Referral Rule Research Articles

Referral patterns of children with poor growth in primary health care

BackgroundTo promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these guidelines, comparing it with cut-off values mentioned by the WHO.MethodsThree sets of referral rules were tested on the growth data of a random sample (n = 400) of all children born between 01-01-1985 and 31-12-1988, attending school doctors between 1998 and 2000 in Leiden and Alphen aan den Rijn (the Netherlands): the screening criteria mentioned in the Dutch Consensus Guideline (DCG), those of the UK Consensus Guideline (UKCG) and the cut-off values mentioned in the WHO Global Database on Child growth and Malnutrition.ResultsApplication of the DCG would lead to the referral of too many children (almost 80%). The largest part of the referrals is due to the deflection of height, followed by distance to target height and takes primarily place during the first 3 years. The deflection away from the parental height would also lead to too many referrals. In contrast, the UKCG only leads to 0.3% referrals and the WHO-criteria to approximately 10%.ConclusionThe current Dutch consensus guideline leads to too many referrals, mainly due to the deflection of length during the first 3 years of life. The UKCG leads to far less referrals, but may be relatively insensitive to detect clinically relevant growth disorders like Turner syndrome. New guidelines for growth monitoring are needed, which combine a low percentage of false positive results with a good sensitivity.

The 2-week Referral Rule for Colorectal Cancer: Bane or Boon?

The poor survival rates for colorectal and other cancers led the government to introduce the National Health Service (NHS) Cancer Plan in 2000 [1]. The strategies of the NHS Cancer Plan 2000 were to reduce the risk of cancer, to detect early stage disease and to improve access to the cancer management team. To achieve these objectives, the Department of Health introduced the waiting time standards. The 2-week standard (TWR), which came into effect in July 2000, required all patients with suspected cancer to be seen by a specialist within 14 days of the referral by the general practitioner (GP) [2].

A prospective survey of skin cancer referrals to a Scottish dermatology department

Conflicts of interest: none declared. Sir, We read with interest the article by Cox, evaluating the 2‐week referral rule for skin cancer based on data collected by a questionnaire survey of the views of hospital consultants.1 It concluded that a high volume of nonrelevant lesions was being referred urgently, yet a large proportion of patients with skin cancer was not referred within the 2‐week limit. Dermatologists in Scotland are not subject to the 2‐week rule but due to patient expectation and political pressure, patients with possible skin cancer are generally fast‐tracked. However, audit data from Scotland are lacking and it is not known whether similar problems exist north of the border. We present data from a prospective survey of patients referred with possible skin cancer. All patients referred with possible skin cancer to the Lanarkshire dermatology department were identified from the general practitioner (GP) referral letter over a 1‐month period. Such letters comprised unstructured free text with a tick box option for prioritizing as urgent, soon or routine. Patients were also included if a skin cancer was suspected in the clinic but the referral letter did not mention this diagnosis. Data from these patients were recorded on a standardized proforma for analysis. Patients given an urgent priority by the dermatologists were deemed to have a high chance of skin cancer [melanoma or squamous cell carcinoma (SCC)] on the basis of the referral letter and should therefore have been seen within 2 weeks.

Committee Power and Amendment Rights in the U.S. House

Much of the extant literature on legislative organization treats Congress’ jurisdictional framework as an exogenous facet of the political landscape. While bill referral and statutory rules are key institutional determinants shaping the politics of committee jurisdiction, we argue that important choices affecting committee power occur at post-referral stages of the legislative process, including actions taken by the Rules Committee. The analysis suggests that variation in amendment challenges to committee bills resulting from special rule decisions is systematically affected by key factors related to organizational theories of Congress. The findings have at least two important implications for committee power in the U.S. House. Special rule decisions can shape committee power by closing or opening access to committee products bill by bill. This result diminishes the significance of prior referral decisions granting committees the prerogative to exercise uninhibited discretion over policies within their jurisdiction. Furthermore, the findings demonstrate that patterns in amendment rights conferred by special rules respond systematically to majority party interests.

