Reaping the Colored Harvest : The Catholic Mission in the American South

A central paradox marks the story of the Roman Catholic mission in the American South. On one hand, the Church committed itself to providing access to quality education in underserved southern black communities. The establishment of southern Catholic schools for African American children supported the nation\u27s traditional emphasis on education as a prerequisite for economic, social, and political advancement. Insofar as Catholic schools and sisters in the Jim Crow South offered opportunity in communities that otherwise lacked access to education, they demonstrated some of the best qualities traditionally associated with the United States of America. On the other hand, Catholic institutions in the South maintained the color line through the mid-twentieth century. Schoolchildren attended segregated schools. Black women who sought admission to traditionally white sisterhoods were routinely denied entrance. Here, the paradox emerges in full force: within these Catholic institutions, in a religion whose very name claims the mantle of human universality and inclusivity, racial segregation and discrimination structured its schools and defined its sisterhoods. The history of Catholic schools in the American South evinces this contradiction. Reaping the `Colored Harvest\u27 focuses on the origins and growth of the Church\u27s southern mission. From the highest reaches of the Catholic hierarchy to the humblest mission schools, a variety of perspectives and individual voices reflect the complicated nature of this story

Living FIFO: the experiences and psychosocial wellbeing of Western Australian fly-in/fly-out employees and partners

Using a concurrent multi-methods design employing both quantitative and qualitative methodologies this study investigated the psychosocial wellbeing Western Australian fly-in/fly-out (FIFO) mining employees and their partners. The quantitative phase of the study assessed the psychological wellbeing, relationship satisfaction and perceptions of family function of 90 FIFO mining employees and 32 partners of FIFO employees using the General Health Questionnaire 12, the Dyadic Adjustment Scale and the Family Assessment Device. Analyses revealed that both FIFO employees and their partners are within the norms for healthy functioning on the scales and sub-scales of the measures of psychological wellbeing, relationship satisfaction and perceptions of family function, and that there were no statistically significant differences between the scores of the two groups on any of these measures. Further, there were no significant differences when data were analysed according to family type or profile of absence. Thus, despite perceptions that regular FIFO employment related absence would have adverse impacts on various aspects of wellbeing, the group of FIFO employees and partners in this study report similar levels of psychological wellbeing, relationship satisfaction and perceptions of family function to those of the general Australian population. The qualitative phase used constructivist grounded theory methodology to explore the experiences of FIFO employees and partners of FIFO employees in order to develop an understanding and theoretical scheme of the role of contextual factors in their adaptation to the FIFO lifestyle. In-depth interviews were conducted with a medium sized sample of 16 FIFO employees and 12 partners of FIFO employees. The findings from the qualitative phase are discussed in light of existing literature and the findings from the quantitative phase. The data revealed a number of individual, family, community and workplace factors that impact on individual experiences of and adaptation to the FIFO lifestyle. Informants generally made purposeful and informed choices to undertake FIFO employment based on the notion that “the benefits outweigh the costs”, that the lifestyle associated with FIFO employment would considerably increase individual and family access to financial and psychosocial resources, and that the net gains in personal and family resources would outweigh any losses. These findings challenge earlier presumptions that the regular absences associated with FIFO employment would result in a loss of individual and family resources and would impact negatively on the psychosocial wellbeing of FIFO employees and their partners. The strengths and limitations of the study are outlined as are suggestions for future research. Implications of the findings at the individual, community, corporate and government levels are presented together with recommendations for future actions

