990 resultados para Digital rectal examination
Resumo:
The construction industry has long been considered as highly fragmented and non-collaborative industry. This fragmentation sprouted from complex and unstructured traditional coordination processes and information exchanges amongst all parties involved in a construction project. This nature coupled with risk and uncertainty has pushed clients and their supply chain to search for new ways of improving their business process to deliver better quality and high performing product. This research will closely investigate the need to implement a Digital Nervous System (DNS), analogous to a biological nervous system, on the flow and management of digital information across the project lifecycle. This will be through direct examination of the key processes and information produced in a construction project and how a DNS can provide a well-integrated flow of digital information throughout the project lifecycle. This research will also investigate how a DNS can create a tight digital feedback loop that enables the organisation to sense, react and adapt to changing project conditions. A Digital Nervous System is a digital infrastructure that provides a well-integrated flow of digital information to the right part of the organisation at the right time. It provides the organisation with the relevant and up-to-date information it needs, for critical project issues, to aid in near real-time decision-making. Previous literature review and survey questionnaires were used in this research to collect and analyse data about information management problems of the industry – e.g. disruption and discontinuity of digital information flow due to interoperability issues, disintegration/fragmentation of the adopted digital solutions and paper-based transactions. Results analysis revealed efficient and effective information management requires the creation and implementation of a DNS.
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Objective To determine whether Treponema-associated papillomatous digital dermatitis (PDD) occurs in Australian dairy cattle. Design Mail-out questionnaire and histological and bacteriological examination of biopsy tissue from suspect PDD lesions. Procedure The questionnaire was mailed to 375 veterinarians to evaluate their knowledge of PDD, determine if they had observed the disease in Australian dairy cattle, and to request biopsy material from suspicious cases. Biopsies were examined for histological and bacteriological evidence of PDD, including for the presence of spirochaetes. Results Eighty-eight replies to the questionnaire were received (23.5%). Of 52 respondents who were aware of PDD as a possible cause of lameness, 26 reported observing the condition in Australian cattle. Of 32 respondents who were unaware of the condition, 6 reported observing lesions that might have been PDD. The majority of reports of PDD-like lesions came from the southern Australian states, the condition occurring during periods of high rainfall and proving responsive to topical or parenteral application of antimicrobials. Biopsies from five erosive lesions showed histological similarity to PDD whereas biopsies from five proliferative lesions were consistent with chronic inflammation, fibroma or cutaneous papilloma. The presence of spirochaetes was not demonstrated in any of the lesions by histological or bacteriological methods. Conclusion Anecdotal reports and analysis of biopsy material confirm that a condition similar to PDD does occur sporadically in dairy cattle in southern Australia. However, this condition has so far not been shown to be associated with the presence of spirochaetes in the lesions.
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DESIGN. Retrospective analysis PURPOSE. To assess the clinical characteristics and outcomes of patients identified with proliferative diabetic retinopathy (PDR) referred from the screening program to the hospital eye services (HES) METHODS. a retrospective analysis of urgently referred PDR cases to Birmingham Heartlands HES from august 2008 until July 2010 RESULTS. 130 urgent diabetic retinopathy referrals were made and reviewed. 103 (68% male, 80% type 2 diabetes) were referred for PDR with a mean age of 59 years, mean diabetes duration of 17.8years. 69% were on insulin treatment at the time of the screening, with mean HbA1c of 10.4% (range-5.7 to 16.5%). 65% of the patients were offered appointments at HES within two weeks after referral from the screening. 50.5% of the patients were seen in the HES within 2 weeks, 22 and 16 % were seen 2-4 and 4-8 weeks after referral respectively. 6 patients never attended ophthalmology examination during the two years of review. Of all the attendees, 56% were booked for pan retinal photocoagulation (PRP) & 9(9.3%) for macular laser respectively on their 1st HES visit. 75% of the patients were newly diagnosed PDR and 26 had previous PRP laser but lost to follow up. 63 patients ( 66%) received either PRP or macular laser treatment (85.7% of which is PRP). 63% of the PRP treatment was performed within a month of first HES attendance. Retinopathy grading discrepancy between the screening program and HES was noted in 20% (21 patients). CONCLUSIONS. This data suggests that the digital screening programme is appropriately identifying high risk patients with PDR with timely PRP laser treatment in the majority of patients but raises concern over patients lost to follow up (hence failsafe tracking of appointment attendance), and review of grading discrepancies between the ophthalmology and screening service.
