The new licencing examination for human medicine: from concept to implementation

A new Swiss federal licencing examination for human medicine (FLE) was developed and released in 2011. This paper describes the process from concept design to the first results obtained on implementation of the new examination. The development process was based on the Federal Act on University Medical Professions and involved all national stakeholders in this venture. During this process questions relating to the assessment aims, the assessment formats, the assessment dimensions, the examination content and necessary trade-offs were clarified. The aims were to create a feasible, fair, valid and psychometrically sound examination in accordance with international standards, thereby indicating the expected knowledge and skills level at the end of undergraduate medical education. Finally, a centrally managed and locally administered examination comprising a written multiple-choice element and a practical “clinical skills” test in the objective structured clinical examination (OSCE) format was developed. The first two administrations of the new FLE show that the examination concept could be implemented as intended. The anticipated psychometric indices were achieved and the results support the validity of the examination. Possible changes to the format or content in the future are discussed.

An Examination of the Contextual Environment of Families with Sexually Abused Adolescents

This study examined the impact of the contextual environment of the family on post abuse adjustment of sexually abused adolescents. Bronfenbrenner’s ecological theory was used to investigate how the external influences of the family impact the capacity of families to foster the recovery of sexually abused adolescents. The results from this secondary analysis of data from the National Survey of Child and Adolescent Well-Being Wave I (NSCAW, Dowd et al., 2002) support contextually sensitive treatment planning for sexually abused adolescents and their families.

An examination of the rate of high school completion experienced by handicapped and nonhandicapped students in the state of Texas

This research examines the graduation rate experienced by students receiving public education services in the state of Texas. Special attention is paid to that subgroup of Texas students who meet Texas Education Agency criteria for handicapped status. The study is guided by two research questions: What are the high school completion rates experienced by handicapped and nonhandicapped students attending Texas public schools? and What are the predictors of graduation for handicapped and nonhandicapped students?^ In addition, the following hypotheses are explored. Hypothesis 1: Handicapped students attending a Texas public school will experience a lower rate of high school completion than their nonhandicapped counterparts. Hypothesis 2: Handicapped and nonhandicapped students attending school in a Texas public school with a budget above the median budget for Texas public schools will experience a higher rate of high school completion than similar students in Texas public schools with a budget below the median budget. Hypothesis 3: Handicapped and nonhandicapped students attending school in large Texas urban areas will experience a lower rate of high school completion than similar students in Texas public schools in rural areas. Hypothesis 4: Handicapped and nonhandicapped students attending a Texas public school in a county which rates above the state median for food stamps and AFDC recipients will experience a lower rate of high school completion than students living in counties below the median.^ The study will employ extant data from the records of the Texas Education Agency for the 1988-1989 and the 1989-1990 school years, from the Texas Department of Health for the years of 1989 and 1990, and from the 1980 Census.^ The study reveals that nonhandicapped students are graduating with a two year average rate of.906, while handicapped students following an Individualized Educational Program (IEP) achieve a two year average rate of.532, and handicapped students following the regular academic program present a two year average graduation rate of only.371. The presence of other handicapped students, and the school district's average expense per student are found to contribute significantly to the completion rates of handicapped students. Size groupings are used to elucidate the various impacts of these variables on different school districts and different student groups.^ Conclusions and implications are offered regarding the need to reach national consensus on the definition and computation of high school completion for both handicapped and nonhandicapped students, and the need for improved statewide tracking of handicapped completion rates. ^

Shakespeare, the Middle Ages and the Luck of the British: Medievalism and National Identity in The Hollow Crown (2012)

Images of the medieval past have long been fertile soil for the identity politics of subsequent periods. Rather than “authentically” reproducing the Middle Ages, medievalism therefore usually tells us more about the concerns and ideological climate of its own time and place of origin. To dramatise the nascent nation, Shakespeare resorts to medievalism in his history plays. Centuries later, the BBC-produced television mini-serial The Hollow Crown – adapting Shakespeare’s second histories tetralogy – revamps this negotiation of national identity for the “Cultural Olympiad” in the run-up to the 2012 London Olympics. In this context of celebratory introspection, The Hollow Crown weaves a genealogical narrative consisting of the increasingly “glorious” medieval history depicted and “national” Shakespearean heritage in order to valorise 21st-century “Britishness”. Encouraging a reading of the histories as medieval history, the films construct an ostensibly inclusive, liberal-minded national identity grounded in this history. Moreover, medieval kingship is represented in distinctly sentimentalising and humanising terms, fostering emotional identification especially with the no longer ambivalent Hal/Henry V and making him an apt model for present-day British grandeur. However, the fact that the films in return marginalise female, Scottish, Irish and Welsh characters gives rise to doubts as to whether this vision of Shakespeare’s Middle Ages really is, as the producers claimed, “for everybody”.

