Cost Determinants in Canadian Universities

The relationship between costs per student and enrollment is examined with regression analysis for 61 Canadian universities for the academic year 1986-87. This relationship is explored for overall costs and for sub-components including instruction, library, computing, administration and physical plant costs. Also examined is the influence on cost per student of student mix, student-faculty ratios, faculty wages and research intensity. Among the conclusions are that economies of scale apply to Canadian universities and costs per student are positively related to faculty salaries, faculty research intensity and the proportion of students in graduate programs and scientific disciplines.La relation entre les coûts par étudiant et la taille des clientèles de 61 universités canadiennes pour l'année académique 1986-87 a été étudiée en employant la méthode de régression multiple. Spécifiquement, la corrélation entre les clientèles et les coûts totaux a été examinée de même que les composantes de ces coûts, soit les coûts d'enseignement, des services de bibliothèque et d'informatique, les coûts administratifs et les coûts des bâtiments et terrains. On a également analysé la relation entre la composition des clientèles, la proportion étudiant/professeur, les salaires du corps professoral et l'intensité de la recherche, et les coûts par étudiant. L'étude démontre qu'il existe des économies d'échelle dans les universités canadiennes, ainsi qu'une correlation positive entre les coûts par étudiant et les variables qui portent sur les salaires des professeurs, l'intensité de la recherche, et la proportion d'étudiants inscrits aux programmes d'études supérieures et dans les disciplines scientifiques

The Determinants of Publication Rates of Faculty Members at a Canadian University

This paper examines the determinants of inter-individual differences in publica- tion rates for a sample of faculty members in a Canadian university. A simple model of publication output is presented and tested with an ordinary least squares regression. Among the conclusions are that academic rank, degree qualifications, academic discipline and the number of years since receipt of first degree significantly influence publication rates.Cet article examine les déterminants inter-individuels des taux de publication d'un échantillon de professeurs appartenant à une université canadienne. On présente un modèle simple, où les publications sont traitées en "output", et on le vérifie au moyen de techniques de régression. Parmi les conclusions, on en trouve que le rang et les qualifications professionelles, aussi bien que la discipline et le temps parcouru dès l'obtention du premier titre académique, ont une influence significative sur le taux de publication

Substrate Specificity Profiling of Histone-Modifying Enzymes by Peptide Microarray

The dynamic addition and removal of covalent posttranslational modifications (PTMs) on histone proteins serves as a major mechanism regulating chromatin-templated biological processes in eukaryotic genomes. Histone PTMs and their combinations function by directly altering the physical structure of chromatin and as rheostats for effector protein interactions. In this chapter, we detail microarray-based methods for analyzing the substrate specificity of lysine methyltransferase and demethylase enzymes on immobilized synthetic histone peptides. Consistent with the “histone code” hypothesis, we reveal a strong influenceof adjacent and,surprisingly,distant histonePTMs onthe ability of histone-modifying enzymes to methylate or demethylate their substrates. This platform will greatly facilitate future investigations into histone substrate specificity and mechanisms of PTM signaling that regulate the catalytic properties of histone-modifying enzymes

Predictors of Medication Nonadherence Differ among Black and White Patients with Heart Failure

Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF

An Update on the Self-Care of Heart Failure Index

Background: The Self-care of Heart Failure Index (SCHFI) is a measure of self-care defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiological stability (maintenance) and the response to symptoms when they occur (management). In the 5 years since the SCHFI was published, we have added items, refined the response format of the maintenance scale and the SCHFI scoring procedure, and modified our advice about how to use the scores. Objective: The objective of this article was to update users on these changes. Methods: In this article, we address 8 specific questions about reliability, item difficulty, frequency of administration, learning effects, social desirability, validity, judgments of self-care adequacy, clinically relevant change, and comparability of the various versions. Results: The addition of items to the self-care maintenance scale did not significantly change the coefficient α, providing evidence that the structure of the instrument is more powerful than the individual items. No learning effect is associated with repeated administration. Social desirability is minimal. More evidence is provided of the validity of the SCHFI. A score of 70 or greater can be used as the cut-point to judge self-care adequacy, although evidence is provided that benefit occurs at even lower levels of self-care. A change in a scale score more than one-half of an SD is considered clinically relevant. Because of the standardized scores, results obtained with prior versions can be compared with those from later versions. Conclusion: The SCHFI v.6 is ready to be used by investigators. By publication in this format, we are putting the instrument in the public domain; permission is not required to use the SCHFI