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Most prior new product diffusion (NPD) models do not specifically consider the role of the business model in the process. However, the context of NPD in today's market has been changed dramatically by the introduction of new business models. Through reinterpretation and extension, this paper empirically examines the feasibility of applying Bass-type NPD models to products that are commercialized by different business models. More specifically, the results and analysis of this study consider the subscription business model for service products, the freemium business model for digital products, and a pre-paid and post-paid business model that is widely used by mobile network providers. The paper offers new insights derived from implementing the models in real-life cases. It also highlights three themes for future research.
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This dissertation addresses how the cultural dimensions of individualism and collectivism affect the attributions people make for unethical behavior at work. The moderating effect of ethnicity is also examined by considering two culturally diverse groups: Hispanics and Anglos. The sample for this study is a group of business graduate students from two universities in the Southeast. A 20-minute survey was distributed to master's degree students at their classroom and later on returned to the researcher. Individualism and collectivism were operationalized as by a set of attitude items, while unethical work behavior was introduced in the form of hypothetical descriptions or scenarios. Data analysis employed multiple group confirmatory factor analysis for both independent and dependent variables, and subsequently multiple group LISREL models, in order to test predictions. Results confirmed the expected link between cultural variables and attribution responses, although the role of independent variables shifted, due to the moderating effect of ethnicity, and to the nuances of each particular situation. ^
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The purpose of this research study was to determine if the Advanced Placement program as it is recognized by the universities in the Florida State University System (SUS) truly serves as an acceleration mechanism for those students who enter an SUS institution with passing AP scores. Despite mandates which attempt to control uniformity of policy, each public university in Florida determines which courses will be exempted and the number of credits they will grant for passing Advanced Placement courses.^ This is a descriptive study in which the AP policies of each of the SUS institutions were compared. Additionally, the college attendance and graduation data on members of a cohort of 593 Broward County high school graduates of the class of June, 1992 were compared. Approximately 28% of the cohort members entered university with passing Advanced Placement scores.^ The rate of early and on time graduation was significantly dependent on the Advanced Placement standing of the students in the cohort. Given the financial and human cost involved, it is recommended that all state universities bring their Advanced Placement policies into line with each other and implement a uniform Advanced Placement policy. It is also recommended that a follow-up study be conducted with a new cohort bound under the current 120 credit limitation for graduation. ^
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Policy/program implementation, e.g., the process of fulfilling policy/program directives, is fundamentally tied to change. Implementation studies have examined the process, identifying many critical organizational variables although individuals perform the activities.^ Many of the studies are predicated on the rational, goal oriented model of organizations and examine implementation, presenting only the goal-oriented view. Organizational change and its resistance, however, are not fully explained by the rational model of organizations. There are other schools of thought providing different views of organizations from which explanation may emerge. Bolman and Deal (1984, 1991a, 1994) provide a different perspective for examining organizations Bolman and Deal argue organizations should be viewed through four different frames or lenses. Framing and reframing organizational action captures the complexity of action and provides better understanding of organizational processes. Understanding of implementation of policies/programs also will benefit from the use of the four-frame approach.^ The goal of this research is to provide a better understanding of the implementation process by examining individual attitudes toward change, the dependent variable of this research, and studying the relationship between the dependent variable and frame. The research was conducted in two phases. In Phase One, a survey was sent to 306 school administrators and teachers in magnet programs in Dade County, Florida. The survey instrument was composed of 55 questions including six from Bolman and Deal's Leadership Orientation Survey (1988) and 38 questions about organizational change. In Phase Two, more in-depth analysis of four school was conducted, to further explore the relationship between frame and attitude toward change.^ The results revealed that frame was a factor in explaining differences in personal Attitude Toward Change and Comfort Level with Change. Individuals using the symbolic frame had more positive attitudes toward change and were also more comfortable with change. The results of Phase Two of the research partially supported this finding in that the most fully implemented program was the product of an administrator who had chosen the symbolic frame. ^
