The Search for Values: Young Adults and the Literary Experience

published or submitted for publicatio

Healthcare disparities and models for change.

With Healthy People 2010 making the goal of eliminating health disparities a national priority, policymakers, researchers, medical centers, managed care organizations (MCOs), and advocacy organizations have been called on to move beyond the historic documentation of health disparities and proceed with an agenda to translate policy recommendations into practice. Working models that have successfully reduced health disparities in managed care settings were presented at the National Managed Health Care Congress Inaugural Forum on Reducing Racial and Ethnic Disparities in Health Care on March 10-11, 2003, in Washington, DC. These models are being used by federal, state, and municipal governments, as well as private, commercial, and Medicaid MCOs. Successful models and programs at all levels reduce health disparities by forming partnerships based on common goals to provide care, to educate, and to rebuild healthcare systems. Municipal models work in collaboration with state and federal agencies to integrate patient care with technology. Several basic elements of MCOs help to reduce disparities through emphasis on preventive care, community and member health education, case management and disease management tracking, centralized data collection, and use of sophisticated technology to analyze data and coordinate services. At the community level, there are leveraged funds from the Health Resources and Services Administration's Bureau of Primary Health Care. Well-designed models provide seamless monitoring of patient care and outcomes by integrating human and information system resources

Using CSL with Special Education and Reading Resource Students

During 1992, as my students and myself created a community service learning opportunity, we were introduced to the fun of researching statistics, to developing our problem-solving skills and to the complexities of geography. But most of all we, as a team, learned ways to improve the ways in which we worked with each other in small groups, in our classrooms and in our community

Doctors at Risk: A Problem As Viewed by Decision Analysis

The authors closely analyze a case in which a Peer Review Organization cited a physician for treatment with potential for significant adverse effect. They also critique the regulatory scheme under which peer review occurs and conclude that such regulation interferes with physicians\u27 primary obligations, fails to encourage cost-effective behavior and may decrease the quality of medical care

Oxytocin in pregnancy and the postpartum: relations to labor and its management.

The purpose of this study was to examine variations in endogenous oxytocin levels in pregnancy and postpartum state. We also explored the associations between delivery variables and oxytocin levels. A final sample of 272 mothers in their first trimester of pregnancy was included for the study. Blood samples were drawn during the first trimester and third trimester of pregnancy and at 8 weeks postpartum. Socio-demographic data were collected at each time point and medical files were consulted for delivery details. In most women, levels of circulating oxytocin increased from the first to third trimester of pregnancy followed by a decrease in the postpartum period. Oxytocin levels varied considerably between individuals, ranging from 50 pg/mL to over 2000 pg/mL. Parity was the main predictor of oxytocin levels in the third trimester of pregnancy and of oxytocin level changes from the first to the third trimester of pregnancy. Oxytocin levels in the third trimester of pregnancy predicted a self-reported negative labor experience and increased the chances of having an epidural. Intrapartum exogenous oxytocin was positively associated with levels of oxytocin during the postpartum period. Our exploratory results suggest that circulating oxytocin levels during the third trimester of pregnancy may predict the type of labor a woman will experience. More importantly, the quantity of intrapartum exogenous oxytocin administered during labor predicted plasma oxytocin levels 2 months postpartum, suggesting a possible long-term effect of this routine intervention, the consequences of which are largely unknown

Self-Determination Skills and Opportunities of Transition-Age Youth With Emotional Disturbance and Learning Disabilities

This is the publisher's version, also found here: http://cec.metapress.com/content/l5vq400577228810/?p=7708b4ddb79e4484ae1a1fc3d5bafcb6&pi=4This study examined the self-determination of adolescents with emotional disturbance (ED) and learning disabilities (LD)from the perspectives of special educators, parents, and the students themselves. Differences in self-determination ratings were associated with both disability group and respondent Specifically, adolescents with ED were found to have lower ratings of selfdetermination than students with LD, with the most pronounced differences evident from the teacher perspective. Eurthermore, students with ED identified infrequent opportunities at school and home for engaging in self-determined behavior, whereas educators and parents differed in their assessments of opportunities in each setting. Implications regarding increasing the self-determination skills and opportunities of adolescents with disabilities are discussed

Using Cluster Analysis to Explore Associations between Cardiovascular Risk and Lifestyle Factors in a Workplace Wellness Program

Background: Cardiovascular disease (CVD) is the number one cause of death in the United States with risk factors including hypertension, hyperlipidemia, diabetes, obesity, smoking, physical inactivity, age, genetics, and unhealthy diets. A university-based workplace wellness program (WWP) consisting of an annual biometric screening assessment with targeted, individualized health coaching was implemented in an effort to reduce these risk factors while encouraging and nurturing ideal cardiovascular health.Objective: The purpose of this study was to examine and describe the prevalence of single and combined, or multiple, CVD risk factors within a workplace wellness dataset.Methods: Cluster analysis was used to determine CVD risk factors within biometric screening data (BMI, waist circumference, LDL, total cholesterol, HDL, triglycerides, blood glucose age, ethnicity, and gender) collected during WWP interventions.Results: The cluster analysis provided visualizations of the distributions of participants having specific CVD risk factors. Of the 8,802 participants, 1,967 (22.4%) had no CVD risk factor, 1,497 (17%) had a single risk factor, and 5,529 (60.5%) had two or more risk factors. The majority of sample members are described as having more than one CVD risk factor with 78% having multiple.Conclusion: Cluster analysis demonstrated utility and efficacy in categorizing participant data based on their CVD risk factors. A baseline analysis of data was captured and provided understanding and awareness into employee health and CVD risk. This process and analysis facilitated WWP planning to target and focus on education to promote ideal cardiovascular health

Communalism in Egyptian politics: The experience of the Copts, 1918-1952.

This thesis explores a particular experiment in political accommodation between the Muslim majority and Coptic minority in Egypt between 1918 and 1952. The Egyptians then seized the opportunity presented by a changing political system to restructure the governing arrangements between Muslims and Copts and involve the latter more fully in the political process. Many hoped to see the collaboration of the 1919 revolution spur the creation of both a new collective Egyptian identity and a state without religious bias. Traditional ways of governing, however, were not so easily cast aside, and Islam continued to have a political role. Some Egyptians held tenaciously to the traditional arrangements which had both guaranteed Muslim primacy and served relatively well to protect the Copts and afford them some autonomy. Differences within the Coptic community over the wisdom of trusting the genuineness and durability of Muslim support for equality were accented by a protracted struggle between reforming laymen and conservative clergy for control of the community. The unwillingness of all parties to compromise hampered the ability of the community both to determine and defend its interests. The Copts met with modest success in their attempt to become full Egyptian citizens. As one example, their influence in the Wafd, the preeminent political party, was very strong prior to and in the early years of the Constitutional Monarchy. As a second, their formal representation was generally adequate and, in some Parliaments, better than adequate. However, this very success produced a backlash which caused many Copts to believe, by the 1940s, that the experiment had failed: political activity had become fraught with risk for them. Coptic complaints about Muslim intolerance abounded and reflected the broad criticisms levelled at minority behaviour by Muslims. At the close of the monarchy, equality and shared power seemed notions as distant as in the disheartening years before the revolution

Testing a Model of Patient Characteristics, Psychologic Status, and Cognitive Function as Predictors of Self-Care in Persons with Chronic Heart Failure

Objective Self-care is a key component in the management of chronic heart failure (CHF). Yet there are many barriers that interfere with a patient\u27s ability to undertake self-care. The primary aim of the study was to test a conceptual model of determinants of CHF self-care. Specifically, we hypothesized that cognitive function and depressive symptoms would predict CHF self-care. Methods Fifty consecutive patients hospitalized with CHF were assessed for self-care (Self-Care of Heart Failure Index), cognitive function (Mini Mental State Exam), and depressive symptoms (Cardiac Depression Scale) during their index hospital admission. Other factors thought to influence self-care were tested in the model: age, gender, social isolation, self-care confidence, and comorbid illnesses. Multiple regression was used to test the model and to identify significant individual determinants of self-care maintenance and management. Results The model of 7 variables explained 39% (F [7, 42] 3.80; P = .003) of the variance in self-care maintenance and 38% (F [7, 42] 3.73; P = .003) of the variance in self-care management. Only 2 variables contributed significantly to the variance in self-care maintenance: age (P \u3c .01) and moderate-to-severe comorbidity (P \u3c .05). Four variables contributed significantly to the variance in self-care management: gender (P \u3c .05), moderate-to-severe comorbidity (P \u3c .05), depression (P \u3c .05), and self-care confidence (P \u3c .01). When cognitive function was removed from the models, the model explained less of the variance in self-care maintenance (35%) (F [6, 43] 3.91; P = .003) and management (34%) (F [6, 43] 3.71; P = .005). Conclusion Although cognitive function added to the model in predicting both self-care maintenance and management, it was not a significant predictor of CHF self-care compared with other modifiable and nonmodifiable factors. Depression explained only self-care management