Sample registration of vital events with verbal autopsy: a renewed commitment to measuring and monitoring vital statistics

Registration of births, recording deaths by age, sex and cause, and calculating mortality levels and differentials are fundamental to evidence-based health policy, monitoring and evaluation. Yet few of the countries with the greatest need for these data have functioning systems to produce them despite legislation providing for the establishment and maintenance of vital registration. Sample vital registration (SVR), when applied in conjunction with validated verbal autopsy, procedures and implemented in a nationally representative sample of population clusters represents an affordable, cost-effective, and sustainable short- and medium-term solution to this problem. SVR complements other information sources by producing age-, sex-, and cause-specific mortality data that are more complete and continuous than those currently available. The tools and methods employed in an SVR system, however, are imperfect and require rigorous validation and continuous quality assurance; sampling strategies for SVR are also still evolving. Nonetheless, interest in establishing SVR is rapidly growing in Africa and Asia. Better systems for reporting and recording data on vital events will be sustainable only if developed hand-in-hand with existing health information strategies at the national and district levels; governance structures; and agendas for social research and development monitoring. If the global community wishes to have mortality measurements 5 or 10 years hence, the foundation stones of SVR must be laid today.

Adjusting to change through song: Themes in songs written by clients with traumatic brain injury

The study aimed to identify themes in songs written by clients with traumatic brain injury (TBI). Lyrics (1834) from 82 songs written by 11 female and 21 male clients aged between 5 and 60 years were categorised into 8 main themes and 24 subcategories. Incidence of subcategories and themes were calculated. Self-reflections and messages were the most frequent themes portrayed within songs. Memories and reflections about significant others were also frequently communicated. It was noticeable that clients felt safer to communicate thoughts and feelings about the past and present but were less inclined to confront the future.

Using process mapping and business process simulation to support a process-based approach to change in a public sector organisation

A case study demonstrates the use of a process-based approach to change regarding the implementation of an information system for road traffic accident reporting in a UK police force. The supporting tools of process mapping and business process simulation are used in the change process and assist in communicating the current process design and people's roles in the overall performance of that design. The simulation model is also used to predict the performance of new designs incorporating the use of information technology. The approach is seen to have a number of advantages in the context of a public sector organisation. These include the ability for personnel to move from a traditional grouping of staff in occupational groups with relationships defined by reporting requirements to a view of their role in a process, which delivers a performance to a customer. By running the simulation through time it is also possible to gauge how changes at an operational level can lead to the meeting of strategic targets over time. Also the ability of simulation to proof new designs was seen as particularly important in a government agency were past failures of information technology investments had contributed to a more risk averse approach to their implementation. © 2004 Elsevier Ltd. All rights reserved.

Building user commitment to implementing a knowledge management strategy

In the IS literature, commitment is typically considered to involve organizational or managerial support for a system and not that of its users. This paper however reports on a field study involving 16 organizations that attempted to build user involvement in developing a knowledge management strategy by having them design it. Twenty-two IT-supported group workshops (involving 183 users) were run to develop action plans for better knowledge management that users would like to see implemented. Each workshop adopted the same problem structuring technique to assist group members develop a politically feasible action plan to which they were psychologically and emotionally dedicated. In addition to reviewing the problem structuring method, this paper provides qualitative insight into the factors a knowledge management strategy should have to encourage user commitment. © 2004 Elsevier B.V. All rights reserved.

Are lipid ratios less susceptible to change with systemic inflammation than individual lipid components in patients with rheumatoid arthritis?

Rheumatoid arthritis (RA) associates with excess cardiovascular risk and there is a need to assess that risk. However, individual lipid levels may be influenced by disease activity and drug use, whereas lipid ratios may be more robust. A cross-sectional cohort of 400 consecutive patients was used to establish factors that influenced individual lipid levels and lipid ratios in RA, using multiple regression models. A further longitudinal cohort of 550 patients with RA was used to confirm these findings, using generalized estimating equations. Cross-sectionally, higher C-reactive protein (CRP) levels correlated with lower levels of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol ([HDL-C] P = .015), whereas lipid ratios did not correlate with CRP. The findings were broadly replicated in the longitudinal data. In summary, the effects of inflammation on individual lipid levels may underestimate lipid-associated cardiovascular disease (CVD) risk in RA, thus lipid ratios may be more appropriate for CVD risk stratification in RA.