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This study investigated the opinions regarding inclusion of parents of both disabled and nondisabled elementary children from a large suburban county. An opinion survey combining Wilczenski's Attitudes Toward Inclusive Education Scale with additional questions was distributed to 1170 children from 24 schools. Three research questions focused on differences between mean parental responses as they related to the inclusion and disability status of the parent's child. Results from the 270 respondents indicated that parents with disabled children had more favorable opinions about inclusion than did those with nondisabled children. Parents with included children were more favorable toward inclusion than were parents whose children were not included. Parents with included disabled children were more accepting of inclusion than were those with nondisabled children in inclusive settings. Parents' answers differed depending on the type of disability being included. Regardless of their child's disability or inclusion status, the ranking for disability types from most acceptable for inclusion to least acceptable were: social, sensory, motor, academic and behavioral. Results across types of questions, including questions relating to acceptance and general inclusion issues, indicated consistently more favorable opinions of parents with disabled children, included children and disabled children in inclusive classes. Two additional research questions examined parental responses as they related to demographic characteristics of the parents and of the schools their children attended. Analysis of Variance found only one significant main effect for any parental demographic variable. This difference was for the number of parents' elementary children when comparing parents with and without disabled children. The only significant main effects of demographics of schools the parents' children attended were for the area of the county and for schools with differing percentages of severely disabled students when comparing responses of parents with disabled and nondisabled children. For all research questions, tests indicated low effect sizes and moderate to high power levels. These results, and the fact that means for all groups were in the middle range of response choices, indicate that there may be little practical significance to the overall results. Further studies should investigate the trends found in this study. ^
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This study investigates the relationship between adoption timing of Statement of Financial Accounting Standards 87 and earnings management after adoption. Earnings management, defined consistent with Schipper (1989), is tested through hypotheses using (1) a portfolio approach and (2) pension rates. One Hypothesis uses a Modified Jones (1991) Model as a proxy for discretionary accruals and the other uses pension rate estimates.^ Statistically significant relationships are found between adoption timing and (1) discretionary accruals and (2) estimated rate-of-return (ROR) on pension plan assets. Early adopting firms tend to have lower discretionary accruals after adoption than on-time adopters. They also tend to use higher ROR estimates which are not supported by higher actual returns. Thus, while early adopters may be using ROR to manage income, this tends to not result in higher discretionary accruals. ^
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The purpose of this dissertation was to examine the form of the consumer satisfaction/dissatisfaction (CS/D) response to disconfirmation. In addition, the cognitive and affective processes underlying the response were also explored. ^ Respondents were provided with information from a prior market research study about a new brand of printer that was being tested. This market research information helped set prior expectations regarding the print quality. Subjects were randomly assigned to an experimental condition that manipulated prior expectations to be either positive or negative. Respondents were then provided with printouts that had performance quality that was either worse (negative disconfirmation) or better (positive disconfirmation) than the prior expectations. In other words, for each level of expectation, respondents were assigned to either positive or negative disconfirmation condition. Subjects were also randomly assigned to a condition of either a high or low level of outcome involvement. ^ Analyses of variance indicated that positive disconfirmation led to a more intense CS/D response than negative disconfirmation, even though there was no significant difference in the intensity for positive and negative disconfirmation. Intensity of CS/D was measured by the distance of the CS/D rating from the midpoint of the scale. The study also found that although outcome involvement did not influence the polarity of the CS/D response, the more direct measures of processing involvement such as the subjects' concentration, attention and care in evaluating the printout did have a significant positive effect on CS/D intensity. ^ Analyses of covariance also indicated that the relationship between the intensity of the CS/D response and the intensity of the disconfirmation was mediated by the intensity of affective responses. Positive disconfirmation led to more intense affective responses than negative disconfirmation. ^
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Immigrants from the West Indies and other nations challenge the simple United States dichotomy of blacks versus whites. Many apparently black Caribbean immigrants proclaim that they did not know they were “black” until they arrived in the U.S. They seek to maintain their national identity and resist identity and solidarity with Black Americans. In response, many Black Americans respond that the immigrants are simply being naive, that U.S. society demands simple racial identity. Regardless of one's self-identity and personal history, in the U.S., if you look black, you are black, was their thinking. ^ This study examines the contemporary struggle of identity and solidarity among and between Black Americans and Jamaicans living in South Florida (Broward and Miami-Dade counties). Even though the primary focus of this study is to examine the relationship between Black Americans and Jamaicans, other West Indian nationals will be addressed more generally. The primary research problem of this study is to determine why the existence of common ancestry and physical traits are insufficient for an assumption of ethnic solidarity between Black Americans and Jamaicans. ^ In examining this problem, I felt that depth rather than breadth would provide insight into the current state of polarization between Black Americans and Jamaicans. To this end, a qualitative study was designed. A non-random snowball sample consisting of forty-seven informants was selected for this study. Realizing that such a technique presents problems with generalizations beyond the sample, this approach was, nonetheless, the most suitable for the current research problem. One of the initial challenges of this research was the use of the label “black” in discussing Caribbean immigrants. Unlike America, where distinctions based on skin color were at the bedrock of America's formation, this was not the case in the Caribbean. In the Caribbean skin color was an important marker as an indicator of class, rather than of race. Therefore, I refrained from using the label, “black Jamaicans,” but rather used Jamaicans throughout. ^
