South Carolina Experience Research Articles

Benefits for Child Care Workers: How the State Could Help through a Medicaid Waiver

Child care is expensive, and many parents struggle to afford care; furthermore, even though child care costs are high, child care providers in the United States (US) are not making a living wage. Child care professionals (ages 0-5 in child care homes or centers) earn less income than Kindergarten teachers, pre-K teachers, non-farm animal caretakers, and the US estimate of all workers’ annual median salary (Bureau of Labor Statistics, 2020a, 2020b). Workers in comparable professions are also usually offered benefits for their labor, which child care professionals are not (Kwon, 2019; National Survey of Early Care and Education Project Team, 2020; Otten et al., 2019; Whitebook, McLean, Austin, & Edwards, 2018). This often necessitates use of public assistance. Because many child care workers are not provided access to health insurance or other health-related benefits through their employers, they must seek access to health care in other ways. Additionally, turnover rates among child care workers are high, and wages and benefits are a large part of the reason why child care professionals leave their jobs (McDougald Scott, 2021a). This policy analysis (a) reviewed the current struggle (as of May 2021) that child care workers in the United States (in general) and South Carolina (in particular) experience compared with employees in other fields; and (b) explore options (particularly a Medicaid waiver option) that might improve the situation. South Carolina (SC) is one of the 13 states that have not expanded Medicaid; most of the 13 states are in Southern United States (US) region, which makes an extrapolation of SC research reasonable. Lessons learned from SC childcare data should reflect closely what may be found in other non-expansion states, but research from the literature review will not be SC-specific. Relevant peer-reviewed, government documents, state and national data, and grey literature were reviewed and analyzed. There have been ongoing efforts (although insufficient even in more successful efforts) with mixed results to improve the pay for child care workers for decades. Progress for earning a living wage will require a systems overhaul for early education, but child care providers cannot wait for workforce environmental improvements. Action must be taken now to augment the shortage of healthcare access for child care providers. In SC, Medicaid helps some child care workers receive access to health care, but expansion through Medicaid waiver 1115 would include many more child care workers who do not currently have access.

Clinical and Technical Considerations of an Open Access Telehealth Network in South Carolina: Definition and Deployment.

BackgroundToday, telehealth is experiencing exponential growth in utilization. Paralleling this trend is the growth in the telehealth industry, with sharp increases in the number of platforms, functionalities, and levels of integrations within both the electronic health record and other technical systems supporting health care. When a telehealth network is intended to be used across independent health care systems, an additional layer of complexity emerges. In the context of regionalized telehealth networks that are not within the same health care system, not only are technical interoperability challenges a practical barrier, but administrative, clinical, and competitive elements also quickly emerge, resulting in fragmented, siloed technologies.ObjectiveThe study aimed to describe a statewide approach to deploying an interoperable open access telehealth network across multiple health systems.MethodsOne promising solution to the abovementioned concerns is an open access telehealth network. In the field of telehealth, an open access network (OAN) can be defined as a network infrastructure that can be used by health care providers without a closed or proprietary platform, specific obligatory network, or service-specific telehealth technologies. This framework for the development of an OAN is grounded in practical examples of clinical programs that function in each stage of network maturity based on the experience of the South Carolina Telehealth Alliance (SCTA). The SCTA’s experience details successes and challenges in an ongoing effort to achieve an OAN. The model describes an OAN in stages of collaborative maturity and provides insights into the technological, clinical, and administrative implications of making the collaboration possible.ResultsThe four stages of an OAN are defined according to operational maturity, ranging from feasibility to demonstration of implementation. Each stage is associated with infrastructure and resource requirements and technical and clinical activities. In stage 1, technical standards are agreed upon, and the clinical programs are designed to utilize compliant technologies. In stage 2, collaboration is demonstrated through technical teams working together to address barriers, whereas clinical and administrative teams share best practices. In stage 3, a functional interoperable network is demonstrated with different institutions providing service through common telehealth end points at different patient care sites. In stage 4, clinical workflows are streamlined and standardized across institutions, and economies of scale are achieved through technical and administrative innovations.ConclusionsThe approach to OAN development described provides a roadmap for achieving a functional telehealth network across independent health systems. The South Carolina experience reveals both successes and challenges in achieving this goal. The next steps toward the development of OANs include advocacy and ongoing engagement with the developers of telehealth technologies regarding their commitment to interoperability.

