Rationale For Programs Research Articles

Newborn Screening for Severe Combined Immunodeficiency

Severe combined immunodeficiency (SCID) is a rare disorder that is lethal in childhood if not diagnosed and treated properly. Recently, a number of states have begun neonatal screening programs for SCID to facilitate diagnosis and improve outcomes. Here we review the pathogenesis and treatment of SCID. We also review the rationale for statewide screening programs, the molecular basis for the screening test, and discuss the experience to date of statewide screening in Wisconsin, the first state to implement such a program.

Why 'Sustainable Development' Is Often Neither: A Constructive Critique

Efforts and programs toward aiding sustainable development in less affluent countries are primarily driven by the moral imperative to relieve and to prevent suffering. This utilitarian principle has provided the moral basis for humanitarian intervention and development aid initiatives worldwide for the past decades. It takes a short term perspective which shapes the initiatives in characteristic ways. While most development aid programs succeed in their goals to relieve hunger and poverty in ad hoc situations, their success in the long term seems increasingly questionable, which throws doubt on the claims that such efforts qualify as sustainable development. This paper aims to test such shortfall and to find some explanations for it. We assessed the economic development in the world’s ten least affluent countries by comparing their ecological footprints with their biocapacities. This ratio, and how it changes over time, indicates how sustainable the development of a country or region is, and whether it risks ecological overshoot. Our results confirm our earlier findings on South-East Asia, namely that poor countries tend to have the advantage of greater sustainability. We also examined the impact that the major development aid programs in those countries are likely to have on the ratio of footprint over capacity. Most development aid tends to increase that ratio, by boosting footprints without adequately increasing biocapacity. One conceptual explanation for this shortfall on sustainability lies in the Conventional Development Paradigm, an ideological construct that provides the rationales for most development aid programs. According to the literature, it rests on unjustified assumptions about economic growth and on the externalisation of losses in natural capital. It also rests on a simplistic version of utilitarianism, usually summed up in the principle of ‘the greatest good for the greatest number’. We suggest that a more realistic interpretation of sustainability necessitates a revision of that principle to ‘ the minimum acceptable amount of good for the greatest sustainable number’. Under that perspective, promoting the transition to sustainability becomes a sine qua non condition for any form of ‘development’.

An Evaluation Study of a Dementia Screening Program in Taiwan: An Application of the Theory of Planned Behaviors

A challenge facing dementia service providers is how to detect dementia early to facilitate timely intervention. This article reports findings of an evaluation study of a dementia-screening program in Taiwan utilizing the Theory of Planned Behaviors. We present the Short Portable Mental Status Questionnaire (SPMSQ) program rationale and examine the effects of this important health and social service intervention. Follow-up telephone interviews were completed by 108 respondents. Findings indicate that the SPMSQ program was successful in identifying suspected dementia. Results also show that the dementia-screening program contributed to an increase in medical service utilization and in unpaid informal care.

Coexistence between wildlife and humans at fine spatial scales

Many wildlife species face imminent extinction because of human impacts, and therefore, a prevailing belief is that some wildlife species, particularly large carnivores and ungulates, cannot coexist with people at fine spatial scales (i.e., cannot regularly use the exact same point locations). This belief provides rationale for various conservation programs, such as resettling human communities outside protected areas. However, quantitative information on the capacity and mechanisms for wildlife to coexist with humans at fine spatial scales is scarce. Such information is vital, because the world is becoming increasingly crowded. Here, we provide empirical information about the capacity and mechanisms for tigers (a globally endangered species) to coexist with humans at fine spatial scales inside and outside Nepal's Chitwan National Park, a flagship protected area for imperiled wildlife. Information obtained from field cameras in 2010 and 2011 indicated that human presence (i.e., people on foot and vehicles) was ubiquitous and abundant throughout the study site; however, tiger density was also high. Surprisingly, even at a fine spatial scale (i.e., camera locations), tigers spatially overlapped with people on foot and vehicles in both years. However, in both years, tigers offset their temporal activity patterns to be much less active during the day when human activity peaked. In addition to temporal displacement, tiger-human coexistence was likely enhanced by abundant tiger prey and low levels of tiger poaching. Incorporating fine-scale spatial and temporal activity patterns into conservation plans can help address a major global challenge-meeting human needs while sustaining wildlife.

