Variant of Lemierre's Syndrome Secondary to Trauma

Classic Lemierre's syndrome is a septic internal jugular venous (IJV) thrombophlebitis secondary to oropharyngeal anaerobic infection in adolescent and young adult. Though upper respiratory tract infection is the most common antecedent, it has also been described following skin, soft tissues, genitourinary and gastrointestinal infections. Fusobacteria necrophorum is the commonest pathogen isolated from blood and tissue cultures but other bacteria like Eikenella correndens, Bacteroides melaninogenicus and Non Group A Streptococcal species have also been reported. The overall incidence of Lemierre's and Lemierre's like syndromes has declined since the first case report in 1936. There is however, a resurgence of cases in recent years due to more judicious use of antibiotics for treatment of upper respiratory tract infection among medical practitioners. The main stay of treatment of complete Lemierre's syndrome is prolonged antibiotic coverage and surgical drainage of nonresolving abscesses. Currently, there is no consensus opinion on the use of anticoagulation in patient with complete Lemierre's syndrome complicated by septic internal jugular thrombosis and embolism. High index of suspicion is required for early diagnosis of Lemierre's and Lemierre's like syndromes. Early and effective antibiotics therapy may prevent the development full spectrum of the syndrome and its associated complication

SELF-DIRECTED LEARNING AMONG SECONDARY EDUCATION STUDENTS SPECIALIZING IN ENGLISH AT UM DIGOS COLLEGE, PHILIPPINES

Self-directed learning is essential in learning a second language since it allows students to accomplish as much as possible in their language learning. This study aimed to determine the level of self-directed learning among secondary education students specializing in English teaching. Furthermore, this study used a descriptive survey involving 133 major English students. Data revealed that the self-directed learning of English language students is high. However, no significant difference was found in the level of self-directed learning among English language students when analyzed by year level, gender, and socioeconomic status. Hence, the researchers highly encouraged self-directed learning as enhancement or innovation on set assessments that can help develop the optimum potential of the learners, as well as integration of the strategy to the teaching learning process based on the study result.  Article visualizations

What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand

Background: While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. Methods: We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. Results: We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. Conclusion: We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report

Current Global Health Impact Assessment Practice

Health impact assessment (HIA) practice has expanded across the world, since it was established more than two decades ago. This paper presents a snapshot of current global HIA practice based on the findings of an online questionnaire survey. HIA practitioners from all world regions were invited to participate. A total of 122 HIA practitioners from 29 countries completed the survey, following a broad international outreach effort. The large variety in the types of HIAs conducted, and the application of HIA in various fields reported by respondents, demonstrates that HIA practice has evolved over the past two decades. Although differences in the use of HIA were reported across world regions, an overall increasing trend in global HIA practice can be observed. In order to sustain this upward trend, efforts are needed to address the main barriers in the utilisation of HIA. The establishment of new national and international HIA teaching and training offerings seems to be an obvious strategy to pursue along with the strengthening of policies and legal frameworks that specify the circumstances, under which HIA is required, and to what extent

What constitutes brilliant aged care? : a qualitative study of practices that exceed expectation

Aim: This study aimed to explore what constitutes brilliant aged care. Background: Although many aged care services do not offer the care that older people and carers need and want, some perform better. Rather than focus on problems with aged care, this study examined brilliant aged care—practices that exceeded expectation. Design: The methodology for this study was informed by grounded theory, under-pinned by constructionism to socially construct meaning. Methods: This study invited nominations for a Brilliant Award via a survey, and inter-views with the nominees via web conference. After receiving survey responses from 10 nominators, interviews were conducted with 12 nominees. Data were analysed using reflexive thematic analysis and documented according to COREQ guidelines to optimise rigour and transparency. Results: According to participants, brilliant aged care involved being relationally at-tuned to older people, a deep understanding of the older person, recognition of aged care as more than a job, innovative practices and permission to reprioritise. Conclusions: This study suggests that, in aged care, brilliance happens. It emphasises the importance of meaningful connections and relationships in aged care, where thoughtful acts acknowledge an older person's value and humanity as well as creativity and innovation. Relevance to Clinical Practice: For those who manage and deliver aged care, the findings suggest that small practice changes can make a positive difference to older people. Brilliant aged care can involve acts of empathy; enthusiasm for aged care; innovative practices, even those that are small scale; and reprioritising workplace tasks to spend time with older people. For policymakers, this study highlights the need to recognise and raise the profile of the pockets of brilliance within the aged care sector. This might be achieved via awards and other initiatives that serve to celebrate and learn from brilliance in its myriad forms. Patient or Public Contribution: The nominees, who included carers, were invited to participate in workshops with other carers and older people to co-design a model of brilliant aged care, during which workshop participants discussed and critiqued the findings constructed from the data