The Psychosocial Well-Being of Children From Fly-In/Fly-Out Mining Families

The children of fly-in/fly-out (FIFO) mining employees are exposed to the risk factors for depressive disorders of regular father absence associated with hazardous employment conditions, together with disruptions to family routines. In the absence of previous research in this area, this exploratory study sought to determine whether the levels of depressive symptomatology, anxiety and perceptions of family function of 30 primary school-aged children whose fathers were in FIFO employment were less healthy than those of a Control Group of 30 children whose fathers did not have FIFO employment. The mothers\u27 perceptions of family function were also compared. The children were matched on age and gender. Analysis comparing the two groups of children\u27s scores on the Children\u27s Depression Inventory (Kovacs, 1992), the Revised Children\u27s Manifest Anxiety Scale (Reynolds & Richmond, 2000), and the General Function sub-scale of the McMaster Family Assessment Device (Epstein, Baldwin 7 Bishop, 1983), found no significant differences. Both groups were functioning at healthy levels in the three areas. Significant differences between the scores of the two groups of mothers on the Communication, Affective Response, Affective Involvement, Behaviour Control and General Functioning sub-scales of the FAD were found. In addition, the FIFO mothers perceived unhealthy family function in the areas of Roles and Affective Involvement. These results indicate that further research, focussing on mediating variables including mothers\u27 wellbeing and FIFO characteristics, is warranted to clarify the impact of FIFO employment on families and children

Як людська упередженість при прийнятті рішень впливає на результат лікування пацієнтів

Purpose: Medical treatments and medical decision making are mostly human based and therefore in risk of being influenced by cognitive biases. The potential impact could lead to bad medical outcome, unnecessary harm or even death. The aim of this comprehensive literature study is to analyse the evidence whether healthcare professionals are biased, which biases are most relevant in medicine and how these biases may be reduced. Approach/Findings: The results of the comprehensive literature based meta-analysis confirm on the one hand that several biases are relevant in the medical decision and treatment process. On the other hand, the study shows that the empirical evidence on the impact of cognitive biases on clinical outcome is scarce for most biases and that further research is necessary in this field. Value/Practical Implications: Nevertheless, it is important to determine the extent to which biases in healthcare professionals translate into negative clinical outcomes such as misdiagnosis, delayed diagnosis, or mistreatment. Only this way, the importance of incorporating debiasing strategies into the clinical setting, and which biases to focus on, can be properly assessed. Research Limitations/Future Research: Though recent literature puts great emphasis on cognitive debiasing strategies, there are still very few approaches that have proven to be efficient. Due to the increasing degree of specialization in medicine, the relevance of the different biases varies. Paper type: Theoretical.Цель работы: Лечение и принятие медицинских решений в основном связаны с человеческим фактором и, следовательно, подвержены риску влияния когнитивных предубеждений. Потенциальное воздействие может привести к неблагоприятному медицинскому исходу, ненужному ущербу или даже смерти. Цель этого всестороннего исследования литературы – проанализировать доказательства того, предвзяты ли медицинские работники, какие предубеждения наиболее актуальны в медицине и как эти предубеждения можно уменьшить. Подходы/Результаты исследования: Результаты обширного метаанализа, основанного на литературных источниках, подтверждают, с одной стороны, что некоторые предубеждений имеют непосредственное отношение к медицинскому решению и процессу лечения. С другой стороны, исследование показывает, что эмпирические данные о влиянии когнитивных предубеждений на клинический результат недостаточны для большинства предубеждений и что в этой области необходимы дальнейшие исследования. Ценность/Практическое значение исследования: Важно определить, в какой степени предубеждения со стороны медицинских работников приводят к негативным клиническим исходам, таким как неправильный диагноз, поздняя постановка диагноза или плохое лечение. Только так можно будет должным образом оценить важность включения стратегий исключения систематических клинических ошибок и определить на каких предубеждениях следует сосредоточить внимание. Ограничения исследования/Перспективы дальнейших исследований: Несмотря на то, что в литературе последних лет большое внимание уделяется стратегиям когнитивной деградации, все еще очень мало подходов, которые доказали свою эффективность. Из-за растущей степени специализации в медицине значимость различных предубеждений варьируется. Тип статьи: Теоретическая.Мета роботи: Лікування та прийняття медичних рішень в основному пов'язані з людським фактором і, безумовно, схильні до ризику впливу когнітивних упереджень. Потенційний вплив може призвести до несприятливого медичного результату, непотрібного збитку або навіть смерті. Мета цього всебічного дослідження літератури – проаналізувати докази того, чи упереджені медичні працівники, які упередження найбільш актуальні в медицині і як ці упередження можна зменшити. Підходи/Результати дослідження: Результати масштабного метааналізу, заснованого на літературних джерелах, підтверджують, з одного боку, що деякі упередження мають безпосереднє відношення до медичного рішення і процесу лікування. З іншого боку, дослідження показує, що емпіричні дані про вплив когнітивних упереджень на клінічний результат недостатні для більшості упереджень і що в цій галузі необхідні подальші дослідження. Цінність/Практичне значення дослідження: Важливо визначити, в якій мірі упередження з боку медичних працівників призводять до негативних клінічних наслідків, таких як неправильний діагноз, пізня постановка діагнозу або неякісне лікування. Тільки так можна буде належним чином оцінити важливість включення стратегій виключення систематичних клінічних помилок і визначити на яких упередженнях слід зосередити увагу. Обмеження дослідження/Перспективи подальших досліджень: Незважаючи на те, що в літературі останніх років велика увага приділяється стратегіям когнітивної деградації, все ще існує дуже мало підходів, які довели свою ефективність. Через зростання ступеню спеціалізації в медицині значимість різних упереджень варіюється. Тип статті: Теоретична