Gay Parenthood and the Revolution of the Modern Family: An Examination of the Unique Barriers Confronting Gay Adoptive Parents

Abstract: In recent decades, the structure of the American family has been revolutionized to incorporate families of diverse and unconventional compositions. Gay and lesbian couples have undoubtedly played a crucial role in this revolution by establishing families through the tool of adoption. Eleven adoptive parents from the state of Connecticut were interviewed to better conceptualize the unique barriers gay couples encounter in the process adoption. Both the scholarly research and the interview data illustrate that although gay couples face enormous legal barriers, the majority of their hardship comes through social interactions. As a result, the cultural myths and legal restrictions that create social hardships for gay adoptive parents forge a vicious and discriminatory cycle of marginalization that American legal history illustrates is best remedied through judicial intervention at the Supreme Court level. While judicial intervention, alone, cannot change the reality of gay parenthood, I argue that past judicial precedent illustrates that such change can serve as a tool of individual, political, and legal validation for the gay community for obtaining equal rights.

An examination of the relationship between maternal and neighborhood-level characteristics and intrauterine growth retardation in Harris County, Texas, 1999--2001

The persistence of low birth weight and intrauterine growth retardation (IUGR) in the United States has puzzled researchers for decades. Much of the work that has been conducted on adverse birth outcomes has focused on low birth weight in general and not on IUGR. Studies that have examined IUGR specifically thus far have focused primarily on individual-level maternal risk factors. These risk factors have only been able to explain a small portion of the variance in IUGR. Therefore, recent work has begun to focus on community-level risk factors in addition to the individual-level maternal characteristics. This study uses Social Ecology to examine the relationship of individual and community-level risk factors and IUGR. Logistic regression was used to establish an individual-level model based on 155, 856 births recorded in Harris County, TX during 1999-2001. IUGR was characterized using a fetal growth ratio method with race/ethnic and sex specific mean birth weights calculated from national vital records. The spatial distributions of 114,460 birth records spatially located within the City of Houston were examined using choropleth, probability and density maps. Census tracts with higher than expected rates of IUGR and high levels of neighborhood disadvantage were highlighted. Neighborhood disadvantage was constructed using socioeconomic variables from the 2000 U.S. Census. Factor analysis was used to create a unified single measure. Lastly, a random coefficients model was used to examine the relationship between varying levels of community disadvantage, given the set of individual-level risk factors for 152,997 birth records spatially located within Harris County, TX. Neighborhood disadvantage was measured using three different indices adapted from previous work. The findings show that pregnancy-induced hypertension, previous preterm infant, tobacco use and insufficient weight gain have the highest association with IUGR. Neighborhood disadvantage only slightly further increases the risk of IUGR (OR 1.12 to 1.23). Although community level disadvantage only helped to explain a small proportion of the variance of IUGR, it did have a significant impact. This finding suggests that community level risk factors should be included in future work with IUGR and that more work needs to be conducted. ^

Symposium for dental treatment of medically complex children: Practice based culminating experience a continuing education course

The purpose of this Continuing Education Course is to provide oral health professionals with information to address the unique dental needs of medically complex children. The objective is to train dentists to treat special needs patients so these children have more access to oral healthcare. ^ Under the auspice of Dell Children Hospital of Austin, Lisa Jacob DDS MS is administering this Continuing Education Course for dentists and dental staff from the 46 counties of central Texas served by the hospital.^ Needs assessment was determined through a survey questionnaire to collect data about the number of special needs patients seen by general dentists in Central Texas.^ In recent years, an increasing number of continuing education courses have been developed to help dentists learn techniques for providing dentistry in more understanding ways to patients with special needs. Dentists and dental staff are trained to provide care specifically in dentistry, regardless of who the patient is. This means dentists can perform a clinical examination, carry out procedures to diagnose and treat oral diseases, and provide restorations such as fillings and crowns. ^ Four prominent speakers will provide an instructional tool to address the need for dentists to increase their competence and comfort level in caring for individuals with developmental disabilities. Each speaker will address one of the most frequently encountered cases of medically complex children. The four topics selected by Dr. Lisa Jacob are Cancer, Mental Disability, Downs Syndrome, and Craniofacial Syndromes.^ The public health implications of this continuing education course are presented in providing dental service to this underserved population. When general dentist turn away patients with special needs because of lack of knowledge to treat them, these patients will, more than likely, postpone or abandon needed dental visits because of difficulties reaching pediatric dentists who may not be available in certain areas.^

An examination of the cross-cultural reliability and construct validity of a measure of loneliness

Loneliness is a pervasive, rather common experience in American culture, particularly notable among adolescents. However, the phenomenon is not well documented in the cross-cultural psychiatric literature. For psychiatric epidemiology to encompass a wide array of psychopathologic phenomena, it is important to develop useful measures to characterize and classify both non-clinical and clinical dysfunction in diverse subgroups and cultures.^ The goal of this research was to examine the cross-cultural reliability and construct validity of a scale designed to measure loneliness. The Roberts Loneliness Scale (RLS-8) was administered to 4,060 adolescents ages 10-19 years enrolled in high schools along either side of the Texas-Tamaulipas border region between the U.S. and Mexico. Data collected in 1988 from a study focusing on substance use and psychological distress among adolescents in these regions were used to examine the operating characteristics of the RLS-8. A sample stratified by nationality and language, age, gender, and grade was used for analysis.^ Results indicated that in general the RLS-8 has moderate reliability in the U.S. sample, but not in the Mexican sample. Validity analyses demonstrated that there was evidence for convergent validity of the RLS-8 in the U.S. sample, but none in the Mexican sample. Discriminant validity of the measures in neither sample could be established. Based on the factor structure of the RLS-8, two subscales were created and analyzed for construct validity. Evidence for convergent validity was established for both subscales in both national samples. However, the discriminant validity of the measure remains unsubstantiated in both national samples. Also, the dimensionality of the scale is unresolved.^ One primary goal for future cross-cultural research would be to develop and test better defined culture-specific models of loneliness within the two cultures. From such scientific endeavor, measures of loneliness can be developed or reconstructed to classify the phenomenon in the same manner across cultures. Since estimates of prevalence and incidence are contingent upon reliable and valid screening or diagnostic measures, this objective would serve as an important foundation for future psychiatric epidemiologic inquiry into loneliness. ^

A critical assessment of the National Institutes of Health Consensus Development Program against the eras which shaped it

This research study offers a critical assessment of NIH's Consensus Development Program (CDP), focusing upon its historical and valuative bases and its institutionalization in response to social and political forces. The analysis encompasses systems-level, as well as interpersonal factors in the adoption of consensus as the mechanism for resolving scientific controversies in clinical practice application. Further, the evolution of the CDP is also considered from an ecological perspective as a reasoned adaptation by NIH to pressures from its supporters and clients for translating biomedical research into medical practice. The assessment examines federal science policy and institutional designs for the inclusion of the public interest and democratic deliberation.^ The study relies on three distinct approaches to social research. Conventional historical methods were utilized in the interpretation of social and political influences across eras on the evolution of the National Institutes of Health and its response to demands for accountability and relevance through its Consensus Development Program. An embedded single-case study was utilized for an empirical examination of the CDP mechanism through five exemplar conferences. Lastly, a sociohistorical approach was taken to the CDP in order to consider its responsiveness to the values of the eras which created and shaped it. An exploration of organizational behavior with considerations for institutional reform as a response to continuing political and social pressure, it is a study of organizational birth, growth, and response to demands from its environment. The study has explanatory import in its attempt to account for the creation, timing, and form of the CDP, relative to political, institutional, and cultural pressures, and predictive import thorough its historical view which provides a basis for informed speculation on the playing out of tensions between extramural and intermural scientists and the current demands for health care reform. ^