Racial Differences in Clinical Treatment and Self-Care Behaviors of Adults with Chronic Heart Failure

BackgroundIn the United States, the highest prevalence of heart failure (HF) is in blacks followed by whites. Compared with whites, blacks have a higher risk of HF‐related morbidity and mortality and HF‐related hospitalization. Little research has focused on explaining the reasons for these disparities. The purpose of this study was to examine racial differences in demographic and clinical characteristics in blacks and whites with HF and to determine if these characteristics influenced treatment, or together with treatment, influenced self‐care behaviors.Methods and ResultsThis was a secondary analysis of existing data collected from adults (n=272) with chronic HF enrolled from outpatient sites in the northeastern United States and followed for 6 months. After adjusting for sociodemographic and clinical characteristics within reduced (HFrEF) and preserved ejection fraction (HFpEF) groups, there were 2 significant racial differences in clinical treatment. Blacks with HFrEF were prescribed ACE inhibitors and hydralazine and isosorbide dinitrate (H‐ISDN) more often than whites. In the HFpEF group, blacks were taking more medications and were prescribed digoxin and a diuretic when symptomatic. Deficits in HF knowledge and decreased medication adherence, objectively measured, were more prominent in blacks. These racial differences were not explained by sociodemographic or clinical characteristics or clinical treatment variables. Premorbid intellect and the quality of support received contributed to clinical treatment and self‐care.ConclusionAlthough few differences in clinical treatment could be attributed solely to race, knowledge about HF and medication adherence is lower in blacks than whites. Further research is needed to explain these observations, which may be targets for future intervention research

Motivational Interviewing Tailored Interventions for Heart Failure (MITI-HF): Study Design and Methods

OBJECTIVE: Lack of engagement in self-care is common among patients needing to follow a complex treatment regimen, especially patients with heart failure who are affected by comorbidity, disability and side effects of poly-pharmacy. The purpose of Motivational Interviewing Tailored Interventions for Heart Failure (MITI-HF) is to test the feasibility and comparative efficacy of an MI intervention on self-care, acute heart failure physical symptoms and quality of life. METHODS: We are conducting a brief, nurse-led motivational interviewing randomized controlled trial to address behavioral and motivational issues related to heart failure self-care. Participants in the intervention group receive home and phone-based motivational interviewing sessions over 90-days and those in the control group receive care as usual. Participants in both groups receive patient education materials. The primary study outcome is change in self-care maintenance from baseline to 90-days. CONCLUSION: This article presents the study design, methods, plans for statistical analysis and descriptive characteristics of the study sample for MITI-HF. Study findings will contribute to the literature on the efficacy of motivational interviewing to promote heart failure self-care. PRACTICAL IMPLICATIONS: We anticipate that using an MI approach can help patients with heart failure focus on their internal motivation to change in a non-confrontational, patient-centered and collaborative way. It also affirms their ability to practice competent self-care relevant to their personal health goals

Mechanisms of Change in Self-Care in Adults with Heart Failure Receiving a Tailored, Motivational Interviewing Intervention

Self-care is challenging but we previously demonstrated that motivational interviewing (MI) was effective in improving heart failure (HF) self-care. OBJECTIVE: To identify the mechanisms of intervention effectiveness by elucidating the MI techniques used and the relationship between the techniques and changes in self-care. METHODS: Audiotaped sessions (first and subsequent sessions) from 8 participants were transcribed verbatim and coded to evaluate changes in self-care. Using a sequential mixed method design, quantitative and qualitative self-care data were triangulated; congruence was 97%. The MI techniques used and mechanisms of intervention effectiveness were identified from the qualitative data. RESULTS: Three MI techniques used were related to improved self-care: 1) reflection and reframing, 2) genuine empathy, affirmation, and humor, and 2) individualized problem solving. These techniques stimulated openness to goal setting, positive self-talk, perceived ability to overcome barriers, and change talk. The mechanisms by which the techniques achieved the desired outcomes were the development of discrepancy and self-efficacy, which are consistent with the principles of MI. CONCLUSION: This study contributes to clarifying the mechanism by which MI facilitates behavioral change. PRACTICE IMPLICATIONS: Using MI to discuss self-care can help to overcome barriers and engage HF patients in goal setting for behavior change

Predictors of medication nonadherence differ among black and white patients with heart failure: PREDICTORS OF MEDICATION NONADHERENCE

Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF