The physical examination in pediatric and adolescent patients.

The initial evaluation and examination of both the pediatric and adolescent patients provides the opportunity for the clinician to establish a relationship that will ensure the successful outcome of the visit. In the younger age group, cooperation of the child before performing an examination should be the focus at the first encounter. This cooperation will enable proper positioning and a systematic approach to examination and documentation of findings. Although the adolescent patients may be older and better able to understand the specifics of the examination, these patients present additional challenges for the examining practitioner

Financial globalization: Unequal blessings

This paper presents a framework to analyze financial globalization. It argues that financial globalization needs to take into account the relation between money (particularly in its role as store of value), asset and factor price flexibility, and contractual and regulatory institutions. Countries that have the “blessed trinity” (international currency, flexible exchange rate regime, and sound contractual and regulatory environment) can integrate successfully into the (imperfect) world financial markets. But developing countries normally display the “unblessed trinity” (weak currency, fear of floating, and weak institutional framework). The paper defines and discusses two alternative avenues (a “dollar trinity” and a “peso trinity”) for developing countries to safely embrace international financial integration while the blessed trinity remains beyond reach.

Financial globalization : unequal blessings

The authors present a framework to analyze financial globalization. They argue that financial globalization needs to take into account the relation between money (particularly in its role as store of value), asset and factor price flexibility, and contractual and regulatory institutions. Countries that have the"blessed trinity"(international currency, flexible exchange rate regime, and sound contractual and regulatory environment) can integrate successfully into the world financial markets. But developing countries normally display the"unblessed trinity"(weak currency, fear of floating, and weak institutional framework). The authors define and discuss two alternative avenues (a"dollar trinity"and a"peso trinity") for developing countries to safely embrace international financial integration while the blessed trinity remains beyond reach.Economic Theory&Research,Fiscal&Monetary Policy,Banks&Banking Reform,Payment Systems&Infrastructure,Financial Intermediation,Financial Economics,Macroeconomic Management,Economic Stabilization,Economic Theory&Research,Fiscal&Monetary Policy

Living and dying with hard pegs : the rise and fall of Argentina's currency board

The rise and fall of Argentina's currency board shows the extent to which the advantages of hard pegs have been overstated. The currency board did provide nominal stability and boosted financial intermediation, at the cost of endogenous financial dollarization, but did not foster monetary or fiscal discipline. The failure to adequately address the currency-growth-debt trap into which Argentina fell at the end of the 1990s precipitated a run on the currency and the banks, followed by the abandonment of the currency board and a sovereign debt default. The crisis can be best interpreted as a bad outcome of a high-stakes strategy to overcome a weak currency problem. To increase the credibility of the hard peg, the government raised its exit costs, which deepened the crisis once exit could no longer be avoided. But some alternative exit strategies would have been less destructive than the one adopted.Economic Theory&Research,Banks&Banking Reform,Fiscal&Monetary Policy,Payment Systems&Infrastructure,Financial Intermediation,Banks&Banking Reform,Fiscal&Monetary Policy,Financial Intermediation,Financial Economics,Economic Theory&Research

Service-Learning: A Homeless Outreach Initiative

A capstone project focused at providing resources and assistance to a growing homeless community living at Sunset Park and surrounding areas. Our mission was aimed at providing the homeless immediate access to a pop-up event that hosts numerous onsite resources from a wide range of services. Which included, but not limited to physical and mental health services, information on how to enter substance abuse rehabilitation programs, assistance with both temporary and permanent housing options. Created by joint partnerships between the Nevada Homeless Alliance, affiliated organizations and volunteers who are all committed and dedicated to advocating for the elimination of homelessness in Southern Nevada

Acreditación y fomento de la calidad. La experiencia chilena de las últimas décadas

La preocupación por la calidad surge como tema prioritario en la educación superior (ES) al producirse cambios en la estructura del sistema chileno a partir de 1981. Estos cambios han implicado una drástica expansión y diversificación de la oferta educativa, originada tanto por la división de instituciones del Estado ya existentes, como por la autorización que permitió la creación de instituciones privadas. De ocho universidades, en gran medida financiadas por el Estado, altamente selectivas y que reclutaban a la élite de estudiantes y académicos, se pasó a un sistema que hoy cuenta con 224 instituciones de muy distinta naturaleza, que incluye universidades, institutos profesionales y centros de formación técnica. Ello ha provocado que la selectividad se circunscriba actualmente a unas pocas instituciones, sólo de nivel universitario y de elevado prestigio social, lo que ha impactado en la calidad del sistema. Por otra parte, las instituciones buscan lograr su autofinanciamiento (incluidas las estatales), por lo que se ha producido una multiplicación de la oferta tradicional de carreras, la creación de nuevas y atractivas carreras para el mercado y la proliferación de sedes por todo el paísPeer Reviewe