BLOOD PRESSURE CHANGES IN RELATION TO DEMOGRAPHIC, ANTHROPOMETRIC, AND SEXUAL MATURATION VARIABLES IN U.S. HEALTH EXAMINATION SURVEY OF CHILDREN AND YOUTHS (UNITED STATES)

The determinants of change in blood pressure during childhood and adolescence were studied in a cohort of U.S. national probability sample of 2146 children examined on two occasions during the Health Examination Survey. Significant negative correlations between the initial level and the subsequent changes in blood pressure were observed. The multiple regression analyses showed that the major determinants of systolic blood pressure (SBP) change were change in weight, baseline SBP, and baseline upper arm girth. Race, time interval between examinations, baseline age, and height change were also significant determinants in SBP change. For the change in diastolic blood pressure (DBP), baseline DBP, baseline weight, and weight change were the major determinants. Baseline SBP, time interval and race were also significant determinants. Sexual maturation variables were also considered in the subgroup analysis for girls. Weight change was the most important predictor of the change in SBP for the group of girls who were still in the pre-menarchal or pre-breast maturation status at the time of the follow-up examination, and who had started to menstruate or to develop breast maturation at sometime between the two examinations. Baseline triceps skinfold thickness or initial SBP were more important variables than weight change for the group of girls who had already experienced menarche or breast maturation at the time of the initial survey. For the total group, pubic hair maturation was found to be a significant predictor of SBP change at the 5% significance level. The importance of weight change and baseline weight for the changes in blood pressure warrants further study. ^

Procedencia escolar de los aspirantes a la Facultad de Ciencias Médicas y su relación con el rendimiento en los exámenes de admisión

La selección de aspirantes para el ingreso a la carrera de Medicina y otras carreras de las Ciencias de la Salud es un tema de constante actualidad tanto en el ámbito nacional como internacional. La Facultad de Ciencias Médicas de la Universidad Nacional de Cuyo tiene un sistema selectivo a través de exámenes de contenidos del nivel de educación secundaria y ofrece un curso de nivelación de un semestre de duración. Se observa que un alto porcentaje de aspirantes no logran compensar la diferencia existente entre los conocimientos que poseen y los que demandan las carreras ofrecidas, únicamente mediante la preparación individual y la preparación que brinda la Facultad. El propósito de este estudio fue el de caracterizar a los aspirantes a las carreras de la Facultad de Ciencias Médicas, de acuerdo a los establecimientos de educación secundaria de procedencia, realizando un estudio retrospectivo de cinco años, sobre la base de datos de aspirantes a las tres carreras de la Facultad, clasificándolos según dicha procedencia y relacionando esa característica con su rendimiento en los exámenes de admisión. La mayoría de los aspirantes a las carreras de la Facultad de Ciencias Médicas proviene de establecimientos oficiales, seguido por establecimientos privados y en tercer lugar por establecimientos dependientes de la Universidad Nacional de Cuyo. El rendimiento en los exámenes de los aspirantes a Enfermería y Tecnicaturas fue independiente a la modalidad de la escuela secundaria. Para ingresar a la carrera de Medicina la modalidad Ciencias Naturales favorece el rendimiento en los exámenes. Del mismo modo, provenir de un colegio de la Universidad o de una escuela privada otorga mayores posibilidades de éxito. La Facultad de Ciencias Médicas realiza esfuerzos constantes, a través de la información sobre los requisitos de admisión y de su oferta de cursos de nivelación para lograr que los aspirantes lleguen con mejor preparación a las instancias de evaluación. Sin embargo, las características relacionadas con la formación previa de los aspirantes deben ser consideradas como factores vinculantes con sus posibilidades de ingresar.

