In Search of a Theory of Integrated Marketing Communications

For the most part, the literature base for Integrated Marketing Communication (IMC) has developed from an applied or tactical level rather than from an intellectual or theoretical one. Since industry, practitioner and even academic studies have provided little insight into what IMC is and how it operates, our approach has been to investigate that other IMC community, that is, the academic or instructional group responsible for disseminating IMC knowledge. We proposed that the people providing course instruction and directing research activities have some basis for how they organize, consider and therefore instruct in the area of IMC. A syllabi analysis of 87 IMC units in six countries investigated the content of the unit, its delivery both physically and conceptually, and defined the audience of the unit. The study failed to discover any type of latent theoretical foundation that might be used as a base for understanding IMC. The students who are being prepared to extend, expand and enhance IMC concepts do not appear to be well-served by the curriculum we found in our research. The study concludes with a model for further IMC curriculum development

Building-based Decision-making: A Shared Planning Model for Inclusive Schools

When given support and the opportunity to work in building-based planning teams, teachers can implement remarkable school reforms

Analisis Status Nitrogen Tanah dalam Kaitannya dengan Serapan N oleh Tanaman Padi Sawah di Desa Waimital, Kecamatan Kairatu, Kabupaten Seram Bagian Barat

Nitrogen is a major nutrient for plant growth. Nitrogen function to increase vegetative growth, increase the number of tillers and increase the number of grains/clusters and increase the size of rice grain. The purpose of research was to analyze the availability of N in the soil and plant N content, and calculating fertilizer needs to increase rice productivity. Research was conducted using survey methods with an area sampling approach, conducted in October 2012 - January 2013. The research area was 590.6 ha. The soil total N ranged from very low (KP3 and 5 at 0.06% and 0.09% respectively), until low (KP 1, 2, 4, 6 and 7 at 0.14%, 0.15%, 0.13% 0.17% and 0.14% respectively. Meanwhile, the plant N sampled from the start of grain filling until harvest were low, ranged from 1% - 1.31%. The doses of fertilizer needed to sustain 5 ton ha-1 rice for the next planting season by adding Urea were as much as KP 1 (224.3 kg ha-1), KP 2 (224.25 kg ha-1), KP 3 (224.7 kg ha-1), KP 4 (224.35 kg ha-1), KP 5 (224.55 kg ha-1), KP 6 (224.15 kg ha-1) and KP 7 (224.3 kg ha-1)

Solvent-induced morphological transitions in methacrylate-based block-copolymer aggregates

Poly(ethylene oxide)-$\textit{b}$-poly(butylmethacrylate) (PEO-$\textit{b}$-PBMA) copolymers have recently been identified as excellent building blocks for the synthesis of hierarchical nanoporous materials. Nevertheless, while experiments have unveiled their potential to form bicontinuous phases and vesicles, a general picture of their phase and aggregation behavior is still missing. By performing Molecular Dynamics simulations, we here apply our recent coarse-grained model of PEO-$\textit{b}$-PBMA to investigate its self-assembly in water and tetrahydrofuran (THF) and unveil the occurrence of a wide spectrum of mesophases. In particular, we find that the morphological phase diagram of this ternary system incorporates bicontinuous and lamellar phases at high copolymer concentrations, and finite-size aggregates, such as dispersed sheets or disk-like aggregates, spherical vesicles and rod-like vesicles, at low copolymer concentrations. The morphology of these mesophases can be controlled by tuning the THF/water relative content, which has a striking effect on the kinetics of self-assembly as well as on the resulting equilibrium structures. Our results disclose the fascinating potential of PEO-$\textit{b}$-PBMA copolymers for the templated synthesis of nanostructured materials and offer a guideline to fine-tune their properties by accurately selecting the THF/water ratio

Challenges of centralizing cancer care in the US

Cancer is a major global public health problem and is the second leading cause of death in the United States (US). Unfortunately, despite tremendous medical advances in early diagnosis and treatment of several cancer types, socioeconomic inequalities persist in cancer survival. Cancer incidence and death rates vary considerably between racial and ethnic groups. Economic status is also a determinant for appropriate cancer care. Within the four cancer types for which screening is widely recommended (colorectal, breast, cervix, and prostate), the proportion of cases diagnosed at advanced stage is higher in high-poverty census groups

Esophageal Cancer Surgery: Spontaneous Centralization in the US Contributed to Reduce Mortality Without Causing Health Disparities