NAFTA Students'Whistle-blowing Perceptions: A Case of Sexual Harassment (La percepción advertidora de Ios alumnos en TLC: un caso de acoso sexual

Abstract, Whistle-blowing mechanisms in the U.S. have gained more prominence as an element of legal compliance and antifraud programs. Sexual harassment is asignificant business risk in terms of financial costs and the loss of reputation. lt is important for corporations to develop sexual harassment policies and to provide mechanisms for employees toreport sexual harassment behaviors to upper level management. This paper reports on business students' responses to a possible Sexual Harassment scenario from Arthur Andersen's Business Ethics Program and the actions that the characters in the video should take in terms of whistle-blowing. l fall 2004,78 students from two U.S. universities and one Mexican and one Canadian university participated in the project as part of the NAFIA Challenges of Accounting and Busrness Sysfems Granf funded by the United States Department of Education Fund for the lmprovement of PostSecondary Education (FIPSE), Human Resources Development Canada (HRDC), and Mexico's Secretaría de Educación Pública (SEP). Students from the three NAFTA countries were shown the vignette and asked to respond to a pre-questionnaire concerning the characters' behaviors and possible actions. The students were then asked to discuss the situation and write a report from the ooints of view of the three characters in the vignette and also to find a copy of an organizations' sexual harassment policy from the Internet. At the end of the project the students responded to a postquestionnaire. The students were asked to consider whether the characters should report the possible harasser iotheir supervisor, end thus engage in whistle-blowing behavior. Hypoiheses are formulated for the three NAFTA countries based on Hofstede's cultural dimensions and comparisons are made based on overall responses to the pre-and posfquestionnaire. There were significant differences, but in some cases not in the direction expected. Gender differences are also explored, but there were few significant differences. The authors are working under the NAFTA Challenges of Accounting and Busrness Sysfems Grant from the United States Depaftment of Education Fund for the lmprovement of PosfSecondary Education (FIPSE), Human Resources Development Canada (HRDC), and Mexico's Secretaría de Educación Pública (SEP). Resúmen. Los llamados "mecanismos de silbato de alerta" en los Estados Unidos han ganado más prominencia como elemento de la conformidad legal y de los programas antifraude. El hostigamiento sexual es un riesgo significativo del negocio en términos de costos financieros y la pérdida de reputación. Esimportante que las corporaciones desarrollen políticas para prevenir y sancionar el hostigamiento sexual en los centros de trabajo y proporcionen los mecanismos para los empleados sobre los comportamientos de hostigamiento sexual y ofrezcan información al respecto a la gerencia. Esta investigaciónnternacional por medio de sus resultadosfrece las respuestas de los estudiantes de las escuelas de negocios de México, Canadá y Estados Unidos sobre un panorama de posible hostigamiento sexual, y forma parte del programa del ética de negocio de promover en las Universidades la firma internacional de consultoría Arturo Andersen y de las acciones que se observaron elos caracteresn un vídeo realizado para este propósito, y que acciones deben tomar en términos de la utilización del "silbato de altera". En otoño del 2004, 78 estudiantes de dos universidades EEUU, una universidad mexicana y una canadiense participaron en el proyecto como parte de los Retos de NAFTA de los sistemas Grant de contabilidad y negocios financiados por el departamento de Educación delos Estados Unidos Secretaría Poste-Secundario de Educación Pública (SEPT) de la educación (FIPSE), del desarrollo de recursos humanos en Canadá (HRDC), y de México. Mediante uso de video y escenificación que fue enviado y posteriormente fueron recibidas las respuestas de los estudiantes delos tres países de NAFTA además de responder a un cuestionario referente a los comportamientos y a las acciones posibles de los caracteres del video. Posteriormente y mediante el uso de Internet, los estudiantes pudieron discutir lasituación y escribir un informe de los puntos de la vista de los tres caracteres en el video y elaborar una propuesta de una política sobre hostigamiento sexual de las organizaciones. Al final del proyecto los estudiantes respondieron a un cuestionario. Pidieron considerar si los caracteres deben divulgar el hostigamiento posible a su supervisor, y como los estudiantes se comprometían a utilizar el mecanismo de silbato de alerta. Las hipótesis se formulan para los tres países del NAFTA basados en las dimensiones culturales de Hofstede y se hacen las comparaciones baado en respuestas totales a los cuestionarios. Se encontraron diferencias significativas, pero en algunos casos no en la dirección esperada. Las diferencias del género también se exploran, pero había pocas diferencias significativas. Los autor autores están trabajando bajo desafíos de NAFTA de los sistemas Grant de la contabilidad y del negocio del departamento de Estados Unidos del fondo de la educación para la mejora de Secretaría Poste-Secundario de Educación Pública (SEPT) de lp educación (FIPSE), del desarrollo de recursos humanos Canadá (HRDC), y de México