Front Porch

Front Porch Harry Watson, Editor Click for larger view View full resolution Improbably, the story from this issue that touches me most directly comes from the Love Valley Rock Festival of 1972. Here and now, I will finally admit in public that your straitlaced editor was in personal attendance for his very own brush with hippiedom. Hard as it is to believe, my own memories thus stretch from family stories of Reconstruction to the Summer of Love and beyond. Love Valley Rock Festival, courtesy of Ed Buzzell Photography. In Faulkner's Requiem for a Nun, the character Gavin Stevens famously declares that "The past is never dead. It's not even past." Stevens's judgment on the power of history seemed profound when I first read it, back in college. It's still true today, but now it's become a platitude, a staple of presidential speeches and Woody Allen movies that raises more questions than it answers. "What past?" we have to ask. Better yet, "Whose past?" And what makes the southern past more living or more present than everyone else's? Is life in the South like a real-life version of Bill Murray's popular comedy, Groundhog Day, in which Jamestown, Pickett's charge, and Freedom Summer keep happening over and over? No, no, thankfully, that's impossible. But William Faulkner knew something about how some southerners can't seem to get the past out of their heads. It keeps playing in a loop, like a nasty [End Page 1] earworm, whining a constant jingle of resentment and regret that keeps driving its victims to reenact old battles in new uniforms. Historians like to think that uncovering the past is part of the process of healing from it, and changing the earworm's tune. If the undying past is all in our heads, then it's not so much a product of what happened, but what we remember about it. Or rather, which version of the past we remember, for controlling memory is a major part of shaping the present and the future. But controlling or steering public memories is a lot harder than rewriting the history books, because memory is such a crucial part of who we are. It's like the horror of amnesia: who would you be if you couldn't remember anything? And as any detective will tell you, memories are notoriously tricky. One witness sees a tall suspect, another sees a short one. One swears he saw a knife, another is sure it was a gun. And so on. The consequences spread far beyond courtrooms and tv dramas. Once when I was ten or so, my father told me about Reconstruction. It wasn't a lesson from the books; it was raw personal memory, surely passed from his own father, who was born when a sprinkling of federal troops still "occupied" South Carolina. Grandfather must have heard a lot about it from his own family, so Dad's memories of Reconstruction were almost as vivid—and certainly as subjective—as if he had been there himself. "That was when white men couldn't vote!" he hissed at me, eyes blazing with undimmed outrage. His passion took me aback, because Dad almost never got upset, especially about history or politics. His feelings were new to me that day; I did not sense hate, but fury and humiliation at his forebears' disgrace. My father's memory was mistaken. No racial test ever took the ballot from white southerners. President Andrew Johnson pardoned ordinary Confederates and affirmed their political rights within six weeks of Appomattox. He excluded Confederate leaders, and so did the Fourteenth Amendment three years later, but these barriers soon fell. Only black southerners ever suffered racial disfranchisement, first before Emancipation and again before the Voting Rights Act of 1965. Now the day would come, I'm glad to say, when my father proudly voted for black political candidates himself, but the pain and outrage he "remembered" from South Carolina's experience of "Negro rule" were just as real as if the freed-men and carpetbaggers had personally stripped away his own rights. And Dad's feelings were certainly not unusual. For much...

Disaster response for people with disability

Emergency Preparedness for people with a disability has been a steadfast activity in the state of South Carolina. In October 2015, the state experienced a natural disaster termed “The 1000 Year Flood”. The disability response to the disaster was swift due to the strong collaborative network. However, the disaster did present challenges that need to be further addressed. The retelling of South Carolina’s response should be informative to other state programs that provide advocacy for people with disability. Agencies and organizations that respond to disasters can learn from South Carolina's experience to ensure that the needs of people with disabilities are addressed rapidly and efficiently.

Print Media Coverage around Failed and Successful Tobacco Tax Initiatives: The South Carolina Experience

Taxes are a critical tobacco control policy, yet little systematic research has determined how mass media represent tobacco taxes. This study aimed to characterize print media coverage of tobacco tax initiatives in South Carolina (SC). Content analysis. The setting comprised 346 news articles from 2006 to 2010 in the four main SC newspapers. N/A . A coding scheme with good inter-rater reliability (α = .90-1.0) assessed article type (news vs. opinion), arguments, and the story tendency regarding whether it was in favor of the tax, against the tax, or neutral/mixed. Chi-square tests and t-tests assessed hypotheses regarding the prevalence and number of different arguments and article tendencies across different time periods (i.e., legislature in session vs. not in session; successful vs. unsuccessful initiative) and article types. Most articles were favorable toward the tax (59%), with favorable articles most likely to be found in opinion pieces than in news articles. Compared to unsuccessful tax initiative years (2006 to 2009), articles from the successful year (2010) were more likely to include pro-tax arguments about how the tax can raise state revenues (47% vs. 33%; p = .020) and pay for tobacco control programs (40% vs. 26%; p = .014). Unsuccessful years included a relatively higher percentage of stories about the lack of consensus regarding how the tax money should be spent (25% vs. 11%; p = .014). Within articles, the mean number of arguments favorable toward the tax and the mean number of economic arguments were marginally higher in the successful year compared to the unsuccessful years. Study results suggest that advocates build consensus and communicate more clearly on how tobacco tax revenue streams should be spent.

