC star-forming clumps in NGC 2207/IC 2163 are compared with those of giant H II regions in M81. We find evidence that in 2001 a radio supernova was present in the core of feature i, a mini-starburst on an outer arm of NGC 2207. X-ray emission is detected from the NGC 2207 nucleus and from nine discrete sources, one of which corresponds to SN 1999ec, and another may be a radio supernova or a background quasar. The X-ray luminosity and X-ray spectrum of the NGC 2207 nucleus suggests it is a highly absorbed, low luminosity AGN.Comment: 30 pages, including 12 embedded eps figure