Ovarian cancer: role of ultrasound in preoperative diagnosis and population screening

Ovarian cancer: role of ultrasound in preoperative diagnosis and population screening

Random student drug testing as a school‐based drug prevention strategy

This paper describes the goals and current practice of school-based random student drug testing (RSDT) as part of an overall drug prevention strategy, briefly explores the available literature evaluating its effectiveness and discusses the controversies related to RSDT. The authors describe the rationale for RSDT programs and the prevalence of RSDT and other drug testing programs in schools. Eight major criticisms and controversies in RSDT are discussed, including those related to acceptance of RSDT, program effectiveness, costs, legality and effects of drug testing on students. The limitations of the current literature are explored. Although there is limited empirical evidence to support or refute the efficacy of RSDT in schools, there remains substantial opposition to such programs, which may contribute to the paucity of empirical studies of RSDT. Rigorous long-term evaluations are needed to evaluate the effectiveness of various versions of RSDT programs to prevent drug use and identify students in need of assistance to become and stay drug-free.

Using the Guide to the Systems Engineering Body of Knowledge (SEBoK version 0.5) for Undergraduate System Engineering Program Assessment

AbstractThe draft of the Guide to the Systems Engineering Body of Knowledge (SEBoK version 0.5) was released in a wiki format on September 19, 2011. This paper uses SEBoK to assess the undergraduate systems engineering programs at the United States Military Academy at West Point and the United States Air Force Academy. Both ABET accredited engineering programs educate cadets in to be future leaders of character in their respective military services. We first review the rationale for undergraduate SE programs at the academies. Next, we compare the two programs including their program objectives, student outcomes, curricula, enrolments, and graduate assignments for each program. Then, we compare each of the SE programs to the SEBoK knowledge areas. We conclude with ideas on how undergraduate SE programs can use the SEBoK in planning and execution of their academic programs.

The “hetero‐ethical” management development rationale

PurposeLees's “ten faces” description of organizational rationales for investing in management development reflected a personal assessment which was not grounded in empirical data. Although frequently discussed and cited since, no critique of the model, or discussion of the ethics of organizational investment in management development, has been offered. The purpose of this paper is to explore the impact of the rationale of a management development programme, particularly on programme participants.Design/methodology/approachAn ethnographic approach was utilized in the collection of data on reactions to the rationale for deploying a spiritual management development initiative in a large Irish services organization.FindingsThe research conducted on the programme found the programme's rationale to be “hetero‐ethical” in that it suggested multiple possible outcomes for participants which they were encouraged to identify and pursue on an individual level.Research limitations/implicationsThe implications of this for participants and organizations are considered.Originality/valueThe concept of the hetero‐ethical rationale for management development, and its implications, are discussed and potential avenues for further research are identified. This concept differs from previous ones in that it considers how rationales for management are received and appreciated by participants.

The Schooling Decision: Family Preferences, Intergenerational Conflict, and Moral Hazard in the Brazilian Favelas

This paper experimentally analyzes the schooling decisions of poor households in urban Brazil. We elicit parents’ choices between monthly government transfers conditional on their adolescent child attending school and guaranteed, unconditional transfers of varying sizes. In the baseline treatment, an overwhelming majority of parents prefer conditional transfers to larger unconditional transfers. However, few parents prefer conditional payments if they are offered text message notifications whenever their child misses school. These findings suggest important intergenerational conflicts in these schooling decisions, a lack of parental control and observability of school attendance, and an additional rationale for conditional cash transfer programs—the monitoring they provide.

Imaging-Assisted Large-Format Breast Pathology: Program Rationale and Development in a Nonprofit Health System in the United States

Modern breast imaging, including magnetic resonance imaging, provides an increasingly clear depiction of breast cancer extent, often with suboptimal pathologic confirmation. Pathologic findings guide management decisions, and small increments in reported tumor characteristics may rationalize significant changes in therapy and staging. Pathologic techniques to grossly examine resected breast tissue have changed little during this era of improved breast imaging and still rely primarily on the techniques of gross inspection and specimen palpation. Only limited imaging information is typically conveyed to pathologists, typically in the form of wire-localization images from breast-conserving procedures. Conventional techniques of specimen dissection and section submission destroy the three-dimensional integrity of the breast anatomy and tumor distribution. These traditional methods of breast specimen examination impose unnecessary limitations on correlation with imaging studies, measurement of cancer extent, multifocality, and margin distance. Improvements in pathologic diagnosis, reporting, and correlation of breast cancer characteristics can be achieved by integrating breast imagers into the specimen examination process and the use of large-format sections which preserve local anatomy. This paper describes the successful creation of a large-format pathology program to routinely serve all patients in a busy interdisciplinary breast center associated with a community-based nonprofit health system in the United States.

Neonatal screening for severe combined immunodeficiency

Population-based newborn screening for severe combined immunodeficiency (SCID) and related disorders has been instituted in five states, with several more planning to add this testing to their newborn screening panels. This review summarizes the rationale, development and implementation of SCID screening programs to date and highlights current and future challenges. Early results of T-cell receptor excision circle (TREC) testing newborns in pilot states indicate that this addition to the newborn screening panel can be successfully integrated into state public health programs. The TREC test has clinical validity and TRECs, as predicted, are an excellent biomarker of poor T lymphocyte production in the thymus or increased lymphocyte loss resulting in T-cell lymphopenia. A variety of cases with typical SCID genotypes and other conditions have been detected in a timely manner and referred for appropriate early treatment. Early detection of primary immunodeficiency is recognized as important for avoiding infectious complications that compromise outcomes. Routine screening of all newborns with the TREC test, implemented as part of an integrated public health program, can achieve presymptomatic diagnosis of SCID and other disorders with T-cell lymphopenia, allowing prompt and effective treatment and leading to a better understanding of the spectrum of these disorders and how to manage them.

Management of cancer risk in Barrett's esophagus

The importance of Barrett's esophagus (BE) lies in its potential to give rise to esophageal adenocarcinoma (EAC), postulated to be through a series of progressive degrees of dysplasia; from intestinal metaplasia to low-grade dysplasia, high-grade dysplasia, and subsequently, to cancer. The management strategies for the detection and treatment of dysplasia and early esophageal cancer on a background of BE have changed significantly in the last few decades, with the emergence of newer and less invasive non-operative alternatives. This review aims to outline BE and its relation to EAC, the rationale and cost-effectiveness of both screening and surveillance programs, methods of diagnosing and identifying dysplasia and early cancer in Barrett's, and approaches to individualizing their endoscopic and surgical management based on best-available staging techniques.

Current Concepts on the Mechanisms of Dystonia and the Beneficial Effects of Deep Brain Stimulation

The application of lesioning procedures in the basal ganglia and, more recently, of deep brain stimulation (DBS) has revolutionalized dystonia treatment. However, our understanding of the mechanism of action of DBS is only minimal. This is largely due to a rudimentary understanding of dystonia pathophysiology itself, which in turn reflects an insufficient understanding of the functional significance of the cortico-striato-pallido-thalamocortical loops. The initial dystonia pathophysiology concept was one of changes in oscillation rate. Soon, it was realized that not only rate but also the pattern of basal ganglia activity is crucial in the etiology of the disease. The observations of altered somatosensory responsiveness and cortical neuroplasticity, along with the vast array of clinical phenotypes, imply the need for a wholistic neuronal pathophysiology model; one in which an underlying defect of basal ganglia function results in increased cortical excitability, misprocessing of sensory feedback, aberrant cortical plasticity, and ultimately clinical dystonia. This unified dystonia pathophysiology model, although simplistic, may provide the scaffold on which all incoming research and clinical data becomes united in a meaningful and practical way. In light of this model, the dramatic response of some forms of dystonia to pallidal stimulation, the time latency for the beneficial effect and even the presence of non-responders may be explained. Additionally, it may help in developing a rationale for more efficacious DBS programming, better selection of the timing of surgery, and more successful identification of those candidates that are most likely to respond to DBS.