Level of health care and services in a tertiary health setting in Nigeria

Background: There is a growing awareness and demand for quality health care across the world; hence the need to describe the level of health care and services provided to meet the patient centered care by the frontline stakeholders.Aim of study: To determine the current level of care provided in a tertiary hospital in a developing country setting. Study design: prospective, descriptive and questionnaire based survey.Methods: The study was conducted at the National Hospital Abuja, atertiary care setting in Nigeria. 157 health workers were enrolled, whoresponded to questions on the clinical, support and corporate servicesof the hospital. Response were either yes, no or do not know. The result were analyzed and presented in tables and charts.Results: Of 157 respondents, 66 males (42.0%) 91 females (58.0%). Doctors and nurses formed 64.3% of the study population. 114 (72.6%) of the health staff agreed that patients received appropriate medical needs and treatments, 118 (75.2%) that care was planned with patient involvement, 107(68.2%) that patients were informed of results and final care processes, 127 (80.9%) that patient were aware of consent processes and 112 (71.3%) that patients at discharge were aware of their ongoing and subsequent care. 90 (57.3%) of the respondents agreed that the patients records were accurate with patients’ participation and medicationswell managed to prevent errors and adverse reactions (75.2%). Infection control and routine surveillance were low. Safe blood sample collectionmeasures (74.5%), measures to reduce break in skin integrity (77.7%), and bed sores rare and effectively managed (38.9%). Some agreed that patient received appropriate nutrition (58.0%). Information on patients’ rights and responsibilities, and continuous quality control measures rateswere low. Others were adverse incidences reported and treated (50.3%), feedbacks mechanism (66.9%) and complaints management rates (54.8%). Hand washing practice rates were low among doctors and nurses and patient relatives. Staff rated that both workforces planning that supported needs and recruitment  and appointment systems low.Records were not updated to meet with international standards (ICD-10); (22.9%) and had low rates for use in future purposes. Also low were the level of medical and environmental research, informal relationship and security, but the management had a high level of social responsibility in form of emergency and disaster management to the immediate  community; (83.4%).Conclusion: Health workers agreed that some of the patients’ needs were met.Key word: Health care, health workers, service

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Bedeutung des Prozessreifegrads für die Patientenorientierung im Gesundheitswesen

