MF890

Edward P. Call & James R. Dunham, A guide to successful AI, Kansas State University, September 1992

Arbitration Outcomes and Employer Size in the Context of the American Arbitration Association 2010-2020

This study examines the ``repeat player effect in employment arbitration for counsel appearing repeatedly in the same arbitration forum, and the impact of employer size on arbitration outcomes, and finds that the repeat player effect has a notable impact only on arbitrations involving the largest employers

Empowerment for Whom? Empowerment for What? Lessons from a Participatory Action Research Project

This article sets forth the process through which I, an educator of over 20 years, my research mentor, and my 52 Latino/a students answered questions that were important to us through participatory action research. I start the process by asking if and how I am empowering my students, and they start their own parallel process by asking about their relationships with their White teachers. By engaging in various data collection approaches, including Boal’s (1985) Theatre of the Oppressed and Photovoice, we are all able to answer these questions. I learn that as a teacher I do not empower students; they empower themselves. As we conduct the research together I watch them and see the processes of empowerment the students go through for myself. I learn how as an educator I can create empowering situations and opportunities my students can take advantage of in the future. In parallel experiences, the students learn that they have always had a voice, but this project helps them discover – and use – the voices they have always had. Overall, our group finds that empowerment takes place in spaces and moments of mutual, active inquiry, where individual voices can be raised to re-imagine what can and should be taking place within our schools

Comparing ST-segment elevation myocardial infarction care between patients residing in central and remote locations: a retrospective case series.

People who experience an ST-elevation myocardial infarction (STEMI) due to an occluded coronary artery require prompt treatment. Treatments to open a blocked artery are called reperfusion therapies (RTs), and can include intravenous pharmacological thrombolysis (TL) or primary percutaneous coronary intervention (pPCI) in a cardiac catheterisation laboratory (cath lab). Optimal RT (ORT) with pPCI or TL reduces morbidity and mortality. In remote areas, a number of geographical and organisational barriers may influence access to ORT. These are not well understood, and the exact proportion of patients who receive ORT - and the relationship to time of day and remoteness from the cardiac cath lab - is unknown. The aim of this retrospective study was to compare the characteristics of ORT delivery in central and remote locations in the north of Scotland, and to identify potential barriers to optimal care with a view to service redesign. The study was set in the north of Scotland. All patients who attended hospital with a STEMI between March 2014 and April 2015 were identified from national coding data. A data collection form was developed by the research team in several iterative stages. Clinical details were collected retrospectively from patients' discharge letters. Data included treatment location, date of admission, distance of patient from the cath lab, route of access to health care, left ventricular function and RT received. Distance of patients from the cath lab was described as remote if they were more than ninety minutes of driving time from the cardiac cath lab, and described as central if they were ninety minutes or less of driving time from the regional centre. For patients who made contact in a pre-hospital setting, ORT was defined as pre-hospital TL (PHT) or pPCI. For patients who self-presented to the hospital first, ORT was defined as in-hospital TL or pPCI. Data were described as mean (standard deviation) as appropriate. Chi-squared and student's t-test were used as appropriate. Each case was reviewed to determine if ORT was received; if ORT was not received, the reasons for this were recorded to identify potentially modifiable barriers. Of the 627 acute myocardial infarction patients initially identified, 131 had a STEMI, and the others were non-STEMI. From this STEMI cohort, 82 (62%) patients were classed as central and 49 (38%) were remote. In terms of initial therapy, 26 (20%) received pPCI, 19 (15%) received PHTs, 52 (40%) received in-hospital TL, while 33 (25%) received no initial RT. ORT was received by 53 (65%) central and 20 (41%) remote patients; chi-squared = 7.05, degrees of freedom = 130, p < 0.01).Several recurring barriers were identified. This study has therefore demonstrated a significant health inequality between the treatment of STEMI in remote locations compared to central locations. Potential barriers identified include staffing availability and training, public awareness and inter-hospital communication. This suggests that there remain significant opportunities to improve STEMI care for people living in the north of Scotland

Views of new internal medicine faculty of their preparedness and competence in physician-patient communication

BACKGROUND: We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center. METHODS: Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training. RESULTS: Between 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77%) completed the survey. The faculty rated (on a 10-point scale) the importance of the medical interview higher than their competence in interviewing; this difference was significant (average ± SD, 9.4 ± 1.0 vs 7.7 ± 1.2, P < .001). Similar results were obtained by sex, age, specialty, years since residency or fellowship training, and perceived benefit of training. Experienced faculty rated their competence in medical interviewing and the importance of the medical interview higher than recent graduates (ie, less than one year since training). For each challenging communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training. CONCLUSION: Although new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers to make curricula in physician-patient communication available to their faculty members because many of them not only care for patients, but also teach clinical skills, including communication skills, to trainees

'Obsessed with goals': functions and mechanisms of teleological interpretation of actions in humans

Humans show a strong and early inclination to interpret observed behaviours of others as goal-directed actions. We identify two main epistemic functions that this ‘teleological obsession’ serves: on-line prediction and social learning. We show how teleological action interpretations can serve these functions by drawing on two kinds of inference (‘action-to-goal’ or ‘goal-to-action’), and argue that both types of teleological inference constitute inverse problems that can only be solved by further assumptions. We pinpoint the assumptions that the three currently proposed mechanisms of goal attribution (action-effect associations, simulation procedures, and teleological reasoning) imply, and contrast them with the functions they are supposed to fulfil. We argue that while action-effect associations and simulation procedures are generally well suited to serve on-line action monitoring and prediction, social learning of new means actions and artefact functions requires the inferential productivity of teleological reasoning

Distribution of health care expenditures for HIV-infected patients

BACKGROUND: Health care expenditures for persons infected with human immunodeficiency virus (HIV) in the United State determined on the basis of actual health care use have not been reported in the era of highly active antiretroviral therapy. METHODS: Patients receiving primary care at the University of Alabama at Birmingham HIV clinic were included in the study. All encounters (except emergency room visits) that occurred within the University of Alabama at Birmingham Hospital System from 1 March 2000 to 1 March 2001 were analyzed. Medication expenditures were determined on the basis of 2001 average wholesale price. Hospitalization expenditures were determined on the basis of 2001 Medicare diagnostic related group reimbursement rates. Clinic expenditures were determined on the basis of 2001 Medicare current procedural terminology reimbursement rates. RESULTS: Among the 635 patients, total annual expenditures for patients with CD4+ cell counts \u3c50 cells/microL (36,533 dollars per patient) were 2.6-times greater than total annual expenditures for patients with CD4+ cell counts \u3e or =350 cells/microL (13,885 dollars per patient), primarily because of increased expenditures for nonantiretroviral medication and hospitalization. Expenditures for highly active antiretroviral therapy were relatively constant at approximately 10,500 dollars per patient per year across CD4+ cell count strata. Outpatient expenditures were 1558 dollars per patient per year; however, the clinic and physician component of these expenditures represented only 359 dollars per patient per year, or 2% of annual expenses. Health care expenditures for patients with HIV infection increased substantially for those with more-advanced disease and were driven predominantly by medication costs (which accounted for 71%-84% of annual expenses). CONCLUSIONS: Physician reimbursements, even with 100% billing and collections, are inadequate to support the activities of most clinics providing HIV care. These findings have important implications for the continued support of HIV treatment programs in the United States

Toward Innovative, Cost-Effective, and Systemic Solutions to Improve Outcomes and Well-Being of Military Families Affected by Autism Spectrum Disorder

The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit