Pennsylvania

The influence of teammates' shared mental models on team processes and performance was tested using 56 undergraduate dyads who "flew" a series of missions on a personal-computer-based flightcombat simulation. The authors both conceptually and empirically distinguished between teammates' task-and team-based mental models and indexed their convergence or "sharedness" using individually completed paired-comparisons matrices analyzed using a network-based algorithm. The results illustrated that both shared-team-and task-based mental models related positively to subsequent team process and performance. Furthermore, team processes fully mediated the relationship between mental model convergence and team effectiveness. Results are discussed in terms of the role of shared cognitions in team effectiveness and the applicability of different interventions designed to achieve such convergence.

Design traffic volumes, vehicle emission factors and meterological data are used to assess the impact of a suburban limited-access highway segment. Mesoscale effects are determined by emission inventory techniques. Microscale effects are determined using a pollutant dispersion model developed by the California Division of Highways. The air pollution impact of the highway segment is small, and should not be considered a significant criteria for decisions concerning construction of the highway.

Specific genetic hypotheses about the mode of transmission of bipolar affective disorders were examined by performing complex segregation analyses of Old Order Amish families. The analyses were performed on 1) the total set of 42 families including 689 relatives, 2) a subset of 19 families consisting of those kindreds sharing common ancestors within three generations that contained 333 relatives, and 3) a subset of 23 more distantly related families with 356 relatives. When all 42 families were included in the analyses, the specific mode of transmission that could be distinguished was dependent upon the diagnostic scheme used in the analysis. An autosomal dominant mode of inheritance could be rejected when relatives with bipolar I, atypical bipolar, major depressive disorder, and hypomania were included as affected. When analyses included only the subset of families more closely related, an autosomal dominant inheritance model was found to be consistent with transmission of BP I disorder. It was not possible to distinguish between other transmission models with broader diagnostic schemes in this subset of families. Finally, results of analyses on the subset of more distantly related families suggest that there is a significant proportion of Old Order Amish families in which the genetic factors contributing to the expression of bipolar illness are either polygenic or oligogenic.

Background: Institutionalized international nurse training organized by national educational institutions is a relatively new phenomenon. This, descriptive case study examines an early example of an American-Italian initiative of such training, in order to stimulate future international education of nurses. Aim: To find out what factors have to be taken into account to improve training and what its potential effects are in exchange and also in the context of nurse migration. Method: A questionnaire was sent to the 85 nurses who all participated in this particular international programme (response rate: 30.6%). Findings: The collected data indicate that personalized and well-aimed training, preparatory language courses, predeparture exposure of nurses to the culture of the host country and well-prepared welcomes are among the most important ways to improve this programme. Implications for practice: While the specific circumstances and cultures involved in this particular case study should not be ignored, these factors might also be applied to maximize the positive effects of nurse-migration. Twoway learning is among the positive effects of such an international training experience. Motivational and teambuilding effects can result in enhanced quality of care and a more efficient allocation of resources. However, the mind-opening effect seems to be the most important learning experience. Therefore, regardless of whether one system is considered better or worse than another, experiencing a different way of nursing/education is considered the most important, enriching element of an international learning experience. The effects of this experience could include avoiding cultural imposition in the increased cultural diversity of nursing in the country of origin.

A sample of 95 coronary artery bypass surgery (CABS) patients was studied in order to examine the relationship between quality of life and CABS. Quality of life is studied through measures of social situation, physical limits, and work status. Findings indicate that quality of life improvement is a function of the patient's post-operative experience and perception of their physical limits, which, in turn, is likely to influence their desire to work. Retirement rates are high, particularly among patients over 55 years of age. Unemployment rates are high among those patients between 49-54 years of age. However, surprisingly few patients saw themselves as physically limited, a reflection of the high overall satisfaction with surgical outcome. The discussion focuses upon the use of productivity rather than work status measures as indicators of CABS success. The importance of the affiliative experience leads to specification of conditions under which life quality can be improved as a result of CABS. Surgery is discussed as a part of a complex interplay of physical and social experiences which influence individual and social benefits.

PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/ lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and fi nancial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices' baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices' structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care.

Objectives-To have healthcare professionals in nursing homes identify organizational-level and individual-level modifiable barriers to medication error reporting. Design-Nominal group technique sessions to identify potential barriers, followed by development and administration of a 20-item cross-sectional mailed survey. Participants and Setting-Representatives of 4 professions (physicians, pharmacists, advanced practitioners, and nurses) from 4 independently owned, nonprofit nursing homes that had an average bed size of 150, were affiliated with an academic medical center, and were located in urban and suburban areas. Measurements-Barriers identified in the nominal group technique sessions were used to design a 20-item survey. Survey respondents used 5-point Likert scales to score factors in terms of their likelihood of posing a barrier ("very unlikely" to "very likely") and their modifiability ("not modifiable" to "very modifiable"). Immediate action factors were identified as factors with mean scores of <3.0 on the likelihood and modifiability scales, and represent barriers that should be addressed to increase medication error reporting frequency. Results-In 4 nominal group technique sessions, 28 professionals identified factors to include in the survey. The survey was mailed to all 154 professionals in the 4 nursing homes, and 104 (67.5%) responded. Response rates by facility ranged from 55.8% to 92.9%, and rates by profession ranged from 52.0% for physicians to 100% for pharmacists. Most respondents (75.0%) were women.

Four hundred eighty-five patients between the ages of 15 and 89 made 631 visits to a medical center emergency department with a chief complaint of headache or head pain during a 12-month period from May 1977 to April 1978, accounting for 1.6% of all patient visits. One hundred ninety-three (40%) had subsequent follow-up data available for review. Muscle contraction-tension headache and migraine headache were the most common diagnoses, accounting for 54.5% of all patients. The female/male distribution was 3:2 for the entire group. Five percent of the overall group had serious neurological conditions. Analysis of the emergency department evaluations, results of follow-up, and reviews of other recent series are reported. Based on current literature, recommendations for the detailed laboratory evaluation of the suspicious headache are described. Leicht M J: Non-traumatic headache in the emergency department. Ann Emerg Med 9:404-409, August 1980. headache, non-traumatic, evaluation in emergency department; neurologic condition., headache, evaluation in emergency department I NTRODUCTION Emergency departments throughout the country are experiencing an increase in patient visits. 1,2 Many factors contribute to this increase, not the least of which is 24-hour availability of medical care. 3 At Geisinger Medical Center we have noted an increase in the number of patients using the emergency department as their community physician. 4 The patient with headache often falls into this category. The number of people Who have experienced headache approaches 90% of the population.~, ~ In a survey by the National Center for Health Statistics, 13.7% of men and 27.8% of women said their headaches occurred "every few days" or !'quite a bit. ''~ As a result of the overall number and the increasing frequency of this problem in the emergency, department, the recent advances in laboratory evaluation of suspicious headache, the dilemma regarding optimal outpatient evaluation, indicators of true emergencies, and proper avenues of referral, this study was undertaken. The objective was to identify the patient population that presents with headache, establish the frequency of expected diagnoses, search for helpful epidemiological and historical clues to diagnosis in a large patient population frequently devoid of physical findings, identify the subgroup of patients with serious neurological conditions and, finally, determine the optimal laboratory evaluation available to the emergency physician, MATERIALS AND METHODS In a 12-month period from May 1977 to April 1978, the emergency department at Geisinger Medical Center had 40,000 patient visits. During this time, 485 patients 15 years old and older made 631 visits to our department (1.6% of total visits) with the chief complaint of"headache" or "head pain" (Figure 1). None

Studies in Europe have reported negative effects of acid deposition on forest birds, and research in North America has identified links between forest bird abundance and rates of acid deposition. We examined the bird community in an acidified forest in central Pennsylvania (USA) and evaluated the effects of terrestrial lime application on birds. We used a before-after control-impact (BACI) study design, with one year of observation before and three years after lime application (2004, 2005, and 2006). Between the 2003 and 2004 field seasons, 4500 kg/ha of dolomitic lime were applied to two of four 100-ha watersheds. Each year, we monitored bird abundance and Ovenbird (Seiurus aurocapilla) eggshell thickness and territory size. Soil and snail abundance data were also collected. The bird community and territory size results indicated that the study area may be providing low-quality habitat for forest birds, perhaps as a result of acid deposition. We found lower forest bird abundances than have been found in less acidified areas of Pennsylvania, and larger Ovenbird territory sizes than have been found in other studies. We found a significant positive relationship between soil calcium and bird abundance, indicating that soil calcium may affect bird abundance. Liming increased soil calcium and pH and led to increased snail and bird abundances. After liming, bird abundance was positively related to snail abundance. No significant changes occurred in Ovenbird territory size or eggshell thickness. Our results suggest that acid deposition could be responsible for reduced bird abundance, and that liming is a potential mitigation technique.

Individuals with disabilities are disproportionately vulnerable in evacuation emergencies, and they face numerous challenges accessing resources for response and recovery.The aim of this study was to compare the preparedness behaviors of households with and without special-needs members.A random-digit-dial telephone survey was conducted of 501 adults in southeastern Pennsylvania in 2008. The survey instrument gathered data on sociodemographic characteristics, disability status/functional limitations, and preparedness behaviors related to an evacuation emergency. Analyses were conducted in 2009 and included multiple logistic regressions. Data were weighted to correct for unequal probabilities of selection and response.Nineteen percent (n=95) of respondents reported living in a household in which someone had a transportation-related special need requiring assistance in case of an emergency. Households with a special-needs member had greater odds of having arranged a place to meet (OR=2.2; 95% CI=1.26, 3.88); located a shelter (OR=1.8; 95% CI=1.05, 3.24); or packed a bag (OR=1.8; 95% CI=1.02, 3.21). No significant differences were identified with respect to awareness of evacuation routes, purchasing of food and water, or creation of an emergency plan to guide evacuation decision-making.Despite both greater vulnerability to disaster and numerous messages by governmental and nongovernmental organizations, households with special-needs members are not more likely to engage in time-consuming preparedness behaviors such as planning and buying. Understanding the motivations and behaviors of special-needs groups is critical to designing informed risk-communication messages and interventions to bolster the preparedness of the most vulnerable populations.

Class IC antiarrhythmic drugs (IC-AADs) can effectively suppress premature ventricular contractions (PVCs). However, IC-AADs increase mortality in patients with PVCs and left ventricular dysfunction after myocardial infarction. Whether IC-AADs can be safely used to treat premature ventricular contraction-induced cardiomyopathy (PVC-CM) remains to be established. The purpose of this study was to determine the safety and efficacy of IC-AADs in patients suspected of having PVC-CM. The electronic medical records at the Hospital of the University of Pennsylvania were screened to identify all patients suspected of having PVC-CM treated with flecainide or propafenone. Clinical, electrocardiographic, and imaging studies were reviewed. Twenty patients suspected of having PVC-CM were treated with IC-AADs. Patients had undergone an average of 1.3 ± 0.2 previous unsuccessful ablations. Six had an implantable or wearable defibrillator. With IC-AAD treatment, mean PVC burden decreased from 36.2% ...

Objective: To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). Methods: This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients’ average travel distance (ATD) to the closest clinic site. Results: A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient loa...

Objective: To assess the impact of the implementation of a daily goals sheet upon nursing perception of communication in an academic, tertiary care paediatric intensive care unit (PICU). Design: Prospective, longitudinal, before-and-after intervention surveys. Setting: University affiliated 12-bed PICU. Subjects: Bedside nurses. Interventions: A questionnaire was administered to PICU nurses addressing their perception of communication. Following this questionnaire, the use of a daily goals sheet was instituted. A second questionnaire was administered one year later. Mann-Whitney Rank Sum Test was used to compare differences of the graded outcome variables. Measurements and main results: The primary outcome was the perception of communication taken from a nursing perspective. Eighty-five percent of nurses felt the daily goals sheet led to improved communication between physicians and nurses in the PICU. All questions related to communication demonstrated a positive influence of the goals sheet, with the perception of the PICU staff working as a team reaching statistical significance (p = 0.05). The perception of the care of one surgical service being attending physician directed also significantly improved after the institution of the goals sheet (p = 0.04). Conclusion: The institution of a daily goals sheet led to an improvement in nursing perception of communication. Future studies are required to determine if this The use of a daily goals sheet to improve communication in the paediatric intensive care unit 265 change in process has a demonstrable effect on health care outcomes of critically ill children, or whether this tool can have the same beneficial effects in other academic and non-academic PICUs.

This study estimates fossil-based CO 2 emissions and energy use from 1900−2000 for Allegheny County, PA. Total energy use and emissions increased from 1900 to1970, reflecting the significant industrial, economic, and population growth that occurred in Allegheny County. From 1970 to 2000, Allegheny County experienced a 30% decrease in total emissions and energy use from peak values, primarily because of a decline in industrial activity (40% decrease in value added) and the loss of a quarter of its population. Despite these dramatic economic and demographic transitions, per capita emissions remained stable from 1970 to 2000, buoyed by relatively stable or slightly increasing emissions in the commercial and transportation sectors. Allegheny County's history suggests the scale of change needed to achieve local emissions reductions may be significant; given years of major technological, economic, and demographic changes, per capita emissions in 1940 were nearly the same in 2000. Most local governments are planning emissions reductions rates that exceed 1% per year, which deviate significantly from historical trends. Our results suggest additional resources and improved planning paradigms are likely necessary to achieve significant emissions reductions, especially for areas where emissions are still increasing.

Study objective: To identify the incidence and major causes of patient and parental complaints in a pediatric emergency department. Design: Retrospective analysis of complaints received regarding patients seen between January 1987 and December I989. Setting: ED of Children's Hospital of Pittsburgh. Participants: All complaints received during the three-year period. Interventions: Complaints were reviewed for reason, validity, and location at which patient was seen. Measurements and results: One hundred seventy-six complaints from a total of 154,648 ED visits yielded a frequency of 1.1 complaints per 1,000 patient visits. Main reasons ,for dissatisfaction were misdiagnosis, billing, and inadequate treatment; 49% of complaints were judged valid. There were 0.69 complaints per 1,000 patient visits in the nonurgent medical portion of the ED. Patients seen emergently (critical care and trauma) had a significantly lower complaint frequency of 0.08 per 1,000 patient visits (P < .001 by X 2 analysis). Conclusion: Assessment of ED complaints is useful to highlight areas of patient dissatisfaction and develop plans for improving patient care. [Chande VT, Bhende MS, Davis HW: Pediatric emergency department complaints: A three-year analysis of sources and trends.

Academic service partnerships are critical for schools of nursing to maintain credibility regarding their missions of education, research, service, and practice. In this paper, we describe a case study of a ten year program, the Living Independently For Elders (LIFE) Program at the University of Pennsylvania School of Nursing that has provided community-based long-term care to high-risk older adults. Quality of care and financial outcomes were met with nurse faculty engagement, administrative commitment, and integration of business practices. As a result, high risk older adults receive care in their communities rather than nursing homes, and the school- owned and -operated program is a nationally recognized innovative nursing model of care. Strategies are described that can be used globally as more schools of nursing embrace and strengthen service partnerships.

Information about the contributions of acute care nurse practitioners to medical management teams in critical care settings is limited. To examine contributions of acute care nurse practitioners to medical management of critically ill patients from the perspectives of 3 disciplines: medicine, respiratory care, and nursing. Attending physicians, respiratory therapists, and nurses in 2 intensive care units were asked to list 3 advantages and 3 disadvantages of collaborative care provided by acute care nurse practitioners. Qualitative methods (coding/constant comparative analysis) were used to identify common themes and subthemes. Overall response rate was 35% (from 69% for attending physicians to 26% for nurses). Responses were grouped into 4 main themes: accessibility, competence/knowledge, care coordination/communication, and system issues. Acute care nurse practitioners were valued for their accessibility, expertise in routine daily management of patients, and ability to meet patie...

Two hundred consecutive cases brought to the attention of a malpractice insurer by evidence of expected legal action were reviewed. Of these cases, 132 (66%) were attributed primarily to misdiagnosis, and 87 of these would have satisfied admission criteria. The most common error was grossly deficient examination relating to the chief complaint. Focused attention to physical examination and diagnostic skills, history taking, and minimal use of laboratory studies could have avoided the initiation of the majority of cases. [Trautlein JJ, Lambert RL, Miller J: Malpractice in the emergency department -

We examined the association between lifetime depression history and sexual function in a communitybased sample of midlife women. Specifically, 914 women aged 42-52 who were participants in the Study of Women's Health Across the Nation completed a self-report assessment of their sexual behaviors, sexual desire, sexual arousal, and sexual satisfaction over the past 6 months. On the basis of the Structured Clinical Interview for the DSM-IV, participants were categorized into 1 of 3 lifetime major depressive disorder (MDD) history groups: no MDD history, single episode MDD, and recurrent MDD. In line with previous reports, women with a history of recurrent MDD reported experiencing less frequent sexual arousal, less physical pleasure, and less emotional satisfaction within their current sexual relationships. Although the groups did not differ in their reported frequency of sexual desire or partnered sexual behaviors, lifetime depression history was associated with increased rates of self-stimulation (masturbation). Associations between lifetime depression history and lower levels of physical pleasure within partnered sexual relationships and higher rates of masturbation remained significant following control for current depressive symptoms, study site, marital status, psychotropic medication use, and lifetime history of anxiety or substance abuse/dependence disorder. Future research is needed to characterize the temporal and etiologic relationships among lifetime depressive disorder, current mood state, and sexual function in women across the lifespan.

ABSTRACT. Objective. Early diagnosis of children with autism spectrum disorders (ASD) is critical but often delayed until school age. Few studies have identified factors that may delay diagnosis. This study attempted to identify these factors among a community sample of children with ASD. Methods. Survey data were collected in Pennsylvania from 969 caregivers of children who had ASD and were

Background A prior study indicated that the effect of OSHA inspections on lost workday injuries had declined from 1979 through 1998. This study provides an updated estimate for 1998-2005. Methods Injury data from the Pennsylvania workers' compensation program were linked with employment data from unemployment compensation records to calculate lost-time rates for single-establishment manufacturing firms with more than 10 employees. These rates were linked to OSHA inspection findings. The RAND Human Subjects Protection Committee determined that this study was exempt from review Results Inspections with penalties reduced injuries by an average of 19-24% annually in the 2 years following the inspection. These effects were not found for workplaces with fewer than 20 or more than 250 employees or for inspections without penalties. Conclusions These findings should be generalizable to the 29 states where federal OSHA directly enforces standards. They suggest that the impact of inspections has increased from the 1990s. Am. J. Ind. Med. ß

Introduction The Substance Abuse Treatment Research Center in Philadelphia is jointly operated by the Philadel-phia Veterans Administration Medical Center and the Department of Psychiatry of the University of Pennsylvania School of Medicine. The Center began as an outpatient ...

Despite the public health burden of adolescent substance use, delinquency, and other problem behavior, few comprehensive models of disseminating evidencebased prevention programs to communities have demonstrated positive youth outcomes at a population level, capacity to maintain program fidelity, and sustainability. We examined whether the Communities That Care (CTC; Hawkins and Catalano 1992) model had a positive impact on risk/protective factors and academic and behavioral outcomes among adolescents in a quasi-experimental effectiveness study. We conducted a longitudinal study of CTC in Pennsylvania utilizing biannual surveillance data collected through anonymous in-school student surveys. We utilized multilevel models to examine CTC impact on change in risk/protective factors, grades, delinquency, and substance use over time. Youth in CTC communities demonstrated less growth in delinquency, but not substance use, than youth in non-CTC communities. Levels of risk factors increased more slowly, and protective factors and academic performance decreased more slowly, among CTC community grade-cohorts that were exposed to evidencebased, universal prevention programs than comparison grade cohorts. Community coalitions can affect adolescent risk and protective behaviors at a population level when evidence-based programs are utilized. CTC represents an effective model for disseminating such programs.

This study examined the frequency of reexperiencing, avoidance, and hyperarousal symptoms most often associated with posttraumatic stress disorder (PTSD) among 45 persons with social anxiety disorder and 30 nonanxious controls in response to an extremely stressful social event (which did not satisfy DSM-IV's PTSD Criterion A). Avoidance and hyperarousal in response to reminders of socially stressful events were common among patients; more than one-third would have met criteria for PTSD if these events satisfied DSM-IV PTSD Criterion A. Frequency of this PTSD-like symptom pattern did not differ among patients who did and did not experience another event that did satisfy PTSD Criterion A. Implications of these findings for the treatment of social anxiety disorder are discussed. #

This paper revisits a developmental model of the origins of early conduct problems. Several of the model&#39;s primary tenets have now been validated in two samples of at-risk children followed prospectively from infancy to school-age. In both cohorts, child, family, and sociodemographic factors all play a significant role in the development of early conduct problems. In particular, the quality of the caregiving environment during the child&#39;s second year differentiates clinical impairment according to both parent and teacher report 6 years later. We conclude by making recommendations for future studies. Research that utilizes a developmental framework, incorporates more sophisticated measurement of infant negative emotionality, and addresses the influences of neighborhood and culture, is suggested.

Previous studies have established that parental smoking. soclo-economic status and scholastic performance are all related to smoking m high school students A study of 1814 students at a high school m Western Pennsylvania confirmed the three factors previously identified as correlates of smokmg m teenagers Fmdmgs of this study also showed that of the three factors scholastic performance was clearly the strongest, with parental smoking next m strength and socio-econonuc status a weak third These results are discussed m relation to smular findings on antlsoclal behavior m teenagers and interpreted following Gold and Mann [ 11, m terms of smoking as a defense against a derogated self-image Research into causes of cigarette smoking has been focused largely on high school students, smce for many adults smokmg began m the high school years [2] Previous studies have determmed that cigarette smokmg among high school students 1s associated with their school performance, the soclo-economic status of then parents. and the smoking habits of their parents [3-71 Results of these studies show that the mcldence of cigarette smoking m high school boys and girls 1s mversely related to their grades m school and to the soclo-economic status of their parents, but positively related to the incidence of smoking among parents Thus, school performance,,soclo-economlc status, and parental smoking have been shown as important condltlons m cigarette smoking among high school students However. previous studies have not compared the strength or magnitude of these condltlons as they affect smokmg among high school students How lmportant are these effects or, more technically, how much of a contrlbutlon does each one make mdependently of the others? Without this mformatlon we may know the factors that contribute to cigarette smoking among teenagers but we cannot put these factors mto quantitative perspective, much less begin to work out the ways m which they interact SUBJECTS AND PROCEDURE Information for this study was obtained through questlonnalres administered to students m the Norwm High School. Irwin Pennsylvania These questlonnalres were completed under the supervision of school teachers, by about 99 per cent of the students present m school at the time the questlonnalre was admmlstered Less than 1 per cent of the students present did not complete the questionnaire satisfactorily Complete data were obtained for 92 per cent (1814) of the 1949 Norwm High School students, and these data form the basis of this report Information was gathered regarding students' school performance, the soc1o-economlc status of students' parents, and the smoking habits of these parents, for "smoking" as well as "nonsmokmg" students School performance was assessed from students' responses to questions about letter grades they had received for courses m the previous five grading periods (30 weeks) Students categorrzed these grades as "A's and B's", "A's, B's and C's", "B's and Cs", or "C or below" All students were enrolled m one of the five curricula College preparatory, General, Commercial, Vo-tech; and Industrial, with the heaviest enrollment m the first two The dlstrlbutlon of letter grades was much the same m all five curricula Socio-economic status m this study was based on the occupation of the student's father, using the Hollmgshead One-Factor Index of Social Position This mdex provided a seven point scale of soclo-economic status A separate category, labelled X was made for students whose fathers were absent from the home or retired Followmg the definition of Salber et al [7-j a student was considered a "smoker" if he had smoked at least 10 cigarettes m the past and considered himself a smoker at the time of the study. The cigarette smoking status of each parent m the study was determined by the students themselves Parents were categorized "smokmg" If either parent smoked and as "nonsmokmg" if neither did

iv Diabetes self-care plays a vital role in achieving better diabetes outcomes. To enhance diabetes self-care, the strategies of goal setting and barrier identification are widely used to assist people in making behavior change. Depression is a common co-morbidity and a barrier to self-care in people with diabetes. The purpose of this study was to examine the effects of depression and antidepressant use on goal setting and barrier identification in patients with type 2 diabetes.