NAFTA Students'Whistle-blowing Perceptions: A Case of Sexual Harassmen

Key words: Sexual harrasment, NAFTA, organizations, policiesAbstract. Whistle-blowing mechanisms in the U.S. have gained more prominence as an element of legal compliance and antifraud programs. Sexual harassment is a significant business risk in terms of financial costs and the loss of reputation. lt is important for corporations to develop sexual harassment policies and to provide mechanisms for employees toreport sexual harassment behaviors to upper level management. This paper reports on business students' responses to a possible Sexual Harassment scenario from Arthur Andersen's Business Ethics Program and the actions that the characters in the video should take in terms of whistle-blowing. l fall 2004,78 students from two U.S. universities and one Mexican and one Canadian university participated in the prolect as part of the NAFIA Challenges of Accounting and Buslness Sysfems Granf funded by the United States Department of Education Fund for the lmprovement of PostSecondary Education (FIPSE), Human Resources Develópment Canada (HRDC), and Mexico's Secretaría de Educación Pública (SEP). Students from the three NAFTA countries were shown the vignette and asked to respond to a pre-questionnaire concerning the characters' behaviors and possible actions. The students were then asked to discuss the situation and write a reoort from the points of view of the three characters in the vigneite and also to find a copy of an organizations' sexual harassment policy from the Internet. At the end of the project the students responded to a post questionnaire. The students were asked to consider whether the characters should report the possible harasser totheir supervisor, and thus engage in whistle-blowing behavior. Hypotheses are formulated for the three NAFTA'countries based on Hofstede's cultural dimensions and comparisons are made based on overall responses to the pre-and posfquestionnaire. There were significant differences, but in some cases not in the direction expected. Gender differences are also explored, but there were few significant differences. The authors are working under the NAFTA Challenges of Accounting and Busrness Sysferns Grant from the United States Department of Education Fund for the lmprovement of PostSecondary Education (FIPSE), Human Resources Development Canada (HRDC), and Mexico's Secretaría de Educación Pública (SEP).Palabras claves: Hostigamiento sexual, NAFTA, organizaciones, políticasResúmen. Los llamados "mecanismos de silbato de alerta" en los Estados Unidos han ganado más prominencia como elemento de Ia conformidad legal y de los programasntifraude. El hostigamiento sexual es un riesgo significativo del negocio en términos de costos financieros y la pérdida de reputación. Esimportante que las corporaciones desarrollen políticas para prevenir y sancionar el hostigamiento sexual en los centros de trabajo y proporcionen los mecanismos para los empleados sobre los comportamientos de hostigamiento sexual y ofrezcan información al respecto a la gerencia. Esta investigaciónnternacional por medio de sus resultados frece las respuestas delos estudiantes de las escuelas de negocios de México, Canadá y Estados Unidos sobre un panorama de posible hostigamiento sexual, y forma parte del programa del ética de negocio de promover en las Universidades la firma internacional de consultoría Arturo Andersen y de las acciones que se observaron elos caracteresn un vídeo realizado para este propósito, y que acciones deben tomar en términos de la utilización del "silbato de altera". En otoño del 2004, 78 estudiantes de dos universidades EEUU, una universidad mexicana y una canadiense participaron en el proyecto como parte de los Retos de NAFTA de los sistemas Grant de contabilidad y negocios financiados por el