Education and Use of the Lelli Test in the Clinical Setting

The knee ligament most susceptible to injury is the anterior cruciate.²˒⁵˒⁸ Detection of a ruptured ACL tear is pivotal in the course of injury care and management process.⁸ The gold reference standard for diagnosing an ACL tear has been arthroscopic evaluation.²˒⁵ However, a MRI may be used as an alternate because it is non-invasive, and it has a sensitivity and specificity of 98% and 94%.²˒⁵ Before the gold reference standard is used, a combination of physical examinations must be performed. The three physical examinations chosen by surgeons because of the exams’ highly researched validity are the Lachman test, Anterior Drawer test, and the Pivot shift. ²˒⁵˒⁶˒⁸ In 2005, a clinical exam called the Lelli test or Lever Sign test was created by Alessandro Lelli of Bologna, Italy.²˒¹⁰ The Lelli test was designed to forgo the factors that negatively influence the results of the previously listed tests. Since there has been little research, the test’s validity has not been verified. Purpose The purpose of this study was to: review the literature over the Lelli test, understand how it is used by medical professionals in different clinical settings, identify how diagnostic accuracy of the examination compares to other trusted exams, provide exact instructions on the proper methods to perform the exam, and create an educational video. Methods A literature review of 10 articles was performed to identify patient population, methods, diagnostic accuracy, and limitations of each study. The procedure was noted and used in the creation of an educational video to teach the technique to the public. Participants were chosen from local areas, consisting of athletic trainers at the high school and collegiate level as well as orthopedic surgeons. Participants were only asked to participate in a short video interview. Informed consent was obtained before the interview process. Interviews displayed the participant’s: history with exam, implementation of the Lelli test in the clinical setting, trust in the supporting evidence of the exam, preference and trust when comparing all four exams, sideline exam procedure, preference in sideline exams and explanation, and patient observations. Conclusion The review of literature was inconsistent. Several identified the Lelli test to be high in sensitivity and low in specificity, a few found sensitivity and specificity to be equal or near equal, and a few found specificity to be higher than sensitivity. There were many limitations in the studies. Examples are: small sample sizes, lower number of acute injuries, few partial tears, differences in techniques, low number of female participants, and absence of specificity. Thus, the test should be labeled as experimental until future research, correcting the mistakes from previous studies, can be conducted. Researchers will begin the interview process in March

SOCIAL WELFARE AND ENVIRONMENTAL DEGRADATION IN AGRICULTURE: THE CASE OF ECUADOR

A non-linear optimization model which maximizes total Ecuadorian social welfare, defined as the sum of consumers' and producers' surpluses for the four major crops (corn, bananas, rice and African palm) is developed to evaluate the tradeoff between welfare and environmental degradation in Ecuador. It was found that a total welfare loss of US$122 million (a 11 percent reduction - from US$ 1.112 billion to US$ 989.66 million) would be expected from a 30 percent reduction in the total pesticide load on the environment in the production of the four major crops. The distributional impacts of the welfare loss were found, however, to be significantly skewed toward the loss of consumers' surplus. Specifically, a 30 percent reduction of total pesticide load on the environment would result in a reduction of 3.86 percent of producers' total surplus while consumers would be expected to loose 19.46 percent of their total surplus.welfare tradeoff, environmental impacts, non-linear optimization, Environmental Economics and Policy,

Preoperative gynecology conference: the impact on resident management of surgical patients

Objective: To determine if a preoperative conference impacts the resident recommended surgery on gynecology patients seen in continuity clinics. Study Design: A twice monthly preoperative conference was initiated in January of 2009 where residents presented their proposed surgical intervention. A retrospective review of the first 100 preoperative conference submission forms was performed and analysis made on how often the type or route of surgery was changed based on conference discussion and if further work up or tests were requested prior to scheduling surgery. Results: Discussion of patients through a preoperative conference venue resulted in a surgical management change in 36% of patients and further medical management prior to surgery was recommended in 29%. Conclusions: A preoperative gynecology conference does impact the chosen surgery for resident patients. This venue may be a valuable tool for teaching residents optimization of the preoperative evaluation and selection of the appropriate surgical intervention