EGFR/KRAS mutations in African Americans (AA) versus Caucasians (CA) in patients with NSCLC: A comparative analysis of the South Carolina experience.

e18018 Background: AAs with NSCLC has inferior survival compared to CAs (Abidoye, Nature 2007). We sought to discern whether differences in incidence of EGFR or KRAS mutations between races could partly explain these differences. Methods: Pts with NSCLC who were seen at the Hollings Cancer Center (HCC) and underwent EGFR and KRAS mutation testing in 2010 were included. Microdissected formalin-fixed paraffin-embedded tumors from 89 patients with NSCLC were analyzed for EGFR/KRAS mutations by allele-specific PCR. Data were compared with previously reported experiences from Memorial Sloan Kettering Cancer Center (MSKCC), (Reinersman et al), Case Western Reserve (CWR), (Leidner et al) and Louisiana State University Health Sciences Center (LSU) (Hunt et al). We estimated the percentage of EGFR+ and KRAS+ AA and CA subjects using exact binomial confidence intervals, and compared proportions using Fisher’s exact test. Aggregate estimates were obtained using inverse variance-weighting and random-effects modeling to account for study heterogeneity. Results: Of the 89 pts, 63 were CAs and 26 were AAs. In AA population, 24/26 pts had successful EGFR and KRAS analysis. In the CA population 59/63 pts and 61/63 pts had successful EGFR and KRAS testing, respectively. Data are in the table below. A weighted aggregate are also compiled. Conclusions: Overall, the incidence of EGFR and KRAS mutations were similar for AAs and CAs. The observed differences in survival between AAs and CAs cannot be explained by differences in the molecular entities examined. Detailed demographic and survival data will be provided at the meeting. EGFR Status KRAS Status N+/total N (%; 95% CI) N+/total N (%; 95% CI) p N+/total N (%; 95% CI) N+/total N (%; 95% CI) p AA CA AA CA HCC 2/24 (8; 1, 27) 10/59 (17; 8, 29) 0.49 6/24 (25; 10, 47) 16/61 (26; 16, 39) >0.99 MSKCC 23/121 (19; 12, 27) 61/476 (13;10, 16) 0.11 21/121 (17; 11, 25) 125/476 (26; 22, 30) 0.04 CWR 1/53 (2; 0, 10) 15/89 (17; 10, 26) 0.005 12/53 (23; 12, 36) 16/76 (21; 13, 32) 0.83 LSU NR NR 22/60 (37; 25, 50) 10/51 (20; 10, 33) 0.06 Aggregate 26/198 (10; 0, 21) 86/624 (14; 11, 16) 0.51 61/258 (25; 16, 33) 167/664 (25; 22, 28) 0.92 Abbreviation: CI, confidence intervals; NR, not reported.

Abstract B19: Developing HPV educational programs in faith-based settings: Results of a community-based participatory research study