Uncompensated care can create financial difficulties for hospitals. The problem is likely to worsen as the number of individuals lacking health insurance continues to grow. The objective of this study is to measure how uncompensated care affects hospitals_ ability to provide the services for which they do receive compensation. Applying output-based data envelopment analysis (DEA) under various assumptions on the disposability of outputs to a sample of Pennsylvania hospitals, we find that, on average, hospitals could have produced 7% more output if they had all operated on the best-practice frontier and that uncompensated care reduced the production of other hospital outputs by 2%. Thus, even if hospitals were to operate efficiently, they might still face financial distress as a result of providing uncompensated care. The findings in our study suggest that policy makers should continue looking at ways to increase funding to hospitals providing uncompensated care while not distorting economic incentives to reduce excessive costs.

The present study was undertaken to examine some of the psychometric properties of the Children's Depression Inventory (CDI), a self-report inventory devised by to measure depression in children and adolescents. Normative and reliability data were obtained from three independent samples taken from eight public schools in central Pennsylvania. Age-and gender-related differences in reported characteristics of depression were also investigated. The subjects were 594 males and 658 females whose ages ranged from 8 to 16 years and whose combined mean age was 11.67years (SD = 1.91). The CDI was group-administered to all 1,252 subjects," 155 fifth-grade subjects (77 males and 78 females) were retested after 3 weeks, and 107seventh-and eight-grade subjects (45 males and 62females) were retested after 1 year. The distribution statistics for the combined samples yielded an overall CDI mean of 9. 09, a standard deviation of 7. 04, and a cutoff score of 19for the upper 10% of the distribution. Reliability assessed through coefficient alpha, item-total score product-moment correlations, and test-retest coefficients proved acceptable. Gender differences were obtained for several item-total score correlations and for test-retest reliability of CD1 scores.

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental disorder in childhood, and primary care clinicians provide a major component of the care for children with ADHD. However, because of limited available evidence, the American Academy of Pediatrics guidelines did not include adolescents and young adults. Contrary to previous beliefs, it has become clear that, in most cases, ADHD does not resolve once children enter puberty. This article reviews the current evidence about the diagnosis and treatment of adolescents and young adults with ADHD and describes how the information informs practice. It describes some of the unique characteristics observed among adolescents, as well as how the core symptoms change with maturity. The diagnostic process is discussed, as well as approaches to the care of adolescents to improve adherences. Both psychosocial and pharmacologic interventions are reviewed, and there is a discussion of these patients' transition into young adulthood. The article also indicates that research is needed to identify the unique adolescent characteristics of ADHD and effective psychosocial and pharmacologic treatments. Pediatrics 2005;115:1734-1746; attention-deficit/hyperactivity disorder, ADHD, adolescents, diagnosis, treatment.

Axial skeletal osteosarcomas were evaluated retrospectively in 11 6 dogs. Thirty-one tumors occurred in the mandible, 26 in the maxilla, 17 in the spine, 14 in the cranium, 12 in the ribs, 10 in the nasal cavity and paranasal sinuses, and 6 in the pelvis. Medium-sized and large dogs were most commonly affected. Females outnumbered males 2.1:1, but this varied with tumor location. The mean age was 8.7 years. Osteosarcomas of the rib occurred in significantly younger dogs (mean age, 5.4 years) than osteosarcomas at any other axial skeletal site. Pulmonary metastasis was diagnosed radiographically in 11.1 % of the dogs. The median survival for dogs treated surgically was 22 weeks, the l-year survival was 26.370, and the 2year survival was 18.4%. The tumor recurrence rate was 66.7%. Most dogs (79.6%) died or were euthanatized for problems associated with the primary tumor.

For example, we've long invested in emerging scientific disciplines by creating new medical school departments in fields like immunology, developmental biology, biomedical informatics, critical care medicine, computational and systems biology, and structural biology. In parallel, we've built interdisciplinary centers where discoveries in multiple fields can lead to great leaps forward; these include our