Instructional change through collaboration and reflection

The purpose of this study was to investigate the effectiveness of the Facilitator-Collaborative-Reflective Model, a strategic plan for changing teachers' practices and beliefs, on a selected group of middle school teachers. This model of staff development training was based on Corey's (1953) Cooperative-Action-Research Model and Anders and Richardson (1994) Collaborative-Reflective Model. It supports the notion that earning a teachers' commitment to change by focusing on collaboration, reflection and the normative-re-educative process aids in altering teachers' beliefs and practices especially crucial to the change process. The year-long training provided for reflection, inquiry, and learning that was useful to teachers as they pursued their goals with their students. The lead teacher, as a change agent and transformational leader, assisted in this commitment to change by improving the teachers' self-concepts as they slowly changed. The collaborative and receptive environment of the staff development fostered acceptance and stimulation of ideas.^ Given the collaborative nature of the change process, qualitative research methods were used in the investigation. The research process was based on Stufflebeam's Context, Input, Process and Product (CIPP) Evaluation Model (Madaus, Scriven & Stufflebeam, 1983). This allowed for all three factors of the staff development model to be evaluated. The case studies and focus group were effective in discerning any actual change in practices or beliefs.^ The findings of the qualitative evaluation, consisting of a baseline survey, case studies, questionnaire and modified focus group interviews, concluded that all of the teachers were strongly influenced by the intervention model which was the subject of this study. From this evaluation, three distinct indicators were looked at to determine if any change in the teachers' practices and beliefs emerged: (1) change in practice and belief, (2) reflective feedback and (3) collaborative reflection. These indicators were common throughout the teacher responses thus substantiating the infusion of the Facilitator-Collaborative-Reflective Model at the school level for effective staff development. ^

Community college faculty commitment to Florida performance -based funding indicators for academic programs

In 1996, the State of Florida implemented a performance-based funding program for the Associate in Arts degree offered by community colleges. Additional funds are allocated for distribution among public community colleges based on performance indicators. The indicators are comprised of 10 performance goals that refer to productivity indexed by overall degree completions as well as subgroups: special disadvantaged populations, transfers, job placements, and education acceleration. ^ This study examined the level of self-reported commitment of community college faculty to the 10 Florida performance-based funding indicators for academic programs. Also examined were the relationships between commitment and (a) self-efficacy in contributing to the achievement of the indicators and (b) personal financial reward expectation for contributing to the achievement of the indicators. The relationships between commitment and (a) gender, (b) academic rank, and (c) types of courses taught were analyzed based on secondary analyses. ^ The participants were 303 full-time faculty members of Miami-Dade Community College who taught courses taken by students pursuing the Associate in Arts degree. A questionnaire was developed to measure commitment, self-efficacy, and expectation of financial reward for each of the 10 indicators. ^ The mean composite commitment score for faculty members who responded to the survey was 4.07 in a scale of 1 to 5. Greater commitment was reported for indicators closely related to the traditional mission of community colleges (i.e., facilitating progress of special groups in earning the AA degree in preparation for transferring to a four-year university). Lower commitment was reported for indicators oriented to State priorities such as education acceleration mechanisms and job placements. Commitment was correlated with three variables: self-efficacy, expectation of financial reward, and types of courses taught. However, commitment was not related to gender and academic rank. Although a cause-effect relationship cannot be inferred from this study, the findings depict a positive relationship between faculty commitment to performance-based funding indicators and faculty self-efficacy to contribute to the achievement of the indicators. ^

Studentized U-quantile processes under dependence with applications to change-point analysis

Peer reviewed