Implications of middle‐school behavior problems for high school graduation and employment outcomes of young adults: estimation of a recursive model

The potentially serious adverse impacts of behavior problems during adolescence on employment outcomes in adulthood provide a key economic rationale for early intervention programs. However, the extent to which lower educational attainment accounts for the total impact of adolescent behavior problems on later employment remains unclear As an initial step in exploring this issue, we specify and estimate a recursive bivariate probit model that 1) relates middle school behavior problems to high school graduation and 2) models later employment in young adulthood as a function of these behavior problems and of high school graduation. Our model thus allows for both a direct effect of behavior problems on later employment as well as an indirect effect that operates via graduation from high school. Our empirical results, based on analysis of data from the NELS, suggest that the direct effects of externalizing behavior problems on later employment are not significant but that these problems have important indirect effects operating through high school graduation.

Enhancing Business Students International Capabilities Through Global Education Programs

Today, the development of a global vision is the cornerstone that guarantees personal, economic and social development, improves competitiveness, and strengthens democracy. Future business professionals will need to understand international business patterns and cultures in order to successfully work in corporations in either the United States or abroad. One way to achieve these goals is through the use of study abroad programs. Study abroad programs develop cross-cultural awareness as well as the interpersonal and professional skills necessary to operate in a changing business environment.A common perception of North Americans is that they are in general ethnocentric and resist efforts to internationalize. While this may or may not be true for all those who reside in the United States, it is undeniable that future college graduates require a better education in international business and cross-cultural differences. The Association to Advance Collegiate Schools of Business International (AACSB) has risen to this challenge by requiring participating schools to include a global perspective in their business education programs. In accordance with AACSB accreditation, colleges and universities must incorporate into their mission a focus on “strong and growing global economic forces” (AACSB Standards for Business Accreditation, 1991). For business schools, this entails covering topics that convey to students the United States’ role in the global environment and understanding economic and cultural dynamics that play a role in transactions between businesses in other countries. Teaching the intricacies of international business law and the difficulties associated with marketing to individuals of a different language cause can lead to a diminished learning environment in traditional classroom settings. In response to AACSB’s charge to improve education on international issues, some schools have stepped out of the classroom and literally moved courses into the global marketplace (Pretzels & Curico, 1996). This paper discusses the rationale for experiential education programs, the benefits of these initiatives to students, and current trends in international study abroad programs.

Implications of middle school behavior problems for high school graduation and employment outcomes of young adults: estimation of a recursive model

The potentially serious adverse impacts of behavior problems during adolescence on employment outcomes in adulthood provide a key economic rationale for early intervention programs. However, the extent to which lower educational attainment accounts for the total impact of adolescent behavior problems on later employment remains unclear. As an initial step in exploring this issue, we specify and estimate a recursive bivariate probit model that (1) relates middle school behavior problems to high school graduation and (2) models later employment in young adulthood as a function of these behavior problems and of high school graduation. Our model thus allows for both a direct effect of behavior problems on later employment as well as an indirect effect that operates via graduation from high school. Our empirical results, based on analysis of data from the National Educational Longitudinal Study, suggest that the direct effects of externalizing behavior problems on later employment are not significant but that these problems have important indirect effects operating through high school graduation.

Rationale and Implementation of Anterior Cruciate Ligament Injury Prevention Warm-Up Programs in Female Athletes

The sex disparity in anterior cruciate ligament (ACL) injury risk and the subsequent adverse effects on knee joint health, psychosocial well-being, and financial costs incurred have produced a surge in research on risk factors and interventions designed to decrease this disparity and overall incidence. Biomechanical and neuromuscular differences have been identified throughout the trunk and lower extremity that may increase noncontact ACL injury risk in female athletes. Evidence demonstrates that many risk factors are modifiable with intervention programs and that athletic performance measures can be enhanced. No universally accepted ACL injury prevention program currently exists, and injury prevention programs are diverse. Anterior cruciate ligament injury prevention programs introduced in a warm-up format offer multiple benefits, primarily, improved compliance based on improved practicality of implementation. However, drawbacks of warm-up style formats also exist, most notably that a lack of equipment and resources may preclude measurable improvements in athletic performance that foster improved compliance among participants. The purpose of this review is to analyze the current literature researching possible biomechanical and neuromuscular risk factors in noncontact ACL injury in female athletes and the most effective means of implementing critical elements of a program to decrease ACL injury risk in female athletes while improving athletic performance. Hip and hamstring training, core stabilization, plyometrics, balance, agility, neuromuscular training with video and verbal feedback to modify technique, and stretching appear to be essential components of these programs. Further research is critical to determine ideal training program volume, intensity, duration, and frequency.