Deseos de la disciplina: viaje etnológico al latinoamericanismo estadounidense

El modelo tradicional de historia literaria -caracterizado por su empeño en borrar las diferencias, emplazar un centro triunfal sobre lo periférico y naturalizar el concepto de lo unitario-, parece haber sido reemplazado por un paradigma más moderno, definido por la integración de lo plurirracial, pluriétnico y pluricultural en su propuesta. Stephen Greenblatt, leyendo desde el campo de los estudios literarios en lengua inglesa, ha observado que ese cambio es resultado tanto del examen crítico-ideológico de la cuestión como de la acción del capitalismo global sobre la producción simbólica. Sin embargo, señala Greenblatt, el modelo tradicional-nacional de historia literaria parece haber migrado "desde el centro a lo que alguna vez fue llamado la periferia". Examinar comparativamente el cariz de esta cuestión desde la perspectiva de los estudios literarios latinoamericanos producidos en los Estados Unidos, uno de los centros de mayor producción académica dentro del campo, puede ayudar a comprender los verdaderos alcances de las condiciones materiales del paradigma cultural existente en las varias y diferentes "historias literarias latinoamericanas". Este trabajo examina la presencia y significado de esas condiciones por dentro de los recientes ciclos de renovación de la crítica literaria latinoamericana producida en la universidad estadounidense, con especial atención tanto a la influencia pragmática planteada por sus específicas exigencias curriculares, como a las presiones de mercado que modelan la posicionalidad del investigador de las humanidades y la dirección teórica misma de sus investigaciones.

Deseos de la disciplina: viaje etnológico al latinoamericanismo estadounidense

El modelo tradicional de historia literaria -caracterizado por su empeño en borrar las diferencias, emplazar un centro triunfal sobre lo periférico y naturalizar el concepto de lo unitario-, parece haber sido reemplazado por un paradigma más moderno, definido por la integración de lo plurirracial, pluriétnico y pluricultural en su propuesta. Stephen Greenblatt, leyendo desde el campo de los estudios literarios en lengua inglesa, ha observado que ese cambio es resultado tanto del examen crítico-ideológico de la cuestión como de la acción del capitalismo global sobre la producción simbólica. Sin embargo, señala Greenblatt, el modelo tradicional-nacional de historia literaria parece haber migrado "desde el centro a lo que alguna vez fue llamado la periferia". Examinar comparativamente el cariz de esta cuestión desde la perspectiva de los estudios literarios latinoamericanos producidos en los Estados Unidos, uno de los centros de mayor producción académica dentro del campo, puede ayudar a comprender los verdaderos alcances de las condiciones materiales del paradigma cultural existente en las varias y diferentes "historias literarias latinoamericanas". Este trabajo examina la presencia y significado de esas condiciones por dentro de los recientes ciclos de renovación de la crítica literaria latinoamericana producida en la universidad estadounidense, con especial atención tanto a la influencia pragmática planteada por sus específicas exigencias curriculares, como a las presiones de mercado que modelan la posicionalidad del investigador de las humanidades y la dirección teórica misma de sus investigaciones.

Deseos de la disciplina: viaje etnológico al latinoamericanismo estadounidense

El modelo tradicional de historia literaria -caracterizado por su empeño en borrar las diferencias, emplazar un centro triunfal sobre lo periférico y naturalizar el concepto de lo unitario-, parece haber sido reemplazado por un paradigma más moderno, definido por la integración de lo plurirracial, pluriétnico y pluricultural en su propuesta. Stephen Greenblatt, leyendo desde el campo de los estudios literarios en lengua inglesa, ha observado que ese cambio es resultado tanto del examen crítico-ideológico de la cuestión como de la acción del capitalismo global sobre la producción simbólica. Sin embargo, señala Greenblatt, el modelo tradicional-nacional de historia literaria parece haber migrado "desde el centro a lo que alguna vez fue llamado la periferia". Examinar comparativamente el cariz de esta cuestión desde la perspectiva de los estudios literarios latinoamericanos producidos en los Estados Unidos, uno de los centros de mayor producción académica dentro del campo, puede ayudar a comprender los verdaderos alcances de las condiciones materiales del paradigma cultural existente en las varias y diferentes "historias literarias latinoamericanas". Este trabajo examina la presencia y significado de esas condiciones por dentro de los recientes ciclos de renovación de la crítica literaria latinoamericana producida en la universidad estadounidense, con especial atención tanto a la influencia pragmática planteada por sus específicas exigencias curriculares, como a las presiones de mercado que modelan la posicionalidad del investigador de las humanidades y la dirección teórica misma de sus investigaciones.

Annotated record of the detailed examination of Mn deposits from SESAM cruise stations

The cores and dredges described at this site were taken on the SESAM cruise from 30 April until 10 June 1976 by the Muséum National d'Histoire Naturelle from the R/V Marion Dufresne. A total of 55 cores, dredges and camera stations were recovered and are available at MNHN for sampling and study.