Abstract Purpose: African-American (AA) women in South Carolina experience excess cervical cancer incidence and mortality despite reporting higher rates of screening. The reasons for this observation are complex and not well understood. The faith-based setting is potentially a model setting to address cancer disparities. The purpose was to explore the acceptance of and opportunities for providing HPV vaccine education in faith-based settings. Methods: The research was community-based and participatory and conducted in collaboration with the State Baptist Young Woman's Auxiliary Health Ministry members in Region 6, five churches (Manning Baptist Church, New Hopewell Baptist Church, Little Mt. Zion Baptist Church, Mt. Pisgah Baptist Church, and Majority Baptist Church), and Carolina Community Based Health Supports Networks. Church liaisons and community data collectors were trained to identify, recruit, and collect data from eligible participants using a closed-ended questionnaire and semi-structured guide. Descriptive data were analyzed in SAS. Qualitative data were analyzed and interpreted using constant comparison and content analysis methods. Results: A total of 20 in-depth interviews and 10 focus groups (96 participants) were conducted. All participants (n=116) were AA and the majority of participants were female (92%); were insured (95%); had completed high school or beyond (89%). The mean age of participants was 38.8 years. Less than half (41%) correctly identified HPV as a main cause of cervical cancer, but 75% of participants had heard of HPV. Most participants (77%) supported a school requirement for HPV vaccination. The in-depth interviews and focus groups provided information on the content and nature of cervical cancer prevention and control educational programs, including HPV vaccines, in faith-based settings. Most participants felt that the church was an appropriate setting for HPV education and discussions about the HPV vaccine and emphasized the importance of involving youth and adults in such efforts. While there was support for HPV vaccination, there were several comments regarding the age, safety, and unknown aspects of the HPV vaccine. Findings were presented back to participants and interested others in feedback sessions held in the partnering churches. Conclusion: Participants’ knowledge of HPV and cervical cancer was average. There was general interest and support of the HPV vaccine among participants, but participants want more information, especially regarding safety. According to participants, the church is an ideal place to conduct programs, but programs need buy-in, support, and collaboration from leaders and stakeholders. Youth and adults should be the focus of such a program planned in partnership with church leaders. There was much discussion on the importance of engaging youth. The findings from this study are encouraging and show that this population of southern, AA church members are accepting of the HPV vaccine, feel that HPV education is needed, and are receptive to an HPV and cervical cancer educational program in the church. The findings are being used to inform development of faith-based interventions to increase knowledge about HPV and cervical cancer and promote informed decision making about HPV vaccines, and potentially decrease excess cervical cancer mortality. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B19.

Voices of our ancestors: language contact in early South Carolina

This is an exploration of diverse linguistic underpinnings in South Carolina's social history.In Voices of Our Ancestors, Patricia Causey Nichols offers the first detailed linguistic history of South Carolina as she explores the contacts between distinctive language cultures in the colonial and early federal eras and studies the dialects that evolved even as English became paramount in the state. As language development reflects historical development, Nichols' work also serves as a new avenue of inquiry into South Carolina's social history from the epoch of Native American primacy to the present day.Because Charleston was among the foremost colonial American seaports, South Carolina experienced a diverse influx of cultures and languages from the onset, drawing influences from Native Americans, enslaved African Americans, and a plethora of European peoples - Scots-Irish, English, Jewish, German, and French Huguenot chief among them. Nichols tells the richly complex story of language contact from groups representing three continents and myriad cultures. In examining how South Carolinians spoke in public and private we glean much about how they developed a common culture while still honoring as best they could the heritages and tongues of their ancestors. Nichols pays particular attention to the development of the Gullah language among the coastal African American peoples and the ways in which this language - and others of South Carolina's early inhabitants - continues to influence the communication and culture of the state's current populations.Nichols' synthetic treatment of language history makes expert use of primary source materials and is further enhanced by the author's field research with Gullah-speaking African Americans and with descendants of Native Americans, as well as her keen observation of her own European American community in South Carolina. Through her deft analysis of contemporary language variations and regional and ethnic speech communities, she advances our understanding of how diverse the South Carolina experience has been, from the lowcountry to the upcountry and all points in between, and yet how the need to communicate shared experiences and values has united the state's population with a common meaningful language in which the diverse voices of our ancestors can still be heard.

Follow-Up of Alcohol Septal Ablation for Symptomatic Hypertrophic Obstructive Cardiomyopathy: The Baylor and Medical University of South Carolina Experience 1996 to 2007

This study sought to determine the long-term outcome of alcohol septal ablation (ASA). There are inadequate data on the long-term outcome of ASA for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Six hundred and twenty-nine patients were enrolled consecutively (1996 to 2007) and 98.4% (n = 619) underwent ASA with 92% follow-up in 2007. Evaluation included deaths, procedural complications, pacemaker requirement, repeat ASA, and myectomy/valve surgery. Follow-up parameters included angina (Canadian Cardiovascular Society score), dyspnea (New York Heart Association functional class), exercise time, and echocardiographic indices (septal thickness, ejection fraction, resting and provoked gradients). Ethanol (2.6 +/- 1.0 ml) was injected into 1.3 +/- 0.5 septal arteries, inducing a septal infarct. Complications included death 1% (n = 6), permanent pacemaker requirement 8.2% (n = 52), coronary dissection 1.3% (n = 8), and worsening mitral regurgitation 0.3% (n = 2). The mean follow-up was 4.6 +/- 2.5 years (range: 3 months to 10.2 years). During follow-up, New York Heart Association functional class decreased from 2.8 +/- 0.6 to 1.2 +/- 0.5 (p < 0.001); Canadian Cardiovascular Society angina score decreased from 2.1 +/- 0.9 to 1.0 +/- 0 (p < 0.001); and exercise time increased from 4.8 +/- 3.3 to 8.2 +/- 1.0 (p < 0.001) min. The resting and provoked left ventricular outflow tract gradients decreased progressively (p < 0.001) and remained low during follow-up. The septal thickness decreased from 2.1 +/- 0.5 cm to 1.0 +/- 0.1 cm (p < 0.001) and the ejection fraction decreased from 68 +/- 9% to 62 +/- 3% (p < 0.001). The survival estimates at 1, 5, and 8 years were 97%, 92%, and 89%, respectively. The initial benefits of ASA were maintained during follow-up.