A theory-based logic model for innovation policy and evaluation

Current policy and program rationale, objectives, and evaluation use a fragmented picture of the innovation process. This presents a challenge since in the United States officials in both the executive and legislative branches of government see innovation, whether that be new products or processes or business models, as the solution to many of the problems the country faces. The logic model is a popular tool for developing and describing the rationale for a policy or program and its context. This article sets out to describe generic logic models of both the R&D process and the diffusion process, building on existing theory-based frameworks. Then a combined, theory-based logic model for the innovation process is presented. Examples of the elements of the logic, each a possible leverage point or intervention, are provided, along with a discussion of how this comprehensive but simple model might be useful for both evaluation and policy development. Copyright , Beech Tree Publishing.

The Office on Women's Health Initiative to Improve Women's Heart Health: Program Description, Site Characteristics, and Lessons Learned

Improving, Enhancing and Evaluating Outcomes of Comprehensive Heart Health Care Programs for High Risk Women has funded six diverse centers to provide chronic disease risk factor screening and lifestyle interventions for women and focuses specifically on low-income, minority women. This article describes the rationale for these diverse programs across the country, all focusing on improving outcomes for women with or at risk for cardiovascular disease (CVD). The six programs include College of Physicians and Surgeons at Columbia University, Christ Community Health Services in Memphis, Women's Heart Center of Fox Valley Cardiovascular Consultants, University of Minnesota, University of California Davis Women's Cardiovascular Medicine Program, and Yale-New Haven Hospital's Women's Heart Advantage. We present six differing approaches to women's heart programs. Based on this experience, promoting CVD prevention in women is a feasible healthcare delivery strategy for health promotion and for delivering preventive strategies for high-risk women. It is possible to deliver heart-healthy programs through existing healthcare infrastructures. These programs provide important models for public health, voluntary, and other health organizations to develop networks for population-based, targeted, relatively low cost programs that support Healthy People 2010 objectives for lifestyle changes and cardiovascular health. Ongoing longitudinal analysis of the programs will provide information about clinical outcomes and sustainability of such programs beyond the funding period.

Zinc Fortification of Cereal Flours: Current Recommendations and Research Needs

Zinc fortification is recommended as an appropriate strategy to enhance population zinc status, but guidelines are needed on the appropriate types and levels of zinc fortification of cereal flours for mass fortification programs. To review available information on the scientific rationale, efficacy, and effectiveness of zinc fortification programs, and to develop guidelines on appropriate levels of fortification of cereal flours, based on simulations of the amount of zinc absorbed under different dietary conditions and information on possible adverse effects. Systematic review of scientific literature and application of an existing prediction equation to estimate zinc absorption. Previously completed research demonstrates that zinc intake and absorption are increased when zinc-fortified foods are consumed, but little information is, as yet, available on the biologic impact of large-scale fortification programs. Studies suggest that there are no disadvantages of the recommended ranges of zinc fortification with regard to the sensory properties of zinc-fortified foods, and most research indicates that there are no adverse effects of zinc fortification on the utilization of other minerals. Zinc fortification of cereal flour is a safe and appropriate strategy for enhancing the zinc status of population subgroups who consume adequate amounts of fortified cereal flour, although additional information is needed to confirm the efficacy and effectiveness of large-scale zinc fortification programs to control zinc deficiency. The appropriate level of fortification depends on the population subgroup, their usual amount of flour intake, the degree of milling and fermentation that is practiced, and the usual intakes of zinc and phytate from other food sources. Fortification recommendations are presented for different dietary scenarios.