Aim Excellent organization of the internal processes is essential for a well-functioning health care system. Particularly, the process of treatment and interaction with the patients is important because the perception of treatment and interaction has a direct relation to the patients’ satisfaction. The latter has a strong influence on the recovery of the patients. The impact of the maturity level of the treatment and interaction process on patient orientation is investigated at the example of an extensive survey of hospital managers in Ukraine. Method The analysis is based on an empirical data collection conducted with hospital managers and their deputies in a large Ukrainian city, which is acknowledged as a ‘model city’ with regard to a comprehensive health care reform in the country. By means of the Business Process Maturity Model (BPMM) we have tested our hypothesis that a high level of process maturity leads to a high level of patient orientation. For this purpose, we have developed a scale for measuring the level of process maturity and have checked the method on validity and reliability. A total of 79 hospital managers and deputies, who represent all public health care facilities of the city (hospitals, primary care clinics, etc.), participated in the study. Results The study reveals a clear relationship between the level of maturity of the treatment and interaction process and the level of patient orientation of the respective health care facility. The variance, which is explained by the independent variable process maturity level, is 16.3 %. All formative dimensions have a strong significant influence on the construct “patient orientation”. Likewise the maturity level of the treatment and interaction process shows a strong significant influence on patient orientation. Conclusion For health care facilities it is of great importance to achieve a high maturity level of the treatment and interaction process to live up to the claim of being patient oriented. The maturity of the process can be tested using the questionnaire developed in the course of our study

Association of Continuation of Loop Diuretics at Hemodialysis Initiation with Clinical Outcomes

BACKGROUND AND OBJECTIVES: Loop diuretics are commonly used to manage nondialysis-dependent CKD. Despite benefits of augmented urine output, loop diuretics are often discontinued after dialysis initiation. Here, we assessed the association of the early decision to continue loop diuretics at hemodialysis start with clinical outcomes during the first year of dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We considered all patients on in-center hemodialysis at a large dialysis organization (2006-2013) with Medicare Part A and D benefits who had an active supply of a loop diuretic at dialysis initiation (n=11,297). Active therapy was determined on the basis of whether loop diuretic prescription was refilled after dialysis initiation and within 30 days of exhaustion of prior supply. Patients were followed under an intention-to-treat paradigm for up to 12 months for rates of death, hospitalization, and intradialytic hypotension and mean monthly values of interdialytic weight gain, serum potassium, predialysis systolic BP, and ultrafiltration rates. RESULTS: We identified 5219 patients who refilled a loop diuretic and 6078 eligible controls who did not. After adjustments for patient mix and clinical differences, continuation of loop diuretics was associated with lower hospitalization (adjusted incidence rate ratio, 0.93; 95% confidence interval, 0.89 to 0.98) and intradialytic hypotension (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.92 to 0.99) rates, no difference in death rate (adjusted hazard ratio, 0.92; 95% confidence interval, 0.84 to 1.01), and lower interdialytic weight gain (P=0.03). CONCLUSIONS: Continuation of loop diuretics after hemodialysis initiation was associated with lower rates of hospitalization and intradialytic hypotension as well as lower interdialytic weight gain, but there was no difference in mortality over the first year of dialysis

De rol van endopolygalacturonases in het infectieproces van Botrytis cinerea

Tijdens het infectieproces van Botrytis cinerea wordt een groot aantal celwand-afbrekende enzymen uitgescheiden, waaronder zes endopolygalacturonases (BcPGs) en een pectine methylesterase (BcPME). Ten Have et al. (1998) liet zien dat de eliminatie van Bcpg1 een reductie in virulentie veroorzaakte op drie verschillende waardplanten. De aanwezigheid van meerdere genen die elk voor celwand afbrekende enzymen coderen doet vragen rijzen over de exacte functie van zo’n set enzymen. Het is onze doelstelling om te weten te komen of elk van deze endoPGs èn pectine methylesterase een specifieke functie hebben tijdens het infectieproces. Om dit te onderzoeken zijn mutanten gemaakt waarin elk van de individuele Bcpg en Bcpme genen is uitgeschakeld. De keuze voor de genen is gebaseerd op een genexpressie studie die hieraan vooraf ging. De virulentie van de verschillende Botrytis cinerea mutanten wordt momenteel getest op verscheidene plantensoorten. De eerste resultaten geven aan dat tenminste twee mutanten minder virulent zijn dan de wildtype stam B05.10. De reductie in virulentie is zelfs sterker dan die van de Bcpg1 mutant. Mededelingenblad van de Koninklijke Nederlandse Plantenziektekundige Vereniging Gewasbeschermin