Incidence and Prognostic Factors for Seroma Development Following MammoSite Breast Brachytherapy (MBT): The Medical University of South Carolina Experience

Purpose/Objective(s): Describe the incidence and identify risk factors for seroma development following MBT. Materials/Methods: MBT patient data were prospectively recorded into a quality assurance database. Departmental and electronic records were reviewed to extract patient-, treatment-, and outcome-specific data. Stepwise logistic regression analysis was performed to identify factors predictive of development of any seroma including the subset of clinically significant seromas (CSS; defined as requiring multiple aspirations, biopsy, and/or excision). Variables analyzed included age, weight, history of diabetes, tobacco use, number of excisions, time from resection to catheter placement, placement technique and approach, catheter dwell time, overlying skin thickness, balloon volume, number of dwell positions, dosimetric factors (V100%, V150%, V200%), chemotherapy, hormone therapy, and post-brachytherapy infection. Results: MBT was performed in 109 patients, of whom 97 had minimum 6 months (median 36) post-MBT follow-up or earlier development of seroma. All patients received 34 Gy to 1cm depth from balloon edge, delivered twice daily in 10 fractions. Seroma developed in 41% of patients at a median of 3 months (range 0.1-25) post-MBT. One third of seromas (13% of all patients) developed CSS. The only factor identified as statistically significant for development of any seroma was catheter placement on day of resection versus >1 day later (59% vs 33%; p=0.0066). Post-MBT infection was highly statistically significant for development of CSS (64% vs 7%; p<0.0001). Prophylactic antibiotics reduced the risk of post-MBT infection from 37.5% to 6% (p=0.011). Conclusions: The incidence of CSS development after MBT is low. Post-MBT infection is a statistically significant predictor for CSS. The incidence of infection is reduced with prophylactic antibiotics.

The influence of evaluators on state medicaid policies: Florida and South Carolina's experience

AbstractThis chapter describes conditions and strategies that played a role in affecting actions taken by the Florida legislature and the South Carolina General Assembly in their respective Medicaid programs.

The Management Academy for Public Health

In the late 1990s, the South Carolina Department of Health and Environmental Control (SCDHEC) was faced with the challenges of a workforce that was not prepared in public health; the impending loss of significant agency expertise, leadership, and institutional knowledge through retirement; the lack of available and accessible training; and continuing state budget cuts. Preparedness for bioterrorism and other public health emergencies was also of concern, a need made more urgent after 2001. To respond to current and emerging public health challenges, the SCDHEC had to have a workforce with the knowledge and skills necessary for the delivery of essential public health services. To address these challenges, the department partnered with the University of North Carolina in the pilot of the Management Academy for Public Health. The Management Academy is now integrated into the South Carolina workforce development strategy, and 199 staff members and 22 community partners have graduated from the program. Along with increased knowledge, skills, and abilities of individual staff and increased organizational and community capacity, a significant result of South Carolina's experience with the Management Academy for Public Health is the development of a training program for emergency preparedness modeled on the Management Academy. This highly successful program illustrates the replicability of the Management Academy model.

Exploring the service needs and experiences of persons with TBI and their families: The South Carolina experience

Primary objective: This article presents the results of four focus groups with persons with traumatic brain injury (TBI) and their families living in South Carolina. The objective was to learn what participants perceive their service needs to be and where they experience service gaps in the existing system of TBI services.Methods and procedures: Four focus groups were conducted. In each group, a convenience sample of persons <5 years post-injury and family members responded to 10 semi-structured questions.Main outcomes: Qualitative content analysis revealed overwhelming consensus regarding the need for (1) early, continuous, comprehensive service delivery; (2) information/education; (3) formal/informal advocacy; (4) empowerment of persons with TBI/families; and (5) human connectedness/social belonging.Conclusions: Persons with TBI and families in South Carolina experience the service system as unorganized, uneducated, unresponsive and uncaring. Effective strategies are needed that link services into an ongoing continuum of TBI care, increase TBI-specific education and awareness and foster social re-integration.