departamento de Educación delos Estados Unidos Secretaría Poste-Secundario de Educación Pública (SEPT) de la educación (FIPSE), del desanollo de recursos humanos en Canadá (HRDC), y de México. Mediante uso de video y escenificación que fue enviado y posteriormente fueron recibidas las respuestas de los estudiantes delos tres países de NAFTA además de responder a un cuestionario referente a los comportamientos y a las acciones posibles de los caracteres del video. Posteriormente y mediante el uso de Internet, los estudiantes pudieron discutir lasituación y escribir un informe de los puntos de la vista de los tres caracteres en el video y elaborar una propuesta de una política sobre hostigamiento sexual de las organizaciones. Al final del proyecto ls estudiantes respondieron a un cuestionario. Pidieron considerar si los caracteres deben divulgar el hostigamiento posible a su supervisor, y como los estudiantes se comprometían a utilizar el mecanismo desilbato de alerta, Las hipótesis se formulan para los tres paÍses del NAFTA basados en las dimensiones culturales de Hofstede y se hacen las comparaciones baado en respuestas totales alos cuestionarios. Se encontraron diferencias significativas, pero en algunos casos no en la dirección esperada. Las diferencias del género también se exploran, pero había pocas diferencias significativas. Los autorautores están trabajando bajo desafíos de NAFTA de los sistemas Grant de la contabilidad y del negocio del departamento de Estados Unidos del fondo de la educación para la mejora de Secretaría Poste-Secundario de Educación Pública (SEPT) de lA educación (FIPSE), del desarrollo de recursos humanos Canadá (HRDC), y de México

Global survey of the frequency of atrial fibrillation-associated stroke: embolic stroke of undetermined source global registry

Background and Purpose—Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features. Methods—Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels. Results—Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P<0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF (r=0.76; P=0.0002). Conclusions—This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women

Process and impact evaluation of the Greater Christchurch Urban Development Strategy Health Impact Assessment

<p>Abstract</p> <p>Background</p> <p>despite health impact assessment (HIA) being increasingly widely used internationally, fundamental questions about its impact on decision-making, implementation and practices remain. In 2005 a collaboration between public health and local government authorities performed an HIA on the Christchurch Urban Development Strategy Options paper in New Zealand. The findings of this were incorporated into the Greater Christchurch Urban Development Strategy;</p> <p>Methods</p> <p>using multiple qualitative methodologies including key informant interviews, focus groups and questionnaires, this study performs process and impact evaluations of the Christchurch HIA including evaluation of costs and resource use;</p> <p>Results</p> <p>the evaluation found that the HIA had demonstrable direct impacts on planning and implementation of the final Urban Development Strategy as well as indirect impacts on understandings and ways of working within and between organisations. It also points out future directions and ways of working in this successful collaboration between public health and local government authorities. It summarises the modest resource use and discusses the important role HIA can play in urban planning with intersectoral collaboration and enhanced relationships as both catalysts and outcomes of the HIA process;</p> <p>Conclusion</p> <p>as one of the few evaluations of HIA that have been published to date, this paper makes a substantial contribution to the literature on the impact, utility and effectiveness of HIA.</p