Morphological Analysis in Comparison (review)

Reviewed by: Morphological analysis in comparison ed. by Wolfgang U. Dressler, et al. Mike Maxwell Morphological analysis in comparison. Ed. By Wolfgang U. Dressler, Oskar E. Pfeiffer, Markus Pöchtrager, and John R. Rennison. (Current issues in linguistic theory 201.) Amsterdam: John Benjamins, 2000. Pp. ix, 253. ISBN 1556199791. $72(Hb). The papers here were presented at the Seventh International Morphology Meeting in Vienna in 1996. The editors briefly summarize the articles, which consist of analyses of various morphological phenomena in various languages from various theoretical viewpoints (hence the phrase ‘in comparison’ in the title). Pablo Albizu and Luis Eguren propose an optimality theoretic analysis of ‘ergative displacement’ in Basque, in which first and second person ergative agreement is marked with absolutive markers (reminiscent of 1/2 person object marking on Potawatomi verbs). Henry Davis asks whether causatives or inchoatives serve as lexical semantic representations (LSRs). Rejecting ‘on conceptual grounds’ the possibility that both might be available, Davis argues from language data (particularly St’át’imcets, a Salish language) that inchoative LSRs are universal—but not universally lexicalized, for pragmatic reasons and for uniformity within a language. Lluïsa Gràcia co-authors two articles: with Miren Azkarate on Basque, and with Olga Fullana on Catalan. The assumption in both is that head-complement order must be identical in syntax and morphology. Basque is a head-final language; thus any prefixes should be analyzable as modifiers, not heads. In general this is true, but in a few cases [End Page 797] the authors resort to a zero suffix (not just a zero affix). Similarly, Catalan is a VO language, but there are constructions in which what appears to be a possessed object is incorporated to the left of the verb. Resolution involves the assumption that the incorporated noun does not act as the head of the verbal complement but rather as a modifier of its possessor. But this leaves the possessor with two theta roles, an apparent Theta Criterion violation. The solution to this problem requires ‘blending’ lexical conceptual structures—perhaps gutting the Theta Criterion. Marianne Kilani-Schoch and Wolfgang U. Dressler study the substitution by children of prosodic ‘fillers’ (often an unstressed vowel) for function morphemes. They argue that fillers start out as purely phonological categories, with children gradually assigning them grammatical function. Mária Ladányi catches grammaticalization in process in Hungarian, where case-marked nouns are becoming verbal prefixes (or perhaps clitics). Morphological theories disagree as to whether affixes are Saussurean signs, and in particular whether they have significant semantics. Adrienne Lehrer takes the position that there is no sharp boundary between the semantics of affixes and that of lexical morphemes, basing her argument on English derivational affixes. Joyce McDonough disputes the need for position classes in Athabaskan morphology, claiming that Navajo verbal morphology is binary branching. A longer presentation would have helped motivate the particular lower level constituents. Vladimir A. Plungian investigates whether a particular affix in the Dogon language (of Mali) is inflectional or derivational; some of his criteria seem debatable. For example, optionality is taken to show that the affix cannot be inflectional. However, at least some inflectional affixes (the plural suffix in Tzeltal, for example) are optional. Andrew Spencer looks at Chukotkan verb morphology, in particular the obligatory use of inverse forms for certain person combinations. These inverse forms are homophonous with antipassives, which Spencer takes to be a syncretism, supporting the need for rules of referral. However, it seems possible that the grammar simply disallows the missing noninverse forms, leaving the antipassives as the only way to express the particular person combinations. Edwin Williams takes a bird’s-eye view of the relationship among the lexicon, morphology, and syntax, suggesting that minimalism is on the wrong track in seeking to explain morphology by reference to functional categories. Williams instead proposes something like a principles-and-parameters approach. While the price is rather hefty for a conference proceedings, all the articles can be read (and for a reasonable price, downloaded or printed) at...

Suppletion and dependency in inflectional morphology

This paper presents a general approach to verbal inflection with special emphasis on suppletion phenomena. The paper focuses on French, but the approach is general enough to apply to a wide variety of languages.
 In the first part of the paper, we show that suppletion is not erratic: suppletive forms tend to always appear in groups, in definite areas of verbal paradigms. Our analysis is based on the observation of a number of dependency relations between inflectional forms of verbs (somewhat similar to rules of referral (Zwicky 1985, Stump 1993)). We define for each language a stem dependency tree based on these observations, which allows one to predict the whole paradigm of every verb in the language on the basis of a minimal number of idiosyncratic stems. We use the tree to minimize the quantity of redundant phonological information that has to be listed in the lexicon for a given lexeme, assuming that an optimal analysis of inflection should be able to derive all and only intuitively predictable inflectional forms from a single representation.
 The second part of the paper attempts to integrate the analysis in an HPSG hierarchical lexicon. Morphological dependency relations are represented directly by mentioning a lexical sign in another sign's lexical entry. The approach to suppletion proposed in the first part is made explicit using a combination of online type construction and default constraints on the phonology of dependent signs.

On Rules of Referral

Dans cet article, l'auteur propose une theorie formelle de la soumission dans le cadre de la morphologie paradigmatique fonctionnelle, il developpe differentes regles qu'il expose dans cet article

Disagreement rules, referral rules, and the Spanish feminine article el

Disagreement rules, referral rules, and the Spanish feminine article <i>el</i>