A History of AIDS social work in hospitals: a daring response to an epidemic

* About the Editors * Contributors * Acknowledgments * Introduction * Section I: Medical Overview * Chapter 1. An Adult Infectious Disease Doctor's Encounter with HIV/AIDS (Alan Berkman) * Chapter 2. A Pediatrician's Encounter with HIV/AIDS * Section II: Uncharted Territory * Chapter 3. Response to the AIDS Epidemic: Metropolitan New York * Chapter 4. The Emergence of Social Workers in the AIDS Epidemic: SWAN--Social Work AIDS Network, San Francisco * The Emergence of SWAN * The Growth of SWAN * The Politicalization of SWAN * Chapter 5. The South Carolina Experience * Organizational Genesis * Organizational Practice and Culture * Daily Life in an Early ASO * Organizational Challenges * The Past Is Present * Family Secrets * Conclusion * Chapter 6. Social Work in HIV Care: A Labor of Love in Philadelphia * Chapter 7. The New York State Response: Case Management for Persons Living with HIV and AIDS * Development of COBRA Community Follow-Up * Measuring Case Management Outcomes * The New Era of Managed Care * The Future of Case Management in New York State * Chapter 8. The New York City Division of AIDS Services * Background * The Model * The Program * The Staff * The Clients * Housing * Change * Chapter 9. A Case of Serendipity: A Brief History of the Early Years of the Annual National Conference on Social Work and HIV/AIDS * Introduction * Can This Idea Work? * The Conference Becomes a Reality * Can This Conference Continue? * A Look at 1992 to the Present * Concluding Thoughts * Chapter 10. Motivating the System from Within * Section III: The Heyday * Chapter 11. From Medical Social Work to the Constant Object: The Long and Winding Road * Chapter 12. You Cannot Make This Stuff Up * Chapter 13. Rethinking Group Process--Or Do We? * Chapter 14. HIV Support Groups in a Hospital Setting * Group Formation * Group Facilitation * Group Themes and Issues * Chapter 15. Group Intervention in the Early Days of the GRID Epidemic: A Reflection of One Social Worker's Personal Experience * Introduction * Common Emotional Reactions * Group Intervention * Yesterday, Today, and Tomorrow * Chapter 16. The Missing Support Group: Interventions with AIDS Patients * The Existing Groups * Program Expansion * Group Expansion * The Absence of Need * Chapter 17. Twenty Years of the Epidemic: A Social Work Administrator's Personal Perspective * 1981 to 1985--The Crisis to Be, Still Unknown (3,500 Cases Worldwide by 1983) * 1985 to 1995--A Decade of Hope (10,000 AIDS Cases in the United States in 1985) * 1995 to the Present--Living with Reality and Coping with New Challenges (500,000 AIDS Cases in the United States in 1995) * Chapter 18. Supervising Pediatric HIV/AIDS Case Managers: Lessons Learned * Introduction * Background * The Supervisory Model * Conclusions * Chapter 19. Social Work with Hospitalized AIDS Patients: Observations from the Front Line of an Inner-City Hospital * Harper Model: Responses and Vignettes * A Model of Hospital AIDS Work * Conclusion * Section IV: The Decline/The Future--What Does It Look Like? * Chapter 20. Social Work, New York State AIDS Centers, and Special Needs Plans * Chapter 21. HIV/AIDS and Social Work Practice in Rural North Carolina: A Retrospective Account * Introduction * Community and Health Care Provider Reactions * Practice Issues * Perspectives on Support Resources * Professional Awareness and Future Practice Considerations * Chapter 22. Hospital Social Work with HIV/AIDS Patients to 1995: Death, Dying, Layoffs, and Managed Care * Chapter 23. Acute Care: Personal Reflections of Providing Social Work Interventions to Patients with HIV/AIDS * Chapter 24. Social Work in an Interdisciplinary

State Level Assessment in Physical Education: The South Carolina Experience

State Level Assessment in Physical Education: The South Carolina Experience

Chapter 6: Insights and Reflections on a State Assessment Program

The purpose of this chapter is to synthesize the results of the studies presented in this monograph and to discuss the implications of those results. The chapter is divided into four sections. In the first section state level assessment as a reform mechanism for high school physical education is discussed in terms of the South Carolina experience. A second section discusses the implications of the identified relationships among the performance indicators and factors related to school performance. In a third section issues related to the appropriateness of the measures, materials, and the design of the assessment program are explored. The chapter concludes with comments on the generalizeability of both the process that was used to establish the assessment program and the results of the first data collection.