Background: Improvement in mortality has been shown for esophagectomies performed at high-volume centers. Objective: This study aimed to determine if centralization of esophageal cancer surgery occurred in the US, and to establish its impact on postoperative mortality. In addition, we aimed to analyze the relationship between regionalization of cancer care and health disparities. Methods: A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000–2014. Adult patients (≥ 18 years of age) diagnosed with esophageal cancer and who underwent esophagectomy were included. Yearly hospital volume was categorized as low ( 20 procedures). Multivariable analyses on the potential effect of hospital volume on patient outcomes were performed, and the yearly rate of esophagectomies was estimated using Poisson regression. Results: A total of 5235 patients were included. Esophagectomy at low- [odds ratio (OR) 2.17] and intermediate-volume (OR 1.62) hospitals, compared with high-volume hospitals, was associated with a significant increase in mortality. The percentage of esophagectomies performed at high-volume centers significantly increased during the study period (29.2–68.5%; p < 0.0001). The trend towards high-volume hospitals was different among the different US regions: South (7.7–54.3%), West (15.0–67.6%), Midwest (37.3–67.7%), and Northeast (55.8–86.8%) [p < 0.0001]. Overall, the mortality rate of esophagectomy dropped from 10.0 to 3.5% (p = 0.006), with non-White race, public insurance, and low household income patients also showing a significant reduction in mortality. Conclusions: A spontaneous centralization for esophageal cancer surgery occurred in the US. This process was associated with a decrease in the mortality rate, without contributing to health disparities

Cholecystectomy Vs. Cholecystostomy for the Management of Acute Cholecystitis in Elderly Patients

Background: Data comparing outcomes following cholecystectomy and cholecystostomy tube placement (CTP) in elderly patients are lacking. We aimed to compare the post-procedural outcomes between cholecystectomy and CTP in elderly patients with acute cholecystitis. Methods: We performed a retrospective, population-based analysis using the National Inpatient Sample for the period 2000–2014. Patients ≥ 65 years old admitted with a primary diagnosis of acute cholecystitis and who underwent either cholecystectomy or CTP during their hospitalization were included. Multivariable linear and logistic regression models were used to analyze post-procedural complications, mortality, length of stay, and total charges. The effect of procedure type on patient outcomes, stratified by acalculous and calculous cholecystitis, was also performed. Results: A total of 200,915 patients were included, of which 7516 underwent CTP and 193,399 underwent cholecystectomy. The median age of patients undergoing CTP and cholecystectomy was 80 (IQR 73–87) and 75 (IQR 70–81), respectively. Patients undergoing CTP were more likely to have post-procedural infection (OR 2.25; 95% CI 2.07, 2.45), bleeding (OR 1.28; 95% CI 1.19, 1.37), and inpatient mortality (OR 9.27; 95% CI 7.95, 10.81). On average, CTP patients stayed 1.25 days longer (95% CI 1.14, 1.37) in hospital after the procedure. The benefits of cholecystectomy were consistent in patients with acalculous and calculous cholecystitis. Conclusions: Elderly patients with both acalculous and calculous acute cholecystitis managed with CTP have higher incidences of post-procedural morbidity and mortality, and longer post-procedure length of hospital stay, as compared to cholecystectomy. Unless prohibitive surgical risks exist, elderly patients with acute cholecystitis should undergo cholecystectomy

Health care disparities in colorectal and esophageal cancer

Background: We aimed to identify differences in disparities among patients with a cancer in which screening is widely recommended (colorectal cancer [CRC]) and one in which it is not (esophageal cancer). Methods: A retrospective analysis was performed using 2004–2015 data from the National Cancer Database. Multivariable generalized logistic regression was used to identify potential differences in the effect of disparities in stage at diagnosis. Results: A total of 96,524 esophageal cancer patients and 361,187 CRC patients were included. Black patients, longer travel distances, and lower educational attainment were only associated with increased odds of stage IV CRC. While both Medicaid and uninsured patients were more likely to be diagnosed with stage IV esophageal and CRC, the effect was larger among CRC patients. From 2004 to 2015, the rates of stage IV esophageal cancer decreased from 42.0% to 38.2%, while the rates of stage IV CRC increased from 36.9% to 40.8% (p < 0.0001). Conclusions: Disparities are more pronounced in CRC, compared to esophageal cancer. Equity in access to screening and cancer care should be prioritized

Medical Repatriation in Vermont: The Current Landscape and Recommendations

Background: Medical repatriation is the practice of returning patients to their country of origin when they have major medical problems. Forced repatriation, or “medical deportation”, disproportionately affects undocumented individuals. This project aimed to assess the prevalence of medical repatriation in Vermont, identity factors that lead to it, and recommendations to prevent it. Methods: Interviews were conducted with ten stakeholders including physicians, lawmakers, and advocates for undocumented patients. Team members then analyzed interview transcripts for major themes. Results: This study did not uncover any occurrences of forced repatriation. Qualitative themes included: lack of awareness about medical repatriation, inability to track medical repatriation, social/legal barriers to care among undocumented individuals, and suggestions to prevent medical repatriation. This work also revealed current legislative initiatives focused on healthcare for undocumented individuals. Conclusion: Medical repatriation is not prevalent in Vermont. However, the increasing number of Vermonters with varying legal statuses in conjunction with rising hospital costs may precipitate economic stressors that put vulnerable patients at higher risk for forced repatriation. Moving forward, efforts may focus on protecting against this event with more inclusive health care coverage and improved clinician awareness about available assistance programs