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The purpose of this study was to assess the prevalence of bullying and victimization in a metropolitan area. A cross-sectional study with kindergarten (n = 127) and first grade (n = 126) children was conducted in two Miami-Dade County Public Schools and three private schools in the same area. Bullying and victimization behavior and social acceptance were assessed through peer nomination and the mental health outcomes of depression and anxiety were assessed through children's self-report. Teachers and parents also completed a social behavior scale for each child. Three areas of analyses were conducted pertaining to membership classification of social roles and the social acceptance and mental health outcomes associated with those roles, reporter agreement within the social roles, and the psychometric properties of the Childhood Social Behavior Scale. Results showed an overall negative pattern of adjustment for children identified as a member of any of the negative social roles. Also, the results support a new analytic approach to the investigation of social roles. The implication of these findings for early identification, social policy, and effective prevention strategies are discussed. ^
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The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the examination that all graduates of nursing education programs must pass to attain the title of registered nurse. Currently the NCLEX-RN passing rate is at an all-time low (81%) for first-time test takers (NCSBN, 2004); amidst a nationwide shortage of registered nurses (Glabman, 2001). Because of the critical need to supply greater numbers of professional nurses, and the potential accreditation ramifications that low NCLEX-RN passing rates can have on schools of nursing and graduates, this research study tests the effectiveness of a predictor model. This model is based upon the theoretical framework of McClusky's (1959) theory of margin (ToM), with the hope that students found to be at-risk for NCLEX-RN failure can be identified and remediated prior to taking the actual licensure examination. To date no theory based predictor model has been identified that predicts success on the NCLEX-RN. ^ The model was tested using prerequisite course grades, nursing course grades and scores on standardized examinations for the 2003 associate degree nursing graduates at a urban community college (N = 235). Success was determined through the reporting of pass on the NCLEX-RN examination by the Florida Board of Nursing. Point biserial correlations tested model assumptions regarding variable relationships, while logistic regression was used to test the model's predictive power. ^ Correlations among variables were significant and the model accounted for 66% of variance in graduates' success on the NCLEX-RN with 98% prediction accuracy. Although certain prerequisite course grades and nursing course grades were found to be significant to NCLEX-RN success, the overall model was found to be most predictive at the conclusion of the academic program of study. The inclusion of the RN Assessment Examination, taken during the final semester of course work, was the most significant predictor of NCLEX-RN success. Success on the NCLEX-RN allows graduates to work as registered nurses, reflects positively on a school's academic performance record, and supports the appropriateness of the educational program's goals and objectives. The study's findings support potential other uses of McClusky's theory of margin as a predictor of program outcome in other venues of adult education. ^
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The implementation of term limits on state legislators has provided a wealth of data for study. Florida, the second largest state in the Union with term limits, has not been comprehensively studied. This research examines the effects of term limits on electoral competition, member composition, legislator career paths, legislative leadership, and intra- and inter-governmental influences on Florida's legislature. This study looks at the Florida legislature from 1992 when term limits were enacted through 2004, three electoral cycles in which term limits have been in effect. This study uses both quantitative and qualitative data where appropriate. Electoral data is used to assess electoral and demographic effects, as well as member career trajectories. Interview data with current and former legislators, lobbyists, and executive branch officials is used to analyze both changes in legislative organization and intra- and inter-governmental influences on the legislative process. Term limits has only created greater competition when a legislative seat opens and has actually created a greater advantage for incumbents. Women and minorities have only made minimal gains in winning seats post-term limits. Newly elected legislators are not political novices with a vast majority having previous elective experience. Leadership is more centralized under term limits and the Senate has gained an advantage over the more inexperienced House. Lastly, the influence of staff, lobbyists, and most importantly, the governor has greatly increased under term limits. This research finds that term limits have not produced the consequences that proponents had envisioned.^