Recent Dissertations

Atleo, Marlene Renate. "Learning Models in the Umeek Narratives: Identifying an Educational Framework through Storywork with First Nations Elders." Ph.D. diss., University of British Columbia, 2001. Bousquet, Marie-Pierre. "Quand Nous Vivions Dans Le Bois; Le Changement Spatial Et Sa Dimension Generationelle: L'Exemple Des Algonquins Du Canada." Ph.D. diss., Laval University, 2002. Brown, Donna Lisa. "The Perceptions of Selected Tribal College Transfer Students Attending the University of North Dakota." Ed.D. diss., University of North Dakota, 2002. Caldwell, Naomi Rachel. "A Comparison of Selection Tool Sources for Developing Collections of Books About American Indians: General and Specialized Tools." Ph.D. diss., University of Pittsburgh, 2002. Carlishe, Jeffrey Deward. "Spanish Relations with the Apache Nations East of the Rio Grand." Ph.D. diss., University of North Texas, 2001. Carpenter, Cari Michelle. "Seeing Red: Anger, Femininity, and the American Indian of Nineteenth-Century Sentimental Literature." Ph.D. diss., University of Michigan, 2002. Churchill, Elizabeth. "Tsuu Tina: A History of a First Nation's Community, 1890­1940." Ph.D. diss., University of Calgary, 2002. Dawn, Leslie Allan. "How Canada Stole the Idea of Native Art: The Group of Seven and Images of the Indian in the 1920s." Ph.D. diss., University of British Columbia, 2002. Dennis, Jeffrey William. "American Revolutionaries and Native Americans: The South Carolina Experience." Ph.D. diss., University of Notre Dame, 2003. Dickey, Freeda A. Hart. "Misatim Pimasew/The Flying Horse." Ph.D. diss., California Institute of Integral Studies, 2002. Fentress, Jeffery B. "The Archaeology of Butte Valley, Siskiyou County, California." Ph.D. diss., University of Oregon, 2002. Ferguson, Laurie L. "Trickster Shows the Way: Humor, Resiliency, and Growth in Modern Native American Literature." Psy.D. diss., Wright Institute, 2002. [End Page 501] Francis, Kevin James. "'Death Enveloped All Nature in a Shroud': The Extinction of Plestocene Mammals and the Persistence of ScientiÞc Generalists." Ph.D. diss., University of Minnesota, 2002. Garon, Stephen C. "Talking Toxics: Narrative Construction of Environmental Risks in Conþict." Ph.D. diss., George Mason University, 2002. Gourneau, Jessica Lynn. "Development of the American Indian Biculturalism Inventory--Northern Plains." Ph.D. diss., University of North Dakota, 2002. Graves, William Michaels. "Power, Autonomy, and Inequality in Rio Grande Puebloan Society, A.D. 1300­1672." Ph.D. diss., Arizona State University, 2002. Grossman, Zoltan Charles. "Unlikely Alliances: Treaty Conþicts and Environmental Cooperation Between Native American and Rural White Communities." Ph.D. diss., University of Wisconsin, 2002. Guillory, Raphael Marceaux. "Factors Related to Native American Students' Persistence in Higher Education: A Comparative Analysis of Student and State and University OfÞcials' Perceptions." Ph.D. diss., Washington State University, 2002. Hanohano, Peter Kauhoa Jr. "Restoring the Sacred Circle: Education for Culturally Responsive Native Families." Ph.D. diss., University of Alberta, 2002. Hare, Jan. "Aboriginal Literacy: Making Meaning across Three Generations in an Anishinaabe Community." Ph.D. diss., University of British Columbia, 2001. Hayashi, Robert Terry. "Haunted by Waters: Race and Place in the American West." Ph.D. diss., University of Massachusetts, 2002. Hebebrand, Christina Marlis. "We Are the People: Native American and Chicano Literatures as Intersecting Indigenous Literatures of the American Southwest." Ph.D. diss., Case Western Reserve University, 2002. Hixon, Kathy Sue. "Formal versus Informal Assessment of the Fundamental Motor Skills of Four-Year-Old Native American Preschoolers." Ph.D. diss., University of Arkansas, 2002. Hoefnagels, Anna Theresa. "Powwows in Southwestern Ontario: Relationships, Inþuences, and Musical Style." Ph.D. diss., York University, 2001. Hogan, Sharon Evon. "Strengthening Identity through Curriculum: A Study of a Custom-Designed Curriculum at a Tribally Controlled Community College and Its Impact on Native American Identity." Ph.D. diss., University of Missouri, 2002. Ishiyama, Noriko. "Environmental Justice and American Indian Sovereignty: Political, Economic, and Ethnic Struggles Regarding the Storage of Radioactive Waste." Ph.D. diss., Rutgers University, 2002. Janda, Sarah Eppler. "The Intersection of Feminism and Indianness in the Activism of LaDonna Harris and Wilma Mankiller." Ph.D. diss., Ohio State University, 2002. Kawamuraa, Hiroaki. "Symbolism and Materialism in the Ecological Analysis of Hunting...

Training Pharmacy Technicians in Support of Rural Health Initiatives: A South Carolina Experience

Objective: To provide an overview of pharmacy technician distance learning based on an established program. Setting: Technical college pharmacy technician training program cooperating with similar institutions located in remote areas of South Carolina. Discussion: Midlands Technical College, Columbia, SC, developed a project to provide pharmacy technician training in underserved rural South Carolina. Didactic instruction is by live television broadcast that is received in the students' local technical college. Laboratory instruction is conducted in two auxiliary laboratories geographically located within reasonable driving distances of the students' local college; instruction is scheduled to require a minimum number of trips. Experiential training is received in the students' home community. Midlands faculty make monthly visits into distance communities to review student progress. Conclusions: The performance of distance-learning students has thus far matched the performance of Columbia-based students. Student performance, both Columbia and distance-learning, was compared using earned grade points. A statistical analysis was not applied to this comparison. Results from the first two years of this project demonstrated a slightly higher grade-point performance for distance-learning students. Success of distance-learning students has shown that pharmacy technician instruction can be delivered successfully into remote sites in South Carolina.

The Pitfalls of Establishing a Statewide Vascular Registry: The South Carolina Experience

Concerned about the inadequacy of a centralized database and the importance of low morbidity and mortality on carotid endarterectomy efficacy, the South Carolina Vascular Surgical Society prospectively instituted a computer registry for carotid procedures performed by its members, to establish a statewide standard of practice. From January 1994 through December 1997, 23 of the 30 physician members voluntarily registered data on 1652 carotid operations at 14 hospitals into a central database. Blinded results were reviewed biannually. Complete data (1995-1997) were available for 1199 cases. The patients tended to be >64 years old (72%), male (62%), and white (93%). Carotid endarterectomy was the most frequently performed operation (90%). Perioperative complications (< or = 30 days) occurred in 173 patients (14.4%), including stroke (n = 19; 1.6%), death (n = 8; 0.7%), and stroke/death (n = 25; 2.0%). Although 23 surgeons (77% of the society) contributed some data, only 10 surgeons (33%) contributed complete data on >10 patients/year. Despite biannual efforts to boost participation, case entry remained stable (1994, 358; 1995, 347; 1996, 425; and 1997, 427), representing about one-third of the estimated carotid procedures performed in the state during that period. The cost of the registry was approximately $11,500. Audit of 8 surgeons revealed a >95 per cent match against the statewide discharge database and low error rate versus independent medical record review. This experience confirms that excellent outcomes after carotid endarterectomy are not limited to a few select centers and can be accomplished by adequately trained surgeons in a variety of institutional settings. Incomplete physician participation, however, inevitably raises questions about the utility of such efforts. Until volunteer registries induce full participation by heightening perceived physician benefit, their role will remain limited for future outcomes research.

The educational needs of families of mentally ill adults: the South Carolina experience.

Family members of patients at South Carolina State Hospital in Columbia were surveyed to learn their needs for education, skill building, and support. A random sample of 80 families participated in a telephone survey in 1995 to obtain information for development of a family program. Families were asked about their information and support needs in 13 areas, their preferences about the location and scheduling of family services, and barriers that might prevent them from participating. Respondents identified needs in several areas. The most frequent need, identified by more than 75 percent of families, was for advocacy in communicating with professionals and others. Twenty-nine percent of respondents reported that more contact with the social worker or physician would help improve their relationship with their ill relative. Families expressed the most interest in individualized sessions of family services (66 percent). Thirty-five percent of families were interested in informal support groups, such as the National Alliance for the Mentally Ill, and 29 percent in formal support groups, such as those developed by mental health professionals. No special preference was noted when families were asked about site of educational and support services-at the hospital (48 percent), in the community (46 percent), or at home (48 percent). Transportation and distance were the chief barriers cited by family members (68 percent) to participating in family services. Results indicated that mental health professionals should continue efforts to engage families in a partnership for the benefit of the patient and the family and to help contain service costs.